Newsletter Editor: Denise Nelson
You're not Alone
Support is Here for You
Support Groups are Confidential
Visalia Family & Friends
Support Group
St. Paul’s Episcopal Church
120 N. Hall – Corner of Center and Hall 
Tuesday, November 5 th
First Tuesday of every month
Speaker: Donna Ortiz, Tulare County Director of Mental Health
General Meeting at 6:00 p.m.
Support Group at 7:00 p.m.
Call for Information:  (559) 627-1306
Porterville Family & Friends Support Group
Wellness and Recovery Center
333 W. Henderson Ave.
Thursday, November 7 th
First Thursday of every month at 6:00 p.m.
Call for Information: (559) 280-5258 or (559) 539-5288
Connections Support Group
My Voice Media near the Transit Center
300 E. Oak St. in Visalia
Every Tuesday from 2:00 to 3:15 p.m
Connections Support Group provides persons with mental health conditions a gathering of respect, understanding, encouragement, and hope. This group is led by trained individuals who are experienced at living well with a mental illness.  No registration is required for this confidential group, just drop by. We look forward to meeting you.
You can call to check if group will be held:  
Phone: (559) 685-2429 or (559) 300-5874
Visalia Wellness Center
1223 S. Lovers Lane
Visalia, CA 93292
Office: (559) 931-1001
Mon-Sat: 8:30 a.m. to 5:30 p.m.
Closed most major holidays

Porterville Wellness Center
333 W. Henderson Ave.
Porterville, CA 93257
Office: (559) 256-1183
Mon-Fri: 8:30 a.m. to 5:30 p.m.
Sat: 9:00 a.m. to 5:00 p.m.
Sunday: Closed
A place for adults to attend support groups and activities,
learn life skills, and practice socialization.
Thank you for helping to make our September 28, 2019 “WALK with NAMI Tulare County” a wonderful success. We were greeted with wonderful weather, inspirational words from speakers, and energetic cheerleaders from Tulare Union High. The quotes of encouragement relating to mental health along the walking path gave us “pause for thought”. The donors, large and small, allow us to continue to provide support, advocacy, and education. Of course, all of the dedicated volunteers help make it all happen.
Your donations help support NAMI Tulare County, and all proceeds stay within the County of Tulare
You can also mail donations to:

NAMI Tulare County
P.O. Box 3655
Visalia, CA 93278
Articles of Interest
When to Worry About Worrying
Heart Beat - Harvard Medical School
There is no shortage of things to worry about --- from personal concerns about job security or health, to fears related to larger issues such as political conflicts or natural disasters. Temporary anxiety can be a healthy response to uncertainty and danger, but constant worry and nervousness may be a sign of generalized anxiety disorder.

Do I have generalized anxiety disorder?

You'll need your doctor's help to know for sure, but while other types of anxiety disorders arise from particular situations, generalized anxiety disorder is characterized by debilitating worry and agitation about nothing in particular, or anything at all.

People with generalized anxiety disorder tend to worry about everyday matters. They can't shake the feeling that something bad will happen and they will not be prepared. They may worry to excess about missing an appointment, losing a job, or having an accident. Some people even worry about worrying too much.

Physical symptoms are common too, and can include a racing heart, dry mouth, upset stomach, muscle tension, sweating, trembling, and irritability. These bodily expressions of anxiety can have a negative effect on physical health. For example, people with
generalized anxiety disorder are at greater risk for heart attack and other cardiovascular problems.

Taming anxiety

If you have generalized anxiety disorder, therapy —particularly cognitive behavioral therapy (CBT) — can help. CBT helps people recognize when they are misinterpreting events, exaggerating difficulties, or making unnecessarily pessimistic assumptions, and offers new ways to respond to anxiety-provoking situations.
For some people, medications can be an important part of treatment. Commonly prescribed drugs include antidepressants, such as selective serotonin reuptake inhibitors (like Prozac or Zoloft), or dual serotonin and norepinephrine reuptake inhibitors (like Effexor or Cymbalta). These drugs take longer to work than the traditional anti-anxiety drugs, but also may provide greater symptom relief over time.

Symptoms of generalized anxiety disorder:

  • Persistent, excessive worry about several different things for at least six months
  • Fatigue, difficulty sleeping, or restlessness
  • Trouble concentrating
  • Irritability
  • Muscle tension
  • Feeling tense or "on edge"

Only your doctor can determine whether you meet the criteria for generalized anxiety disorder. If you think you might have this condition, don't hesitate to talk to your primary care doctor. There are many different treatments that can ease the very real discomfort of this condition
A New Way to Diagnose and Treat Autism
        Ami Klin, M.D., Ph.D. of Atlanta

Professor & Chief, Division of Autism & Related Disabilities, Dept. of Pediatrics Emory University School of Medicine & Emory Center for Translational Social Neuroscience Director, Marcus Autism Center at Children’s Healthcare
Dr. Klin, your research in the clinic suggests there is going to be a new way to diagnose autism, a new way of imagining the world of the child who has autism spectrum disorder (ASD) that seems more hopeful.
As a graduate student working in a residential unit for adults with autism it seemed that autism was an unchangeable condition. We already knew it was strongly genetic and we wondered if a person’s state in life was wholly determined on the basis of genes. I began working with babies because the only way to follow the early development of individuals with autism was if we were to follow younger siblings already diagnosed with autism. It became clear that about one in five of the younger siblings of children with autism also develop autism and additionally one in five developed something that either was a transient form of autism or a sub-threshold form. We now know that this is true.
We started looking into ways in which we could promote better outcomes by trying to intervene between birth and the age of 3 years. If we could increase their abilities by age 3 we would be changing their lifetime trajectory.
There is now incontrovertible science suggesting that early detection and early intervention does optimize outcomes in children. But still we have a huge public health challenge on our hands, because the median age of diagnosis of autism in this country is stuck at around 6 months to 5 years of age. Diagnosis is especially problematic in children who have less access to services---minorities, low-income families, and rural populations, in whom the diagnosis is usually made later on in life.
There is the need to focus on early identification and diagnosis, and provision of early treatment and early prevention services.
Parents will be interested to know about the distinction you make between genetic and environmental factors contributing to the way a child with autism develops.
What is inherited in autism is the trait, and the trait is reduced sociability. But there are many different routes to autism, not all of them strictly genetic. The important fact is that autism might not relate back to a single gene, or to even a combination of genes. Rather, it may be the result of deviations from normative socialization. 
Tell us about you were instrumental in helping to develop, which makes early diagnosis possible. I’m referring to “eyetracking” technology.
We began to develop “eyetracking” technology around the year 2000. It is a quantitative way, using science and technology, to measure sociability---the way children engage in the world around them. We learned how to quantify what happens when a child is looking at a caregiver or a child is looking at some peers playing.
You are trying to measure how children are seeing the world, and your technology gives you an ability to do that by tracing what their eyes are looking at, where they are looking and how long their attention is sustained. The difference between children who are developing normally and are learning to socialize and children who diverge from that path. Your research reveals the significance of whether a child is looking at the eyes or the mouth of the caregiver, for instance.
In studying toddlers who have older siblings with autism, we have them look at a short film of a couple of toddlers interacting. All children have the same stimulus in front of them, but brain connectivity, the neural tracts being formed as a result of those experiences is radically different in the children who will go on to develop autism. They are looking at the same film, but what their brains are learning about is entirely different.

Eye-tracking data of very young typically developing children vs. children who go on to develop autism tell us amazing things that no parent could possibly detect. They learned that at a very early age they were missing about 500 moments of social learning in about 6 minutes of
watching their peers playing. When multiplied throughout the day it amounts to thousands of opportunities and millions in the first 3 years of life.

Like all children they are “creating” their own world, but they are diverging from the normative experience. As they are building their own brains, they are becoming autistic every day of their young lives.
When do the paths begins to diverge?
To begin with, in the first 2 months of life, all children are on the same track. All children are born with reflexes—social reflexes---signaling to caregivers that they are there. The caregivers accordingly will engage the babies, and it’s out of this mutually reinforcing choreography that the “social brain” emerges.
We found that between 4 and 12 weeks of age, babies are transitioning from these “reflex” behaviors to what we call “volitional” behavior. The initial reflex behaviors are guided by subcortical structures in the brain. But this normally transitions to reward-driven visual behaviors that are guided by the cortex. We can see this transitioning happening. We see the emergence of the interactional smile. We see the emergence of, basically, a human being that is reacting to the surrounding world.

Were you able to see where the paths began to diverge?
Yes, we found later, is those babies that later develop autism, those divergences began already by the age of 2 months. We learned this in 2013. They seem to be born with the typical visual and behavioral reflexes, but they don’t seem to make that transition into volitional behavior. There is something that is not happening between 4 and 12 weeks of age that is not supporting that neurodevelopmental transition for children with autism.
Tell us about the treatments.
Rather than have the child spend one hour a week with a developmental expert, we choose instead to tract the child through the engineering of social environments. We take a parent-mediated treatment approach. We take this approach because every single second throughout the week, the child is going to be diverging. 
We train parents to use everyday experiences, what they do with their babies every day, through all of their routines, in order to engineer the social engagement that is crucial. We use a form of treatment called early social interaction, and we send coaches to train parents in their homes, but we also train parents who don’t have access to us, so we can treat from far away.
A parent in interacting with the child, has a “bud” in their ear, there is a camera, and our interventionist is siting in our center monitoring that engagement in the home, and coaching parents on how to take advantage of those moment-by-moment experiences that are learning opportunities for socialization.
When the environment becomes the daycare center, we train daycare providers. When it becomes preschool, we train preschool teachers. It makes no sense at all for us to create treatment for which there is going to be very limited access.
What about the diagnostic part?
We are now completing a national clinical trial that uses eye-tracking technology in a diagnostic device that we hope will substantially increase access to diagnosis. With the device, which is mobile, we hope that in a 12-minute procedure a trained technician will be able to do what expert clinicians can do in a multi-hour diagnostic assessment.
All children seen at the Marcus Autism Center that are at high risk for autism receive treatment. They begin the treatment at 6 months, but from 6 to 12 months, the treatment s entirely informational and is about training parents. They are training them to become more sensitive to child development milestones and to principles of engaging their own child. At 12 months, children who we feel are now showing risks for autism are randomized into two groups. One provides treatment on the existing model: treatment is given by an expert clinician. The other group gets parent-mediated treatment. Then there is another assessment at 2 years.
Brain and Behavior, July, 2019, Peter Tarr. 
Next month I will continue with the article from Dr. Klin, M.D., Ph.D. “Advice for Parents” in the same journal.
Monthly Activities at My Voice Media Center
The purpose of My Voice Media Center, located in the Art District of downtown Visalia, is to help peers in their wellness and recovery. They do so by providing a creative outlet for self-expression, striving to reduce stigma in surrounding communities, and promoting available wellness and recovery services.
Support & Resources
Your membership makes it possible for NAMI Tulare County to advocate for access to services, treatment, and research.
Please continue to join us!
Ralph Nelson (President)
Sandra Juarez (Vice President)
Kathy Farrell (Secretary)
Mary Mederos (Treasurer)

Board of Directors:
Donna Grigsby
Ivy Jones
Ray Lara
Karen Mabry
Bruce Nicotero
Elizabeth Vander Meer
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