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    • THE IMD RULE & ADMIN. ENFORCEMENT OF DISABILITY CIVIL RIGHTS LAWS
    • Medicaid & Supportive Housing & Housing-Related Services
    • CMS' FAILURE TO COVER HOUSING FOR LTC & THE IMD RULE: WHAT THEY HAVE IN COMMON IS DISCRIMINATION
    • National Take
  • Immunology & Mental Health
    • Alcoholism & the Immune System & Mental Health
    • Brain Injury, the Immune System & Mental Health
    • Celiac Disease & Sensitivities, the Immune System & Mental Illness
    • Mental Illness & The Immune System
    • Racial Discrimination & the Immune System & Mental Health
    • Trauma & the Immune System & Mental Health
    • ***Physical Health Issues, the Immune System & Mental Health Index
  • University of Chicago: Institute of Translational Medicine
  • Hot Topics
    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
    • Executive Functioning & "Prison Brain" >
      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
  • Take A Walk Around Orchid's Resource Block
  • Colorado Abuse & Neglect Scandals Involving People with Disabilities
  • Mental Health By The Numbers
  • New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW
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  • Double V
  • " 'Defund the Police" Means 'Invest in the Resources Our Communities Need' " or Don't Cost Shift to the Police
  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
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  • CO HB22-1278
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  • Inflammation, the Immune System, Neuro-Developmental Disorders, Psychiatric Disorders, Substance Use Issues & Chronic Disease
  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System



















                 








​                  NEURODiversity          Wednesday

Creativity, Energy dyregulations & Mental Health Struggles

8/2/2025

 
Val's Take/Conjecture:  Frank James weighs in on having a high powered mind in a Toyota Corolla Body.  That is how it can feel.

But Olympic Athletes and other Athletic Folks with mental health challenges illustrate that mental health issues are quite individual, and not limited to people who aren't exercising.

A good diet, exercise and socializing are good things --- and for many people, those things may be enough or close to enough to address their mental health struggles.

My concern is that for some people it's not enough --- and when it is not enough we are looking for a reason to blame the person.

Both James and Club Well, show that a BRAIN ENERGY understanding of Mental Health is going MAINSTREAM. 

​Those "BRAIN ENERGY DYSREGULATIONS" often involve dysregulations of the Brain's Immune Cells (MICROGLIA) and MITOCHONDRIAL DYSFUNCTION.

Dysregulation of MICROGLIA often occurred IN UTERO as a result of Maternal Immune Activation.

Orchid invokes legal notions of BURDEN OF PROOF.  There are also MEDICAL and SOCIETAL IDEAS regarding who should bear the burden of neurodevelopmental, psychiatric and substance use struggles when we don't always have adequate treatments.

​Frank James
Creativity and Mental Health Struggles
​Club Well
Bipolar Energy --
The Engine Analogy
Are you Synapse Rich & Energy Poor?
Synapses & Energy
Sensory Processing, Synapses, Energy, the Immune System & Emotional Dysregulation
19th Century Painters & Imagine Dragons: "I'm Gonna Say All The Words Inside My Head"

Rain Man & Ricky Gervais

7/15/2025

 
​Val's Take:  Most neuro-diverse folks are not SAVANTS --- but many have "SPECIAL ABILITIES" that need to be developed and employed.

What's the CATCH 22:  Those "SPECIAL ABILITIES" have complex relationships to "BRAIN ENERGY."

In the words of Ricky Gervais, we've gotta make it work for us.

​Rain Man trailer (1988)
​Ricky Gervais
Autism and Rain Man

Autism Youtuber Paul Micallef on accepting chronic illness and Research papers on mitochondrial dysfunction

7/11/2025

 
Autism from the Inside
Paul Micallef


The Productivity Paradox: Lessons from Being Sick in Bed for a Week!
​Val's Take/Conjecture:  "Poor little guy --- he's so tired and he doesn't know what he should do.  BOO HOO."  That can be our society's response.

When we see CATASTROPHIC issues in Mental Health --- we don't often associate those issues with FATIGUE because the person may be so EMOTIONALLY DYSREGULATED that fatigue is not the first thing that comes to mind.

Paul Micallef, along with other Neuro-Diverse YouTubers, has discussed the challenges of BURNOUTS, MELTDOWNS and FATIGUE.

For those who have "progressed" further down that NEURO-DEVELOPMENTAL--PSYCHIATRIC CONTINUUM  --- ENERGY ISSUES are extremely complex.​
Picture
​Mitochondrial dynamics dysfunction and neurodevelopmental disorders: From pathological mechanisms to clinical translation (2025)
Picture
​The neurobiology of antisocial personality disorder  (2024)
Picture
​Mitochondrial dysfunction: A fatal blow in depression (2023)
Picture
​Mitochondrial Dysfunction, Altered Mitochondrial Oxygen, and Energy Metabolism Associated with the Pathogenesis of Schizophrenia  (2023)
Picture
​Mitochondrial Impairment: A Common Motif in Neuropsychiatric Presentation? The Link to the Tryptophan–Kynurenine Metabolic System (2022)
Picture
​Prenatal immune activation in mice induces long-term alterations in brain mitochondrial function  (2024)

Dysregulated Astrocytes, Sensory Processing and Fatigue?

6/26/2025

 
Picture
​Induction of astrocytic Slc22a3 regulates sensory processing through histone serotonylation (2023)
"Taken together, these results identify new mechanisms for how astrocytes integrate neuromodulator signaling to gate neurotransmitter release for sensory processing."
Picture
​Rethinking Sensory Information Processing: The Essential Role of Astrocytes (2025)
Picture
​Astrocytes: integrators of arousal state and sensory context  (2023)
Adhd, Reciprocity, Rejection Sensitive Dysphoria, and Differences in Intensity
Executive Functioning Issues as an Energy -- ATP Issue
Picture
​Astrocytes as Key Regulators of Brain Energy Metabolism: New Therapeutic Perspectives (2022)
Picture
​Sensory processing, executive function, and behavior in children with ADHD (2025)
​Summary:  It is concluded that peripheral inflammation and immune activation, together with the subsequent activation of glial cells and mitochondrial damage, likely account for the severe levels of intractable fatigue and disability seen in many patients with neuroimmune and autoimmune diseases.

This would also appear to be the case for many patients afforded a diagnosis of Chronic Fatigue Syndrome.
Picture
​Microglia and astrocytes underlie neuroinflammation and synaptic susceptibility in autism spectrum disorder (2023)
Picture
​Glial Activation and Expression of the Serotonin Transporter in Chronic Fatigue Syndrome  (2018)

Gifted or Disabled?

6/2/2025

 
Val's Take/Conjecture:   The idea that one's greatest strength could be one's greatest weakness goes back to the ancient Greeks and Shakespeare.

That idiosyncratic sensory processing may have helped you out academically or through some special talent, but the Sensory Overload can be incredibly hard  to manage, especially when you're doing it in ignorance.

Further, there seems to be some evidence that Sensory Overload can increase pro-inflammatory cytokines.


The Serious Health Risks of Unmanaged Sensory Overload in the Sensitive and Neurodivergent

​The "Therapy" needed may be Occupational Therapy.  Even better, directly addressing Microglial Dysregulation and Mitochondrial Dysfunction.
Picture
​Sensory experience engages microglia to shape neural connectivity through a non-phagocytic mechanism (2020)
Picture
A systematic review on the role of mitochondrial dysfunction/disorders in neurodevelopmental disorders and psychiatric/behavioral disorders (2024)
​Autism from the Inside
Paul MIcallef
Gifted or Disabled?

​Val's Note:  Not everyone fits the STEREOTYPE of Neuro-Diversity --- that's why we need those BIOMARKERS and the application of insights from Neuro-Immunology.
​Rachel, Speech & Language Pathologist and Homeschool Mom
Sensory Processing Differences in Gifted Learners
Picture
Sensory Processing Difficulties in Psychiatric Disorders (2022)
 ​Highlights

Many individuals with psychiatric disorders report difficulties in sensory processing.

This meta-analysis examined sensory processing patterns in psychiatric conditions.

We detected a general pattern of sensory processing difficulties in psychopathology.

Sensory processing difficulties are considered to be a transdiagnostic phenotype.

​
Further research may improve long-term prognosis and treatment in psychiatry.

"FATIGUE" ---A Huge issue in Neuro-developmental & Psychiatric disordeRs

5/20/2025

 
Val's Take/Conjecture
​

  • Obviously, we want good treatments for fatigue
  • BUT just getting it on  everyone's radar screen would help a lot.
When someone is subject to ENERGY ISSUES that are NOT NORMAL and are impacting the person's ability to perform "NORMALLY" ---
  • ​That person may be subject to considerable SHAME and EMOTIONAL ABUSE.
​​

​On the other hand, we're not always sympathetic to the "fatigue" and "executive functioning" issues of others --- that may look different than our own.
Picture
​The many roads to mitochondrial dysfunction in neuroimmune and neuropsychiatric disorders (2015)

* Welsh and Australian Researchers
Picture
[Autism and burnout] (2025)

*Argentine Researcher
​Florence + Machine
Free
​Florence Welch invokes the crucified Christ and she herself is pictured on a kind of cross --- a suffering that she is hiding and is not understood by others.

This video captures the hyper sensitivity, the hidden pain, the selective energy and the grinding  fatigue that often accompany Neuro-Diversity.
Picture
​Residual Fatigue in Unipolar and Bipolar Depression: A Systematic Review (2025)

*Polish researchers
Picture
​The relationship between central fatigue and Attention Deficit/Hyperactivity Disorder of the inattentive type (2022)

*Japanese Researcher

Accommodating "Spikiness"

5/15/2025

 
​Val's Take/Conjecture
  • When we think of accommodating "DISABILITIES" we think of accommodating the weaknesses.
  • But it is just as important to accommodate the STRENGTHS.
  • We have not appreciated how important it is for people to EXERCISE their STRENGTHS.
  • On the other hand, neuro-diverse people cannot SURVIVE if we don't get our weaknesses such as idiosyncratic
    • Bioenergetics, and
    • Executive Functioning 
    • ​Etc.
             out on the table.
Strength-Based Approach
19th Century Painters and Imagine Dragons --- "I'm Gonna say all the words inside my head"
Picture
​Dr. Saltz recommends 80% of the time spent on STRENGTHS DEVELOPMENT and 20% of the time on WORK-AROUNDS for WEAKNESSES.
​"WORK-AROUNDS for WEAKNESSES" for DEVELOPMENTAL DIFFERENCES in Neuro-Developmental & Psychiatric Disorders is a lot different than "Behavioral Modification."​
Further, addressing:
  • pro-inflammatory cytokine levels,
  • dysregulated microglia and
  • dysfunctional mitochondria
might be the more direct medical approaches to improve behavior and well-being in people with Neuro-Developmental and Psychiatric Disorders.

Autism, Disorder or Different --- Dr. Chris Palmer

4/20/2025

 
​Val's Take:  Dr. Chris Palmer has been a major leader in re-conceptualizing Neuro-Developmental & Psychiatric Disorders as "Brain Energy" issues.

Dr. Chris Palmer is a Harvard Medical School psychiatrist, researcher, educator, and author of Brain Energy.

Once again Dr. Palmer is taking on the Tough Issues, bringing Clarity and Respect.

Importantly, Dr. Palmer understands these issues as "DEVELOPMENTAL" often beginning IN UTERO and some traits becoming "FIXED" by Adulthood --- 

[Further, a lot of people with "Autism" or some form of Neuro-Developmental/Psychiatric Disorder have "Hyper-Plastic Brains" so the idea that Neuro-Plasticity is going to solve everything is a lot more complicated than even professionals can think --- many Neuro-Diverse people are "MAXXED OUT" --- so we need to either Expand the Capacity or Work Within Our Limits]

The Criminal Justice System has become the Disability Provider of Last Resort really as a Default because we haven't had the Systems to deal with the RANGE of DEVELOPMENTAL ISSUES with which people are contending.

We do understand now that we need a CONTINUUM OF CARE and we need to marry that with more up to date understandings of Neuro-Developmental and Psychiatric Disorders.
​​P.S.  "Person-First Language" would be "a person with autism."

Executive Functioning Challenges as an Energy --- ATP Issue

4/18/2025

 
​Val's Take/Conjecture
  • ​​We are starting to hone in on Developmental Mitochondrial Dysfunction as a result of Maternal Immune Activation.
  • These Energy issues are CRITICAL.  Societies, Professionals and Families are often perplexed by the IDIOSYNCRATIC ENERGY ISSUES of the person with a neuro-developmental and or psychiatric disorder.
  • ​The failure to Treat and/or Accommodate those Energy Issues generally makes the person worse.
Picture
Brain levels of high-energy phosphate metabolites and executive function in geriatric depression (2016)
Conclusions: These findings suggest two independent sources of executive function dependence on bioenergetic state in the aging brain.

The dependence of executive function performance in subjects with late life depression on ATP in white matter may be associated with mitochondrial impairment and is consistent with predictions of the vascular depression hypothesis.

Further research with wider neuropsychological testing targeting bioenergetic markers could help clarify the scope of these effects. 
​
Picture
​Prenatal immune activation in mice induces long-term alterations in brain mitochondrial function  (2024)
Picture
​Dr. Chris Palmer advocates a Metabolic Theory of Brain Disorder.

He and the Metabolic Mind folks advocate for a Keto Diet.
Picture
​Impaired mitochondrial function in bipolar disorder and alcohol use disorder: a case study using 18F-BCPP-EF PET imaging of mitochondrial Complex I  (2024)
​Conclusions: Despite mounting evidence implicating mitochondria in BD [Bipolar Disorder], this study represents the first PET imaging study to investigate this mechanistic connection.

T
here were key limitations in the form of comorbid alcohol use disorder, limited statistical power inherent to a case study, no sex matched controls, and the absence of a comprehensive psychiatric history.

However, even with these limitations in mind, the significant overlap between dysfunction previously demonstrated on functional MRI and this imaging provides compelling preliminary evidence that strengthens the mechanistic link between mitochondrial dysfunction and BD [Bipolar Disorder].
Florence & the Machine
Free
​Florence Welch is a person with Dyslexia and Dyspraxia and she's been open about substance issues.

I love this video.  Her Anxiety is being personified as an Old Man.

The video begins with Her Anxiety handing her a cup of coffee/caffeine for some Energy. 

[As an aside, comedian and mental health advocate Maria Bamford, often says, "I need another frickin' Diet Coke" --- something I can very much relate to.  

Further, some ADHD advocates do talk about using Caffeine medicinally.

There's even a sweatshirt on Etsy saying "I need a Diet Coke."]

When Florence is Dancing --- she has plenty of Energy, but most of the time she is running to catch-up.

She's presenting a  complicated, confusing picture --- a picture that many people with Neurodevelopmental & Psychiatric Disorders present.
Picture
Extracellular ATP Is a Homeostatic Messenger That Mediates Cell–Cell Communication in Physiological Processes and Psychiatric Diseases (2025)
​ Dysregulation of extracellular ATP leads to a destabilizing effect on the neural network, as found in the etiopathology of many psychiatric diseases, including depression, anxiety, schizophrenia, and autism spectrum disorder.

​In this review, we summarize advances in the understanding of the mechanisms by which extracellular ATP serves as an intercellular signaling molecule to regulate neural activity, with a focus on how it maintains the homeostasis of neural networks.

In particular, we also focus on neural activity issues that result from dysregulation of extracellular ATP and propose that aberrant levels of extracellular ATP may play a role in the etiopathology of some psychiatric diseases, highlighting the potential therapeutic targets of ATP signaling in the treatment of these psychiatric diseases.

Finally, we suggest potential avenues to further elucidate the role of extracellular ATP in intercellular communication and psychiatric diseases.
Picture
​The multifaceted role of mitochondria in autism spectrum disorder (2025)
Normal brain functioning relies on high aerobic energy production provided by mitochondria.

Failure to supply a sufficient amount of energy, seen in different brain disorders, including autism spectrum disorder (ASD), may have a significant negative impact on brain development and support of different brain functions.

Mitochondrial dysfunction, manifested in the abnormal activities of the electron transport chain and impaired energy metabolism, greatly contributes to ASD.

The aberrant functioning of this organelle is of such high importance that ASD has been proposed as a mitochondrial disease. 
​

Pre-Natal Inflammatory Exposure (PIE), Neuro-Diversity and Disease

4/11/2025

 
Val's Take/Conjecture
  • Even as we're identifying Mechanism Sub-Types in Neuro-Developmental & Psychiatric Disorders ---
  • Those Mechanism Sub-Types are often relevant for other chronic diseases such as Autoimmune Disorders and Cancer.
Pre-Natal Inflammatory Exposure (PIE) is relevant for:
  • ​Neuro-Developmental & Psychiatric Disorders 
  • Auto-Immune Disorders, and
  • Cancer
Is PIE relevant for every single case --- maybe not.  But it is relevant for many, many cases.
​Additionally, there is a need to marry a concern for  "Lifestyle Choices" with the long-term ramifications of "Pre-Natal Inflammatory Exposure."
Picture
Prenatal inflammation exposure accelerates lung cancer tumorigenesis in offspring mouse: possible links to IRE1α/XBP1-mediated M2-like polarization of TAMs and PD-L1 up-expression (2024)
PBS
The Brain with David Eagleman​

A One-Word Label is Enough to Change Your Brain's Pre-Conscious Response to Someone in Pain
Picture
The fetal programming effect of maternal immune activation (MIA) on the offspring’s immune system  (2024)
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    Neuro-Diversity
    Wednesday

    (with variable spellings of Neurodiversity)


    NEURODIVERSITY  is BLURRED. 

    What people are keying off of is:  EXECUTIVE FUNCTIONING DIFFERENCES or DEFICITS --- and saying "Hey, that's me."

    BUT they are also saying:  "Hey, I've got some BIG TIME STRENGTHS and I need those recognized too." 

    ​
     

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  • Home
    • About Orchid >
      • Why Orchid?
      • ORCHID'S SYSTEMIC FOCUS & "ROOT CAUSE" ANALYSIS APPROACH TO PROBLEM SOLVING WITH A COMMITMENT TO CREATIVITY & INNOVATION
      • Disclaimers, Limitations and An Invitation
      • Orchid Board
      • Orchid Book Club
      • Conjecture, Science & Translational Research & Medicine
      • Orchid Themes & Symbols
      • The Tipping Point
      • Orchid's Website Advertising Policy
      • Statement for Potential Website Contributors
      • Contact
  • Blogs
    • Val's Blog
    • Val's Blog 2
    • ​TRANSLATIONAL/ ​TRANSITIONAL JUSTICE MONDAY
    • NEURO-DIVERSITY Wednesday
    • Olmstead Law & Order Thursday
    • Translational Medicine Friday
    • Translational Love, Relationships & Neuro-Diversity Saturday
  • Orchid's A-Z Index
    • Crisis Services in CO, the US & Around the World
    • Assertive Community Treatment & Flexible ACT Index
    • Housing & Homelessness Index
    • Criminal Justice
    • Innovation Index
    • For More: See the Main Orchid Index Page
  • US Federal
    • THE IMD RULE & ADMIN. ENFORCEMENT OF DISABILITY CIVIL RIGHTS LAWS
    • Medicaid & Supportive Housing & Housing-Related Services
    • CMS' FAILURE TO COVER HOUSING FOR LTC & THE IMD RULE: WHAT THEY HAVE IN COMMON IS DISCRIMINATION
    • National Take
  • Immunology & Mental Health
    • Alcoholism & the Immune System & Mental Health
    • Brain Injury, the Immune System & Mental Health
    • Celiac Disease & Sensitivities, the Immune System & Mental Illness
    • Mental Illness & The Immune System
    • Racial Discrimination & the Immune System & Mental Health
    • Trauma & the Immune System & Mental Health
    • ***Physical Health Issues, the Immune System & Mental Health Index
  • University of Chicago: Institute of Translational Medicine
  • Hot Topics
    • What We Want --- SAMHSA Grant Opportunities Due Jan. 22, 2019
    • Anti-Social Personality Disorder >
      • DECONSTRUCTING ANTISOCIAL PERSONALITY DISORDER AND PSYCHOPATHY: A GUIDELINES-BASED APPROACH TO PREJUDICIAL PSYCHIATRIC LABELS [Hofstra Law Review 2013]
      • Personality Disorders -- Unscientific & Vague -- Must Be Reformed
    • Executive Functioning & "Prison Brain" >
      • Job Accommodation Network on Executive Functioning Deficits
    • Medicaid & Medicare Network Adequacy >
      • OIG: STATE STANDARDS FOR ACCESS TO CARE IN MEDICAID MANAGED CARE (Sept. 2014)
      • OIG: ACCESS TO CARE: PROVIDER AVAILABILITY IN MEDICAID MANAGED CARE (Dec. 2014)
      • GAO 15-710: MEDICARE ADVANTAGE: Actions Needed to Enhance CMS Oversight of Provider Network Adequacy (Aug. 2015)
      • CMS: Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability (April 2017)
    • Medicaid Mental Health & Substance Use Disorder Parity >
      • CMS Parity Compliance Toolkit Applying Mental Health and Substance Use Disorder Parity Requirements to Medicaid and Children’s Health Insurance Programs [Jan. 17, 2017]
      • Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP [CMS October 11, 2017]
    • Olmstead Disability Rights >
      • Statement of the Department of Justice on Enforcement of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. (2011)
      • Comprehensive Olmstead Planning
      • the Logical Long Term Consequences of our failure to provide Intensive Community MH Treatment
      • Olmstead Nation ---State Pages: How Far to Comply with Olmstead?
  • Take A Walk Around Orchid's Resource Block
  • Colorado Abuse & Neglect Scandals Involving People with Disabilities
  • Mental Health By The Numbers
  • New Science Is Amazing AND It Has HUGE Moral Implications for Our Society: NOW
  • Olmstead & Homelessness
  • Double V
  • " 'Defund the Police" Means 'Invest in the Resources Our Communities Need' " or Don't Cost Shift to the Police
  • VAGUE OLMSTEAD PLANS, EXPENSIVE LITIGATION
  • Updating & Reforming our Understanding & Treatment of "Anti-Social Personality Disorder" Blog
  • Reform of " Anti-Social Personality Disorder" in Criminal Justice
  • CO HB22-1278
  • New Understandings Matter
  • Mental Health, Ethics & Law
  • CO Olmstead Disability Homeless Law & Policy Project
  • Inflammation, the Immune System, Neuro-Developmental Disorders, Psychiatric Disorders, Substance Use Issues & Chronic Disease
  • Microglia and the Brain's Immune System
  • Substance Issues & the Immune System