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PAIN In ADHD & AUTISM

1/24/2024

(Differences in sensory Processing are at least recognized in Autism as affecting perceptions of PAIN)

Val's Take/Conjecture

I'm going to be focusing initially on "emotional pain" and then "physical pain."
The History of "REJECTION SENSITIVE DYSPHORIA" (RSD) is interesting as told by now retired Colorado Psychiatrist William Dodson ---- who is not only considered a national expert, but also an international expert.
- The term "REJECTION SENSITIVE DYSPHORIA" originally referred to "ATYPICAL DEPRESSION."
- Dodson noticed that his ADHD clients had seemed to experience it and it seemed appropriate in every way ---- except --- PROPORTION.
  - I think this is one of the critical reasons you see so many people in Criminal Justice tagged with ADHD and so many people struggling with substance problems trying to medicate this pain.
- See also: The Bizarre Intersection Between Law & "Giftedness" -- Adulting with Exceptionalities in the Criminal Justice System
But it is NOT just ADHDers --- many in the Autism Camp have said --- "Hey, that sounds like me."
Further, ADHD and Autism are now at least by the researchers viewed as very BLURRED --- and part of a Neuro-Developmental -- Psychiatric Continuum.
Additionally, EMOTIONAL INTENSITY is the calling card of the "gifted"/asynchronous.

BUT --- it is NOT just emotional pain that neuro-diverse folks are more sensitive too --- they are also more sensitive to PHYSICAL PAIN.

Oregon Health & Science University School of Medicine

Associations between Chronic Pain and Attention-Deficit Hyperactivity Disorder (ADHD) in Youth: A Scoping Review.

January 2023

"We also outline future directions to inform future research and interventions directed to youth with comorbid pain and ADHD. Design: A scoping review of the literature was performed in MEDLINE, PsycInfo, and Cochrane Database of Systematic Reviews using a wide range …"

"Conclusions: Findings from this scoping review suggest an association between chronic pain and ADHD among youth. Little research was found to examine the etiology of this association. Future studies should examine underlying mechanisms of comorbid chronic pain and ADHD."

Effect of atomoxetine on ADHD-pain hypersensitization comorbidity in 6-OHDA lesioned mice.

April 2023

BACKGROUND: Methylphenidate and atomoxetine are used for the treatment of attention-deficit/hyperactivity disorder (ADHD).

Our previous studies established the validity of the 6-hydroxydopamine (6-OHDA) mouse model of ADHD and demonstrate …

Conclusion: "These findings demonstrated that when administered chronically, atomoxetine has a significant effect on ADHD-associated pain hypersensitization, likely mediated by both α- and β-adrenergic and D2/D3 dopaminergic receptors, and suggest new indications for atomoxetine that will need to be confirmed by well-designed clinical trials."

The Current View on the Paradox of Pain in Autism Spectrum Disorders.

July 2022

"Autism spectrum disorder (ASD) is a neurodevelopmental disorder, which affects 1 in 44 children and may cause severe disabilities. ...An integrative view on the regulation of the pain cycle offers a more robust framework to characterize the experience …

"A growing body of evidence is challenging the idea of alterations in pain processing in ASD due to a single factor, and calls for an integrative view.

"We propose a model of the pain cycle that includes the interplay between the molecular and neurophysiological pathways of pain processing and it conscious appraisal that may interfere with pain reactivity and coping in autism.

The role of social factors in pain-induced response is also discussed. Pain assessment in clinical care is mostly based on subjective rather than objective measures.

This review clarifies the strong need for a consistent methodology, and describes innovative tools to cope with the heterogeneity of pain expression in ASD, enabling individualized assessment.

Incidental physical pain reduces brain activities associated with affective social feedback and increases aggression.

February 2023

"Thus, this study aimed to investigate the neural mechanisms underlying pain-induced aggression using functional magnetic resonance imaging. ...The results revealed that participants in the pain group exhibited more aggression than those in the control …

Homelessness, Employment & IDIOSYNCRATIC BRAINS

12/20/2023

Aurora Mayor Mike Coffman

Aurora mayor hones in on "work first" approach to homelessness in state of city speech -- The Denver Gazette

I agree --- but like so many things --- if a lecture was going to fix it --- we wouldn't have a problem.
We'd like to see more partnerships with Voc ReHab and others to make this the SUCCESS --- everyone wants it to be.

Unfortunately, Neuro-Diverse folks are over-represented in the chronically homeless population and that Neuro-Developmental Continuum is also a Psychiatric Continuum.

Addressing this has been hard to do --- but we have more understanding and tools then we ever have had before.

Idiosyncratic brains

"When researchers superimposed non-autistic brain scans on top of each other, the brains were all very similar.

"However, when the same thing was done to autistic brain scans, the autistic brains were all very different.

"The autistic brains all had areas of high and low connectivity, but no distinct areas of high and low connectivity were discernible.

"In other words, autistic people have more individualized, idiosyncratic connectivity patterns than controls do; each autistic brain differed from the norm, but each did so in its own way."

National Center on Advancing Person-Centered Practices & Systems

October 2023

Screening for Autism Spectrum Condition Through Inner City Homeless Services in the Republic of Ireland

"These findings suggest a high estimate of autism prevalence and support emerging evidence that, people with autism are overrepresented in the homeless population, compared to housed populations.

"Autism may be a risk factor for entry into homelessness and a challenge to exiting homeless and engaging with relevant services."

Nov. 2016

Childhood Attention-Deficit/Hyperactivity Disorder and Homelessness: A 33-Year Follow-Up Study

"Conclusion:

"Among boys of white ethnicity who were followed into adulthood, childhood ADHD was associated with an elevated rate of homelessness.

"Findings point to the need for clinical monitoring of childhood ADHD through adolescence, even when ADHD does not persist, in hopes of mitigating a cascade of malfunction that includes homelessness."

Uncertainty, Complexity and Stigma are Driving the Need for Better Treatments and Answers

12/19/2023

Conjecture

I came across a Harvard Course on STIGMA and they were looking at it from various perspectives including mental health, weight, sexuality, poverty, etc.
- I thought it was very interesting the discussion on "Mental Illness" and it was very much looking at PUBLIC ATTITUDES to various explanations of Mental Illness.
  - None of which seemed particularly accurate given current research.

The point I'm trying to make is that PUBLIC ATTITUDES are not IRRELEVANT ---

But the keys that are really going to alleviate that UNCERTAINTY ----
Are better understandings and treatments.

Further, our CHRONIC DISEASE CRISIS is driving the need for PRECISION, INDIVIDUALIZED MEDICINE.The NUMBER OF FACTORS to be considered is also driving the development of AI in Medicine.

Neuro-Developmental & Psychiatric Disorders and An IQ over 70

12/10/2023

For people with neuro-developmental & psychiatric disorders and an IQ over 70 ---

I would submit they need pretty much the same things as people with an Intellectual Disability and IQ under 70 ---
- But tailored to their specific higher intellectual needs

The American Psychiatric Association lists the following needs for people with Intellectual Disability --- I'm adding some of the MODIFICATIONS I think need to be there for Neuro-Diverse People with an IQ Over 70:

Early intervention (infants and toddlers).
Special education.
- Providing Specialized Educational Support for "gifted"/asynchronous kids is at least theoretically recognized in Education.
Family support (for example, respite care support groups for families).
- I remember my parents saying, "Someday Val you're gonna have children of your own and we will be laughing in the background."
- School Psychologist Cait Curley makes the important point that these kids are NOT EASY TO RAISE. [ Asynchronous Development & the Gifted Child ]
- See Also Asynchrony, Integrative Thinking & The Need for A Third Alternative
Transition services from childhood to adulthood.
- I'm 60 years old and some of the Senior Neuro-Diverse People I'm running into could use those TRANSITION SERVICES ---NOW.
  - Couldn't we all.
Vocational programs
- This is a HUGE ISSUE
- For Neuro-Diverse People with an IQ over 70-- you have to INCLUDE THEM in the STRUCTURE & DESIGN ---
  - Because they may be "SMARTER" than anybody in the room
  - Even if they are struggling with
    - Short Term Memory
    - Sensory Processing Issues
    - Organization
    - Emotional Regulation
    - Etc.
  - BUT DON"T MAKE THEM MINI OR LARGE-SCALE DICTATORS
    - Even if they think they are BENEVOLENT, they generally aren't.
Day programs for adults.
Housing and residential options.
Case management.

Our Mental Health Crisis and our Addiction Crisis are putting into HIGH RELIEF that Neuro-Diversity is becoming much more the NORM than the EXCEPTION.

Further, I think DEVELOPMENTAL INFLAMMATION DRIVES IT --- BUT that can be many things and many combinations of things.

The Society has largely thought it didn't need to make ACCOMMODATIONS or WORK-AROUNDS or EXPLICIT GUARD-RAILS for Neuro-Diverse People with an IQ over 70:

that just hasn't turned out to be the case
further we've been using Unconscious Bias, Hierarchy and our spoken and unspoken CASTE SYSTEM to manage ---
a great deal of HUMAN COMPLEXITY
See also Isabel Wilkerson's "Caste -- The Origins of our Discontents"

The Bottom Line is it IS WORSE TO BE AT THE BOTTOM OF THE SOCIAL HEAP:

But if we're NOT CAREFUL --- we're just playing MUSICAL CHAIRS
- That's becoming very obvious to a lot of people in 2023.
"EQUALITY" is part of the WAY OUT
- But we're NOT CLONES
- Equality of What?
  - What works for me --- doesn't work for others --
  - And what works for them --- doesn't work for me.

What Is "MINORITY STRESS" ---???

12/9/2023

Val's Take/Conjecture

I would say there is MORE going on here than we may realize.
Specifically, I think there are some POSITIVE FEEDBACK LOOPS that when we're under STRESS -----
- We're becoming "MORE SENSITIVE"
- We're RAMPING UP that SENSORY PROCESSING ---
  - Ostensibly --- so we can REASON and get out of the STRESSFUL SITUATION.

When you're in a COMPLEX SOCIETY and you're being MARGINALIZED ---
- It is a long, hard road to get out of that --- that may SPAN GENERATIONS.
- At that point --- we are into MATERNAL IMMUNE ACTIVATION.

LGBTQ+ are often Neuro-Diverse ---

Not everyone who is Neuro-Diverse is LGBTQ+
BUT the percentages of Non-Heterosexual People are HIGHER in Neuro-Diverse Populations ---

The Link Between Neurodiversity and the LGBTQIA+ Community

I will just say this as a Heterosexual Neuro-Diverse woman --- the smartest women at my college were lamenting the fact that many (not all) of the smart men were gay.

So there was a lot of competition for those heterosexual smart men.

Neuro-Diversity, Gender & Sexuality

Understanding The Weight Of Minority Stress

"Minority stress is a type of stress felt by members of minority groups that involves emotionally taxing situations and experiences specific to one’s race, ethnicity, sexual orientation, and/or gender."

ETC.

Rock-n-Roll Baby --- Making Autism Cool

12/5/2023

Grateful Dead --- "Touch of Grey"

I think the Modern Music Scene is "ADAPTED" for people with Autism ---

gives people something to do with their hands
there's plenty of "ROCKING" which is a physical release and could be thought of as a form of "stimming"
repetitive sounds and vocals -- can be done in COMPLICATED PATTERNS
"ACCOMMODATES" --- Circadian Rhythms that might be a little different .
Musical Artists and Artists in general are often very concerned about being "HONEST" ---
- I think that is being driven a lot by INTENSE EMOTION and sometimes the MAJORITY ---
  - does not want to hear it.
  - so I think Neuro-Diverse people often turn it into a "VIRTUE" or "ART" or at least try.

I think there is a lot behind the statistic below right (73% of independent music makers experience symptoms of mental illness) ---

one of the things (not necessarily the only thing) is that Neuro-Diverse people are having a hard time fitting into the dominant economy.

See"Go With the Flow."

There's a big need to "CO-CREATE OPPORTUNITIES" for the people we actually have.

Composing to Avoid Cacophony --- Composing to Avoid Cacophony

Why Do Autistic People Rock Back and Forth?

Image Credit the Conversation

Music and Autism | Spectrum Disorder

Music therapy has been shown to improve symptoms associated with autism spectrum disorders (ASD), such as anxiety, depression, and hyperactivity.

In addition, music therapy has also been found to increase attention span, reduce aggression, and improve language development.

On the other hand . . .

The Music Industry is Having a Mental Health Crisis

"More than 73 percent of independent music makers experience symptoms of mental illness.

"And this statistic was released before the pandemic. In 2019, Swedish digital distribution platform . . ."

Neuro-Diverse Professionals --- BIG STRENGTHS and BIG CHALLENGES

10/10/2023

Conjecture

I remember a judge in Oklahoma County who was extremely smart and he was verbally abusive to pretty much all the attorneys and anybody else who appeared before him ---

So there was a certain EQUAL OPPORTUNITY aspect to this.

AND HE GOT AWAY WITH IT --- because he was in a position of AUTHORITY.

I don't think it was clear to anybody what his problem was --- and I don't think it was clear to him either.

I think that would be a little harder to get away with in Colorado because of surveys involving the Judiciary --- but not impossible.

There were also at least a couple of Oklahoma judges who routinely obliquely shared their own problems with alcohol to DUI Defendants.

I don't think that kind of "SHARING" is a magic bullet --- BUT I do think it's PART of creating a MORE HONEST and GROUNDED SOCIAL REALITY.

The Epidemic of "Misdiagnosis" of Mental Health Problems in the Gifted Community

Adulting with Exceptionalities in the Criminal Justice System

Anti-Social Personality Disorder as a Developmental Disorder

What we need from the Medical Profession is MORE HONESTY about the LIMITS OF THEIR KNOWLEDGE and TREATMENTS.

We need something MORE SOPHISTICATED than tagging many if not most people in the Criminal Justice System with "ANTI-SOCIAL PERSONALITY DISORDER."

If we don't have something "MORE SOPHISTICATED" we need to be honest about that as well as the REASONABLE DOUBTS that are being created by CURRENT RESEARCH.

Maternal Immune Activation and Pre-Mature Aging

8/7/2023

Conjecture

So as Neuro-Diverse Folks --- we were often BORN with
- Developmental Systemic Inflammation, and
- Sometimes Subtle Dysregulations of:
  - the Central Nervous System
  - the Immune System
  - the Endocrine System
  - the Metabolism and
  - the Microbiome
Further, these DYSREGULATIONS along with having a "HYPER-CONNECTED BRAIN" are NOT ALL BAD ---

BUT

there are some pretty WICKED TRADE-OFFS:

More susectibility to Stroke
More Susceptibility to Cancer
A "Continuum" of Neuro-Developmental and Psychiatric Disorders, and
"Excitable" neurons that are involved with a greater pace of AGING.

This is requiring "INTEGRATIVE THINKING" to solve WICKED PROBLEMS.

Rotman Program of Integrative Thinking at the University of Toronto
How to Solve Wicked Problems Using Integrative Thinking

The ISOLATION of "SENSING," "PERCEIVING," "KNOWING" MORE* than Most of the People Around You

5/22/2023

And having Intense Emotions and Executive Functioning Challenges

*MORE --- Not Everything

Conjecture

The approach to the right is a very different approach than --- "Let me help you to change or get better coping mechanisms" ----

for an ENVIRONMENT that may be BLISSFULLY IGNORANT that it is DESTROYING YOU.

On the other hand, we're often ignorant of how our Intense Emotions and Executive Functioning Challenges affect OTHERS ---

even as we're very aware of how the CHALLENGES OF OTHERS AFFECT US.

Ultimately, this isn't about Neuro-Typical vs. Neuro-Diverse ---

As the psychologist recognizes in the video above --- Most people are OUTLIERS in some respect.

Further, the Standards of Danger to Self, Others or Gravely Disabled are probably pretty good ----

our ability to keep people out of those danger zones has not been that great.
more UNDERSTANDING regarding managing INTENSE EMOTIONS and EXECUTIVE FUNCTIONING could HELP.

[As an Aside:

On a Macro Level it's not letting people with PARKINSON'S engage in INTERNATIONAL ACTS OF AGGRESSION.]

The Counselling Channel (UK)
What is Neurodiversity?

Paraphrasing at 11:48 :

The Temptation of the Therapist if THEY WEREN'T ALIVE TO THIS could be to say there is nothing wrong with you.

Obviously, there is a problem with saying there is something wrong with someone and I'm not saying there is something wrong --

What I'm saying is you have significant differences from other people that can make life more difficult than it is for most people.

WHAT ARE WE GOING TO DO ABOUT IT?

Public Health, Time & Executive Functioning

5/9/2023

Conjecture

Challenges in TIME MANAGEMENT and other Executive Functioning Issues for People with an IQ over 70 are often not perceived as "REASONABLE."

Further, those TIME MANAGMENT ISSUES are often related to GREATER NOT LESS SENSORY and EMOTIONAL PROCESSING.

There are absolutely GIFTS that come with these Differences --- but some of it can be quite difficult to manage and we need better STRATEGIES & TREATMENTS.

Additionally, a lot of the HELPERS have their own LIMITS --- and our DYSFUNCTIONAL SYSTEMS have a habit of exposing those LIMITS.

I'm highlighting this British Medical Journal Cover for its Observation that we need a NEW DEAL on Disease Definition.

Our current categories are breaking down and nowhere is that more evident than in the outdated DSM 5.

We are needing to integrate Physical, Neuro-Developmental & Mental Health --- just so we can understand what is going on.

'I can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19 (2022)

Affiliations

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
3 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.

Associations between executive function impairment and biochemical abnormalities in depressed adolescents with non-suicidal self-injury. (2022)

Affiliations

1 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
2 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China; The Department of Child and Adolescent Psychology Xiamen Xianyue hospital, Fujian 361012, China.
3 Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.
4 School of Management, Jinan University, Guangzhou 510316, China.
5 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China. Electronic address: [email protected].
6 Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou 510630, China.

Conclusions: Depressed adolescents with NSSI may have executive dysfunction and NAA and Cho metabolism abnormalities in the thalamus. And the NAA/Cr ratios of the right LN could distinguish NSSI from depressed adolescents. Further, the executive dysfunction may be associated with the abnormal NAA metabolism in the left thalamus and ACC.

Executive Functions, Time Organization and Quality of Life among Adults with Learning Disabilities

Affiliation

The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, Haifa University, Haifa, Israel.

Conclusions: Deficits in initiation and emotional executive functions as well as organization in time abilities and emotional responses to impairments in organizing time affect the QoL of adults with LD and thus should be considered in further research as well as in clinical applications.

20/20
Carly Fleischmann

Most people are NOT experiencing exactly what Carly Fleischmann is --- BUT many of us are getting various levels of sensory and emotional input that are difficult to manage.

Understood
ADHD & Dyslexia --- Working Smarter Not Harder

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