Major Depressive and Bipolar Disorders

Depressive Disorders

• Examples of depressive disorders include major depressive disorder, dysthymia (persistent depressive disorder), mixed anxiety/depressive disorder, premenstrual dysphoric disorder, and disruptive mood dysregulation disorder.
• Bipolar disorders include bipolar 1 disorder, bipolar 2 disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another condition, other specified, unspecified, and specifiers for bipolar.

Major Depressive Disorder

• A common disorder with a lifetime prevalence of approximately 20%.
• Occurs twice as commonly in women.
• Can be chronic and recurrent.

Diagnostic Criteria for Major Depressive Disorder

• Sad mood and/or lack of pleasure (anhedonia).
• Associated symptoms include significant changes in weight or appetite, insomnia or hypersomnia, psychomotor retardation or agitation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, diminished ability to concentrate or indecisiveness, and suicidal ideation or behavior.
• Causes impairment.

Depression Subtypes

• Seasonal pattern
• Rapid cycling (4 or more distinct depressions in a year, but with time in between)
• Psychotic features
• Catatonic features (severe psychomotor retardation)
• Melancholic features (sadness and hopelessness, less anhedonia)
• Postpartum onset

Postpartum Depression

• Onset within four weeks of birth.
• Up to 30% of women experience postpartum symptoms.
• About 10% have full postpartum major depressive disorder.
• Individuals usually have a history of mood disorders.
• According to DSM 5, bereavement-related symptoms are no longer excluded from the diagnosis of major depressive disorder.

Dysthymia

• Involves a depressed mood for at least 2 years.
• Characterized by two or more symptoms: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or indecisiveness, and feelings of hopelessness.
• Symptoms cannot be absent for more than 2 months at a time.

Mixed Anxiety/Depressive Disorder

• The co-occurrence of anxiety and depressive symptoms.
• Diagnosed when diagnostic criteria for other anxiety and depressive disorders are not met.

Premenstrual Dysphoric Disorder (PMDD)

• Characterized by significant depressive and/or physical symptoms typically present in the week before menses.
• Symptoms remit several days after menses begin.

Disruptive Mood Dysregulation Disorder (DMDD)

• Involves the presence of severe recurrent temper outbursts and persistent negative mood (irritability, anger).
• Symptoms begin before the age of 10 and must be present for at least 1 year.

Emotion and Psychopathology

• Extremes: greater intensity of emotional displays and greater amplitude of emotional reactivity.
• Absences: lower intensity of emotional displays (or absent) and decreased amplitude of emotional reactivity (or absent).
• Disjunctions: emotions as a multi-component system (experience, behavior, physiology) where channels ideally cohere together; disjunction involves a mismatch between channels of emotion.

Tale of Two Views: Magnification

• Negative potentiation where there is an increased response to negative stimuli.
• It results in sad mood (increased negative emotion).
• Cognitive theories of depression suggest negative distortions of the world lead to negative emotions.

Attenuation

• Positive attenuation involves decreased responses to positive stimuli.
• Symptom: anhedonia (decreased pleasure).
• Individuals report less pleasure from pleasant photos, positive films, and drink stimuli.

Experimental Procedure on Emotions

• Participants watched films (neutral, sad, happy) and underwent an emotional life events interview (neutral, sad, happy).

Emotion Context Insensitivity (ECI)

• Depression can flatten the emotional landscape.
• It constricts reactions to differing contexts (even neutral or non-emotional ones).
• Emotions may be inappropriate or "insensitive" to the context.

Treatments

• Cognitive and behavioral therapies
• Interpersonal therapy
• Psychopharmacology
• Electroconvulsive therapy
• Transcranial magnetic stimulation
• Deep brain stimulation
• Vagus nerve stimulation
• Light therapy for seasonal affective disorder

Mood Disorders: Bipolar Disorder

• Mania Diagnostic Criteria: Abnormally and persistently elevated mood (may also be irritable) for one week or longer. Associated Symptoms:
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Pressured speech
• Increased physical activity and energy
• Racing thoughts
• Increase in goal-directed activity
• Causes impairment.

Bipolar Disorder

• Significant impairment, with the highest suicide rate (up to 29%) of all psychiatric disorders.
• Accounts for 1½ inpatient mental health care costs.
• The 6th leading cause of worldwide disability according to the World Health Organization.

"FIND" Guidelines

• F: Most days of the week (frequency).
• I: Severe enough to cause extreme disturbance in 1 domain or moderate disturbance in 2 domains (intensity).
• N: 3-4 times per day (number).
• D: 4 or more hours per day (duration).

Diagnosis in Youth

• "When I feel happy, I get real bouncy... I'm hopping all over the place, and my mind seems to be focused on one thing for a short time. Sometimes I don't necessarily feel bouncy, just kind of light and airy, like a butterfly. I sort of flit and float from place to place, physically and in my mind."

Tale of 2 Views (of Mania)

• “Positive-to-all": Increased response during presence and absence of emotional stimuli (e.g., “Tonic-level"); mania heightened reactivity across positive, negative, and neutral stimuli.
• "Positive-to-positive": Increased response to positive emotional stimuli (e.g., "affective-reactivity"); mania heightened reactivity to positive stimuli only.

Multi-Method Assessment of Emotion

• Self-reported motion: Positive emotions include happy, pride, amusement, compassion, love, and gratitude; Negative emotions include sadness, fear, disgust, anger, shame, and embarrassment.
• Emotional behavior: Positive emotions include happy, pride, and amusement; negative emotions include sadness, fear, disgust, and anger.
• Peripheral physiology: heart rate, skin conductance, cardiac vagal tone (RSA), finger/ear pulse transit time.

Discrete Positive Emotions

Schizophrenia

• Lifetime prevalence is 1%.
• Most commonly appears in adolescence or early adulthood. Diagnostic Criteria:
• Characteristic symptoms: two (or more) of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.
• Social/occupational dysfunction.
• Duration: continuous signs of the disturbance persist for at least 6 months (at least 1 month of symptoms or less if successfully treated) that meet Criterion A.
• Schizoaffective and mood disorder exclusion.
• Substance/general medical condition exclusion.
• Relationship to a pervasive developmental disorder.
• Symptoms are classified as positive, negative, and disorganized.
• "Positive" Symptoms: Excess or distortion of normal functioning.

Delusions

• Beliefs are highly unlikely to be true or are impossible.
• Persecutory delusions: Thinking people are always after you.
• Delusions of reference: Thinking things online have different meanings than they do.
• Grandiose delusions: Thinking you have special powers to do things that others cannot do.
• Thought insertion: Thinking people or things can put thoughts into your head involuntarily.
• Somatic: Thinking things are wrong physically.

Hallucinations

• Unreal perceptual or sensory experiences.
• Types include auditory, visual, tactile, and somatic hallucinations.
• The most common hallucinations in schizophrenia are auditory.

"Negative" Symptoms

• Deficit or diminution of normal functioning.
• Four Types: flat affect, anhedonia (absence of pleasure), alogia (absence of speech), avolition (absence of motivation).
• Affective flattening (or blunted affect): Severe reduction or complete absence of affective (emotional) responses; outward emotion express (usually face expressions).
• Alogia: Severe reduction or complete absence of speech.
• Avolition: Inability to persist at common, goal-oriented tasks.
• Anhedonia: Lack of pleasure.

Disorganization/Incoherence of Thought and Behavior

• Two types: disorganized speech and disorganized behavior.
• May be tied to fundamental problems in maintaining attention and working memory.
• Disorganized Speech: Loosening of associations, word salad.
• Disorganized Behavior: Inability to organize behavior, unpredictable and inappropriate behavior, catatonia (extreme lack of responsiveness to outside world).

"Rule of Thirds" in Schizophrenia

• ⅓ recover more or less completely.
• ⅓ episodic impairment.
• ⅓ chronic decline.

Disjunctions

• Emotions as a multi-component system (experience, behavior, physiology) where channels ideally cohere together; disjunction involves a mismatch between channels of emotion.

Ann Kring's Research

• Emotion behavior: Fewer facial expressions of emotion to films and pictures compared to controls.
• Emotion experience: Similar or more intense internal emotion experience.
• Research indicates that someone with schizophrenia who exhibits flat affect can still experience comparable emotion.
• Schizophrenia is best described by the "disjunction" theme.

Expressed Emotion (EE) in Schizophrenia

• Patients with schizophrenia are more likely to return to the hospital after discharge if living with families.
• EE in family discussions were examined, focusing on hostility toward the patient, criticism of the patient, and overprotective/ over-involved attitudes.
• Unusual patient thoughts lead to increased critical comments.

Psychosis Neurotransmitter Theories

• Imbalance in levels of receptors for dopamine causes symptoms.
• Serotonin, GABA, and glutamate may also play roles.
• Dopamine most consistently implicated in schizophrenia.
  • May be unusually high activity in the mesolimbic pathway.
  • May be unusually low activity in the prefrontal area.

Psychosis Structural Brain Abnormalities

• Enlarged ventricles, reduced volume, and neuron density in the frontal cortex and other brain abnormalities linked to cognitive and emotional deficits.
• Reductions in the area and activity of the prefrontal cortex.
• Hippocampus abnormalities in volume, shape, and level of activity.
• Amygdala impacts emotion and cognition, involves abnormal activity in response to emotionally evocative stimuli.
• Basal Ganglia implicated in catatonic behaviors.

Genetic Risks

• Family, twin, and adoption studies indicate a genetic component to schizophrenia or at least a vulnerability to it.
• Family history and twin studies show evidence that genetic factors contribute.
• Specific genes likely include those that affect dopamine.
• Epigenetics: DNA can be chemically modified by different environmental conditions, resulting in genes being turned on or off, and as a result, cells, tissues, and organs being altered in their development.
• MZ twins discordant for schizophrenia showed numerous differences in the molecule structure of their DNA, particularly on genes regulating.

Birth and Prenatal Complications

• People with schizophrenia show higher rates of several birth complications, especially hypoxia.
• Schizophrenia rates are higher among persons whose mothers were exposed to influenza virus while pregnant.
• Higher average paternal age.
• Stress may contribute to relapse.
• Family-related stress may be especially important.
  • Expressed-emotion: family members over-involved with one another, self-sacrificing while also being critical.

Psychological Treatments

• Behavioral and cognitive.
• Gently challenging cognitive distortions or delusions.
• Recognition of demoralizing attitudes toward their illness.
• Operant conditioning (reinforce adaptive behaviors).
• Token economies. Social and Family therapy
• Family therapy (e.g., targeting Expressed Emotion).
• Self-help groups.
• Pharmacological treatments.

Other Psychotic Disorders: Schizoaffective Disorder

• Recurring episodes of mood disorders and psychosis.
• An uninterrupted period of illness during which there is either a major depressive episode, a manic episode, or a mixed episode concurrent with criterion A schizophrenia symptoms. Delusions or hallucinations for at least 2 weeks without prominent mood symptoms.
• Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.
• Disturbance not due to the direct physiological effects of a substance or general medical condition.

Schizophreniform Disorder

• Characteristic symptoms: two (or more) of the following, each present for a significant portion of time for a 1-month period (or less if successfully treated) but less than 6 months: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms.

Brief Psychotic Disorder

• Symptoms: presence of one (or more) delusions, hallucinations, disorganized speech, grossly disorganized, or catatonic behavior.
• An episode of the disturbance lasts at least 1 day but less than 1 month, with eventual full return to the premorbid level of functioning.

Delusional Disorder

• One or more delusions for at least 1 month.
• Criterion A for Schizophrenia is not met.
• Tactile and olfactory hallucinations may be present if they are related to the delusional theme.
• Functioning is not markedly impaired.
• If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusions.

Developmental Psychopathology

• Includes neurodevelopmental disorders, which arise in childhood and are lifelong.
• Also includes disorders that are not seen as lifelong (e.g., depression and anxiety).
• Takes into account the developmental stage (what is typical of someone of a particular age).
• "Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one "right" way of thinking, learning, and behaving, and differences are not viewed as deficits."

Attention Deficit/Hyperactivity Disorder (ADHD) - DSM Criteria

• A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
• Symptoms present prior to the age of 12 years.
• Symptoms present in two or more settings.
• Symptoms interfere with social, academic, and occupational functioning.
• Symptoms do not occur exclusively during schizophrenia or another psychotic disorder and are not better explained by another mental disorder, substance intoxication, or withdrawal.

Inattentive ADHD symptoms

• Careless mistakes
• Difficulty sustaining attention
• Difficulty completing tasks
• Disorganization
• Often loses things
• Distractibility
• Forgetfulness Hyperactive-Impulsive Symptoms
• Fidgeting or squirming in seat
• Running/climbing when inappropriate
• Unable to play or engage in leisure activities quietly
• Talks excessively
• Has difficult waiting for their turn
• Restlessness
• Three Subtypes: Predominantly Inattentive, Predominantly Hyperactive-Impulsive, and Combined.

Neurobiological Influences - Genetics

• Highly heritable, with twin studies estimating heritability at 70-80%.
• Highly polygenic, with hundreds of risk variants identified in GWAS studies.
• Brain Structure: Overall smaller brain volumes (in children/adolescents, is less pronounced in adults); delayed cortical maturation; smaller prefrontal cortex responsible for executive function.
• Neurotransmitters: Dopamine (Reduced transmission leads to weaker reward processing, motivation deficits, and impulsivity); Norepinephrine (Modulates attention, arousal, and cognitive control in the prefrontal cortex; dysregulation may contribute to inattention and poor impulse control).
• Genetics
  • Highly heritable - Twin studies estimate heritability at 70-80%
  • Highly polygenic - Hundreds of risk variants identified in GWAS studies
• Brain structure
  • Overall smaller brain volumes - In children and adolescents - Less pronounced in adults
  • Delayed cortical maturation
  • Smaller prefrontal cortex - Responsible for executive function
• Dopamine
  • Particularly in the prefrontal cortex (PFC) and striatum
  • Reduced transmission leads to weaker reward processing, motivation deficits, and impulsivity
• Norepinephrine
  • Modulates attention, arousal, and cognitive control in the PFC
  • Dysregulation may contribute to inattention and poor impulse control
• Interventions
  • Medications work for approx 70-80% of individuals with ADHD - Stimulants that target both dopamine and norepinephrine activity (e.g., ritalin, adderall) - Nonstimulants (e.g., SNRIs, alpha-2 agonists)
  • Cognitive behavioral therapy - E.g., targeting avoidance, emotion regulation and coping strategies - More effective in conjunction with medication - Longer lasting effects than medications
  • Executive function (EF) coaching - Organization, time management, goal setting - Limited in generalizability
  • Supplemental lifestyle changes - Regular physical activity can improve dopamine regulation

ADHD Interventions

• Medications work for approximately 70-80% of individuals with ADHD; stimulants target both dopamine and norepinephrine activity (e.g., Ritalin, Adderall), nonstimulants (e.g., SNRIs, alpha-2 agonists).
• Cognitive behavioral therapy targets avoidance, emotion regulation, and coping strategies, and is more effective in conjunction with medication, with longer-lasting effects than medications alone.
• Executive function coaching (organization, time management, and goal setting) has limited generalizability.
• Supplemental lifestyle changes like regular physical activity can improve dopamine regulation.

Common Comorbidities of ADHD

• As many as 80% of adults with ADHD have at least one comorbid psychiatric disorder.
• Common comorbidities include anxiety, depression, bipolar disorder, substance use, and oppositional defiant disorder.

ADHD Outcomes and Risks

• Additional difficulties: sleep difficulties, social difficulties, emotion dysregulation.
• Educational outcomes: higher rates of suspension and dropout, more likely to repeat a grade.
• Occupational outcomes: greater risk of job instability, underemployment, and frequent job changes.
• Life outcomes: higher rates of divorce, financial struggles, and legal issues; higher morbidity.
• You don't "grow out" of ADHD.

ADHD Superpowers

• Hyperfocus
• Resilience
• Energetic enthusiasm
• Intuitive
• Creativity
• Communication skills

Diagnostic Considerations for ADHD

• What does ADHD look like in girls and nonbinary individuals? Majority of research has been done on boys.
• Can be diagnosed by a medical doctor (e.g., psychiatrist, pediatrician).
• Best practice involves multiple raters and a diagnostic interview, as opposed to solely a questionnaire.
• This can be expensive and is rarely covered by insurance.

Cognitive Disengagement Syndrome

• Cognitive Disengagement Syndrome is not a DSM-5 disorder, but a behavioral construct characterized by symptoms in three domains: daydreaming, mental confusion, and hypoactivity.
• Occurs frequently in individuals with ADHD, with an estimated overlap of up to 59%; highly correlated with depression.
• More internal distractions compared to ADHD.

Cognitive Disengagement Syndrome - Distinction from ADHD

• Originally emerged as another possible subtype of ADHD
• Factor analysis has shown it is distinct
• Unique correlates: global impairment, social impairment, emotion regulation difficulty, reduced quality of life, lowered self-esteem, increased daytime tiredness.

Autism Spectrum Disorder

• DSM-5 Diagnostic Criteria:
  • Social communication and social interaction deficits in social and emotional reciprocity, deficits in nonverbal communication, deficits in developing and maintaining relationships.
  • Restricted and repetitive behaviors, interests, and activities: stereotyped or repetitive speech, motor movements, or use of objects; excessive adherence to routines or ritualized patterns; excessive resistance to change; highly restricted, fixated interests abnormal in intensity or focus; hyper- or hypo-sensitivity to sensory input or unusual interest in sensory aspects of the environment.
  • Symptoms present in early childhood. Symptoms limit and impair daily functioning.
• Severity Levels: Level 1 (requiring support), Level 2 (requiring substantial support), Level 3 (requiring very substantial support).
• DSM-5 Changes from DSM-IV : Combination of autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified; first inclusion of sensory symptoms: hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment.
• Common Comorbidities: ADHD, Anxiety, Depression.

Associated Characteristics of Autism

• Motor difficulties, unusual gait, walking on tiptoes, clumsiness
• Self-injurious behavior, headbanging
• Self-harm
• Executive dysfunction
• Emotional dysregulation
• Impulse control
• Sleep difficulties
• Insomnia and difficulty staying asleep
• 1 in 26 prevalence for autism spectrum disorder

Genetic Risk Factors for Autism

• Family studies indicate a very strong family risk (15-30x population risk), and related symptoms in family members without autism (e.g., social oddities, language difficulties).
• Twin studies suggest that genes account for 80-90% of the risk.
• Exome Sequencing has identified 102 risk genes, while 85% are idiopathic (cases where there is no known genetic cause).
• Genetic and Chromosomal Anomalies:
  • Fragile X syndrome
  • FMR1 gene
  • Phelan McDermid Syndrome
  • 22q13 deletion
  • Down Syndrome
  • Trisomy 21

Environmental Risk Factors in Autism

• Prenatal environment.
  • Sperm and egg cells from older individuals, especially paternal age.
  • Preterm birth.
  • Birth complications resulting in ischemia (lack of blood) and hypoxia (lack of oxygen).
  • Environmental exposure to toxins, including heavy metals like inorganic mercury and lead.
  • Maternal valproate use during pregnancy.

Natural Basis of Autism

• Early accelerated brain growth, specifically in frontal regions.
• Disrupted functional connectivity, including reduced connectivity in the cerebellum, fusiform gyrus, and occipital cortex, as well as reduced-short and long-range connectivity. All imaging findings are complicated by the heterogeneity (individual variability) of the disorder.
• Amygdala enlargement in toddlers positively correlated with the extent of social interaction and communication deficits.
  • Hypoactive in ASD individuals relative to TD controls during social tasks.
• Basal ganglia, caudate nucleus volume increased.

Neuropsychological Correlates of Autism

• Lower IQ average, driven by verbal measures of intelligence.
• Deficits in theory of mind, specifically difficulty understanding what someone else is thinking and that it may be different from one’s own thoughts/experience (cognitive empathy).

Common Autistic Strengths

• Passionate interests
• Intense focus
• Attention to detail
• Memory
• Curiosity
• Integrity
• Fairness
• Sincerity
• Loyalty
• Helpfulness

ASD and Emotion

• Early studies of autistic individuals have suggested they lack empathy, have reduced emotional expression, and have poor emotional discrimination.
• More recent research, however, reveals a more nuanced picture of autistic individuals, suggesting they can socially interact, effectively communicate, and empathize with other autistic individuals, coining the "double empathy problem."
• Some emotional expression may be reduced, some may be enhanced.
• Emotion discrimination difficulties are a separate issue: alexithymia.

Behavioral Intervention

• Applied behavioral analysis focusing on attention, behaviors, imitation communication, and social and play skills.

Highly Structures Teaching Strategies

• Reinforcement
• Involvement of Parents and training
• Gradual transition towards natural environments
• Requires Extremely intensive (20-40 hrs/week for 2+ years)

ABA Pros and Cons

Pros:

• Empirically supported.
• Gains in Intellectual.
• Language.
• Skills of daily living
• Social functioning.

Cons

• Expensive
• Focus on eliminating behaviors, not building skills
• Based on neurotypical standards

What is ok for Problem behaviors?

What about social norms?

Pharmacological Interventions

• Generally, treat comorbidities, not ASD itself
• Stimulants for attention/impulsivity
• SSRIs for depression/anxiety

Off-label uses of drugs

• Atypical antipsychotics for repetitive behaviors
• Oxytocin for social impairment
• Propranolol (beta blocker) for self-injurious behavior (SIB), sensory overload

Long-term Outcomes

• Remaining challenges are an ongoing.
• Relatively few autistic adults live independently (only 10% are fully employed).
• Majority require some support and parents are often the main source of support.
• Few programs for adults with autism, and even fewer that are affordable.

Ethical Considerations

• Characterizing ASD in comparison to neurotypical norms.
• Responsibility to autistic individuals, not parents, society, etc.
• Considering what is important to individuals affected.

Language Note

• Focus on person first versus identity first language - (A person with autism vs an autistic person).
• Diagnostic Criteria Deficits in intellectual function (e.g., reasoning, problem-solving, planning, abstract thinking, judgment, academics), confirmed by both clinical assessment and individualized, standardized intelligence testing. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, deficits limit functioning in activities of daily life.

Intellectual Developmental Disorder (IDD)

• Generally, IQ and adaptive functioning must be 2 standard deviations or more below the population mean; the severity is specified as Mild, Moderate, Severe, or Profound.

Etiology:

• Genetic and chromosomal syndromes like Down syndrome and Rett syndrome.
• Acquired injuries: Head trauma, Encephalitis, Hypoxic birth injuries.
• Environmental influences, in utero drug or alcohol exposure, Lead or mercury intoxication.

Functional Outcomes

• Broad challenges with learning and problem-solving.
  • Social difficulties
  • Risk of social isolation and bullying. Vocation and employment; with employment; varying with severity of IDD.
• Daily living skills; varying varying with severity of IDD.

Specific Learning Disorder (SLD) Diagnostic Criteria from DSM-5

A. Difficulties learning and using academic skills, indicated by one or more of the following symptoms that have persisted at last 6 months, despite targeted interventions: a) Inaccurate or slow and effortful, b) Difficulty to understand understanding the meaning of meaning, c) Difficulties with spelings spelling.

• Affected academic skills are substantially below those expected for the that for age of chronlogical, and a a significant interference with academic or performance performance. Learning difficulties begin during the school-age years, but may not become fully manifested until demands for affected academic skills exceed individual’s limited capacities.

SLD with Impairment in Reading

• Dyslexia, encompasses both word reading accuracy, reading fluency and rate, reading comprehensive
• SLD with Impairment in Written Expression
• Encompasses with grammar, spelling

SLD with Impairment in Mathematics

• Dyscalculia, encompasses: number sense, memorisation of arithmetic factors, accuracy or fluent calculations, accurate math reasoning. General intelligence is not impacted by SDLS.Outcomes depend on severatity, early and and even even. With of, individualdyslexia stillmay be with spell..

SLD Interventions

• Reading Phonics Based
• Multi-sensory and Text-to-Speech
• Mathematics Step-by-Step.

Legal and Ethical Issues

• How do psychology and law intersect - psychology and the and psychology and and forensic psychoogy psychology
• Psychology and law: finding balance, patients rights asa as and and rights to
• Insanity as a "not of a crime, and a mental state - at the of the acthethey could not know it for, and or not know act was wrng
• Civil (Involuntary) Commitment:
• Person had ment, so that needed.
• Danger to
• Grave yable

Voluntary Commitment

• voluntary commitment is when you are admitted to hospitals for disabilities. A for 16 is for parent or guadian
• Not guitly by insanity of ""at defendant as. unable appreciate conduct 1984 and some that she was were at the of of crime

Verdict

• Individual of the with that the will be whileated, treatmentately