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Neuro-diversity and the blurring of diagnostic categories -- So Many implications

12/2/2021

Conjecture

Our ideas about Neuro-Developmental Disorders such as ADHD and Autism and Psychiatric Disorders are undergoing MAJOR REVISIONS.

The OLD WAY --- the DSM 5 way --- these are all DISTINCT DISORDERS with DISTINCT GENETICS and / or SOCIAL ENVIRONMENTAL ASPECTS of NEGLECT or ABUSE.

WHAT HAPPENED? The RESEARCH wasn't CORROBORATING these NEAT, DISTINCT CATEGORIES.

Researchers found GENETICS were important -- BUT they were often SHARED across CATEGORIES.

Maternal Immune Activation and Epigenetics are BIG DRIVERS of these DISORDERS as well as Environment.

Further, these "DISORDERS" often involve EXECUTIVE FUNCTIONING DIFFERENCES and SENSORY PROCESSING DIFFERENCES --- that are often NOT BEING WELL IDENTIFIED by the MENTAL HEALTH PROFESSION, the INDIVIDUALS THEMSELVES or the COMMUNITY because people are often NOT fitting into these NEAT, DISTINCT CATEGORIES.

If you were to have asked my parents if I had ADHD or Autism ---- they would have said that was RIDICULOUS --- she's a top student and very empathetic.

On the other hand, if you were to have asked them --- Does Val have problems with organization and emotional regulation? Oh yeah, yeah, yeah --- but she seems to make it work.

Let me just say there are REASONS why I and many others with NEURO-DEVELOPMENTAL / PSYCHIATRIC DISORDERS have HYPER-CONNECTED BRAINS and one of those REASONS -- we worked it just as hard as we could and we reached our LIMITS and it often wasn't pretty.

I would submit we now have a SIGNIFICANT PERCENTAGE of the POPULATION with ATYPICAL HIGH LEVELS of DEVELOPMENTAL INFLAMMATION and often corresponding EXECUTIVE FUNCTIONING ISSUES.

The PROGNOSIS if we just continue as we have:

EXECUTIVE FUNCTIONING ISSUES --- BAD
TRY HARDER

is not good.

We must identify those BIG STRENGTHS that often come with NEURO-DIVERSITY at the same time that we are providing practical WORK-AROUNDS for often IDIOSYNCRATIC EXECUTIVE FUNCTIONING CHALLENGES.

Thinking twice about ADHD and autism spectrum disorder (2018)
--goes to the blurred nature of the two neuro-developmental disorders.

Talk delivered by Professor Patrick Bolton, Professor of Child & Adolescent Neuropsychiatry, Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience at King's College London.

Neuro-Diversity, Sensory Processing and Mental health

11/27/2021

Carly Fleishchmann's amazing story is captured on this episode of 20/20.

This does represent an "EXTREME" --- but it is often in the EXTREMES that we are able to understand the significance of basic principles.

ABC News -- 20/20

Non-verbal girl with Autism speaks through her computer

@7:02 of the video above:

"Carly -- Why do Autistic kids cover their ears, flap their hands, hum, and rock?"

Carly types:

"It's a way for us to drown out all sensory input that overloads us all at once. We create output to block out input . . . "

ADHD and Autism are the 2 BIG Neuro-Developmental Disorders --- that are considered BLURRED with psychiatric disorders such as Bipolar Disorder, Depression and Schizophrenia.

In both ADHD and Autism, there is information and sensory overload.

But see also:

National Migraine Centre -- UK

MIGRAINE

On top of that, what is one of the BIG Physical Manifestations of Psychiatric Disorders: MIGRAINE.

MIGRAINE is now being conceptualized as loss of control of inputs.
Pathophysiology of Migraine: A Disorder of Sensory Processing (2017)
- The pathophysiology of migraine has emerged from a historical consideration of the “humors” through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder.
- It could be said there are three questions: why, how, and when?
- Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs.
- How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack.
- When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment.
- In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase.
Understanding the nature of psychiatric comorbidity in migraine: a systematic review focused on interactions and treatment implications (2019)
The Link Between Migraine and Mental Health (2021)
Evaluating Psychiatric Disorders Among Adolescents With Chronic Migraine (2021)

Difficult to Treat Chronic Migraine: The Bipolar Spectrum and Personality Disorders
Patients with refractory chronic migraine may also have a high prevalence of comorbidities, including anxiety, depression, bipolar spectrum, and personality disorders.
- How many FORENSIC EVALUATORS are considering MIGRAINE as part of their evaluation?
- WHAT IS A "PERSONALITY DISORDER?"
  - It certainly appears that it has a BIOLOGICAL BASIS
  - In some states it will be the JUSTIFICATION for KILLING a Criminal Defendant
  - In Colorado it will JUSTIFY a BRUTAL SYSTEM of INCARCERATION.
- What is the link between migraine and psychiatric disorders? From epidemiology to therapeutics (2021)
  - Recently, genome-wide association studies gave leads to a genetic common heritability between major depressive disorder and migraine.
- Racial Disparities in Migraine and Headache Care (2021)
- A pilot study by the STAR Institute of Centennial, Colorado found that the 35% of the children in one large sample (n=550) from a gifted and talented center exhibited symptoms of SPD (Sensory Processing Disorder).
  
  This is significantly more than the 5% that pilot studies have found in the general population.

What's the Point?

Well, there are a number of points.
What I'm going to focus on is our SIMPLISTIC VIEW of STRENGTHS and WEAKNESSES.
Where would some of our great thinkers and artists be without their SENSORY PROCESSING DISORDERS? Maybe not very far.
On the other hand, this can come with some BIG CHALLENGES even in the BEST of CIRCUMSTANCES, much less the widespread IGNORANCE ENVIRONMENT most people find themselves in today.
It's not all good or all bad --- it can be good and bad.
By and large people who are experiencing SENSORY OVERLOAD, are going to need more sophisticated Health Care and Emotional Support and OPPORTUNITIES to DEVELOP some BIG STRENGTHS that may be the result of a lifetime of INFORMATION and SENSORY OVERLOAD.

Neuro-diversity in Culture, Justice and Biology

11/22/2021

South Park has A LOT OF SKEPTICISM about "illness" or "disability" used as an "EXCUSE" for BAD BEHAVIOR.

My sense is they're not necessarily questioning the reality of Tourette's as much as saying Cartman is just a jerk, he doesn't have Tourette's.

In a strange way I agree with South Park -- and in BIG WAYS -- I don't.

When you talk about most of the people in the Criminal Justice System with BRAIN INJURY, MENTAL ILLNESS or NEURO-DEVELOPMENTAL DISORDERS --

They intended the crime, and
They weren't psychotic

"ASSESSING INTENT" is what we use and what a lot of animals use to try to protect ourselves.

So if we start saying --- Hey, this BEHAVIOR is the result of an underlying BIOLOGY --- one of the FIRST BIG QUESTIONS to come flying back is ---

Are you tryin' to tell me that so-n-so didn't INTEND this? -- What kind of an IDIOT are you?

AND generally I'm not trying to say that the person didn't intend the crime.

BUT by and large, the person would NOT have intended the crime BUT FOR the BRAIN INJURY, MENTAL ILLNESS, NEURO-DEVELOPMENTAL DISORDER, etc.

What I am saying is we need to go to the next LINK OF CASUALITY if we really want to provide SAFETY and HUMANE TREATMENT.

That next link is the UNDERLYING BIOLOGY.

Warning: Language Issues

SOUTH PARK: Cartman Has Tourette's Syndrome

Adapting flow to neuro-diversity

11/11/2021

I think it is fairly well established at this point that various types of neuro-diversity can have benefits.
What I'm really riffing off of is Malcolm Gladwell's idea of the beneficial adversity.
I think that has been taken to PERVERSE EXTREMES in our society and goes a long way to explaining HOMELESSNESS and INCARCERATION.
I'm going to be tying this in with ideas of "FLOW."

Benefits of Neurodiversity:
Dyslexia, Autism, & ADHD

I'm not using Facebook as much as I once did --- that really happened before the latest scandals. But when I was prioritizing Facebook --- one of the issues that would come up would be: "IF IT DOESN'T KILL YOU, IT MAKES YOU STRONGER."

A number of people took issue with that --- pointing out it could kill you and even if it didn't kill you --- it could weaken you to such a point as to make your life miserable.

Some of these BROMIDES ("trite and unoriginal ideas or remarks, typically intended to soothe or placate") do tend to inhabit the MENTAL HEALTH WORLD and have often done so out of necessity due to GAPS IN THE KNOWLEDGE BASE.

Further, it is where I think one gets the PRO SOCIAL COMPETENCY RELIGION that has grown up over the last few decades and is very much tied to "PERSONALITY DISORDERS."

ADVERSITY and IGNORANCE

A lot of the ADVERSITY that NEURO-DIVERSE children and adults face is a result of SOCIETAL IGNORANCE.
That IGNORANCE for Children is not as bad as it once was, BUT there is a long way to go.
For NEURO-DIVERSE ADULTS who did not get identified as Children it can turn into a LIVING HELL and set the stage for COMPLEX TRAUMA.
- Nothing like a little COMPLEX TRAUMA to motivate you, right?
"GIFTEDNESS" is a part of NEURO-DIVERSTIY and it's not that surprising. What is surprising is that "GIFTEDNESS" often comes with EXECUTIVE FUNCTIONING DIFFERENCES.
- "This doesn't look SMART, but it must be SMART because we're SMART."
It is appearing that the great bulk of people with PSYCHIATRIC DISORDERS are NEURO-DIVERSE
- Came with a lot of DEVELOPMENTAL INFLAMMATION,
- And took on even more "INFLAMMATION" as a result of EPIGENETIC changes to the IMMUNE SYSTEM.
The DOUBLE-EDGED SWORD for NEURO-DIVERSE People is that they are BIOLOGICALLY MORE SENSITIVE and that is FUELING some of their GIFTS.
- On the other hand, it is FUELING ADDITIONAL INFLAMMATION that might be greater for the NEURO-DIVERSE person than it would be for the NEURO-TYPICAL person from the same SOURCE of INFLAMMATION.
So positing a lot of ADVERSITY for NEURO-DIVERSE people to PULL THEMSELVES UP BY THEIR BOOTSTRAPS is probably going to FAIL more than it SUCCEEDS.

Neuro-Diversity in Homelessness & Incarceration

Homelessness --- Neurodiversity Hidden in Plain Sight
Autism and Homelessness --- The Real Crisis
Childhood Attention-Deficit/Hyperactivity Disorder Predicts Homelessness in Adulthood
- "Among people diagnosed with ADHD in childhood, the homelessness rate at age 41 was 24%, far higher than in the general population."

ADAPTING FLOW to NEURO-DIVERSITY

Go with the Flow
FLOW is a lot about --- Not Too Hard, Not Too Easy
That often looks different for Neuro-Diverse people than Neuro-Typical people
On the one hand, Neuro-Diverse people can often benefit from some supports and workarounds for EXECUTIVE FUNCTIONING
- But that's EASY --- EVERYONE CAN DO THAT --- you don't need support for that --- SOME PEOPLE (in fact a lot of people) need support and workarounds
On the other hand, Neuro-Diverse people can have HIGH NEEDS to develop their STRENGTHS that can be far above the NORM.

This is in line with our Society's continuing ARC of Authenticity and Canadian Psychologist Tayyab Rashid's observation from the research --- "Nobody has it all, nobody lacks it all."

Neurodiversity, genetics, stakeholders, epigenetics and Personality Disorders --- It is way past time to shift those paradigms

11/6/2021

Genetics on the neurodiversity spectrum:

Genetic, phenotypic and endophenotypic continua in autism and ADHD
(2021)

The perspectives of autistic people and people with ADHD continue to be absent from discussions concerning genetics.

Further research actively engaging these stakeholder groups is urgently needed in order to ensure their perspectives are integrated into the aims and claims of future research.

When we talk about Neuro-Developmental Disorders such as ADHD and Autism and/or Psychiatric Disorders such as Bipolar Disorder, Depression or Schizophrenia we're often talking about:

Genetics
Maternal Immune Activation, and
Epigenetics

---and the "CLASSIFICATIONS" themselves can look extremely BLURRED --- even though we sometimes might consider ADHD and Autism --- OPPOSITES.

When we don't get to the UNDERLYING BIOLOGY and just STAY on the SURFACE with CLUSTERS of SYMPTOMS -- it can be difficult to understand how such DIVERSE PRESENTATIONS can have COMMON MECHANISMS.

I'm including this article because it is calling for the INCLUSION of STAKEHOLDERS in the aims and goals of FUTURE RESEARCH.

When we talk about "Anti-Social Personality Disorder" --- EPIGENETICS is relevant.

But are "Anti-Social Personality Disorder" and other "Personality Disorders --- BIOLOGICAL?

It is becoming more and more clear that "PERSONALITY DISORDERS" are BIOLOGICAL --- even as the ENVIRONMENT may have influenced that BIOLOGY.

Epigenetics in Personality Disorders:
Today's Insights
(Frontiers is Psychiatry 2018)

Summary: Epigenetic studies in PD (Personality Disorder) seem to be a useful approach to elucidate the interaction of co-working risk factors in the pathogenesis of personality traits and disorders.

However, the complexity of pathogenesis leads to divergent results and impedes an explicit interpretation.

Differing methylation patterns within the selected PD (Personality Disorders) could indicate subgroups which would benefit from patient-oriented therapeutic adjustments.

They might play a major role in the future design and observation of early therapeutic intervention and thus could help to prevent severe dysfunctional conduct or full-blown personality disorder in risk subjects.

What is Methylation?

"DNA methylation is an epigenetic mechanism that occurs by the addition of a methyl (CH3) group to DNA, thereby often modifying the function of the genes and affecting gene expression."

Universities are in a much better position to INTEGRATE vast amounts of KNOWLEDGE across disciplines than PROFESSIONAL ASSOCIATIONS such as the American Psychiatric Association.

On the other hand, CLINICIANS are in a much better position to get that knowledge to ACTUAL PATIENTS.

We need more INVESTMENT and COLLABORATION on those 2 FRONTS.

Photo Credit: CNN

The PSYCHIATRIC DISORDER "CATEGORIES" in the DSM are 1/2 way in the ASHBIN of history and we're waiting for SOMETHING ELSE.

That hasn't come and probably shouldn't come from the AMERICAN PSYCHIATRIC ASSOCIATION --- the DSM had its place in HISTORY and it's time to MOVE ON,

ACADEMICS are in a much better position to provide TEXTBOOKS and MANUALS.

The ROLE OF STAKEHOLDERS such as INDIVIDUALS and CLINICIANS needs to be HASHED OUT.

Having said that, STAKEHOLDERS most want to be HEARD when things are not going well.

Things are not going well in Mental Health on a lot of fronts: UPDATING OUR PARADIGMS COULD HELP A LOT.

Executive Functioning --- Looking for a Strength-based and Equitable Approach

10/29/2021

University of Toronto

Forgetful?

It might actually make you smarter, study says

CONJECTURE

There's a "CLUSTER" of Executive Functioning Differences that often lead to Higher Abilities in one or more areas:

Poor Working Memory (the "Absent Minded Professor")
Differences in Information and Sensory Processing.
Slow Processing that often is the result of greater demands of information and sensory processing.
Emotional Intensity / Emotional Dysregulation --- that is related to among other things differences in information and sensory processing.

The "Weaknesses" and "Strengths" of NEURO-DIVERSITY are often ALL OF A PIECE and run through EXECUTIVE FUNCTIONING.

Greater Understanding of Executive Functioning Differences has the potential to dramatically improve the ability of different minds to work together.

The great hope of Temple Grandin and many of us.

We Need to be STRENGTH-BASED when it comes to these EXECUTIVE FUNCTIONING DIFFERENCES.

We are SOCIAL ANIMALS and if our EXECUTIVE FUNCTIONING DIFFERENCES are being DEMONIZED --- that's a BIG PROBLEM.

On the other hand. our HIERARCHICAL, STATUS-SEEKING SOCIETY is leading us to give the Bill Clintons and Donald Trumps of the World a PASS.

This actually extends far beyond the Oval Office.

I'm not for CRUCIFYING either Clinton, Trump or other powerful or wealthy people who do have some BIG STRENGTHS, but have some BIG WEAKNESSES too --- and look pretty NEURO-DIVERSE.

BUT if you are paying attention -- it's hard to miss that some people are getting away with a lot more than others.

Differences in Sensory Processing can look like opposites

10/20/2021

Val's Take: We all have differences in sensory and information processing --- BUT at some point that can start to look SIGNIFICANTLY DIFFERENT than the MAJORITY.

These differences can impact among other things TRADITIONAL EXECUTIVE FUNCTIONING.

These differences can come as a shock even to the person ---- "Well, nobody could do that or remember that." Well, Bob you're the only one in the room who can't do that.

On the other hand, restricted or enhanced SENSORY and INFORMATION PROCESSING is likely to provide Bob a VIEW ON THE WORLD ---- that nobody else in the room has either.

Further, it is often those INTENSE --- often DIFFERENT NEURO-DIVERSE WORLD VIEWS --- that create a lot of the DRAMA in the HUMAN WORLD.

THIS IS THE BIG KAHUNA --- Neuro-Diversity is a BIG SOURCE of "Mental Illness"

10/14/2021

ADHD, AUTISM, DYSLEXIA and GIFTEDNESS --- seem in some ways OPPOSITES --- but they all generally or often involve:
- Developmental Inflammation, AND
- Executive Functioning Differences or Deficits

One way to look at this is to say something like "ADHD" generally comes with or develops one or more psychiatric co-morbidities contained in the DSM.

Another way to look at this is that "psychiatric co-morbidities" are additional manifestations of DEVELOPMENTAL and AFTER AQUIRED INFLAMMATION.

The DSM with its CLUSTER OF SYMPTOMS has done the best it could --- but it hasn't been able to get us to the UNDERLYING BIOLOGY --- which a lot of the RESEARCH of the last 10 years is uncovering.

Further, that UNDERLYING BIOLOGY is involving not only NEURO-TRANSMITTERS and the NERVOUS SYSTEM but also the IMMUNE SYSTEM, the MICROBIOME and the ENDOCRINE SYSTEM as well.

NO WONDER THIS HAS TAKEN A LONG TIME TO FIGURE OUT.

That ADDITIONAL INFLAMMATION brings GIFTS and plenty of CHALLENGES, really regardless of the SOCIETY.

BUT the SOCIETY can certainly make it WORSE and is making it A LOT WORSE.

Advanced Psychiatry, Inc. --- Majority of People with ADHD have at least 1 comorbidity.

Understood: Thriving with Learning Differences

Quite frankly, for many people in the Criminal Justice System --- the BIGGEST WEAKNESS is SENSITIVITY.

So working on "COPING SKILLS" to deal with the Emotional Dysregulation that often comes with NEURO-DIVERSITY is IMPORTANT.

BUT if we are not DEVELOPING THOSE GIFTS and finding WORK-AROUNDS for those EXECUTIVE FUNCTIONING DIFFERENCES --- we're not making a place for the person in the SOCIETY and that will have LONG TERM CONSEQUENCES for the INDIVIDUAL and the SOCIETY.

Overcoming the challenges and realizing the gifts of Dyslexia

10/7/2021

Tedx @ Martha's Vineyard
The True Gifts of a Dyslexic Mind --- Dean Bragonier, Executive Director of NoticeAbility

Bragonier is thankfully NOT about turning people with Dyslexia into Neurotypicals.

Instead, he recognizes 4 potentially strong vocational areas for people with DYSLEXIA ---- ENTREPRENEURSHIP, ENGINEERING, ARCHITECTURE & THE ARTS.

YCDC Applauds New Federal Dyslexia Policy (2019)

Department of Justice Announces Enhancements to the Risk Assessment System and Updates on First Step Act Implementation (Jan. 2020)

(See also prisonlegalnews.org)

Colorado SB20-180

Dyslexia Education In Criminal And Juvenile Justice System Concerning services for persons with dyslexia in the criminal justice system.

05/26/2020 Senate Committee on Judiciary Postpone Indefinitely

People in Prison Are Way More Likely to Have Dyslexia.

The Justice System Sets Them Up to Fail.

A new initiative will require federal prisons to screen for the disorder—if it ever gets off the ground. (2019)

By Dr. Kathryn Currier Moody

"While the prevalence of dyslexia in the general population is about 20%, the prevalence of dyslexia in prisoners is more than twice that, or 48% according to a scientific study my colleagues and I, conducted at the University of Texas Medical Branch in conjunction with the Texas Department of Criminal Justice ( ...

Dyslexia in the Prison Population - Education Update (2008)

Neuro-Diverse People are INNOVATORS

9/30/2021

We NEED INNOVATORS working with

Community Organizers and
Institutional Players such as non-profit and governmental agencies

For a lot of people, it's not that they don't UNDERSTAND the GROUP DYNAMICS -- BUT they DON'T APPROVE OF THEM.

For all our talk about the RULE OF LAW --- It is STILL LARGELY A POWER GAME.

That was innovative thinking in 1776, I'm not sure how INNOVATIVE it is now --- BUT it is in a DIFFERENT CONTEXT and that often brings ADDITIONAL INSIGHT and UNDERSTANDING.

Asperger's from the Inside
Autistics are Not Leaders (We're THIS Instead)

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