From Neurons to Thought: Coherent Electrical Patterns Observed Across the Brain

Amidst the background hum of electrical signaling generated by neurons in the brain, scientists have found that local groups of neurons, firing in coordination, sometimes create a signal that is mirrored instantaneously and precisely by other groups of neurons across the brain. These transient episodes of coherence across different parts of the brain may be an electrical signature of thought and actions. MFT CEUs
Background
One of the goals of neuroscience research is to identify how thoughts and actions are encoded in the activity of neurons. A challenge has been to extract meaningful patterns from the ongoing tumult of electrical activity in the brain. This global electrical activity is built from the firing of individual neurons. A single neuron responds to a stimulus in an all or nothing manner—if the stimulus reaches a certain threshold, the neuron “fires” an electrical signal. Groups of neurons firing in a coordinated way create a local electrical field that is in itself a signal that can vary in pattern. These local field potentials (LFPs) have been a target of research.

This Study
In this research, Dietmar Plenz and colleagues at NIMH and Duke University pinpointed LFPs in the cortex that surpassed a minimal size threshold, and then searched the rest of the cortex to see what was occurring at the same time. In each case, they found other answering LFPs across the brain that mimicked each other with high precision: there was no degradation or loss of power (amplitude) in the signal. Unlike what is observed after dropping a stone in a pond—with wavelets getting smaller farther from the stone—the intensity of the LFPs was the same across the brain. The investigators call these LFPs coherence potentials. Although LFPs that occur during these transient episodes of coherence are identical to each other, they are also multidimensional and potentially infinitely diverse, providing a means to encode information. Most LFPs do not reach the threshold that characterizes a coherence potential but with those that do, propagation of the LFPs across the brain is extraordinarily rapid. The authors note that the rapid dispersion of such a signal mimics the spread of ideas and behaviors in social networks; a sufficiently provocative idea can spread very swiftly through a population.

Significance
Coherence potentials simultaneously engage groups of neurons in different parts of the brain with diverse functions. This is consistent with the multi-faceted nature of mental associations and memories—a memory focused on a person or object might conjure various kinds of sensations and thoughts—visual, tactile, auditory, and emotional, for example.

These findings emerged from recent work that demonstrated that, like other systems in nature, the cortex exists at a critical state between stability and instability. A characteristic of this state in the brain is the presence of neuronal avalanches—if a stimulus reaches a certain threshold, it will set off cascades of neuronal firing. This dynamic is analogous to when the slope of a sandpile reaches a point at which adding one more grain will trigger an avalanche. The adherence of the cortex to this critical state ensures that the brain can respond to a wide range of stimuli, but not lapse into a chaos of excess activity (such as the too-synchronous firing during epilepsy). Coherence potentials emerge predominantly when the cortex is critical, that is, when it displays neuronal avalanches. Nudging the cortex away from this point, by inhibiting neuronal signaling with medications for example, disrupts these dynamical patterns.

What’s Next
Coherence potentials were present in cells in culture as well as awake monkeys, a robust demonstration that they occur in the functioning cortex. Future studies will be aimed at monitoring coherence potentials in the context of behavioral function with the ultimate aim of making a connection between specific coherence potentials and behaviors.

Reference
Thiagarajan, T.C., Lebedev, M.A., Nicolelis, M.A., and Plenz, D. Coherence potentials: loss-less, all-or-none network events in the cortex. PLoS Biology 2010, doi:10.1371/journal.pbio.1000278.

Substance Abuse and Inhalants CEUs

The percentage of adolescents (i.e., youths aged 12 to 17) who used inhalants in the past year was lower in 2007 (3.9 percent) than in 2003, 2004, and 2005 (4.5, 4.6, and 4.5 percent, respectively)

Among adolescents who used inhalants for the first time in the past year (i.e., past year initiates), the rate of use of nitrous oxide or "whippits" declined between 2002 and 2007 among both genders (males: 40.2 to 20.2 percent; females: 22.3 to 12.2 percent)

In 2007, 17.2 percent of adolescents who initiated illicit drug use during the past year indicated that inhalants were the first drug that they used; this rate remained relatively stable between 2002 and 2007

Adolescents have easy access to some dangerous substances—ordinary household products such as glue, shoe polish, and aerosol sprays. These products are safe when used as intended, but they can be dangerous and even deadly when sniffed or "huffed" to get high. Preventing and treating inhalant use problems, as well as raising awareness about the dangers of inhalant use, are important ongoing goals of the Substance Abuse and Mental Health Services Administration (SAMHSA). Monitoring trends in inhalant use is vital to assessing policies intended to reduce inhalant use.
This issue of The NSDUH Report examines trends in the use, dependence or abuse,1 and initiation of inhalants among adolescents (i.e., youths aged 12 to 17). The National Survey on Drug Use and Health (NSDUH) defines inhalants as "liquids, sprays, and gases that people sniff or inhale to get high or to make them feel good." NSDUH collects data not only about the use of any inhalant, but also about the use of specific types of inhalants. Respondents who used inhalants were asked when they first used them, and responses to this question were used to identify persons who had initiated use in the 12 months before the survey. This report uses data from the 2002 through 2007 NSDUHs.

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Use and Dependence or Abuse
--------------------------------------------------------------------------------

In 2007, almost 1.0 million adolescents used inhalants in the past year; this represents 3.9 percent of adolescents, which was lower than the rate in 2003, 2004, and 2005 (4.5, 4.6, and 4.5 percent, respectively) (Figure 1). Past year dependence on or abuse of inhalants remained relatively stable between 2002 and 2007, with 0.4 percent of adolescents (around 99,000 persons) meeting the criteria for dependence or abuse in 2007.

Figure 1. Trends in Past Year Inhalant Use and Dependence or Abuse among Adolescents: 2002 to 2007



Figure 1 Table. Trends in Past Year Inhalant Use and Dependence or Abuse among Adolescents: 2002 to 2007 Trend 2002 2003 2004 2005 2006 2007
Past Year Use 4.4% 4.5%* 4.6%* 4.5%* 4.4% 3.9%
Past Year Dependence or Abuse 0.4% 0.4% 0.5% 0.4% 0.4% 0.4%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).



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Past Year Initiation of Inhalant Use
--------------------------------------------------------------------------------

In 2007, 2.1 percent of adolescents who had not previously used inhalants began using them during the 12 months prior to the survey (Figure 2). This rate was lower than the rates of initiation for 2002, 2003, 2004, and 2005.

Figure 2. Trends in Past Year Initiation of Inhalants among Adolescents Who Had Not Previously Used Inhalants: 2002 to 2007**



Figure 2 Table. Trends in Past Year Initiation of Inhalants among Adolescents Who Had Not Previously Used Inhalants: 2002 to 2007** Trend 2002 2003 2004 2005 2006 2007
Past Year Initiation of Inhalants 2.6%* 2.6%* 2.6%* 2.6%* 2.4% 2.1%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).



NSDUH also provides data on the first illicit drug initiated among past year initiates.2 In 2007, 17.2 percent of past year illicit drug initiates indicated that inhalants were the first drug that they used (Table 1). Marijuana was the first drug used by 56.3 percent of past year illicit drug initiates; nonmedically used prescription-type drugs were the first type of drug used by 23.5 percent of past year illicit drug initiates. These rates remained relatively stable between 2002 and 2007.

Table 1. Trends for First Drug Initiated in the Past Year among Adolescents Who Initiated Illicit Drug Use in the Past Year: 2002 to 2007** First Drug Initiated*** 2002
(%) 2003
(%) 2004
(%) 2005
(%) 2006
(%) 2007
(%)
Marijuana and Hashish 59.9% 57.6% 57.3% 55.0% 57.1% 56.3%
Nonmedical Use of Prescription-Type Drugs 22.2% 20.4% 21.3% 22.0% 22.0% 23.5%
Inhalants 14.5% 19.4% 19.2% 19.6% 17.4% 17.2%
Hallucinogens 2.9% 2.3% 2.1% 2.5% 3.0% 2.3%
Cocaine 0.7% 0.4% 0.5% 1.0% 0.9% 0.8%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).


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Use of Specific Inhalants among Past Year Inhalant Initiates
--------------------------------------------------------------------------------

Among past year inhalant initiates, the percentage using most specific types of inhalants in 2007 did not differ significantly from the percentage in 2002 (Table 2); however, there were a few exceptions. Among past year inhalant initiates, use of nitrous oxide or "whippits" was lower in 2007 than in 2002 (16.3 vs. 31.6 percent), and use of aerosol spray other than spray paint3 was higher in 2007 than 2002 (25.0 vs. 12.6 percent).

Table 2. Trends in Past Year Use of Specific Types of Inhalants among Past Year Inhalant Initiates Aged 12 to 17: 2002 to 2007** Type of Inhalant 2002
(%) 2003
(%) 2004
(%) 2005
(%) 2006
(%) 2007
(%)
Amyl Nitrite, "Poppers," Locker Room Odorizers,
or "Rush" 14.0% 17.0% 12.6% 16.4% 16.5% 19.3%
Correction Fluid, Degreaser, or Cleaning Fluid 15.7% 19.7% 19.6% 19.6% 22.5% 19.3%
Gasoline or Lighter Fluid 26.2% 23.2% 25.3% 26.7% 27.0% 28.1%
Glue, Shoe Polish, or Toluene 32.9% 30.2% 27.6% 31.3% 25.6% 28.8%
Halothane, Ether, or Other Anesthetics 2.9% 2.9% 4.5% 3.4% 4.5% 5.7%
Lacquer Thinner or Other Paint Solvents 13.9% 10.7% 10.8% 13.3% 14.2% 12.8%
Lighter Gases, Such as Butane or Propane 9.3% 9.7% 9.2% 8.1% 7.1% 9.9%
Nitrous Oxide or "Whippits" 31.6% 23.0% 20.1% 21.3% 17.7% 16.3%
Spray Paints 21.4% 23.3% 25.4% 23.9% 28.1% 25.1%
Aerosol Sprays Other than Spray Paints+ 12.6% 17.6% 23.6% 25.4% 23.5% 25.0%
Source: 2002 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).


--------------------------------------------------------------------------------
Discussion
--------------------------------------------------------------------------------

Although the rates of inhalant use and inhalant initiation appeared to be on a downward trend, particularly since 2005, the rates of dependence on or abuse of these substances remained stable between 2002 and 2007. Rates of use of specific types of inhalants among past year initiates generally did not differ significantly from 2002 to 2007, although a few types showed significant changes. Use of nitrous oxide or "whippits" decreased by half, and use of aerosol sprays other than spray paints doubled. Over the period from 2002 to 2007, 15 to 20 percent of past year illicit drug initiates indicated that inhalants were the first illicit drug they had used.

These findings highlight the ongoing need for prevention and treatment of inhalant use and abuse. Continuing efforts are needed among adolescents and their parents, other family members, teachers, service providers, and policymakers to increase awareness of the dangers of inhalant use. Awareness campaigns and prevention efforts may need targeted messages about the use of specific inhalants, such as aerosol air fresheners, aerosol sprays, and aerosol cleaning products.



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End Notes
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1 Substance dependence or abuse is defined using criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which includes symptoms such as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.
2 Illicit drugs refer to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.
3 Aerosol sprays other than spray paint include products such as aerosol air fresheners, aerosol spray, and aerosol cleaning products (e.g., dusting sprays, furniture polish). The aerosol propellants in these products are commonly chlorofluorocarbons. By contrast, nitrous oxide is used as a propellant for whipped cream and is available in 2-inch tapered cylinders called "whippits" that are used to pressurize home whipped-cream charging bottles.


--------------------------------------------------------------------------------
Figure and Table Notes
--------------------------------------------------------------------------------
* Difference between this estimate and 2007 estimate is statistically significant at the .05 level.
** Past year initiates are defined as adolescents who used a drug for the first time during the 12 months prior to the survey.
*** First drug initiated is based on the date of the first use for each drug, with imputation for the day of the month and for the month of the year, if not reported. Respondents may be counted in more than one drug category if they reported initiating multiple drugs on the same day the first time that they used drugs.
+ See End Note 3.


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Suggested Citation
--------------------------------------------------------------------------------
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (March 16, 2009). The NSDUH Report: Trends in Adolescent Inhalant Use: 2002 to 2007. Rockville, MD.

The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2002 to 2007 data used in this report are based on information obtained from 136,449 persons aged 12 to 17. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.

The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)

Information on the most recent NSDUH is available in the following publication:

Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration. Also available online: http://oas.samhsa.gov.

Marijuana Treatment Project

The Center for Substance Abuse Treatment (CSAT), part of the Substance Abuse and Mental Health Services Administration, funded three clinical sites and a Coordinating Center (CC) to design and implement the Marijuana Treatment Project (MTP) in the late 1990s. A major focus of CSAT is rigorous testing of approaches to treat marijuana dependence in both adults and adolescents. MTP studied the efficacy of treatments for adults who are dependent on marijuana. At the time of funding, MTP was one of the largest Knowledge Development and Applications initiatives funded by CSAT. Another was the Cannabis Youth Treatment (CYT) Study, which resulted
in the CYT Series, a five-volume resource that provides unique perspectives on treating adolescents for marijuana use (Godley et al. 2001; Hamilton et al. 2001; Liddle 2002; Sampl and Kadden 2001; Webb et al. 2002). This manual for Brief Marijuana Dependence Counseling (BMDC) is based on the research
protocol used by counselors in MTP. The manual provides guidelines for counselors, social workers, and psychologists in both public and private settings who treat adults dependent on marijuana.

The 10 weekly one-on-one sessions in the BMDC manual offer examples of how a counselor can help a client understand certain topics, keep his or her determination to change, learn new skills, and access needed community supports (exhibit I-1). Stephens and colleagues (2002) describe the MTP rationale, design, and participant characteristics. Findings from MTP are presented in supplemental reading B of section VII.

Me? Hooked on Pot?
Many individuals for whom this intervention was designed often have difficulty accepting that they are dependent on marijuana. The topic is controversial, even for those who walk through a counselor’s door to talk about their marijuana use.
People who become clients in BMDC may have
• Put off actions and decisions to the point of being a burden on family and friends
• Given up personal aspirations
• Had nagging health concerns, such as worries about lung damage
• Made excuses for unfinished tasks or broken promises
• Experienced disapproval from family and friends
• Been involved in the criminal justice system.

Current Findings About Marijuana Use
Marijuana is the most commonly used illicit substance in the United States (Clark et al. 2002; Substance Abuse and Mental Health Services Administration 2003). According to the 2003 National Survey on Drug Use and Health, 14.6 million people ages 12 and older had smoked marijuana in the preceding month (Substance Abuse and Mental Health Services Administration 2004). It is estimated that approximately 4.3 million people used marijuana at levels consistent with abuse or dependence in the past year. Given that it is an illicit substance, any use of marijuana carries with it some significant risks. However, this document focuses on people who use marijuana heavily or are dependent on it. This treatment manual is directed primarily at these
persons but may be useful for other persons with substance abuse or substance use disorders. Studies have demonstrated that tolerance and withdrawal develop with daily use of large doses of marijuana or THC (Haney et al. 1999a; Jones and Benowitz 1976; Kouri and Pope 2000). About 15 percent of people who acknowledge moderate-to-heavy use reported a withdrawal syndrome with symptoms of nervousness, sleep disturbance, and appetite change (Wiesbeck et al. 1996). Many adults who are marijuana dependent report affective (i.e., mood) symptoms and craving
during periods of abstinence when they present for treatment (Budney et al. 1999). The contribution of physical dependence to chronic marijuana use is not yet clear, but the existence of a dependence syndrome is fairly certain. An Epidemiological Catchment Area study conducted in Baltimore found that 6 percent of people who used marijuana met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), criteria for dependence and 7 percent met DSM-IV criteria for substance abuse (Rosenberg and Anthony 2001). Coffey and colleagues (2002) found that persons who use marijuana more than
once a week are at significant risk for dependence. In the 1990s, the number of people who sought treatment for marijuana dependence more than doubled (Budney et al. 2001). Therefore, a large group of adults who smoke marijuana is dependent and may need and benefit from treatment. Surveys of people using marijuana who are not in treatment consistently show that a majority report impairment of memory, concentration, motivation, self-esteem, interpersonal relationships,
health, employment, or finances related to their heavy marijuana use (Haas and Hendin 1987;

Section I. Introduction
Rainone et al. 1987; Roffman and Barnhart 1987; Solowij 1998). Similar marijuana-related consequences are seen among those seeking treatment for their marijuana use (Budney et al. 1998; Stephens et al. 1994b, 2000). People using marijuana who participated in previous treatment studies averaged more than 10 years of near-daily use and more than six serious attempts to quit (Stephens et al. 1994b, 2000). These individuals had persisted in their use despite multiple forms of impairment (i.e., social, psychological, physical), and most perceived themselves as unable to stop.
During the past decade evidence has emerged that a variety of problems are associated with chronic marijuana use. Although the severity of these problems appears to be less than that of problems caused by other drugs and alcohol, the large number of people using who may have these problems raises the possibility of a significant public health problem. Like those who use other mood-altering substances, many individuals who use marijuana chronically perceive the
problems to be severe enough to warrant treatment. The results of earlier studies on treatments for marijuana problems indicated that some adults
who used marijuana responded well to several types of interventions, such as cognitive behavioral, motivational enhancement, and voucher-based treatments (Budney et al. 2000; Stephens et al. 1994b, 2000). Relapse rates following treatment were similar to those for other drugs of abuse and, as found with other types of substance abuse treatment, improvements in drug use were accompanied by other positive gains, including improvements in dependence symptoms, problems
related to marijuana use, and anxiety symptoms. However, the generalizability of the treatment findings appeared to be limited by the predominantly white, male, and socioeconomically stable (i.e., educated and employed) characteristics of the samples. Therefore, the results of these studies may be limited to this fairly homogeneous group of people who are marijuana users.

Overview of the Marijuana Treatment Project1
CSAT funded MTP to design and conduct a study of the efficacy of treatments for marijuana
dependence, to extend this line of research, and to broaden the applicability of the approach to a
more diverse group than that used in earlier trials (Stephens et al. 1994b, 2000). The treatment
sites were the University of Connecticut School of Medicine, Department of Psychiatry,
Farmington, Connecticut; The Village South, Miami, Florida; and the University of Washington,
School of Social Work, Seattle, Washington. The CC was at the University of Connecticut,
Department of Psychiatry.
The study examined the efficacy of treatments of different durations for a diverse group of adults who
were marijuana dependent. Two treatments—one lasting two sessions, the other nine sessions—
were compared with a delayed treatment control (DTC) condition, in which subjects were offered
treatment 4 months after their baseline assessment. The same counselors delivered treatments of
both durations to avoid confounding the mode of treatment, length of treatment, and counselor
experience. A case management component was incorporated in the longer treatment to help clients
identify and overcome barriers to successful behavior change in their everyday environments. The
hypothesis was the nine-session and two-session interventions would produce outcomes superior to
the DTC in terms of higher abstinence rates and associated negative consequences.

Developing A Recovery And Wellness Lifestyle, A Self-Help Guide: Sleep

Developing A Recovery And Wellness Lifestyle
A Self-Help Guide
Sleep
You will feel better if you sleep well. Your body needs time every day to rest and heal. If you often have trouble sleeping–either falling asleep, or waking during the night and being unable to get back to sleep–one or several of the following ideas might be helpful to you —

Go to bed at the same time every night and get up at the same time every morning. Avoid "sleeping in" (sleeping much later than your usual time for getting up). It will make you feel worse.

Establish a bedtime "ritual" by doing the same things every night for an hour or two before bedtime so your body knows when it is time to go to sleep.

Avoid caffeine, nicotine, and alcohol.

Eat on a regular schedule and avoid a heavy meal prior to going to bed. Don't skip any meals.

Eat plenty of dairy foods and dark green leafy vegetables.

Exercise daily, but avoid strenuous or invigorating activity before going to bed.

Play soothing music on a tape or CD that shuts off automatically after you are in bed.

Try a turkey sandwich and a glass of milk before bedtime to make you feel drowsy.

Try having a small snack before you go to bed, something like a piece of fruit and a piece of cheese or some cottage cheese so you don't wake up hungry in the middle of the night. Have a similar small snack if you awaken in the middle of the night.

Take a warm bath or shower before going to bed.

Place a drop of lavender oil on your pillow.

Drink a cup of herbal chamomile tea or take several chamomile capsules before going to bed.
You need to see your doctor if —

you often have difficulty sleeping and the solutions listed above are not working for you.

you awaken during the night gasping for breath

your partner reports that your breathing is interrupted when you are sleeping

you snore loudly

you wake up feeling like you haven't been asleep

you fall asleep often during the day
Do you have a hard time getting to sleep or staying asleep?

If so, what are you going to do to help yourself get a good night's sleep?

Autism

What is autism?

Autism, also called autistic disorder, appears in early childhood, usually before age 3 (National Institutes of Health, 2001). Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development.

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What are the signs of autism?

Autism has a wide variety of characteristics ranging in intensity from mild to severe. One child with autism does not behave like another child with the same diagnosis. Children and adolescents with autism typically:


Have difficulty communicating with others.
Exhibit repetitious behaviors, such as rocking back and forth, head banging, or touching or twirling objects.
Have a limited range of interests and activities.
May become upset by a small change in their environment or daily routine.
In addition to these characteristics, some children with autism experience hypersensitivity to hearing, touch, smell, or taste. Symptoms of autism can be seen in early infancy, but the condition also may appear after months of normal development. In most cases, however, it is not possible to identify a specific event that triggers the disorder.

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How common is autism?

Studies estimate that as many as 12 in every 10,000 children have autism or a related condition (U.S. Department of Health and Human Services, 1999). Autism is three times more common in boys than in girls (National Institutes of Health, 2001).

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What causes autism?

Researchers are unsure about what causes autism. Several studies suggest that autism might be caused by a combination of biological or environmental factors, or both, including viral exposure before birth, a problem with the immune system, or genetics. Many recently published scientific investigations have examined the possible connection between autism and the measles, mumps, and rubella (MMR) vaccine. At this time, though, the available data do not appear to support a causal link.

Studies of families and twins suggest a genetic basis for the disorder. It is important for scientists to find the genes responsible for autism, if any, because this knowledge would give physicians new tools to diagnose the disorder and help scientists develop gene-based therapies.

Some studies have found that the brains of people with autism may function differently from those that are considered "normal." Research suggests that an abnormal slowing down of brain development before birth may cause autism. Studies also are looking at how autism-related problems in brain development may affect behavior later in childhood. For example, some researchers are investigating the ways in which infants with autism process information and how the disorder may lead to poor development of social skills, knowledge, and awareness.

Chemicals in the brain also may play a role in autism. As a normal brain develops, the level of serotonin, a chemical found in the brain, declines. In some children with autism, however, serotonin levels do not decline. Researchers are investigating whether this happens only to children with autism or whether other factors are involved.

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What help is available for families?

Since brain development can be influenced during early childhood, the treatment of autism has a greater chance of success when initiated as early as possible. In addition, when children with autism are treated early, the cost of long-term care may be reduced. Services and treatments that may benefit children and adolescents with autism and their families include:


Training in communication, social, learning, and self-help skills.
Programs in which other children help to teach children with autism.
Parent training.
Medications to reduce symptoms related to self-injury, seizures, digestive difficulties, and attention problems.
When services are started soon after a child is diagnosed with autism, the child's language, social, and academic skills and abilities may be greatly improved. On the other hand, some children and adolescents do not respond well to treatment or may experience negative side effects from autism medications. Recent data suggest that some of the newer antipsychotic drugs may have fewer side effects than conventional drugs, but more studies are needed before experts can determine any possible safety advantages over traditional treatments.

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What can parents do?

Parents or other caregivers concerned about a child who shows symptoms of autism should:


Talk with a health care provider about their concerns. He or she can help to determine whether the symptoms are caused by autism, a related disorder, or another condition. If necessary, the health care provider can refer the family to a mental health expert who specializes in treating persons with autism.
Get accurate information from libraries, hotlines, or other sources.
Ask questions about treatments and services.
Talk to other families in their communities who are coping with autism.
Find family network organizations.
People who are not satisfied with the mental health care they receive should discuss their concerns with the provider, ask for information, and/or seek help from other sources.

This is one of many fact sheets in a series on children's mental health disorders. All the fact sheets listed below are written in an easy-to-read style. Families, caretakers, and media professionals may find them helpful when researching particular mental health disorders. To obtain free copies, call 1-800-789-2647 or visit http://mentalhealth.samhsa.gov/child.

Mental Health Stigma

Anti-Stigma: Do You Know the Facts?
Stigma is not just a matter of using the wrong word or action. Stigma is about disrespect. It is the use of negative labels to identify a person living with mental illness. Stigma is a barrier. Fear of stigma, and the resulting discrimination, discourages individuals and their families from getting the help they need. An estimated 22 to 23 percent of the U.S. population experience a mental disorder in any given year, but almost half of these individuals do not seek treatment (U.S. Department of Health and Human Services, 2002; U.S. Surgeon General, 2001).

The educational information on this web site encourages the use of positive images to refer to people with mental illness and underscores the reality that mental illness can be successfully treated.

Do you know that an estimated 44 million Americans experience a mental disorder in any given year?

Do you know that stigma is not a matter of using the wrong word or action?

Do you know that stigma is about disrespect and using negative labels to identify a person living with mental illness?

Do you know that stigma is a barrier that discourages individuals and their families from seeking help?

Do you know that many people would rather tell employers they committed a petty crime and served time in jail, than admit to being in a psychiatric hospital?

Do you know that stigma can result in inadequate insurance coverage for mental health services?

Do you know that stigma leads to fear, mistrust, and violence against people living with mental illness and their families?

Do you know that stigma can cause families and friends to turn their backs on people with mental illness?

Do you know that stigma can prevent people from getting access to needed mental health services?

DO'S

Do use respectful language

Do emphasize abilities, not limitations.

Do tell someone if they express a stigmatizing attitude.

DONT'S

Don't portray successful persons with disabilities as super human.

Don't use generic labels such as retarded, or the mentally ill.

Don't use terms like crazy, lunatic, manic depressive, or slow functioning.

Disaster Crisis Counseling Program

Crisis Counseling Programs for the Rural Community
Disaster Crisis Counseling Program
The Nature of Disasters
Definition of a Federal Disaster Declaration

The Federal Emergency Management Agency (FEMA) provides supplemental funding to States for short-term crisis counseling projects to assist survivors/victims of Presidentially declared major disasters. FEMA supplements, but does not supplant, mental health services traditionally provided by State and local mental health agencies. The Crisis Counseling Assistance and Training Program (commonly referred to as the Crisis Counseling Program) was first authorized by the U.S. Congress under the Disaster Relief Act of 1974 (Public Law 93-288) and later modified by the Robert T. Stafford Disaster Relief and Emergency Assistance Act of 1988 (Public Law 100-707). FEMA is responsible for administering the disaster assistance programs of the Stafford Act, including Federal assistance for crisis counseling services.

A major disaster, as defined by the Stafford Act, is any natural catastrophe, or regardless of cause, any fire, flood, or explosion, which in the determination of the President causes damage of sufficient severity and magnitude to warrant major disaster assistance to supplement efforts and available resources of States, local government, and disaster relief organizations in alleviating the damage, loss, hardship, or suffering caused by the disaster.

Disaster Types

Different types of disasters covered by the Stafford Act that may impact rural areas include: hurricane, tornado, storm, high water, wind driven water, tidal wave, tsunami, earthquake, volcanic eruption, landslide, mudslide, snowstorm, drought, fire, flood, or explosion. Disasters also differ by a number of characteristics including the following:

Origin of disaster (natural versus human-caused)


Length of warning time

Intensity of the event

Extent of property damage

Number of persons impacted

Number of injuries and deaths

Dynamics of the recovery period
Each type of disaster has its own unique pattern of destruction and characteristics that affect the emotional response of disaster victims (NIMH, 1983):

Flood disasters can result in long incident periods and the evacuation of whole communities.

Earthquakes strike without warning and after shocks intensify fright and despair.

Tornadoes randomly choose their victims, skipping one house and striking the next.

Hurricanes can be unpredictable and suddenly change course causing the evacuation of large areas.
Disasters may be classified as either natural or human-caused. The following chart describes the different characteristics of natural and human-caused disasters. Blame is a characteristic that differs significantly for natural and human-caused disasters. Disaster survivors of human-caused disasters may blame and feel anger toward individuals, groups, or organizations they believe caused or contributed to the disaster. In contrast, survivors of natural disasters may blame and feel anger toward themselves, believe it is "God's Will" or a punishment. Survivors of natural disasters may project their anger onto caretakers, disaster workers, or others (CMHS, 1996).


Natural vs. Human-Caused Disasters

Natural Human-Caused
Causes Forces of nature Human error, malfunctioning
Examples Earthquakes, hurricanes, floods Airplane crashes, major chemical leaks, nuclear reactor accidents
Blame No one Person, government, business
Scope Various locations Locations may be inaccessible to rescuers, unfamiliar to survivors, little advance warning
Post-disaster
Distress High Higher, often felt by family members not involved in actual disaster

Source: CMHS. Psychosocial Issues for Children and Families in Disasters. A Guide for the Primary Care Physician. Washington, D.C.: U.S. Department of Health and Human Services; Publication No. (SMA) 96-3077, 1996.


Definition of Crisis Counseling Services
The Crisis Counseling Program, as it has been supported in the past twenty-five years by the Federal government, provides for short-term interventions with individuals and groups experiencing psychological sequelae from Presidentially-declared disasters. This type of intervention involves classic counseling goals of helping people to understand their current situation and reactions, assisting in the review of their options, providing emotional support, and encouraging linkage with other resources and agencies who may assist the individual. The assistance is focused upon helping the person deal with the current situation in which they may find themselves.

It draws upon the assumption, until there are contradictory indications, that the individual can resume a productive and fulfilling life following the disaster experience if given support, assistance, and information at a time and in a manner appropriate to his or her experience, education, developmental stage, and ethnicity (CMHS, 1994.

The Emergency Services and Disaster Relief Branch (ESDRB) of the Center for Mental Health Services (CMHS) will provide technical assistance to states in developing a grant request.
The ESDRB can be reached by phone at (301) 443-4735.
The Crisis Counseling Program is unique in comparison to the mix of Federal programs made available through a Presidential disaster declaration. It is the one program for which virtually anyone qualifies and where the person affected by disaster does not have to recall numbers, estimate damages, or otherwise justify need. The program provides primary assistance in dealing with the emotional sequelae to disaster.

Robert T. Stafford Act

The Stafford Act authorizes the President to provide training and services to alleviate mental health problems caused or aggravated by declared disasters. The Crisis Counseling Program is designed to provide supplemental funding to States for short-term crisis counseling services and is implemented when creating such services are beyond the resources of the State or local providers, given a Presidential disaster declaration.

FEMA may fund two separate portions of the Crisis Counseling Program: Immediate Services (IS) and Regular Services (RS). The IS grant enables the State and its local agency to respond to the immediate mental health needs with crisis counseling services. IS can be funded for up to sixty days after the Presidential declaration. If an RS application has been submitted, the program period for the immediate services may be extended thirty days and additional funding may be awarded. FEMA may approve a longer extension, if the review process of the regular program application exceeds thirty days. Costs incurred from the date of the incident to the date of declaration may be reimbursable under the immediate services program. The RS provides up to nine months of crisis counseling services, community outreach, and consultation and education services to people affected by the disaster. Funding for RS is separate from IS. The State may apply for either or both portions of the Crisis Counseling Program.

Application for IS funding must be completed within fourteen days of the disaster declaration. The application must contain a disaster description, needs assessment, program plan, budget, and budget narrative. The needs assessment is based on the needs of the affected communities and the ability of the current mental health system to respond to those needs. A State must demonstrate that State and local resources are insufficient to provide adequate services.

Differences Between Disaster Mental Health and Traditional Mental Health Programs

Disaster Crisis Counseling Programs are a departure from traditional mental health practice in many ways. The program is designed to address incident specific stress reactions, rather than ongoing or developmental mental health needs (CMHS, 1994). Programs must be structured and implemented according to Federally established guidelines and for a specific period. Emphasis is on serving individuals, families, and groups of people - all of whom share a devastating event that most likely changed the face of their entire community.

CRISIS COUNSELING PROGRAM
Immediate Services
Application due in fourteen days
Sixty-day program
Extension if RS is applied for
Regular Services
Apply within sixty days of declaration
Nine month program
Applications must include
Disaster description
Needs Assessment
Program Plan
Budget
Budget narrative
for more information click below
crisis counseling ceus

Outreach and crisis counseling activities are the core of the Crisis Counseling Program and create a unique set of challenges. Disaster crisis counseling requires breaking out of traditional ways of identifying people in need of services, providing access to those services, maintaining documentation, and determining effectiveness. Mental health professionals will work hand-in-hand with paraprofessionals, volunteers, community leaders, and survivors/victims of the disaster in ways that may be foreign to their clinical training. This publication will focus on the implementation of appropriate crisis counseling services for rural communities across the United States.

mft ceu online

mft ceu online

The Board of Behavioral Sciences for California has determined that all ceus may be earned by homestudy.

What is the difference between an Online Interactive CE Course and a Homestudy Course?
If you submit a completed course/exam to the CE provider via regular mail, then you have taken a homestudy course. If the course/exam is completed and submitted online, then the hours are approved as regular continuing education. Many state boards, such as the California Board of Behavioral Services, allow all required continuing education to be earned from online interactive continuing education courses. Check with your respective board to determine the amount of hours/units are permitted online.

mft ceu california

mft ceu california

online ceus for mfts in california

The following is public information quoted from the BBS Website:

MFT and LCSW CE Requirements
MFTs and LCSWs must complete 36 hours of continuing education within the preceding two years of their license renewal date. Licensees renewing for the first time only need to complete a minimum of 18 hours of continuing education by the expiration date of the license. The Continuing Education and License Renewal Information Brochure is a helpful publication for keeping licensees informed of new continuing education requirements.

Continuing education must be taken from current Board approved providers.

Mandatory Coursework
MFTs and LCSWs are required to complete 6 hours of Law and Ethics training with every renewal. All other mandatory courses are one-time requirements. Please refer to the CE Chart for more information.

Auditing Information
If you are a licensee, you certify completion of continuing education on your renewal application. Random CE audits ensure compliance. If audited, you will receive a letter from the Board requesting copies of your continuing education certificates or course documentation as proof of compliance. Failure to comply with the Board’s audit may result in enforcement action.

Keep proof of completed coursework for at least four years.

Exceptions from the CE Requirements
A Request for Continuing Education Exception must be submitted to the Board at least 60 days prior to license expiration.The Board will notifies you within 30 working days after receipt of the request for exception’s status. If the request for exception is denied, you are responsible for completing the full amount of continuing education required for license renewal. The Board shall grant the exception if provided evidence, satisfactory to the Board, that:

For at least one year during the licensee’s previous license renewal period the licensee was absent from California due to military service.
For at least one year during the licensee’s previous license renewal period the licensee resided in another country; or
During the licensee’s previous renewal period, the licensee or an immediate family member where the licensee has primary responsibility for the care of that family member was suffering from or suffered a disability. A disability is a physical or mental impairment that substantially limits one or more of the major life activities of an individual. Verification of the disability must include all of the following:
1.The nature and extent of the disability
2.An explanation of how the disability would hinder the licensee from completing the continuing education requirement.
3.The name, title, address, telephone number, professional license or certification number, and original signature of the licensed physician or psychologist verifying the disability
4.If the request for exception is approved, it shall be valid for one renewal period.
For more information on exceptions to the continuing education, please call (916) 574-7866.