diversity talk final version

7/28/2019 Diversity Talk Final Version

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This is the final version

It will be posted on circlestretch.com


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Society Needs Diversity:Innovation, Globalization, Public Policy,

and Finding a Niche for Everyone

ICDL Annual ConferenceMontclaire, NJ

Saturday, November 17th, 2012

Josh Feder, MD


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Director of Research, Graduate School,

Interdisciplinary Council on Developmental and

Learning Disorders

Assistant Clinical Professor, Voluntary

Dept of Psychiatry, University of California at San

Diego School of Medicine

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Because our job is to take it apart and look at it

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Outline: From hate to healing

Zeitgeist: Middle Earth

Hate gets Personal

Clinical Case - acclimate or accommodate?

Diversity is central to Innovation

Diversity in Healthy International Relations

Diverse Expertise: The Wisdom of Crowds

Neurodiversity as Human Necessity

Applications: Practical Diversity Accommodations,Evidence Based Practice, and World Peace

Denouement: The Fault in Our Stars


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Zeitgeist: Middle Earth

Its a wonderful world

But the problems are real: war, eco-loss, etc.

What can we do to help?

Be honest, make no assumptions, dont takethings personally, and try our best*

To start, we need to understand the development

of hate and empathy

*The Four Agreements - Don Miguel Ruiz


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Caution:

Some of this material is upsetting

Recent events, including

the hurricane and the events in the middle east, have shifted my tone.

The issues are more immediate and dire.

My hope is that, as we do in difficult times,

we can manage the pain and move forward through:

Use of a symbolic framework (Tolkein did this)

Understanding empathy and diversity

Practical ideas for addressing our challenges


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Recent travel pictures, theme music, etc.

pretty much skipping them


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missile command November 2012


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1978: obsessive,failing symbolic

(no respawning you always, eventually lose)


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Hate Gets Personal, So Does Empathy

The wrong trope

Baron-Cohen: empathy is inside the group

Gordis: the development of empathy requirespersonal experience

Greenspan: empathy develops in the context

of a flow of interaction between caregiver and

child, reading and responding to each others

cues over time


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Tronick: messy interactions

from infancy there is a natural, messy process of break andrepair [of engagement]

founded on the real differences in perspective betweeninfant and parent

there is a break, and then there is repair, over and over

this is necessary for emergence of a sense of self and forresilience

confidence in ones own competence to repair the breaks inengagement (Georgias case showed this with an adult

yesterday) Differences are necessary for development

Clinical work: in the course of life differences also causepain


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Diversity in stark relief

Clinical Case: Lupus

Depression, not exactly

Chronically suicidal

Medical diagnosis, and exacerbated disability

The Dilemma of Belonging: Accommodate or Acclimate(life onlyon lifes terms)?

Finding kinsmen and perhaps a way forward

Sharing an entirely different experience of the world,with so much to offer

As it turns out, we need these different points of viewto meet to challenges of society and technology


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COLUMBIAs WING

Di it f Thi ki i C t l t


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Diversity of Thinking is Central to

Innovation, Problem Solving, and

Critical Decision Making

We need these different points of view in solving the problems oftechnology and society

The Challenger and Columbia Disasters: NASA Culture, Groupthink,The culture of power point

Lesson: We need local information, uncensored

Steve Jobs at Apple: was he one driving force, or were there manypeople driving forward and convincing Jobs until he took things onas his own ideas

Start Up Nation: Dan Senor - when people pipe up, everything ispossible

We must seek all voices to support critical decision making andinnovation

This is also true in international relations


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Gordis: Diversity is a part of

healthy international relations

Imperialism, war, hatred: all suppress freedom

Universalism (e.g. The European Union) is not

necessarily an ideal solution: threatens to suppresscreativity, erases the unique cultural identity of anation. (Note loss of 4000/ 10000 languages overthe past century, and loss of another 1000 expectedin the next century)

Respect for Cultural Diversity and Nationalism donot equal Imperialism: liberal democracies do notgo to war against each other.


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Think DIR

We support the emergence and elaboration of theideas to help another build social-emotional

capacities and problem solvingTolerance, diversity, and freedom are the minimalelements needed for countries to exist in a diverseinternational community.

Human communities need diversity moreover,independent thinking is built into communalproblem solving.


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Universalism at work.


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Communal Problem Solving:

Guess my weight and take me home!

Diverse Expertise:


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Diverse Expertise:

The Wisdom of Crowds- Surowiecki

Many people together can create a

powerful form ofartificial-artificial

intelligence

Requires independence of thought and

diversity of people

(many people are better than one expert

opinion)


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Problems solved by groups

the weight of a cow,

the location of a lost sub

the shapes of protein molecules

in everyday life: complexity of traffic flow

(and note the problems caused by less

expert drivers)


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Group Exercise: Crowd-Sourcing

Close your eyes

Raise your hands to the percentage you think

is about right

Our volunteer will eyeball the result


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Crowd Sourcing - how to

vote

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Lugnega, et. al.

Psychiatric comorbidity in young adults with a

clinical diagnosis of

Asperger Syndrome.

Res. Dev. Disab. 32 (2011) 19101917

This is the study we are comparing withour intuition.

Well just do a couple of these

Then well look at what the numbers

are in the neuro-typical population 37


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Diagnosis % - crowd

source

% - Lugnega % - NT

Depression -

lifetime

?

Depression,

recurrent

Bipolar Disorder

Anxiety

Disorders

?

OCD

ADHD

Substance

Disorders

Tourettes

Psychosis ?


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Diagnosis % - crowd

source (ICDL)

% - Lugnega % - NT

Depression -

lifetime

70 25

Depression,

recurrent

50 12.5

Bipolar Disorder 9 1

Anxiety

Disorders

56 25

OCD 7 1

ADHD 30 5

Substance

Disorders

7 7

Tourettes 2 1

Psychosis 2 1


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40

Diagnosis % - crowd

source (UCSD)

% - Lugnega % - NT

Depression -

lifetime

60 70 25

Depression,

recurrent

50 50 12.5

Bipolar Disorder 15 9 1

Anxiety

Disorders

45 56 25

OCD 35 7 1

ADHD 25 30 5

Substance

Disorders

5 7 7

Tourettes 6 2 1

Psychosis 3 2 1


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Neurodiversity as Human Necessity:

What Make Us Human?

Diversity in thinking is built into communalproblem solving.

It is actually built into our genetic code.

Anthropogeny is the study of how we come to behuman (CARTA at UCSD free webinars)

A difference only in gene expression: Human vs.Chimps; dino-chickens in development

Close enough cousins: mouse models inmedicine, testing fruit flies for medication forFragile X


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dino-chicken


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identification

Natural Genetic Variation


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Natural Genetic Variationin Social-Emotional Development

So we have these genes that code for social emotional function.

And we know that genes vary in their transmission and characterfrom generation to generation.

Some genes vary more than others, e.g., hair color varies morethan whether or not you will grow a heart. Back to MiddleEarth: the heights of Hobbits, while all short, presumably vary in

a normal distribution about a mean or average height. However,there is less variation in whether they have hairy feetthey allhave hairy feet.

Back to, anthropogeny, i.e., what is unique to actual humans:large brain size; intense drive to imitate, which allows ourspecies to learn from others; sophisticated social abilities;

sophisticated technical abilities. These areas make us human and as it happens they are all

extremely variable in their genetic allelic construction.


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Patterns of Genetic Variation

Numbers of genes: too many CGG repeats in Fragile X; Down'sSyndrome trisomy 21. Too few genes in deletion syndromes.

Single specific spontaneous changes can create ASD. Usually severeand the person does not have kids and pass on that change.

More often ASDs involve a number of genes that affect those highly

human qualities. Some people have moer trouble reading social cues but are more

able to focus on detail, range in severity along the ASD spectrum.

For others the same genes vary in opposite directions, towardmanic, psychotic, and borderline personality symptoms.

We typically see both poles of symptoms and syndromes running infamilies, with the easy variability of those genetic alleles leading tonatural neurodiversity.


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Neurodiversity is Necessary

This may explain the growing number of studiesshowing the same rates of broadly defined ASDs inolder people as in children, roughly 1/100. Our ASDepidemic is more and more seen as a recognition ofthe true rate of this kind of natural genetic variation.

Temple Grandin says it best when she talks about howif we were all the same we would still be chatting ateach other in caves with no technology.

This variability has evolutionary value or it would have

been dropped over the 6 million or so years thathominids have been developing

(Dawn of Humankind).


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Applications: Practical Diversity

Accommodations in everyday life

Evidence Based Practice research and

intervention that leverages freedom of

thought toward more effective action

World Peace


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A d ti


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Accomodations:

Neurodiversity - Armstrong

Disabled or gifted? Often depends largely on whenand where you were born, i.e. what kind of supportyou have.

Finding or creating a niche is key to adaptivefunction and, notably, can create (positive ) brainchanges.

Job ideas that embrace neurodiversity: Marine

point men with ADHD, computer engineers on theSpectrum, senstive and perceptive writers withmood disorders, etc. re dyslexia, anxiety)

A d ti


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Accomodations:

Neurodiversity - Armstrong

Working with intellectual ranges, schizophrenia

Inclusion in education (see also Paula Kluth)

Combating 'ableism i.e., the bias that only theable-bodied should be selected for jobs,promotions, etc.

Ari and Morton will talk more about these things.

Deciding how to help requires good research,appropriately applied.


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Evidence Based Practice (EBP):

We want to know what interventions mighthelp, but we typically do not know for sure.EBP helps us wend our way toward betterintervention.

EBP combines relevant research with clinicaljudgment to provide families with choices sothat they can make informed consentdecisions based on their own family cultureand values.

This in contrast to Evidence Based Treatment(EBT) that uses a study to dictate intervention,or clinical experience alone without adequatebasis in research.

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Relevant Research

Beyond traditional randomized controlledefficacy trials (RCTs) that use pure diagnostic

populations with narrow interventions and are

often aimed at short term, process variables

(e.g., IQ) vs. outcome variables (got a job).

EBP includes strategies in addition to RCTs to

address shortcomings of RCTs, e.g., efficiency

studies, survival studies, single case studies,and other strategies

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We are doing the research!

Solomon, et. al BRIDGE - me, Marilee, Aubyn, et. al.

York MEHRI thanks to Eunice and Amanda!

And Devin, Jim, Stuart and Sharon Alexanderand the Unicorn Foundation!

At ICDL we are joining the growing world of

innovative, diversified research.

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Be a part of it

become a grad student in our PhD program

Join our research webinars!

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ICDL Grad school faculty and students


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Clinical Judgment

Implicit, rapid pattern recognition Gained over time (10,000 hrs.)

Built in biases, e.g. low risk high gain

(lottery) thinking and high risk outcomesleading to harm-avoidance.

Powerful when guided by a reflective

process that values independent,

innovative, iterative thinking (as in good

DIR/Floortime).

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Family Culture & Values

Family is typically the most powerful force

in the system.

If an intervention is thrust at a family and

doesnt fit the family, it is unlikely to help -

effort and resources are wasted.

We never really know what is best, and so,

ethically, families must decide what is best,based on true informed consent.

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Evidence Based Practice

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Be a part of it

Many or most treatments and interventions

are heavily impacted by economic forces

WE MUST ADVOCATE for Choice in treatment

Come tonight to hear more from Jim Lantry

(who knows you might win lunch with Dan

Siegel or a Feder clutch purse!)

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this clutch could be yours!


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World Peace

Debiasing: speaking truth, developing

interdependent relationships (economic, etc.)

Back to the Four Agreements: be honest,

dont make assumptions, dont take thingspersonally, and try our best


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Global Interdependency

Greenspan The Development of the Ego - nature andnurture combine in development of groups as well aspeople.

Greenspan & Shanker: Global Interdependency, The FirstIdea safety, shared sense of humanity, presymbolic

affective (dependency, fear, assertive, aggressive, etc.),symbolic

From determinism (polarized thinking) towardinterdependency. More diverse populations leads to morereflective integration demanded by the dynamic.

Policy: recognize global interdependence; never intimidate;patient persistence; support basic needs, safety, andprovisions for conflict resolution and reflective institutions.

More on this tomorrow from Gerry Costa!


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F d Sh k l i f d


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Feder, Shanker, et. al. moving forward

Belfast and Babies:

healing over generations

Tronick revisited, in parallel reflective process

Supporting caregivers from early on to

support their children in the development fo

Functional Emotional Developmental

Capacities.

Join us? Email me! [email protected]

Diversity Denouement:


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Diversity Denouement:

The Fault in Our Stars - Green

Cancer in teens: a population of people,

genetically diversified to have cancer and have

a very high mortality early in life.

Contra-maslovian? Pseudo-contra-maslovian?

Not the wrong trope, but a different trope


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'I wish it need not have happened in my time,'said Frodo. So do I,' said Gandalf, 'and so do

all who live to see such times. But that is not forthem to decide. All we have to decide is whatto do with the time that is given us.


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Recap: What we can do

Advocacy: come tonight!

Research: join the ICDL effort!

World peace: join me and Stuart!


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diversity talk final version

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