Psychiatrists are medical doctors (MDs or DOs) who complete the same four years of medical school as any other specialist, such as a cardiologist or surgeon. Because they are licensed physicians, they have broad legal authority to prescribe medication, though they often refer to other specialists for non-psychiatric issues to avoid malpractice risks. Medical Knowledge and Training Identical Foundation: Psychiatrists spend four years in medical school studying anatomy, pharmacology, and physiology alongside all other future doctors. General Medical Rotations: During their four-year residency, psychiatrists must complete rotations in internal medicine, family medicine, and neurology. Complex Diagnoses: They are trained to identify medical conditions that mimic mental illness, such as thyroid disease causing depression or brain tumors causing anxiety. Why Specialists May "Degrade" or Ignore Recommendations Specialists sometimes dismiss a psychiatrist's input due to systemic and professional barriers: Stigma and Bias: There is a historical lack of respect for psychiatry as an "exact science" compared to biological specialties like surgery. Communication Gaps: Specialists may believe they can manage the patient's symptoms without psychiatric help or feel that the psychiatrist lacks current knowledge in their specific surgical or medical niche. Focus on Physical Markers: Other specialists rely heavily on biological metrics (blood tests, scans), while psychiatric diagnosis is often based on clinical observation, which some non-psychiatric doctors view as less "evidence-based". Prescribing Limits and Malpractice Legal Authority: In most states, a psychiatrist is licensed as a "physician and surgeon," which legally allows them to prescribe any FDA-approved medication. Scope of Practice: While they can prescribe for non-psychiatric issues (e.g., blood pressure meds if relevant to a patient's care), they typically do not. Malpractice Risks: A psychiatrist risks a malpractice lawsuit if they prescribe outside their field and the patient suffers harm. To be "defensible" in court, they must prove they followed the standard of care, including obtaining the necessary lab work and physical exams that a specialist would normally perform. Insurance Restrictions: Many malpractice insurance policies specifically cover "psychiatric practice." If a psychiatrist prescribes chemotherapy or high-risk cardiac drugs, their insurance may not cover any resulting legal claims.

Psychoanalytic child and adult psychiatrists can identify medical conditions missed by other specialists because they are trained medical doctors who utilize a "whole-person" diagnostic approach . While other specialists may focus narrowly on a single organ, psychiatrists often spend more time gathering detailed histories that uncover systemic issues. How Psychiatrists Identify Non-Psychiatric Conditions Psychiatrists often "out-diagnose" other fields by identifying medical mimics physical illnesses that present with behavioral or psychological symptoms. Neurology: Psychiatrists may identify conditions like Parkinson’s disease or central nervous system tumors when an "abrupt" change in behavior occurs that does not fit typical psychiatric patterns. Rheumatology & Immunology: Conditions like systemic lupus erythematosus or Lyme disease often present with non-specific symptoms (fatigue, brain fog) that other doctors may dismiss as "just stress". Endocrinology: Hormone imbalances can cause mood swings or anxiety, which a psychiatrist may trace back to an underlying thyroid or adrenal issue. Urology & Gynecology: Patients with "unexplained" chronic pelvic pain or urinary issues are frequently dismissed. Psychiatrists can bridge this gap by identifying the bladder-brain axis or noticing patterns that suggest physical pathology rather than purely functional causes. The Role of Psychiatrists in Countering "Medical Gaslighting" Medical gaslighting occurs when a physician dismisses a patient's genuine symptoms as "all in your head" or "normal" without proper investigation. Diagnostic Overshadowing: This is a common form of negligence where a doctor attributes new physical symptoms to a patient's existing mental health diagnosis, leading to missed life-threatening conditions. Advocacy through History-Taking: Because psychoanalytic psychiatrists prioritize listening to complex stories that "don't fit neatly into test panels," they are often the first to believe a patient's report and order necessary medical labs or referrals that other specialists refused. Validation: Unlike doctors who may use terms like "somatizer" to dismiss symptoms, a good psychiatrist validates that symptoms are real and works to find the biological or psychological root. Actionable Strategies for Patients If you feel your symptoms are being dismissed by other specialists: Request Documentation: Ask the doctor to note in your chart that they are declining further testing. Seek a Psychiatric Consultation: A psychiatrist can perform a comprehensive evaluation to help rule out medical causes for your symptoms. Bring an Advocate: Having a partner or friend present can make it harder for a clinician to dismiss your reports.

The professional tension between neurologists and psychiatrists is deeply rooted in a historical divide between "brain" and "mind" that continues to influence medical culture in 2026. The Historical and Philosophical Divide The rift began in the late 19th century when neurology and psychiatry split into separate disciplines. Physical vs. Behavioral: Neurologists traditionally focus on "organic" disorders with visible physical signs (like stroke or Parkinson’s), while psychiatrists manage "functional" disorders of mood and thought that often lack gross physical markers. Scientific "Hardness": Neurologists may view their field as more scientifically "objective" because it relies on measurable data from MRIs, EEGs, and physical exams. Conversely, psychiatry is sometimes unfairly dismissed as "subjective" because it relies heavily on clinical observation and patient self-reporting. The "Pseudo-science" Label: Some extremist views within the medical community still categorize psychiatry as a "pseudo-science" because it deals with the abstract "mind" rather than the physical "wiring" of the brain, leading to a sense of intellectual superiority among some neurologists. Differences in Training and Focus Training pathways reinforce these distinct worldviews: Neurology Training: Emphasizes diagnostic precision, neuroanatomy, and physiological mechanisms. This can lead to a "reductionist" approach where symptoms are seen only as electrical or chemical failures. Psychiatry Training: Prioritizes the bio-psycho-social model, integrating biological factors with psychological and social contexts. Empathy and Communication: While psychiatrists are specifically trained in psychotherapy and deep patient communication, neurologists often have shorter, task-oriented interactions focused on localized brain damage. Personality and Behavioral Profiles Research into the personality traits of these specialists suggests distinct profiles: Agreeableness: Psychiatrists typically score significantly higher in "agreeableness" (a trait linked to empathy and cooperation) compared to neurologists and neurosurgeons. Conscientiousness: Neurologists often score higher in "conscientiousness," a trait associated with order and precision, which can sometimes manifest as a more rigid or dismissive professional style. Professional Arrogance: A "myth of mastery" can permeate neurology, where the pressure to provide precise, scan-based answers may lead to a dismissive attitude toward the "gray zones" of mental health that psychiatrists handle daily. Move Toward Unified "Brain Medicine" By 2026, many experts are calling to abolish this artificial divide and reunite the fields into a single discipline of "Brain Medicine". This movement argues that the brain does not distinguish between "neurological" and "psychiatric" symptoms and that patients are best served when both biological and emotional health are treated as one.

In 2026, mental health continues to face structural and interpersonal discrepancies that distinguish it from other medical fields, often resulting in what patients and providers describe as devaluing or "subhuman" treatment compared to physical health counterparts . Structural Discrepancies Systemic Underfunding: Mental health research and clinical services historically receive significantly lower funding than physical health, a disparity termed "structural stigma". Insurance & Reimbursement Gaps: Reimbursement rates for behavioral health visits in 2026 average roughly 22% lower than those for medical or surgical visits, creating a massive financial barrier for both providers and patients. Mandatory Licensure Declarations: Unlike many physical illnesses, physicians must often declare mental health conditions for medical licensure, which can lead to intrusive "fitness to practice" assessments and restricted licenses. Referral & Diagnostic Discrepancies Diagnostic Overshadowing: Physical symptoms in patients with mental illness are often misattributed to their psychiatric condition, leading to delays in diagnosing serious physical ailments like heart disease or cancer. Limited Outpatient Training: Most medical students learn psychiatry in inpatient settings with extreme cases, receiving minimal exposure to the outpatient care where over 80% of mental health treatment occurs. Therapeutic Pessimism: Providers outside the field frequently hold the belief that mental illnesses are "incurable," leading to dismissive or demeaning interactions that deter patients from seeking further help. Pharmaceutical & Market Discrepancies Lack of Personalized Engagement: Historically, pharmaceutical representation in mental health lagged behind highly commercialized fields like oncology or cardiology. However, in 2026, companies are shifting toward "hyper-personalized" direct-to-consumer platforms to reclaim the patient relationship and drive care coordination. Prescribing Imbalance: Non-psychiatric physicians and nurses write 80-90% of psychiatric prescriptions but often demonstrate lower knowledge levels regarding psychopharmacology compared to specialists. Will it change? The landscape is shifting in 2026 due to several emerging trends: Enforcement of Parity Laws: Stronger enforcement is finally pushing for insurance coverage of mental health and substance use services at the same level as physical health. Value-Based Care Integration: Systems are moving mental health from the "periphery to the core," adopting new measures like treatment engagement and social determinants of health to better capture patient outcomes. Collaborative Care Models: Integrating mental health into primary care settings is becoming standard practice to improve medication adherence and reduce the "isolation" of psychiatric treatment. Stigma in 2026 remains a significant barrier, often causing mental health patients to be viewed through a lens of "weakness" or "craziness" rather than as individuals with medical conditions . This bias manifests in healthcare, social settings, and policy. Healthcare and Structural Disparities Substandard Care: Patients reporting unfair treatment or disrespect by healthcare providers are twice as likely to go without needed mental health care. Many providers, including non-psychiatric physicians, still exhibit implicit biases that can lead to devaluing or dehumanizing patients. Arbitrary Benefit Caps: Medicare laws in 2026 still include discriminatory limits, such as a 190-day lifetime capon inpatient psychiatric hospital care a restriction that does not exist for any other medical specialty. Reimbursement Gaps: Insurers often provide lower reimbursement rates for mental health services compared to physical health, driving clinicians out-of-network and forcing patients to pay higher out-of-pocket costs. Social and Personal Impacts Perceptions of Weakness: Cultural emphasis on "toughness" leads many to view seeking help as a vulnerability or failure of character. Men, in particular, often face heightened stigma, as mental health symptoms are frequently misidentified as a lack of willpower. The "Crazy" Label: The label "crazy" is still used to isolate and dismiss individuals, effectively treating them as the opposite of "normal". Self-Stigma and Isolation: Approximately 47% of people with serious mental illness report discrimination when trying to maintain friendships, and 72% feel the need to hide their diagnosis. Ongoing Progress and Challenges in 2026 Mental Health Parity: New federal rules aimed at closing insurance gaps took effect on January 1, 2025, with more phases rolling out through 2026. These rules prohibit stricter medical necessity criteria for behavioral health than for physical health. Reducing Stigma: While stigma has decreased for conditions like anxiety and depression due to more open public dialogue, it remains high for serious conditions like schizophrenia and bipolar disorder. Access Inequities: Significant "mental health deserts" persist; for example, distressed areas may have as few as two providers per ZIP code compared to eleven in prosperous areas.

This situation involves potentially severe violations of medical standards and civil rights across two different systems. In 2026, legal precedents clearly establish that both hospitals and correctional facilities have a duty of care that includes both physical and mental health. Potential Lawsuits Against the Hospital A hospital can be sued for medical malpractice or negligence if their care falls below the "standard of care"what a reasonable physician would do in the same situation. Failure to Treat or Consult: If acute psychosis and encephalopathy were evident, the failure to provide a psychiatric consultation or neurological evaluation may constitute a breach of the standard of care. Negligent Infection Management: Hospitals are liable for MRSA and sepsis if they fail to follow sterilization protocols or if delayed/incorrect antibiotic treatment causes the infection to spread to muscles or the heart (endocarditis). Failure to Assess Capacity: In 2026, hospitals must document a patient's medical competency (capacity) before allowing them to refuse care or leave against medical advice while in a life-threatening state like sepsis or encephalopathy. Premature Discharge: Sending a septic patient home with antibiotics that fail, leading to a rapid spread of infection, is a common ground for negligence claims. Potential Lawsuits Against the Prison System Incarcerated individuals have constitutional rights to adequate medical and mental health care under the Eighth Amendment. Deliberate Indifference: To sue a prison, you must often prove "deliberate indifference" that officials knew of a serious medical need (like acute psychosis or a spreading MRSA infection) and ignored it. Section 1983 Civil Rights Claim: This federal lawsuit can be filed if the prison system failed to treat a serious mental illness or physical condition, resulting in permanent injury or trauma. Lack of Capacity for Incarceration: If the individual was in an acute state of encephalopathy or psychosis, they may not have had the legal capacity to stand trial or be held in a general prison population rather than a medical/psychiatric facility. Why Psychosis is Often Mismanaged Diagnostic Overshadowing: Medical professionals often prioritize physical symptoms or, conversely, dismiss physical symptoms (like sepsis-induced confusion) as purely "psychiatric," leading to fragmented care. Resource Constraints: Hospitals and prisons frequently lack immediate access to on-call psychiatrists, leading to the use of law enforcement rather than medical personnel to manage psychotic breaks. Recommended Actions Request Medical Records: Secure all records from both the hospital and the prison to document the timeline of the MRSA spread and the lack of psychiatric intervention. Consult a Medical Malpractice Attorney: Specifically one who handles cases involving sepsis and hospital-acquired infections. Consult a Civil Rights Attorney: To evaluate an Eighth Amendment claim against the prison for the 27 months of untreated psychosis and medical neglect. File Formal Grievances: If not already done, follow the prison's internal grievance process, as this is often required before filing a lawsuit. In cases involving acute psychosis complicated by sepsis and MRSA brain encephalopathy, medical and correctional failures often center on standard-of-care violations and constitutional rights. Medical and Legal Considerations Capacity and Elopement: Patients with MRSA brain encephalopathy and acute psychosis typically lack the legal capacity to refuse treatment or leave against medical advice. Hospitals may be found negligent if they fail to implement a "1-to-1" sitter or secure the environment for a patient known to be delusional or at high risk of elopement. Treatment Priority: Medical protocols for septic encephalopathy prioritize treating the underlying infection(sepsis) to resolve the neurological dysfunction. While antipsychotics can manage paranoia, they may take days or weeks to reduce delusions, whereas aggressive source control (e.g., draining MRSA abscesses) and antibiotics are required within the first hours to prevent permanent brain damage. Failure to Restrain or Sedate: Doctors must balance the risk of "chemical restraints" against the patient's medical instability. For example, benzodiazepines are often avoided in septic patients as they can worsen delirium. However, failure to protect a patient from their own delusional actions (like eloping while septic) can form the basis of a medical malpractice claim. Rights in Prison Deliberate Indifference: Under the Eighth Amendment, prisons are prohibited from "deliberate indifference" to an inmate's serious medical or psychiatric needs. Treating a patient with acute psychosis or encephalopathy without proper medical intervention may be considered "cruel and unusual punishment". Constitutional Rights: Courts have ruled there is no distinction between the right to medical care for physical illness and for psychiatric conditions. If a prison fails to provide adequate psychiatric treatment for an inmate with a brain infection, they can be held legally liable. Potential Compensation and Recourse If the medical field and prison system failed a patient, they may be entitled to damages for: Physical and Emotional Suffering: Compensation for the physical pain caused by untreated sepsis and the trauma of being imprisoned while mentally incapacitated. Disability and Disfigurement: If the delay in treatment led to muscle loss or other permanent physical damage. Medical Costs: Recovery of all past and future expenses related to the injuries sustained due to negligence. To pursue these claims, a patient or their family must prove a breach of duty—that the care provided (or lack thereof) fell below the accepted 2026 medical standards. Consult the American Civil Liberties Union (ACLU) or Disability Rights Texas for specific guidance on prisoner healthcare rights.

In Jungian analysis, the development of these symptoms in a 10-year-old child represents a "lowering of the mental level" ( abaissement du niveau mental), where the ego becomes too weak to filter out intense contents from the unconscious. Jung viewed psychosis not as "nonsense," but as a highly symbolic attempt by the psyche to compensate for a deep-seated lack of balance. The NBA Player Obsession (The Hero Archetype): Jung would see this as a manifestation of the Hero Archetype. For a child with severe negative symptoms (emotional flattening, lack of drive), this obsession is a compensatory "inflation". The psyche creates an image of peak physical power and social "visibility" to counter the inner experience of invisibility and impotence. The Command Hallucinations (Autonomous Complexes): The voices are viewed as autonomous complexes fragmented parts of the personality that have split off and gained their own "will". They command the child because the ego has lost its authority. Physical Rituals (Symbolic Language): Touching the Door Frame: Thresholds (doors) symbolize transitions between states of being. Touching the frame may be a ritualistic attempt to "ground" the self or mark a boundary between the inner world and the external reality. Walking on Tiptoes: This can represent a psychic "detachment" from the earth (reality). In Jungian terms, the child is "floating" or being pulled into the "air" of spirit/fantasy, losing the "ground" of concrete existence. Pushing Out the Chest: This is a psychomotor expression of the NBA/Hero fantasy. It is a "puffed up" physical manifestation of the ego trying to occupy more space to defend against being overwhelmed by the unconscious. Mechanisms of Development Faiblesse de la Volonté (Weakness of Will): Jung believed that when the "will" to remain in reality weakens, the "unconscious contents" (hallucinations/obsessions) rush in to fill the vacuum. Teleological View: Jung would ask: "What is this psychosis trying to achieve?". The symptoms are seen as a disorganized attempt at individuation the psyche is trying to "grow" or solve a problem, but it is doing so in a fragmented, "shattered mirror" fashion. For a 2026 clinical perspective on managing such early-onset symptoms, specialized pediatric centers like the NIMH Early Psychosis Program or the AACAP Psychosis Resource Center provide evidence-based guidance for families.

Introduction Patients with intellectual disabilities, can be admitted to an inpatient psychiatric unit from their home environment, on a voluntary basis, but are more likely to be admitted based on the recommendations of the patient’s staff or family, due to acute changes in patient’s pattern of behavior. This collaborative effort, by various members of the patient’s support team, help provide the treatment team, with a global picture of the potential struggles that the patient is dealing with. They also help provide objective information, as the patient, based on the linguistic and cognitive capabilities, may not be able to express their symptoms or may lack insight into their behavior. In addition to medication management, on the inpatient unit, it is very important to help patient acquire skills, which can be used to deal with their underlying mental health needs. Therapy is one important mode of treatment that should be emphasized during hospitalization, by increasing a patient’s level of awareness about their condition and helping empower patients, by mitigate feelings of helplessness through acquiring new coping skills, which can be applied in the future. However, based on limited resources, on the inpatient unit, individual therapy may not be feasible. At alternative option, that can be very beneficial in an inpatient setting, is group therapy. Group therapy is a type of psychotherapy that involves one or more therapists working with several patients at the same time. Groups can be as small as 3-4 patients, however group therapy sessions generally involve 7-10 individuals (Lesczc and Yalom, 2005). The implementation of group therapy, for patients on an inpatient setting, can potentially improve compliance with treatment, by increasing a patient’s level of awareness and insight about their underlying symptoms, and decreasing feelings of emotional isolation. Based on the type of staff available, group therapy can incorporate varying creative activities, including music and art therapy, which will increase participation and provide possible coping skills that a patient can utilize in the future (Montgomery, 2002). The number of staff involved in group therapy, should be based on the level of assistance that patients of the group require, to maximization that level of direct participation. Structure of Group Therapy To help define the structure for group therapy, sessions should be held in a room that is exclusively dedicated to group therapy, to minimize the level of unwarranted environmental distractions. One entrance/exit door is preferred to help facilitator keep track of participants. The best sitting arrangement for group therapy would be in a large circle, where the therapist is sitting among the patients, to limit the therapist being viewed as an authoritative figure or the central focus of therapy (Lesczc and Yalom, 2005). Members of the group should be capable of seeing one another, during the entire session. A structured, daily schedule should be posted in the common patient area at the start of the day, with staff reiterating the various activities throughout the day, to maximize participation. As group therapy is not mandatory on the inpatient unit, if possible, staff could offer words of encouragement or small items of appreciation, to participating patients, which can include additional recreational privileges. This type of positive reinforcement will help increase participation in groups and help patients feel empowered in the process. Patients with intellectual disabilities, based on prior experiences, are often told what to do, by an authority figures in their life, so it is important to help maintain a level of autonomy for patients, on the inpatient unit. Principles of Group Therapy In The Theory and Practice of Group Psychotherapy, Dr. Irvin D. Yalom (2005) , discusses the key therapeutics principles that illustrate the benefit of group therapy for patients. Introduction of Hope – A group will consist of individuals at different stages of the treatment process. The journey for recovery will seem less daunting, if patients are able to witness others that are coping and recovering, allowing those in the beginning in the process to feel more hopeful. Togetherness – Being a part of a group, with similar experiences, helps each individual understand and recognize that they are not alone or isolated in dealing with their mental illness. Also, it helps the individual understand they accepted and valuable for whom they are. Empowerment – Patients have the ability to help one another by sharing their experiences, by increasing the level of awareness of group members. Safe haven – Group therapy can be a safe haven for patients, to allow them to discuss their issues and experiences, in a non-judgmental, neutral environment. Mirroring – Patients participating in group therapy, can be capable of mirroring positive behaviors and actions of a therapist, to provide them with more tangible ways to communicate and address underlying issues. Practice – Through repetition, patients will be able to practice how to apply their newly acquired techniques, which can alter their behavior in a positive fashion. Through repetition, habitual actions may develop into an underlying mentality that the patient can develop. Interpersonal learning – Through reflection, individuals can better understand themselves and their experiences. The knowledge they acquire can allow them understand the meaning of events in their lives. Purification – The act of sharing feelings or experiences in a group environment can be beneficial. An individual can release their suppressed emotions, which reduce his level of pain, guilt, or distress. Suppression of emotions can cause physical and psychological tensions within each individual. Confidence – As group members are capable of sharing their feelings and emotions, it can help individuals increase levels of self-esteem and confidence Tailoring Group Therapy for Patients with Intellectual Disability It may have been thought for years, that patients with Intellectual Disability may not benefit from insight-oriented group therapy, to help address their mental health issues, due to potential cognitive limitation, that hinder therapeutic intervention. However, there is increasing evidence and literature over the past 20 years, to illustrate that such individuals can benefit from therapy, if the therapeutic interventions were designed to better fit these individuals’ needs and capabilities (Razza and Tomasulo, 2005). Psychotherapy for patients with ID, is more effective, if it was focused on the use of active/interactive techniques that stimulate learning than a verbal modality alone (Psychology Today, 2013). According to literature, Interactive Behavior Therapy (IBT), developed by Daniel J. Tomasulo, Ph.D, is the most widely used form for group psychotherapy for individuals with intellectual disability, chronic psychiatric issues, or dual diagnosis (Razza and Tomasulo, 2005). The central focus of IBT, is altering the nature and methods to which therapy in conducted, to meet the needs of individuals with ID, as expressive and/or receptive language can be reduced or limited, for certain individuals (Gardner et al., 1996). Importance of Role Playing Role-playing is used in nearly every phase of human development to teach and model behavior. It is a fundamental concept that is reiterated in IBT, to help enrich the therapeutic experience, which has been coined Psychodrama (Marineau, 1989). Psychodrama is an action oriented therapy and technique, which allows expression of a condition or offer a solution, to a particular situation, through active participation in a collaborative group environment (Marineau, 1989). This collaborative approach conducted in an IBT format, places an emphasis on the interaction of participants in the group, rather than the interaction between the patient and facilitator, as the facilitator should provide guidance on the direction of therapy (Razza and Tomasulo, 2005). Structure of the IBT Model The Interactive-Behavioral Model, which in conducted in a four-stage process, uses 45 minute to 1-hour time slots for therapy sessions. The reduced time demands are beneficial to maximize participation, as patients are more physically/emotional present, limiting levels of exhaustion or inattention (Razza and Tomasulo, 2005). 4 Stages of IBT Stage 1: Orientation Goal of facilitator – to create a stable environment for participants, with cognitive impairment to develop skills needed for successful group participation. Focus on creating an environment where each individual is capable of experiencing their feelings and emotions, without interruption, as patients with ID, are unfortunately accustomed to people not listening to them or talking over them. Facilitator should continue demonstrating skills of actively listening to participants, and redirecting members on the importance of paying attention to one another and maintaining good eye contact (Psychology Today, 2013). Stage 2: Warm-Up & Sharing Goal of Facilitator: Inviting members to talk about themselves within the group. It is important that each facilitator pay attention to the interaction of members within the group, to help maximize the therapeutic experience. Each member of the group, should take turns disclosing their experiences relating to the topic discussed. Interaction amongst peers is preferred rather than interaction with the facilitator to maximize group adhesion. It can also be beneficial for the experience be interactive, as one member selects another member to continue share his/her experiences (Psychology Today, 2013). Stage 3: Enactment Goal of Facilitator: Help the implement techniques such as role-playing to help drive the therapeutic experience for each patient, through direct or indirect participation. The issues or topics that were discussed during the warm-up/sharing experiences are formulated into characters through the collaborative effort of participants and facilitator (Marineau,1989). One type of role playing technique has been coined, the double, in which one or more group members will voice the feelings and thoughts of another member, who is struggling with a given problem. Various styles of enactment can be used such as mirroring, role reversal, doubling, etc., selected by the therapist. Therapist can also include allow participants to select which type of enactment they wish to do (Psychology Today, 2013). Stage 4: Affirmation Goal of Facilitator: Validate and acknowledge the effort of each of the participants, involved in-group. Reflect on important highlights of the session, qualities or characteristics of individuals involved that helped maximize the quality of therapy, acknowledge the level of interaction between individuals, which helped to make the group more cohesive. The period of the session helps individuals to identify components of participation that are applicable to the therapeutic goals of the session and applicability in their own life (Psychology Today, 2013). Benefit of IBT approach The style and techniques used in IBT, are not only beneficial for patients with an intellectual disability, but can be utilized for patients with chronic mental illness, such as schizophrenia, depression, etc., as well those with a dual diagnosis. The therapeutic goal is to increase the overall social competence of such individuals and increase each patient’s insight into their condition (Daniels, 1998). The technique of IBT can be applicable to addressing particular mental health issues, such as anxiety, depression, psychosis, which can help patients to address their underlying pathological issues, through a therapeutic modality (Mental Health Reviews, 2005). General Topics to Discuss with Inpatient Population In addition, to IBT, staff involvement should focus on educating patients on topics that are important for mental and physical well being, including nutrition, sleep hygiene, psychotropic education, and exercise. Education on Proper Nutrition –important to discuss with patients the importance of quality nutrition, what types of food/beverage is beneficial for each patient’s medical health. In addition, it is important to address topics such as proper portioning of meals, monitoring calorie intake, and type and quality of nutritional items. Patients are often misinformed or not educated about the importance of quality nutrition, which can have benefits on mental and physical health, to limit or hinder likelihood of developing conditions such as diabetes, heart disease, etc. Education on Sleep Hygiene – important for patients to understand the importance of structuring their life to allow them to maximize the quality and duration that they sleep, as it can be beneficial for mental health. Therapist should discuss topics such as limiting caffeinated beverages before evening, restricting bedroom activities for sleep/sexual activities (limited stimulating activities such as TV, eating, reading), possibility of incorporating relaxation techniques before sleep to reduce internal tension, educating patients on leaving the bedroom, if unable to maintain sleep, etc. Also, important to focus on establishing a consistent regimen in which patients should limit oversleeping, as this can be a counter-productive process. Education on Sleep Medications – inadequate quality of sleep (nighttime restlessness, inability to fall and/or stay asleep, early morning awakening) can have direct effects on any psychiatric condition, the following day, as the brain is unable to feel rested and calm. Important to address topics related to sleep medications, such as residual sluggishness, grogginess to educate patients on being watchful of over-sedating effects of medications. Also, to educate patients on the ill effects of overmedicating with sleep aids, particularly important for patients who self-administer medications. Also, important to discuss with patients to look out for possible side effects with particular medications, such as parasomnia with Ambien, etc. Psychotropic Education – based on patients’ cognitive capabilities, discussing with patients the importance of continuity of medication use, the type of psychotropic meds, as well as potential side effects or withdrawal symptoms. Also, harmful effects that patients experience should be discussed with their providers. Pictorial diagrams or illustrations can be helpful for all patients, particularly those with reception cognitive impairment. Benefits of Exercise – exercise, particularly aerobic exercises, for at least 30 minutes to 1 hour, daily, can be beneficial outlet to dissipate internal tension, which can exist, regards of the etiology of psychiatric illness. Exercise can have physiological effects on the body, as it can reduce level of stress hormones, including cortisol, as well as stimulating the production of endorphins, which are nature mood elevator, as well as pain reliever (Anderson and Shivakumar, 2013). This concept has been vocalized by athletes, as a ”runner’s high”, in which euphoric feelings are felt, after an extended period of exercise. It is important for staff to screen patients, who would be appropriate to participate in physical activities, to limit the likelihood of injury. If patients had physical limitations, exercises could be altered, to allow varying levels of participation within a group. It would beneficial for patient to be capable of participating in exercise groups 20-30 minutes, hopefully three times a day, according to staff availability. Also, outdoor activity, due to increased level of sunlight would be beneficial for patients to naturally increase their level of Vitamin D. Relaxation Skills – it is important for a therapist to help patients address the physical tension that exist, as this is one among a constellation of symptoms of anxiety. A therapist can incorporate techniques such as progressive muscle relaxation or deep breathing, however the level of communication among staff, should be focused on meets the cognitive abilities of each patient. Simpler terminology or directions regarding the exercises, as well as ongoing reiteration, are beneficial to maximize participation within the group. It is important for facilitator to be aware of patients, who have decreased receptive skills, as they may require more individual attention, to reduce the likelihood of being derailed from the group environment. The patient, to reduce or dampen the physical tension that exists during periods of anxiety, can utilize these newly acquired skills (Anderson and Shivakumar, 2013). Conclusion Group therapy can be an effective mode of therapy, used on an in-patient unit, as it can allow patients to become allies in their journey to understand and overcome their mental health needs. The principles of group therapy, discussed by Dr. Yalom, help emphasis the synergistic effect of group therapy on each patient. Patients with intellectual disabilities, in addition to mental health needs, may need adjustment in the type and delivery of group therapy. Based on the discussed literature, the main focus on group therapy, among patients with intellectual disability, should be focused on therapy activities that are more action oriented. According to Interactive Behavior Therapy, patients with intellectual disability are able to absorb and understand topics, when the activities are tailored around their cognitive and linguistic abilities. The duration of each IBT activity should be shorter in duration in maximize concentration on each topic (Psychology Today, 2013). Therapist should devote additional time to reiterate concepts to patients. It is less important to cover a number of topics, but more important that each topic is well understood by the patients. Also, the structure of therapy should focus on interaction among patients, in which they are capable of using role-playing. Also, the therapist seeks the assistance of each member in the group for guidance on developing resolutions to each scenario. This style of therapy is more tangible and meaningful, as patients are capable of participating, rather be lectured to. Also, it may increase their attention span, as various participants are involved. The mode of IBT, in addition to other general topics, should be incorporated into varying therapeutic modalities for patients, while on the in-patient unit. Patients experiencing various mental health issues can participate in IBT, which can be tailored to discuss psychological issues that stem from such conditions. However, it is important to be mindful about how the patient would act in a group therapy, as the purpose of the event in group participation or collaboration, rather than central focus on one particular patient’s behavior or actions. It is important for staff to screen patients before allowing them to participate; otherwise the process would be counterintuitive or counterproductive. Source: Inpatient group therapeutic interventions for patients with intellectual disabilities; Journal of Intellectual Disabilities 19(1); November 2014. Author: Vilash Reddy, MD .

Key Takeaways ADHD symptoms can worsen during and after pregnancy, necessitating careful consideration of medication continuation. Automatic discontinuation of ADHD medication in pregnancy poses risks, requiring individualized treatment plans. Recent studies show mixed data on medication effects, with concerns about congenital malformations and preterm birth. No significant long-term neurodevelopmental risks have been found with continued ADHD medication during pregnancy. A collaborative risk-risk analysis is essential for informed decision-making between clinicians and patients. CONFERENCE REPORTER “This is the hottest topic in ADHD,” said Greg Mattingly, MD, of the day’s first session topic at the American Professional Society for ADHD and Other Related Disorders conference. Attention deficit hyperactive disorder (ADHD) and pregnancy has been much discussed, with clinicians considering effects of altering ADHD pharmacotherapy on both mothers and their developing children. Presenters Allison Baker, MD, and Katherine Bang-Madsen, PhD, showcased the risk-risk analysis strategy that may be most beneficial for clinicians helping patients decide whether to continue medication into pregnancy.1 Baker began the session, highlighting how ADHD symptom s can become more challenging to manage during and after pregnancy, and many women have a desire to continue their medication after becoming pregnant. In the perinatal period, there are a range of treatments that are nonpharmacological, but some patients may still need their medication for daily functioning. These patients should consider continuing their medication through pregnancy, Baker recommended. Though, for more mild to moderate cases, clinicians can provide psychoeducation, cognitive behavioral therapy, dialectical behavioral therapy, and mindfulness exercises. Baker emphasized that clinicians should not jump to discontinue pharmacotherapy for ADHD immediately when a patient becomes pregnant. A study “highlighted that the decision, very strictly, of discontinuing medication may roughen ADHD symptoms, specifically functional impairment, as well as be a vulnerability factor for mood symptom roughening,” Baker said.1,2 Clinicians must consider the balance of risks and benefits for continuation vs discontinuation, Baker advocated. Baker characterized postpartum as a “high stress and low control period” for the mother. With the period surrounding pregnancy being a particularly vulnerable time, women with ADHD may experience heightened symptoms and increased burden. Postpartum, ADHD symptom burden can increase the most, especially with the mother’s self-concept declining and functional impairments increasing. The risk of going untreated during pregnancy can be high for the mother, but the risk to the development of the child should be weighed as well. Clinicians must be aware that automatic discontinuation of ADHD medication in pregnancy does pose a meaningful risk, Baker explained. While many patients may choose to limit medication exposure during pregnancy, the postpartum period can also then be an opportunity to optimize medication dosage. Ultimately, treatment decisions should be individualized and incorporate a collaborative risk-risk analysis between the clinician and patient, Baker concluded. Katherine Bang-Madsen, PhD, continued the conversation, incorporating recent research on ADHD and pregnancy. She posed the essential questions that patients are asking: If I continue my medication, what could happen to the baby? If I stop my medication, what could happen to me? Concerns cited about potential impact of stimulants often include congenital malformations, increased blood pressure or vascular tone, increased risk of miscarriage in already vulnerable pregnancies, and complications like preterm birth.1 There has been a general increase in ADHD medication use during pregnancy in the last decade, but we still lack randomized controlled trials in this area, Madsen outlined. Madsen emphasized that studies on ADHD medication and pregnancy show mixed data and are not definitive. The estimate of medication effect on pregnancy is highly sensitive to study design, she pointed out. With a lack of randomized controlled trials, we must interpret carefully and consider issues with confounding and ascertainment bias. A recent observational study showed no increased risk for congenital malformation in pregnancy with amphetamines, but an increased risk with methylphenidate.3 Though the effects were small, methylphenidate was found to be related a possible small increase in child cardiac malformation.3 Some papers have outlined hypertensive disorder complications with continuation of ADHD medication through pregnancy, and Madsen noted this as the biologically most plausible effect of the medication, though the effect is likely modest.4-6 Another population-based registry study on preterm birth found that medication exposure may modestly increase preterm risk particularly with longer or continued use but the study cannot determine definitive causality.7 In terms of neurodevelopmental outcomes for the child, Madsen described recent studies as having a “reassuring pattern.” Across 4 studies noted, there was no signal fond of increased long term neurodevelopmental condition risk when mothers continued ADHD medication .8-11 These studies included useful sensitivity analysis like sibling-controlled design and fathers as negative controlled, Madsen pointed out. Looking at long-term growth trajectories, Madsen provided data from a Danish registry cohort study not yet published which looked at outcomes in child height and weight from age 0 to 15 years. The study followed children of mothers who continued their ADHD medication (methylphenidate or lisdexamphetamine) through pregnancy compared with mothers who discontinued medication. Analysis excluded children who went on to start their own ADHD medication in childhood. The study showed that there may be a small effect on height trajectory with prenatal stimulant exposure, and the pattern is compatible with sex-modified vulnerability. This pattern still requires replication, Madsen noted. The mother’s mental health is also an important factor in considering risks and benefits of continuing ADHD medication in pregnancy, Madsen highlighted. A pattern has emerged of women discontinuing medication for pregnancy, and then not returning to their medication postpartum—even though, as Baker mentioned, postpartum can be a time of worsened ADHD symptoms. Women with ADHD were found to have elevated baseline risk of perinatal depression and anxiety, and data suggested some women deteriorate in mood or functioning when they discontinue medication during pregnancy. However, discontinuation showed no increase in overall perinatal depression and anxiety. Both presenters concluded that a risk-risk analysis, rather than a risk-no risk analysis is essential when deciding with patients whether to continue ADHD medication into pregnancy. Note: This article originally appeared on Psychiatric Times .

Wonder drugs” for opioid use disorder look different on the streets than in medical journals. Key points Medications for opioid use disorder have downsides that don't appear in most of the medical literature. Fentanyl use is up even though overdose deaths are down. Full-abstinence recovery is both possible and beneficial for many patients. Nearly all Americans are aware of the U.S. opioid crisis. Overdose deaths increased sixfold between 2003 and 2023, from 12,940 to 79,358. Yearly increases have been especially steep since 2013, when fentanyl hit the streets. COVID-19 further exacerbated the crisis until a marked decline in overdoses in 2024. The recent drop in overdose deaths is credited by public health officials primarily to medications for opioid use disorder (MOUDs), particularly naloxone (Narcan) and Suboxone/Subutex. Naloxone reverses active overdoses almost immediately by “kicking” opioids out of receptors in the brain and body and blocking their return. Nasally administered Narcan, when given quickly, can literally bring overdosed users “back from the dead.” The second drug, Suboxone, is used to prevent overdoses in the first place. Suboxone combines naloxone with buprenorphine, a powerful opioid itself. Buprenorphine spares patients from withdrawal, while low-dose naloxone limits the euphoria and risk of overdose that buprenorphine alone carries. Although patients maintain a low-level “high” and remain physically addicted to buprenorphine, low-dose naloxone prevents intense intoxication and overdoses by partially blocking opioid receptors. Both naloxone and Suboxone have been available for more than two decades. Those who credit them with the recent downturn in overdoses point to broader distribution and availability following intensive promotion in medical journals, by healthcare systems, and by the National Institutes of Health. Yet post-COVID-19 reductions in several causes of death have been reported. Alcohol-related deaths, cocaine overdose deaths, and suicides all trended down in 2024. This suggests an additional common cause that isn’t explained by MOUDs. The Downsides of MOUDs I’m not suggesting Narcan and Suboxone aren’t essential parts of treatment. Rather, I argue that the current public health narrative minimizes their drawbacks. Opponents of Narcan have long held that it enables opioid usena worry many public health officials flatly reject. Many of us who work on the streets, however, have heard our opioid-addicted clients describe hoarding Narcan so they can get “higher” and be revived if needed. As Reuters reported in "Fentanyl Express," their Pulitzer Prize-winning investigation of the opioid crisis, fentanyl use has increased even though overdoses have declined. This is almost surely attributable to Narcan. Suboxone treatment also comes with costs, particularly diminished quality of life for those who are treated long-term. Memory problems, constant sedation, fatigue, and low motivation are common side effects that can easily be overlooked in primary care settings because they’re less intense than the symptoms of heavier opioid use they replace. Over time, however, these side effects can erode well-being and may undermine patients’ agency in their extended recovery. Employment instability, social disengagement, oral infections, and tooth loss are also common with long-term Suboxone treatment, and overdose risk, though far lower than for heroin or fentanyl, isn’t trivial. None of these findings should be surprising given similar long-term effects of methadone, another long-acting opioid that was commonly used to treat opioid addiction before Suboxone was available. The American Society of Addiction Medicine doesn't mention these long-term effects in its National Practice Guideline, which encourages indefinite Suboxone treatment. In addition, buprenorphine like all long-acting opioids carries a very long withdrawal period, extending up to a month beyond the few days of heroin and fentanyl withdrawal. Patients who eventually seek full abstinence therefore face a more difficult road to get there. Many aren’t informed of this when Suboxone is prescribed. Some promotional materials distributed to prescribing physicians misleadingly claim that opioid detox is ineffective. Here again, those of us who work on the streets see many people choose detox and fully recover especially when that detox is paired with inpatient treatment. At the Hope Resource Center in Columbus, where I contract part-time, all eight peer support specialists were once addicted to fentanyl and have a year or more of full-abstinence recovery. Several of them were homeless before they first detoxed and entered treatment. These people’s stories show us that opioid use disorder can be overcome without indefinite buprenorphine treatment and maintained opioid addiction. Ashley Arick, a former peer support specialist at the Hope Resource Center who is now its outreach director, shares her story of repeated relapses while treated with Suboxone, and how her decision to choose full abstinence changed her life. (Readers can hear Ashley’s story on the Get a Grip Podcast.) My point in writing this post isn’t to deride MOUDs, which are essential tools in our treatment armament and are needed to save lives. Even long-term Suboxone treatment is necessary for some patients. Yet transparency about these medications is also essential given their effects on quality of life. These effects should not be swept under the rug, despite the well-meaning intentions of public health officials. Whether one is a prescribing physician, a person fighting opioid addiction, or a family member, we deserve to know the downsides of medications to make informed treatment decisions. Two things can be true at once. In the long run, we lose credibility with patients and the public when we hide the downsides of a treatment for any disorder. Note: This article originally appeared on Psychology Today .

Early research has linked Alzheimer’s disease (AD) medications cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) receptor antagonists to modest cognitive benefits in children and adolescents with autism spectrum disorder (ASD) and comorbid cognitive disability. The preliminary evidence, which is drawn from a mix of randomized controlled trials (RCTs), cohort studies, case series, and case reports suggests these medications most frequently had a positive effect on learning and memory, though some improvements were also reported in complex attention, executive function, perceptual-motor functioning, and general cognitive ability. The only three drugs assessed were donepezil, rivastigmine tartrate, and memantine. “Given the lack of FDA-approved treatments for cognitive impairment or core features of ASD, these findings highlight a critical opportunity to explore the therapeutic potential of these pharmacologic classes for improving neurocognition in this population,” investigators led by Nicholas Diamandis, research coordinator in the lab of senior author Kristina Denisova at The City University of New York, New York City, wrote. “Given the promising evidence synthesized in the present scoping review, there may be a need to shift focus from treating core symptoms of ASD (social communication, restricted or repetitive behaviors or interests) to cognitive abilities,” they added. Most of the studies were small, however, and several relied on findings only from case reports. The authors also noted substantial differences in what improvements were reported based on the age of the participants with younger children showing greater potential benefit and durations of treatment, which ranged from 1.5 to 212 weeks. The study was published online on November 17 in Translational Psychiatry . Potential Autism/AD Link Children with ASD and co-occurring intellectual disability (ID) face particularly poor cognitive-development trajectories and have a nearly threefold increased risk of developing AD in later life compared with those without comorbid ID and the general population. This suggests there could be an important mechanistic link underlying ASD and AD and that “individuals with these conditions may stand to benefit from similar psychopharmacological treatments,” the investigators noted. To evaluate and synthesize the evidence on the effect of AD medications on neurocognitive outcomes in children and adolescents with ASD and low intelligence quotient (IQ) the researchers conducted a scoping review. The investigators searched PubMed, PsycInfo, Scopus, and Web of Science to conduct a scoping review of studies in any language published through May 2025 that published empirical results on the use of FDA-approved AD medications in individuals aged 2-21 years with ASD and an IQ at least one SD below the mean. The review included studies evaluating any of these AD drugs: donepezil, galantamine, rivastigmine, benzgalantamine, memantine, aducanumab, lecanemab, or donanemab. The studies also needed to provide an estimate of intellectual ability and at least one outcome in one of the six domains of neurocognitive ability. These include complex attention, executive function, learning and memory, language, perceptual-motor function, and social cognition. Of 404 studies initially identified, 12 studies, with a total of 353 participants and published between 2002-2024, met the criteria. They included four RCTs, a prospective open-label trial, a retrospective open-label trial, two retrospective observational studies, three retrospective case series, and one case report. The majority of studies were conducted in the US, one was conducted in Canada, and two in Israel. Mixed Findings Six of the studies, with 152 combined participants, reported on treatment with a cholinesterase inhibitor, mostly donepezil plus one on rivastigmine tartrate. The other six studies included 201 participants and reported on the NMDA receptor agonist memantine. Four of the five studies assessing language reported statistically significant improvements following treatment with a cholinesterase inhibitor. These included two RCTs of donepezil — one showing gains in receptive language among children but not adolescents, and another demonstrating improvements in both receptive and expressive language. Two retrospective case series, one involving donepezil and the other rivastigmine tartrate, also reported improvements in expressive language. Of the two studies evaluating executive function, a retrospective open-label series reported improvements in hyperactivity with donepezil, and another study showed gains on the Delis-Kaplan Executive Function System sorting test during an open-label extension that followed a negative RCT. Only one study assessed complex attention, and it showed improvement after treatment with rivastigmine tartrate. Two studies reported on general cognitive ability, with one finding significant improvements after 12 months of donepezil and the other finding no improvement. Some Notable Improvements Among the five studies reporting on memantine treatment and language, three of them showed improvements, but one was a case study and another was a case series of two patients, with both relying solely on clinical evaluations and caregiver reports rather than objective assessments. The third was a retrospective case series. Four studies reported on executive function, and three found improvements. These included one case study and two observational studies, one retrospective with 18 participants and one prospective with 14 participants. The same case study showed improvement in complex attention, the only study to report on this outcome with memantine, and it was among two of the three studies reporting improvement in visuospatial abilities. The other showed improvement in one of eight children in a case series. One of the two studies reporting on general cognitive ability reported improvement, a small RCT in which five of seven participants receiving memantine improved in verbal IQ while no participants receiving placebo improved. Finally, both studies looking at learning and memory after memantine treatment found significant improvements, 1 in 23 children after 24 weeks of treatment (but not 12 weeks) and 1 in 14 children after 8 weeks of treatment. Although the results of the review suggest justification for further investigation of these medications in populations with ASD and low IQ, the authors emphasized both the lack of safety data for these medications in children and the poor understanding of how the drugs might work in pediatric patients. More Research Needed Commenting on the findings, Glen Elliott, MD, PhD, chief psychiatrist and medical director at the Children’s Health Council and part-time associate training director at Stanford Medicine’s Division of Child and Adolescent Psychiatry in Stanford, California, agreed that more investigation is necessary before any of these medications could be considered for pediatric populations. “It’s far too early to believe that either of these medications are going to be provide a major contribution to the outcome of children with autism,” Elliott, who was not involved in the research, told Medscape Medical News . “The summary of the results are that we could call for more research, but these are not likely to become mainstream medication for use in autism spectrum disorder.” Even with AD, Elliott noted that the therapeutic benefits of these medications can be marginal. Just as autism is complex, so is cognitive dysfunction, so attempting to identify therapies that address both is even more challenging, he added. While both Elliott and the investigators noted that it’s not entirely clear why a drug with potential benefits for AD might also offer therapeutic value in children with autism autistic children, a leading hypothesis they both identified is that the drugs may influence the brain’s neuroplasticity, “particularly with language,” Elliott said. “You’d like the language areas to be more amenable to change, and these drugs may have that effect,” he added. Like the investigators, Elliott underscored the importance of continued investigation into treatments for autistic children with significant cognitive dysfunction because many of those families feel left behind by autism research. “The people who did these studies should be applauded for working on this particular population with medications that are different than what have been used traditionally,” Elliott said. “We don’t have much to offer this population in terms of medications .” But he also does not advise that families try giving these medications to their autistic children, and even if they did so, they’re unlikely to see significant, notable improvement. Statistically significant results reported in these studies do not necessarily translate to clinically significant results, and the medications are unlikely to make a substantially noticeable difference in everyday life, he said. “These are very modest results and certainly not what would be considered a breakthrough,” he said. Note: This article originally appeared on Medscape .

Autism spectrum disorder (ASD) is a complex developmental condition involving persistent challenges with social communication, restricted interests, and repetitive behavior. While autism is considered a lifelong disorder, the degree of impairment in functioning because of these challenges varies between individuals with autism. Diagnosis of Autism Spectrum Disorders Early signs of this disorder can be noticed by parents/caregivers or pediatricians before a child reaches one year of age. However, symptoms typically become more consistently visible by the time a child is 2 or 3 years old. In some cases, the functional impairment related to autism may be mild and not apparent until the child starts school, after which their deficits may be pronounced when amongst their peers. Social communication deficits may include: Decreased sharing of interests with others Difficulty appreciating their own & others' emotions Aversion to maintaining eye contact Lack of proficiency with use of non-verbal gestures Stilted or scripted speech Interpreting abstract ideas literally Difficulty making friends or keeping them Restricted interests and repetitive behaviors may include: Inflexibility of behavior, extreme difficulty coping with change Being overly focused on niche subjects to the exclusion of others Expecting others to be equally interested in those subjects Difficulty tolerating changes in routine and new experiences Sensory hypersensitivity, e.g., aversion to loud noises Stereotypical movements such as hand flapping, rocking, spinning Arranging things, often toys, in a very particular manner Parent/caregiver/teacher concerns about the child's behavior should lead to a specialized evaluation by a developmental pediatrician, pediatric psychologist, child neurologist and/or a child & adolescent psychiatrist . This evaluation involves interviewing the parent/caregiver, observing, and interacting with the child in a structured manner, and sometimes conducting additional tests to rule out other disorders. In some ambiguous cases, the diagnosis of autism may be deferred, but otherwise an early diagnosis can greatly improve a child's functioning by providing the family early access to supportive resources in the community. The first step is seeking an evaluation . Most parents start with their pediatrician who is checking on developmental milestones. If your child is under the age of 3 years, you can obtain an evaluation through your local early intervention system. If your child is over the age of 3, you can get an evaluation through your local school (even if your child does not go there). Risk Factors The current science suggests that several genetic factors may increase the risk of autism in a complex manner. Having certain specific genetic conditions such as Fragile X Syndrome and Tuberous Sclerosis has been identified as conferring a particularly increased risk for being diagnosed with autism. Certain medications, such as valproic acid and thalidomide, when taken during pregnancy, have been linked with a higher risk of autism as well. (CDC) Having a sibling with autism also increases the likelihood of a child being diagnosed with autism. Parents being older at the time of pregnancy is additionally linked with greater risk of autism. Contrary to popular belief, vaccines have not been shown to increase the likelihood of an autism diagnosis, and race, ethnicity or socioeconomic status does not seem to have a link either. Male children tend to be diagnosed with autism more often than those assigned female sex at birth, albeit this ratio is changing over time. Treatment While there is no "cure" for autism, there are several effective interventions that can improve a child's functioning: Applied behavioral analysis: It involves systematic study of the child's functional challenges, which is used to create a structured behavioral plan for improving their adaptive skills and decreasing inappropriate behavior Social skills training: Done in group or individual settings, this intervention helps children with autism improve their ability to navigate social situations Speech & language therapy: It can improve the child's speech patterns and understanding of language Occupational therapy : This address adaptive skills deficits with activities of daily living, as well as problems with handwriting Parent management training : Parents learn effective ways of responding to problematic behavior and encouraging appropriate behavior in their child. Parent support groups help parents cope with the stressors of raising a child with autism Special education services : Under an Individual Education Plan provided by their school, which accommodates for their social communication deficits, restricted interests, and repetitive behaviors, children with autism can achieve their fullest potential academically. This includes special day classes for very young children to address language, social, and life skills. Treating co-occurring conditions: Children with autism experience insomnia, anxiety, and depression more often than peers without autism. They also more often have ADHD. Children with autism may have intellectual disability and this needs to be addressed. The impact of these conditions can be reduced with the proper services, which include all of the above, in addition psychotherapy and/or medication treatment Medication: A child psychiatrist can evaluate for co-morbid depression, anxiety, and impulsivity. If appropriate medications can be helpful. For example, a utism-related irritability can be reduced by medications such as aripiprazole and risperidone (the two medications approved by the Food and Drug Administration for irritability associated with autism), prescribed judiciously by a knowledgeable clinician in collaboration with the child's parents. Several complementary and alternative interventions involving special diets and supplements have been tried over the years by parents/caregivers seeking ways to help their child with autism function better. To date compelling evidence has not been found to clearly recommend any such specific interventions. Research into these types of interventions continues, and parents/caregivers interested in them should discuss them with their child's treating clinician. Tips For Parents Learn as much as possible about autism spectrum disorder Provide consistent structure and routine Connect with other parents of children with autism Seek professional help for specific concerns Take time for yourself and other family members Having a child with autism affects the whole family. It can be stressful, time-consuming and expensive. Paying attention to the physical and emotional health of the whole family is important. Many national and local advocacy organizations provide information, resources and support to individuals with autism spectrum disorder and their families. A few are listed in the Resources section. Related Conditions Attention-deficit/hyperactivity disorder Social communication disorder Specific learning disorder Intellectual disability Source: American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . Washington, DC: American Psychiatric Association Publishing.CDC. (2021, April 29). Autism Spectrum Disorder (ASD). Retrieved August 19, 2021, from: https://www.cdc.gov/ncbddd/autism/index.html

Untangling potential differences between prevention and treatment interventions. Key points Being able to prevent the onset of mental health problems is a critical need. Unlike in some other areas, the distinction between prevention and treatment in mental health is less clear. Many research studies that claim to focus on prevention actually have many components of treatment. It is worthwhile to separate these areas better and look for possible differences. As the number of people who struggle with clinical levels of mental health problems continues to rise, many experts and policy makers are calling not only for more availability of mental health treatment but also preventative efforts that might reduce the burden of these conditions in the first place. The recommendation certainly makes a lot of sense on many levels, from motivations to reduce human suffering to saving money. The call also is based on an assumption that prevention work is substantively different than treatment. But is it? Or is the difference based less on what interventions are being done and more on when interventions are being done (that is, earlier in life and before the onset of symptoms)? In other areas of medicine, the distinction is much clearer: You wear sunscreen to prevent the onset of skin cancer. You wear a seatbelt to prevent injuries in case of a car crash. Here, not only is the timing important but the intervention is vastly different than the treatment of those things you are trying to prevent; sunscreen doesn’t do much to treat melanoma. But in the mental health world, things seem much murkier. Prevention efforts can look an awful lot like what occurs in treatment, and these efforts are frequently being performed with folks who already have developed some level of distress when it comes to their mental health. Take, for example, an important study published in the respected journal JAMA Psychiatry : “Effect of a cognitive-behavioral prevention program on depression 6 years after implementation among at-risk adolescents.” While this is a strong and well-constructed study, it highlights many of the complexities of the prevention/treatment conundrum. It is billed as a prevention study for “at risk” youth who receive a “cognitive behavioral prevention program.” Looking more closely, however, most of the participants had already suffered a depressive episode and many at baseline had elevated depressive symptoms. Further, the prevention intervention was modified from a depression treatment program. Finally, the outcomes being measured included not only the onset of a future diagnosable depressive episode but also quantitative measures such as reductions in depressive symptoms and numbers of “depression free” days. Many other purported prevention studies don’t even look at rate of diagnosable psychiatric disorders at all as an outcome and assess solely a quantitative reduction in symptoms. Acknowledging these blurry boundaries between treatment and prevention in both practice and research, a logical next question might be, Does it matter? If something helps reduce the burden of emotional-behavioral problems maybe what we call it is just semantics. But, in my view, the answer to the does-it-atter question is maybe. Indeed, there may be important distinctions to understand between interventions that can truly prevent the onset of full-fledged mental health conditions among those who don’t meet criteria at baseline versus interventions that can statistically reduce the level of problems in folks who are already showing signs of distress. These may be differences related both to the amount or “dose” of the intervention required or actually qualitative differences in what the intervention actually looks like. A group of us at the American Academy of Child and Adolescent Psychiatry have been tasked to review what is now known about the prevention of psychiatric disorders in youth. In doing so, we are applying this more narrow definition of prevention to see if the answer we get is different than what we have been hearing previously. Preventing mental health problems before they start, rather than waiting for people to struggle, is a critical line of research and intervention that needs much more attention and resources if we are ever going to be able to stem the tide of our growing epidemic. Understanding what exactly prevention means is an important part of this equation. Note: This article originally appeared on Psychology Today .