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ADHD, Assessments, and The Criminal Justice System

According to Skowyra et al., (2007), “seventy percent of youth in juvenile justice systems have at least one mental health condition and at least 20 percent live with a severe mental illness" (p. vii). According to the U.S. Surgeon General Report, “10% of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school, and with peers” (Rousseau, Module 2, 2023). This means the likelihood is high that youth in the juvenile justice system struggle in both school and vocational planning, significantly impacting their future. One reason this may occur is that “norms for vocational inventories and assessments have not been established that consider minority groups" (Dipeolu et al, 2019). One minority group that this affects are individuals with attention deficit hyperactivity disorder (ADHD).

ADHD is a neurodevelopmental disorder with which symptoms can cause clinically significant distress or impairment in school and occupational functioning (DSM, 2013). This is also shown to influence criminal behavior. According to Bartol et al., (2021) approximately one-fourth of children diagnosed with ADHD “engage in serious antisocial behavior during childhood and adolescence and criminal behavior as adults” (p. 53). Within correctional facilities, “the prevalence rate for ADHD at 3 to 10 times higher than are found in the general population” (Bartol et al., 2021, p. 54). With ADHD considered a “puzzling problem (Bartol et al., 2020, p.53) it is often misunderstood. For forensic psychologists to provide effective support and guidance when working with juveniles and adults in the criminal justice system with ADHD, ADHD must be well understood.

Research has shown that inventories based on norms from the majority that are used to assess personality and behavior characteristics along with career paths in individuals with ADHD are ineffective (Dipeolu et al., 2015, Royal et al., 2015). With that, it is important for a forensic psychologist to be able to identify the common characteristics of ADHD. Being well versed in common thought and behavior patterns of someone with ADHD is important to consider to ensure that what is being asked within an inventory and assessment is being interpreted and measured accurately. If we are not doing this, how can we assume results to be accurate for those with ADHD if the inventories used are based on majority norms?

Administering assessments and inventories to a minority group, designed with norms established by a majority within the criminal justice system may be impacting the effectiveness of treatment. In the words of Dr. Rousseau, “without treatment, the consequences of mental illness for the individual and society are staggering” (Rousseau, Module 2, 2023).

For more information on ADHD please check out:

https://drhallowell.com/

References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders  (5^th edition). Washington, DC

Bartol, C. R., & Bartol, A. M. (2021). Criminal behavior: a psychological approach (12th ed.). Pearson.

Dipeolu, A., Deutch, S., Hargrave, S., & Storlie, C. A. (2019). Developmentally Relevant Career      Constructs: Response Patterns of Youth with ADHD and LDs. Canadian Journal of  Career Development, 18(1), 45-55.

Dipeolu, A., Hargrave, S., & Storlie, C. A. (2015). Enhancing ADHD and LD diagnostic       accuracy using career instruments. Journal of Career Development, 42(1), 19-32.

Rousseau, D. (2023). Module 2. Boston University.

Royal, C., Wade, W., & Nickel, H. (2015). Career development and vocational behavior of     adults with attention-deficit/hyperactivity disorder [ADHD]. Career Planning & Adult  Development Journal, 31(4), 54-63.

Skowyra, K. R., & Cocozza, J. J. (2007). Blueprint for change: A comprehensive model for the identification and treatment of youth with mental health needs in contact with the juvenile justice system. Policy Research Associates, Inc.

Risk Assessment-Forensic Behavior Analysis

Risk assessment can be determined by forensic psychologists within the prison system to justify whether or not a prisoner is at risk for committing more crime when they are released from prison. A risk assessor is there to prevent criminals from getting out of prison if they still have a key factor in their mind that would make them want to commit crime.  There are many different kinds of risk assessment, one of them that stands out is "threat assessment". When looking at how individuals came about committing crime and becoming criminals, there are different social and environmental factors which can take place to cause these outbursts as criminals. There is also the term "dangerousness". Dangerousness is the thought of how dangerous an offender might be when they are re-integrated to the community (Bartol & Bartol, 2020). Risk assessment also includes the understanding of family life, peer interactions, household environment, and individual mental health states. By examining all of these environmental factors as well as different risks that correspond to the environmental factors, researchers will be able to come up with conclusions about how individuals develop criminal tendencies and how they might develop mental health, whether it be genetic or learned from family or peers. "Risk assessment suggests that clinicians and researchers are more proficient at assessing the probability that a given individual—or group of individuals—will engage in harmful behavior than they are at out rightly predicting that someone is dangerous or will be violent" (Bartol & Bartol, 2020).

According to Dr. Rousseau, “Outcomes of forensic assessments can be used to determine criminal responsibility, culpability, capacity to stand trial, and risk of re-offense. Forensic assessment can inform not only court procedures and outcomes, but also placement and treatment planning” (Rousseau, 2023). “In addition to general psychological-testing tools, there are tools that are designed specifically for forensic assessment and the assessment of risk of criminal behavior. Forensic risk-assessment strategies are commonly integrated into a psychological-testing protocol when one is dealing with a client involved in the criminal justice system” (Rousseau, 2023). There is a benefit to having risk assessment within the prison system to make sure that the prisoners who need treatment the most get it. As mentioned above, the program helps place individuals in treatment programs and place them in certain prisons that would benefit them in the long run. 

 According to the American Psychological Association, “They can give an informed opinion of whether a suspect knew right from wrong at the time of a crime and even whether a minor is being truthful in recounting an unlawful act. Some forensic psychologists work in the area of threat assessment, an emerging science predicting who may be at risk for committing a violent act” (APA, 2014). Understanding the roles of forensic psychologists within the criminal justice system is important because it will help individuals like researchers who are outside of the criminal justice system understand what their mission is and how it is beneficial for everyone that criminals are diagnosed and get the help they need if they are living under a mentally unstable life. Threat assessment is another program which pinpoints the problem and makes sure that it is resolved before the reintegration process is started. After they do their time whether it be at a prison or in a mental institution getting the treatment they need, then the forensic psychologist makes sure that the offender is able to get back into society or if he or she will be a risk to society when they are released. This kind of goes hand in hand with veterans, after coming back from overseas and fighting wars, the forensic psychologists can determine whether or not they need treatment to get them used to the way society is run and make sure they are ready to return to society at the best they can be without having a relapse of fear or anger from their overseas battle (APA, 2014). 

The question of owing morale to different branches has come about when talking about forensic psychologists. After they do their time whether it be at a prison or in a mental institution getting the treatment they need, then the forensic psychologist makes sure that the offender is able to get back into society or if he or she will be a risk to society when they are released. This kind of goes hand in hand with veterans, after coming back from overseas and fighting wars, the forensic psychologists can determine whether or not they need treatment to get them used to the way society is run and make sure they are ready to return to society at the best they can be without having a relapse of fear or anger from their overseas battle (APA, 2014). 

Overall, by having a specialized unit in the prison system for forensic psychologists to work is a good idea when thinking about the risk assessment and threat assessment models. By having these forensic psychologists work daily to improve this program and find treatment for the criminals incarcerated, this will benefit the overall threat to the community if the criminal gets out of prison. There are specialized units within Law Enforcement Agencies which work directly with the community for community engagement and to make sure that everything is ok in peoples minds and at their homes. For example: a Problem Oriented Policing Unit is formed to follow up with victims of domestic violence. They follow up with them to make sure that everything is ok within the household and their life overall. If there is the slightest of problems, then the officers will find different treatment or counseling programs they could attend to put them back on their feet and get them motivated to move past the incident that occurred in the past.

References:

American Psychological Association. (n.d.). Forensic and public service psychology. American Psychological Association.

Bartol, C. R., & Bartol, A. M. (2020). Criminal Behavior: A Psychological Approach (12th ed.). Pearson Education (US)

Rousseau, D. (n.d.). Assessment In Forensic Psychology. Onlinecampus.bu.edu.

Ketamine Infused Therapy for PTSD

Ketamine Infusion Treatment for Post-Traumatic Stress Disorder (PTSD)

Written By Cady Balde

Over the last two decades, the anesthetic drug ketamine has become a popular new treatment approach for mental health disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). Derived from the psychedelic drug phencyclidine, commonly known as PCP or angel dust, ketamine is a dissociative anesthetic. Legally, ketamine is a F.D. Ketamine is an approved anesthetic that is commonly used in emergency rooms; however, when used recreationally, it causes mind-altering effects that are described as a "separation of mind from body even as the mind retained consciousness" (Witt, 2021). With regard to illicit drugs and human subject research, purposefully inducing these hallucinogenic properties has raised controversy within the clinical and psychiatric realms. However, in 2006, the National Institute of Mental Health, along with Yale clinician Dr. Gerard Sanacora, found schizophrenic patients experienced mood improvement after receiving a single intravenous dose of ketamine.

Patients who suffer from major depressive disorder, chronic stress, or PTSD experience synapse loss. Synapses are wire-like signals that regulate our brain's responsibility for behavior, mood, and cognitive function. Neurotransmitters such as cortisol, dopamine, and serotonin are brain chemicals that signal danger in our bodies. However, when an individual experiences a traumatic event, these chemicals become imbalanced due to the brain synapses thinking they are in a constant fight-or-flight situation. Ketamine therapy, administered intravenously, has shown promise in re-growing lost synapses. Chief Psychiatrist at Yale-New Haven Hospital, John Krystal, identified that "within 24 hours of a person’s first dose of medically supervised ketamine, those lost connections start to regrow. The more synapses they grow, the better the antidepressant effects of ketamine are for them" (Collins, 2022). Dr. Krystal did note that ketamine therapy should not be used as a sole treatment plan but should be used in conjunction with anti-depressant medication and cognitive behavioral therapy (CBT).

A possible limitation of ketamine infusion therapy is the increased risk of psychosis due to its hallucinogenic effects and the possibility for individuals to develop drug dependence. However, I found ketamine infusion therapy overall to be an effective new treatment approach for those with medication resistant depression and treatment resistant PTSD.

References

Witt, E. (2021, December 29). Ketamine Therapy Is Going Mainstream. Are We Ready? The New       Yorker. https://www.newyorker.com/culture/annals-of-inquiry/ketamine-therapy-is-going-mainstream-are-we-ready

Collins, S. (2022, May 4). What is Ketamine? How it Works and Helps Severe Depression. WebMD. https://www.webmd.com/depression/features/what-does-ketamine-do-your-brain

Warnings signs for suicide in the workplace

The holiday season can be a time of great joy, social support, gifts, and nostalgic traditions. However, the holidays can also be a challenging time for many people, being reminded of their grief and loss, effects of seasonal depression, and end of the year reflections. Some people might feel extremely joyous and hopeful for the new year, and some might feel great anxiety and hopelessness. 

In this post, I want to share warning signs for suicidality that may show up in the workplace. Employees that are often sad. There may be changes in the appetites, extreme weight gain or weight loss, and they might be more agitated over time. A decrease in productivity could be an indicator of other issues. Some employees may have trouble concentrating, remembering things, and following through on tasks, and this may be a change in their regular work behavior. You might notice employees having a lot less energy, expressing changes in sleep patterns, showing up late, or not keeping up with their appearance in the same way. They may potentially come to work less, calling out sick, or not attending events as they used to. On the more dangerous spectrum, employees may be under the influence of drugs or alcohol at work and they may even just express thoughts or comments about suicide. 

If you are a supervisor or another employee seeing these changes in someone you work with, I would encourage you to approach their behavioral changes with curiosity instead of judgment. An example could be “Hi, I just wanted to check in and see how you’re feeling or if there is any way I can help. I’m noticing that your tasks are being completed late when you used to complete them early.” Also, maintaining confidentiality. If any information is shared, sharing with the proper people in the workplace who can help provide necessary care. It would not help for someone’s mental distress to become workplace gossip. Lastly, reach out to people who can help. Encourage the employee to utilize appropriate hotlines, ask Human Resources for accommodations, or use EAP benefits to get mental health treatment. Don't feel that you have to manage someone’s suicidality alone. 

988 Suicide and Crisis Lifeline

Goel, C. (2022, August 8). Top 7 employee suicidal warning signs . Axiom Medical. Retrieved December 15, 2022, from https://www.axiomllc.com/blog/employee-suicidal-warning-signs/ 

When Routine Workplace Stress Is More Than Routine and More Than Stress – Secondary Trauma, First Responders, and the Case of Jeffrey Reynolds

October 23, 2012 started out like any other day for me at my office in Livingston, Louisiana. I had only been a prosecutor for a little more than two years and was expecting another quiet day in the office. Sometime that afternoon a police officer came by my office to drop off paperwork and informed the receptionist that there was a bad case developing in the City of Walker. The officer informed the receptionist of what he knew about the case and left. A few minutes later, the receptionist came to my office and informed me that a woman had been stabbed by her husband, killing their unborn child. She also informed me that she thinks the woman was a victim on one of my domestic violence cases. I decided that I would walk over to the Detectives Division of the Livingston Parish Sheriff's Office to gather more information. Speaking with one of the detectives, whom I know well, he apprised me of what was going on and we were able to figure out that this case was unrelated to anything my office was currently prosecuting. He also played me the 911 call of this dreadful incident. I will say, at this point, hearing the screams of this woman as she was being attacked by her own husband was traumatic in itself, but hearing the full details of what all transpired has left an indelible mark in my memory and in my career as a prosecutor. Still, what I experienced was nothing compared to what this woman was made to endure and what the first responders witnessed as they came on scene.

On that date 31-year old Jeffrey Reynolds ingested some sort of synthetic marijuana, which he claimed produced a hallucinating effect on him and led him to believe that the fetus inside of his wife Paula, who was 8 months pregnant, was actually a demon (Gaulden, 2015). Reynolds called 911 to tell them that he had ingested synthetic marijuana and that he was afraid that he was about to do something bad and they better send someone to stop him (Gaulden, 2015). While on the phone with 911 and while seeming very calm to the operator, Reynolds proceeded to grab a pairing knife, slash his wife's throat and proceed to attempt to cut the fetus from her womb (Gaulden, 2015). Paula Reynolds can be heard on the 911 call screaming as the attack first takes place and then yelling, "I'm dying! I'm dying!" (Gaulden, 2015). Reynolds can also be heard asking his wife why she is not dead yet. When first responders first arrived and observed the gruesome scene, some immediately apprehended Reynolds, one swaddled the child though it was clearly dead from a knife cut across its head, while others tended to Paula. None of these first responders would ever be the same. Sheriff Jason Ard agreed to have his department pay for counseling for all law enforcement, firemen, coroner's investigators, and medical personnel that were on scene that day.

Though he continues to blame a drug-induced psychosis for his actions that day, Jeffrey Reynolds was charged with and later pled to 15 years for the attempted second degree murder of his wife and 20 years for the first degree feticide of his child "baby Isaac" (Hardy, 2015). There were many who were upset with my office's decision to accept this plea deal. Unbeknownst to the general public and even misunderstood by many of the officers involved with this case, there was a legal technicality that may have resulted in no conviction at all or perhaps a finding of not guilty by reason of insanity. While Louisiana law states that voluntary intoxication is not a defense to any crime, it does vitiate specific intent. Both attempted second degree murder and first degree feticide require prosecutors to prove that the defendant acted with specific intent. Furthermore, a divided sanity commission could not agree whether Jeffrey Reynolds suffered from a drug-induced psychosis, such that he was deprived of the ability to distinguish between right and wrong, and therefore not guilty by reason of insanity. While we had very little doubts that a jury would find him guilty, this plea deal was, in effect, a compromise to avoid lengthy appeals that would not only re-traumatize Paula and her family, but also run the risk of an appellate court overturning the conviction on these legal grounds altogether. Though I was not the prosecutor in charge of this case, all of us in the office agreed with the decision; as did Paula and her parents.

While the criminal case may be over, the trauma inflicted that day has had a ripple effect that continues to this day, not only for Paula, who has since divorced her husband and remarried, though she still bears the scars (physically and emotionally), but also for the first responders who witnessed the horrors of that day. I have a hard time calling the trauma they experienced "vicarious" or "secondary," as if that somehow lessens the reality of what they went through. It is said that vicarious trauma "occurs when someone experiences a crisis secondhand" (Marin, 2021). Quoting Susan Ferrin, founder and executive director of First Responders Resiliency, Inc., Kate Marin (2021) writes in her blog: "'Research indicates that when you're exposed to things that are traumatizing to your brain, your brain spends an enormous amount of energy trying to sort it out, trying to make sense of it, trying to create reasons for this kind of thing.' This process is exhausting, particularly when an individual is emotionally invested in the people and events they work with." This is at the heart of vicarious trauma, particularly with criminal justice professions. While being a first responder is an inherently stressful occupation, including for law enforcement, when these routine work environment stresses are combined with traumatic experiences, the risk of developing PTSD symptoms increases (Maguen et al., 2009). While the first responders who came on that traumatic scene in October 2012 may have learned to deal with their experience and relieve any PTSD symptoms they were suffering, I know personally that they are still trying to understand why this happened emotionally, maybe even spiritually. While I doubt that I have been able to give to them a satisfactory answer, I have never let them doubt my support for them. So, keep the faith brothers and sisters and keep up the good fight. There will be more Paula's out there that will need you to hold their hand in their darkest hour. Just make sure there are people in your life who are there to hold your hand as well.

References:

Gaulden, T. (2015, Sep. 18). 911 call details brutal feticide attack. WBRZ Channel 2 News. https://www.wbrz.com/news/911-call-details-brutal-feticide-attack/

Hardy, S. (2015, Sep. 23). Livingston Parish man pleads no contest in feticide case; cut unborn child from wife's body while high on synthetic marijuana. The Baton Rouge Advocate. https://www.theadvocate.com/baton_rouge/news/communities/livingston-parish-man-pleads-no-contest-in-feticide-case-cut-unborn-child-from-wife-s/article_6352ade9-6f16-593f-9a08-33804bbb31b4.html

Maguen, S., Metzler, T.J., McCaslin, S.E., Inslicht, S.S., Henn-Haase, C., Neylan, T.C., & Marmar, C.R. (2009). Routine work environment stress and PTSD symptoms in police officers. Journal of Nervous and Mental Disease, 197(10), 754-760. doi:10/1097/NMD.0b013e3181b975f8.

Marin, K. (2021, Aug. 20). Vicarious trauma: Understanding traumatic stress in first responders [Blog]. Perimeter Platform. https://perimeterplatform.com/vicarious-trauma-understanding-traumatic-stress-in-first-responders/#:~:text=Experiencing%20vicarious%20trauma%20as%20a%20first%20responder&text=This%20process%20is%20exhausting%2C%20particularly,than%20to%20work%20through%20them.

Practicing Self-Care After Trauma

Trauma can have devastating effects on the body and mind; physically, trauma can cause lethargy, exhaustion, fatigue, and racing heartbeats, among others; emotionally, trauma can cause anxiety, depression, post-traumatic stress disorder, and dissociation, among others. In the aftermath of a traumatic event, one of the most vital things one can do for oneself is practice effective self-care strategies. The traditional forms of care and support for survivors include cognitive behavioral therapy, dialectic behavior therapy, EMDR therapy, and prolonged exposure therapy. In addition to these therapies, self-care strategies that survivors should practice outside of treatment are also essential to aid in the healing process.

Utilizing self-care strategies can help trauma survivors heal in a variety of ways: 

1. Breathing exercises: Several breathing exercises can calm an individual when experiencing a stressful situation or flashbacks. The applications "Calm" and "Headspace" are excellent for beginners interested in using breath work to relieve symptoms.
2. Journaling: Writing down thoughts and feelings is a great way to safely express one's emotions and feelings. Trying to suppress feelings and emotions will ultimately result in an even more intense outburst; regardless of how hard you try, those emotions will eventually surface. Journaling can provide insight into why and how the individual is experiencing the feelings they are experiencing, as well as being a very introspective experience. It's also helpful for assessing situations and coming up with solutions. 
3. Physical self-care: Taking a hot or cold shower, applying a face mask, and exercising are excellent self-care strategies. By taking a hot shower, you can stimulate the release of oxytocin in the brain. In contrast, a cold shower and exercise will produce endorphins responsible for boosting happiness and reducing stress. Cold conditions also stimulate the vagus nerve, which regulates internal functions that promote calmness and clarity by slowing down the sympathetic nervous system and activating the parasympathetic nervous system. 
4. Spirituality: Practicing gratitude, breath work, meditating, yoga, manifesting, and self-reflecting can be powerful tools to foster a new sense of being, leading to a better quality of life. Spirituality has been a vital part of my life for the past few years.
5. Healthy eating habits: Eating unprocessed whole foods is the key to fostering a healthy body and mind. There is a direct link between our gut microbiome and our mental health. Instabilities in our gut flora can lead to various health issues, including brain fog, depression, and anxiety. It is possible to alleviate those symptoms by improving gut health. There should always be a balance; it's essential not to restrict oneself, and occasionally indulging is fine. Maintaining a healthy relationship with food can be difficult, but it is necessary for our mental well-being. 
6. Goal setting: Goal setting and creating a plan for the future is a great way to stay focused and excited about the future. During times of distress, focusing on the positive aspects of life can be difficult. It is helpful to remain present when one is working toward a goal.
7. Music: Music is an essential source of comfort when facing mental challenges. It is an excellent form of self-care and helps to relieve trauma and negative emotions. It's a great way to express feelings and improve your mood and mind. 

We all find it difficult to remember to take care of ourselves. Trauma can exacerbate these difficulties, making it easy to fall into a vicious cycle of self-destruction. In addition to more traditional forms of therapy, these self-care strategies are incredibly beneficial for healing trauma and promoting long-term recovery.

References

Self-care after trauma. RAINN. (n.d.). Retrieved December 12, 2022, from https://www.rainn.org/articles/self-care-after-trauma

Self-care after trauma. RAINN. (n.d.). Retrieved December 12, 2022, from https://www.rainn.org/articles/self-care-after-trauma

Self-care for PTSD. Mind. (n.d.). Retrieved December 12, 2022, from https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress-disorder-ptsd-and-complex-ptsd/self-care/