​Val's Take/Conjecture

• Having access to the most up-to-date treatments and understandings is an Olmstead issue.​
• Immuno-psychiatry really got started with this recognition of a relationship between auto-immune disorders and psychiatric symptoms.

​These new understandings are relevant to people with Neuro-Immune Disorders who find themselves homeless and or incarcerated. and dependent on a mental health profession that is relying on an out-of-date diagnostic manual.

​Further, this isn't just about having the perfect treatment (although we all want that) --- these new understandings themselves are raising reasonable doubt about how we treat people with Neuro-Immune Disorders.

Evidence suggests that altered VN [Vagus Nerve] signaling is linked to changes in the neuroimmune system, including microglia.

Dysfunction of microglia, the resident innate immune cells of the brain, is associated with various neurodevelopmental disorders, including schizophrenia, attention deficit hyperactive disorder (ADHD), autism spectrum disorder (ASD), and epilepsy. ​

​THE ECONOMICS OF BRINGING MENTAL HEALTH PRACTICE IN LINE WITH THE MARCH 2019 FRONTIERS IN PSYCHIATRY EDITORIAL & CURRENT RESEARCH

​Val's Take/Conjecture

• ​The RATE OF AGING is IDIOSYNCRATIC and dependent on a number of factors among which is MATERNAL IMMUNE ACTIVATION.
• Also, there are complicated sex differences in aging.

​Neonatal inflammation impairs developmentally-associated microglia and promotes a highly reactive microglial subset (2025)

​For younger people with Neuro-Developmental Disorders and an IQ over 70

• Historically, we haven't appreciated the underlying biology and executive functioning deficits or the idiosyncratic strengths.
• At least sometimes the Societal Response has been --- "If you don't stop crying, I'm gonna give you something to cry about."​ 

​Prenatal maternal C-reactive protein prospectively predicts child executive functioning at ages 4-6 years (2020)

​"These findings provide novel, prospective evidence that maternal inflammation uniquely predicts child cognitive flexibility deficits, and that these associations depend on the timing of exposure before or during pregnancy."

​Aggression and its correlation with plasma C-reactive protein levels in patients with schizophrenia: A hospital based cross-sectional study (2023)

​Val's Take/Conjecture

• When We're Talkin' Neuro-Diversity, We're Talkin' Neuro-Diversity
• ​It is that Diversity that makes Neuro-Diversity so complicated to understand in the absence of BIO-MARKERS --- although researchers are identifying biomarkers.
• Neuro-Diverse kids, adolescents and adults are more different from one another than Neuro-Typical people are different than one another.
• When I use the word "Neuro-Diverse," I generally mean someone who was subject to Maternal Immune Activation IN UTERO and has some greater form of systemic developmental inflammation.
• This DIVERSITY which has so many benefits is also putting a lot of pressure on policymakers and system designers at various levels to provide systems that are even adequate, much less good or excellent.

​​​There are some Neuro-Diverse folks often viewed as having "ADHD" --- who need a lot of physical activity --

• ​Need that at School and for much of the day, and
• A Work Environment with a lot of Physical Activity that will pay them a living wage.

​For some people, just saying MORE EXERCISE is the Answer is going to lead to DISASTER.

• Whether or not they have ME/CFS (Chronic Fatigue Syndrome), they may need any Exercise Routine carefully tailored to their "FATIGUE LEVEL" and that may not be "the average person."​
• Further, their Metabolism may be dysregulated as the result of DEVELOPMENTAL ISSUES.

​For kids who need significantly more physical activity at school, "fidget spinners" and "brain breaks" may be far from adequate educational responses.

Further kids in general, especially neuro-diverse kids need individualized programming and attention.

​THAT MEANS ADEQUATE STAFFING which many Colorado schools do not have.

​​
​Increased physical activity can spur cognitive development, help children manage symptoms of ADHD (2024)

​Val's Conjecture

I think the benefits of exercise and the frequency and intensity of exercise vary greatly among individuals generally,  and among Neuro-Diverse people with MITOCHONDRIAL DYSFUNCTION.

​Val's Take/Conjecture

• My observation is that some Schools have improved their staffing for High Needs Students.
  • Some schools may be struggling, but others even in less well funded school districts seem close to IDEAL.
    • There are notable exceptions.
  • This is severely restricted observation.

​On the other hand,  kids with Medium Needs and "ADHD" and/or "Autism" are challenging staffing schedules.

• There may be some paraprofessional support but it is often not enough.
• What is enough? ​

A legislative audit of School Staffing for kids with disabilities could provide the data that is needed.

• This should include kids with an IQ over 70 and invisible disabilities.

​Val's Take​​

• Ostensibly this bill is about securing Olmstead protections should the US Supreme Court overturn the 1999 landmark decision.
  • That is one of its purposes.
• What is not said is that most States, including Colorado, are not fully complying with Olmstead anyway --- although the bill does note that Colorado's State Plan is 10 years old and many feel it is insufficient.
  • So this also lays the groundwork/foundation for BETTER REALIZING THE PROMISE OF OLMSTEAD.
  • Additionally, the bill provides more of a PROCESS to do that without being unduly prescriptive. 

​"HB25-1017 - lays the groundwork for putting Olmstead into state statute should the Supreme Court of the United States overturn the decision."

​"The neurodevelopmental continuum is based on emerging evidence for shared genetic risk and overlapping pathogenic mechanisms of neurodevelopmental disorders in early ages –

Intellectual disability, autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD) – with schizophrenia and bipolar disorder."
[Va]'s Take:  Many researchers are including aspects of Depression in that NEURO-DEVELOPMENTAL CONTINUUM].

​Job Accommodation Network --- Accommodations for ​Decreased Stamina/Fatigue

​As our understanding of the biology of Neuro-Developmental and Psychiatric Disorders is making dramatic improvements --- fatigue will be more treated and accommodated.

​Recently, "BRAIN ENERGY" has become a Hot Topic in Mental Health.  Dr. Chris Palmer and others are pushing a KETO diet and there has been some promising research.​

​Brain energy failure in dementia syndromes (2021).

​Mitochondrial dysfunction: A fatal blow in depression (2023).

​"The accumulation of defective mitochondria accelerates cellular nerve dysfunction.

"In addition, impaired mitochondria aggravate alterations in the brain microenvironment, promoting neuroinflammation and energy depletion, thereby exacerbating the development of depression."

​Brain Mitochondrial Bioenergetics in Genetic Neurodevelopmental Disorders: Focus on Down, Rett and Fragile X Syndromes (2023)

​Val's Take

• If ever there was a need for specialized organizing and advocacy --- I think it is needed for Adult Children with cognitive issues in mental hospitals and jails.

​HUD Takes Action to Support Community Living for People with Disabilities (August 2024)

​After 25 years of Olmstead, it became painfully obvious that there were not enough housing resources for people with disabilities in most states, and it wasn't getting addressed ---- except maybe by Denver Mayor Mike Johnston and he was relying at least in great part on Federal Housing Vouchers.

Could a 2nd Trump Administration roll back "Olmstead Housing Vouchers" --- It could but it may not want to.

If HUD can cover Housing Vouchers, I think that makes the process of "Olmstead Planning" much easier for all the Stakeholders.

I don't think a 2nd Trump Administration is going to be focused on Olmstead Enforcement --- but there could be encouragement of reasonable, flexible plans to address the needs of people of disabilities who are institutionalized or at risk of institutionalization.

The new paradigms often involve the 3 M's:

• Maternal Immune Activation
• Microglia, and
• Mitochondria

Maternal Inflammation During Pregnancy and Offspring Brain Development: The Role of Mitochondria  (2022)

Surprisingly, Suicidality involves dysfunctional mitochondria.