High-Risk Behaviors Among Youth – Part 1

What Are Risk Behaviors?

High-risk behaviors are those that can have adverse effects on the overall development and well-being of youth, or that might prevent them from future successes and development.

This includes behaviors that cause immediate physical injury (e.g., fighting), as well as behaviors with cumulative negative effects (e.g., substance use). Risk behaviors also can affect youth by disrupting their normal development or prevent them from participating in ‘typical’ experiences for their age group. For example, teen pregnancy can prevent youth from experiencing typical adolescent events such as graduating from school or from developing close friendships with peers.

Because high-risk behaviors can significantly impact the lives of youth and those around them, it is essential that parents, educators and other concerned adults become aware of the prevalence of these behaviors, the factors that increase their likelihood, and what can be done to abate or prevent those risks.

Types And Prevalence Of High-Risk Behaviors

Several high-risk behaviors have been of particular interest to professionals because of their prevalence in youth today.

Many of these behaviors cause a large number of deaths and injury among teens, or have negative impacts on society.

Behaviors Related To Obesity And Unhealthy Dieting

In recent years, the rate of obesity in the U.S. has reached epidemic levels. For this reason, many professionals have started to consider behaviors leading to being overweight and obesity as risky. Nationally, only 66 percent of youth report engaging in vigorous physical activity at least three times during the past week. While an increasing number of youth are overweight or obese, a large number of youth also are engaging in unhealthy dietary behaviors to lose weight.

Teens use unhealthy methods including vomiting, laxatives, unsupervised/non-prescribed diet pills and fasting.

Risky Sexual Behaviors

Engagement in sexual behavior is considered to be another group of high-risk behaviors for youth because of the potential physical (e.g., STDs or sexually transmitted diseases) and socioemotional risks they present. Youth may or may not be ready for the social and emotional implications of sexual activity, and many sexually active youth do not use safe sexual practices. Teens engage in sexual intercourse at a young age – 47 percent of youth nationwide.

Among those who report engaging in sex, only 63 percent report having used a condom during their last intercourse and 17 percent report using alternative methods of birth control. Unprotected sex exacerbates risks because of the potential for developing STDs and the potential for unwanted pregnancy.

Approximately half of the 19 million new STD cases diagnosed per year are of youth ages 15-19; and 13 percent of new HIV/AIDS diagnoses are of youth ages 13-24. Teen pregnancy is both a possible effect of risky behaviors as well as a risk factor in itself. Teen pregnancy has been linked to higher rates of school dropout, as well as other socio-emotional risks. Rates of U.S. teen pregnancy have declined over the last few years. To date, the rate of teen pregnancy is about 7.5 percent for girls between the ages of 15 and 19, which is 36 percent lower than in 1990.

Nonetheless, this rate remains the highest in all the other developed countries (e.g., compared to Canada, Germany, Japan) (Gutmacher Institute, 2006).

Self-injurious Behaviors, Violence And Suicide

Among teens, many of the most self-injurious behaviors are related to driving.

Obtaining a driver’s license is considered as one of the most exciting milestones of the teen years but unfortunately, car accidents make up the leading cause of death among teens. Many injuries are exacerbated (and deaths are caused) by the failure to wear seat belts, being distracted by others in the car, talking on their cell phones, and texting. Approximately 30 percent of youth nationwide report that they rarely or never wear seat belts. The combination of alcohol use and driving also contributes to deaths among teens from car crashes. About 10 percent of teens report driving after drinking, and 36 percent admit riding in a car where the driver had been drinking. Driving-related risk behaviors continue to be a serious problem during the teen years.

Fighting and aggression include another group of self-injurious behaviors. It is second to vehicular accidents as the leading cause of death among those 15-34 years of age.

Nationally, 36 percent of teens report having been involved in physical fighting over the last year with males (43 percent) outnumbering females (28 percent) dramatically. Similarly, both males and females reported carrying a weapon or a gun (19 percent nationally), however males (29 percent) outnumbered females (7 percent) significantly. Finally, suicide is one of the highest risk behaviors among youth today. Close to 17 percent (almost one out of every five) of youth report having considered suicide within the past year and 13 percent actually planned it (national and state numbers are similar). Among teens, 8.4 percent attempt suicide every year. Suicide now is the third leading cause of death among those ages 15-24, with 86 percent of those deaths from males, and 14 percent from females.

Substance Use

Substance use is another group of behaviors that contribute to immediate as well as long-term damage. Drinking and drug use have been linked to motor vehicle accidents, fighting/violence, problematic relationships and social interactions, and various diseases. Drinking and cigarette smoking are among the most common in this group of behaviors.

Over 43 percent of youth nationwide report that they drink alcohol, and 26 percent of youth nationwide admit to heavy drinking (five or more drinks in a row).

Approximately 23 percent of teens admit to being cigarette smokers with 9.4 percent being frequent cigarette users (smoked on 20 of last 30 days). Like self-injurious behaviors, the prevalence of alcohol and cigarette use has decreased over the last few years, but nonetheless continues to be serious risks to adolescent health. Illicit drug use is both a health and public concern because of the obvious negative physical effects it has on users. Effects of illicit drug use include, but are not limited to, brain damage and damage to major physical organs. It also has been linked to a host of other health compromising behaviors such as risky driving, engagement in high-risk sexual behaviors, and violence. Recent estimates suggest that 22 percent of teens use marijuana and that 10 percent of teens used marijuana before the age of 13. Approximately 3 percent use cocaine.

In recent years, methamphetamine use has become a serious concern in the United States. The low-cost of the drug and the ease at which many youth are able to access this substance have contributed significantly to its rapid spread.

The serious, immediate and long-term effects of methamphetamine have made it a top concern for many professionals and policy-makers. Today, about 3 percent of eighth graders, and over 4 percent of 10th and 12th graders report having tried or used methamphetamine nationally.

Par 2 – Relationship Between Adolescence and High-Risk Behaviors

Does my child need a therapist?

George, age fifteen, rebellious teen, only eats white foods-macaroni, milk, rice, sugar.

Sarah, age sixteen, has cuts on her arms and bruises on her back, and says smoking pot once in a while is okay. Claudia, age thirteen, has nightmares, and has probably started being sexually active.

Barbara, age seventeen can’t seem to make or keep a friend and is losing more weight than normal.

Robin, age fourteen, loses something almost every day, like friends phone number, homework, library card, and even money. Which of these children needs professional help?

When it comes to knowing if a child (say, your child) needs therapeutic help for mood or behavioral disorders, professionals agree on one answer: “It all depends.” And there’s agreement that dealing with childhood psychological disorders is a risky business.

If you take action, you risk harm; and if you do nothing, you risk harm.

What a choice!

Keeping in mind the specific complexities of any human being, the range of possible diagnoses, the ever-increasing knowledge about interconnections between biology, chemistry and mental health, and the myriad treatment options available, the only sane thing to do is to bone up on the When-Where-What-Who-How’s of child-specific therapy, and make the best decisions you can. Herewith is some brief notes and assistance  of what to expect and do when you enter the world of children’s special needs.

• When. It’s time to seek help when you’ve engaged in everything that common sense, parenting books, and trusted friends and family recommend. Understandably, parents are loath to admit that their offspring could be anything less than perfection incarnate.

There’s an active self-protective mechanism that allows parents to chalk difficulties up to “it’s a stage (he’s) she’s going through” or “boys will be boys” or “the system needs to adjust to the kids, not the other way around.”

Given that hesitancy, the truism, “when parents think the child needs help, then the child does need help,” is probably true. That day may come only after a teacher suggests that an evaluation is in order, the child hurts him or herself, or a doctor sees something that raises a red flag. Red flags tend to go up more readily for boys than girls, and that makes it appear as though boys have more psychological difficulties than girls. This is not necessarily so. Girls often present psychological problems in quiet ways, such as avoiding friends, falling grades and new fears.

Boys, on the other hand, tend to “act out” which gets everyone’s attention. One set of problems is no better or worse than other; both can be helped by professionals.

If you’re thinking of waiting, envision doing nothing until David enters adolescence with the same problems, newly compounded with hormones and semi-independence from home. Sooner is better.

• Where. When parents have a general idea that something isn’t right, the next step is to seek a diagnosis. Often, public institutions are the first line of defense. Any parent with any concerns can have their child screened for academic, learning disabilities, mental, physical, emotional and any other issues imaginable. The outcome might be reassurance that the child is on the appropriate trajectory, or that the child does have a problem, and can be connected to appropriate services. Babies born prematurely are particularly at risk for behavioral, learning, and emotional problems, even after the child has caught up physically. So care has to be taken from the onset to protect the fragile child

Past the preschool years, public schools are mandated to offer screenings for a variety of learning and developmental problems. These are free to the parents and will provide lots of information and a proposed plan to deal with any issues that surface. When you don’t like or trust the outcomes of such a screening, seek a second opinion. Call a clinical psychologist who specializes in children for an evaluation; this person should be able to recognize what signs and symptoms point to which kind of therapy. Especially when the issue is anxiety or depression, a clinical evaluation may be enough and treatment can begin promptly. Such an assessment might also lead to a whole battery of quantitative tests that include academic, mental and emotional health, and speech, language, sensory, and neurological testing. These are usually offered at large institutions, such as a Children’s Hospital. You may find that your child has a very high IQ but also very high distractibility and mild dyslexia, for example. Oftentimes learning difficulties go hand in hand with emotional and behavioral issues. This kind of detailed, quantitative information can save time in treatment by getting the child to the right professional’s office immediately, although it comes with a hefty price tag that insurance may or may not cover.

• What. Now that you’ve had an assessment, evaluation or battery of screening tests for Theresa, does she have attention deficit/hyperactivity disorder (ADHD)? Obsessive-compulsive disorder? Attachment disorder?

Sensory integration disorder? Something on the autism spectrum?

Dyslexia? Oppositional disorder? Perhaps a hearing deficit? A mood disorder?

Post traumatic stress?

Some of these are psychological issues, and some are learning differences or deficits. More to the point, they often come in two’s or three’s, not singly.

• Who. With overlapping diagnoses, parents may be on a long and winding road through many professionals’ offices. Don’t be surprised to end up with a team of professionals that might include a psychiatrist, a therapist for the parents, another for the child, and perhaps an occupational or speech therapist as well.  Ideally, parents are part of that team. Some say that when the child has a problem, it’s the parents who need the work. And yet, research is uncovering the biological bases of more and more disorders every year. Parents are, at the very least, almost certain to play a part in their child’s treatment. When parents are facing battles of their own with grief, mental illness, substance abuse, severe financial stress or other problems, they may not be as active as they’d like on behalf of their children. In these cases, it may fall to child care providers, teachers, or others in the family to work with and for that child. As for the lead therapist of a working team, what should a parent look for? Compassion, a broad-based view of children’s psychological needs, and someone who “clicks” with your Steven. Of those, compassion comes first.

Seek someone who is kind and understanding about the difficult path your child has been on. When the therapist approaches you as if your child is a bundle of pathologies, think twice. Instead, look for a “first, do no harm” approach, with a person who sees the excellent qualities Jeremy brings, as well as the struggles he faces. Then make sure he or she has a broad set of skills, and the flexibility to recognize that when one approach isn’t working it’s time to move to plan B, C or D.

There is no one right road, regardless of how many parenting gurus suggest otherwise. As for “clicking,” a therapist has to have a relationship with the child.

Chemistry counts, and if after a handful of sessions your child is still uncommunicative, don’t lose time before trying a new therapist.

(Consider that it is the parents’ job to get the child to the first appointment; after that, it’s the therapist’s job to create a bond.)

• How. After getting a diagnosis and choosing a therapeutic team, you’ll be offered a bushel of ways to treat childhood behavioral, emotional, and learning disorders.

Step one in almost all cases is pretty basic: consistency, diet, rest, and regulation.

In fact, some say that the best things you can do for a child with depression is give him or her a protein-rich breakfast, an hour of aerobic exercise daily and fish oil, which has a palliative effect on mood disorders. In general, though, when a child leads a chaotic life with questionable nutrition and inadequate sleep, disorders are hard to treat. And the therapy itself? Young children will play with puppets, dolls, other toys or games, and from this play the therapist learns about their world.

When difficult issues surface in play (Mom and Dad fighting, for instance) the therapist will guide the play to a resolution more satisfactory than having the child get pummeled in the process. The play becomes the conduit for offering new perspectives, coping strategies, and even concrete techniques such as deep breathing to ward off anxiety. If your Dawn won’t go alone, Mom and Dad may go along, too. If that doesn’t work, then the parents might go without Dawn, and receive coaching on how to set up a consistent household, schedule and expectations that work.

Another option: family therapy. Here, the idea is that the child who presents “problems” in the family constellation isn’t operating in a vacuum. Instead, Donald is performing his role, as are all the other family members. Perhaps a sibling has the role of “good child,” the mother has the role of the family’s emotional barometer, and the father has the role of playmate. With family therapy, all (or at least most) of the family attend sessions together, and it’s the interactions between them that are the focus, and breaking out of those roles may be the goal. Family therapy takes the pressure off Donald, a potentially huge relief.

Yet another option: group therapy. If it’s a group of 12-year-olds who tell Brian that they don’t like him because he argues all the time, grabs and interrupts, he may hear it more clearly than if a caring adult gives the same message.

And, the group provides an opportunity to practice budding social skills.

Still more: there is a surprising body of research indicating that Eye Movement Desensitization and Reprocessing (EMDR) can help, especially with children who are suffering from past traumas. In practice, this looks like the child following an object that the therapist moves rapidly before his or her eyes. Any form of activity that bounces attention quickly back and forth from the right to the left side of the brain helps “unstick” traumatic memories that are impeding daily life or growth.

• And finally, there are psychotropic medications to treat many conditions: anxiety, compulsiveness, attention deficit/hyperactivity disorder, depression or impulsiveness. Many parents are reluctant to use them for understandable reasons: they believe using psychotropic drugs may set up a pattern of medicating problems away, they fear dulling little Angelo’s personality, or they may cause metabolic changes that effect growth. Recent news about a link between antidepressants and higher rates of suicide, the abuse of ADHD drugs among older teens, and the overuse of sleeping medications for children all scare parents away. So, choosing to medicate isn’t always straightforward, and probably the child’s pediatrician isn’t the right person to make that call. Ask for a referral to a child psychiatrist. While thinking about whether to medicate or not to medicate, note that there is risk if you choose not to. If you don’t medicate, the child suffers from the presenting problem and very likely social problems that are an outgrowth, and which can become ingrained patterns that are hard to shift later.

Parent after parent says, “I wanted to do everything I could to avoid using medications, but once we finally went that route, life was bearable for Tara for the very first time. Medication has been a lifesaver.” Expect that it will take time to get the right drug and dosage, and that when the child grows, your doctor will need to reformulate the prescription again, and again. Note, too, that medication is rarely a solution all on its own; it works best in conjunction with some kind of “talk” therapy and consistent modifications to the home and school expectations and environment.

Whatever treatment is pursued, you’ll want to know when recovery has begun.

“Recovery” can be a tricky word; when parents hold on to the glowing expectations they’ve carried since Rob’s birth, recovery may be hard to achieve. If, on the other hand, recovery means that life gets easier for him, then recovery is eminently achievable. The best sign that you’re on the right track? Friendships improve.

When your child brings home friends who represent the best, not the worst, in him or herself, you’re on the road forward.

Red Flags
When you see these behaviors in your child, consider seeking help:

• attachment difficulties
• changes from your child’s usual behavior
• cruelty to animals
• difficulty making and keeping friends
• difficulty sleeping
• excessive shyness
• explosive behavior
• lack of empathy and/or remorse
• missing medication from parents or siblings
• newly developed fears
• nightmares
• repetitive behaviors such as hand washing
• self-abuse (burning, hitting, biting, hair pulling, cutting) – Self-harm consists of behaviors that people intentionally engage in that cause physical bodily harm to themselves
• substance abuse – Teen substance abuse is both a frightening and frustrating experience that affects the entire family
• unexplained behavioral problems
• unreasonable defiance
• violence against others
• withdrawal

Say “no” to stigmas

Even when parents recognize that their child is experiencing problems in school, with friends, or at home, parents may want to avoid screening and say, “I don’t want my kid labeled.”

(There may be a subtext of “I don’t want myself labeled as the parent of a problem child” underlying this viewpoint, too.)

There’s good reason to worry for the children; lots of research indicates that teachers and others treat children according to their expectations; when they’ve been told that the child has “oppositional disorder,” they may take a geared-for-struggle stance, for instance. And children tend to live up (or down) to those expectations. As for relationships with peers, you don’t have to go far to find stories of children who have been embarrassed by being labeled a “special education student,” a broad category that includes children with anything from mild dyslexia to severe developmental disabilities. Classmates do notice who goes to the office to receive medication, who gets pulled out of class for “special” help, who gets to have an extended time for test taking, all common (and appropriate) ways that children are accommodated. They notice, and they may be unkind about it. In other words, stigma is alive and well in relation to mental illness and every form of special needs. Having agreed that stigma is a persistent hindrance to seeking treatment, experts say parents simply have to face it and proceed to treatment anyway.

That begins with accepting for themselves and their children that mental disorders are no different than diabetes or any other disorder: unpleasant and long-term, but treatable. Then parents (and children as they grow older) may find themselves becoming advocates for people with mental or emotional disorders, spreading the word that stigma is perhaps the most treatable part of a child’s special needs.

“Just Say No to Stigma” could be the rallying cry.

New Haven

RESIDENTIAL TREATMENT PROGRAM AND BOARDING SCHOOL FOR TEEN GIRLS, AGES 12-18

At New Haven, we base our treatment decisions on a simple question: What would I want for my daughter?

We know that underneath her struggles – whether with an eating disorder, substance abuse, trauma, or another challenging emotional issue – your daughter is still there, waiting to be discovered, loved back to wholeness, and reunited with her family. After fifteen years working together, our treatment team is one of the most experienced in the field of girls’ adolescent treatment. We know from experience that girls struggling with complex emotional and behavioral issues need access to a variety of proven therapies. Experience has also taught us that even the most clinically sophisticated approaches to treatment are only effective if those delivering them come from a place of connection, compassion, and hope.

Hello Everyone!

Are you worried about your teens recent behavior?

You are not alone! 

Parents of troubled pre-teens, teens and young adults across the country are realizing that they need help dealing with daughter or son that is making poor decisions. And they are discovering that they are not alone.

While it can be devastating to learn that your child has fallen into the wrong crowd or has begun to make decisions that will destroy their lives, it is not something to be embarrassed about or to try to hide from others.

It is a time to take action!

Making a decision. 

The most important thing that you can do as the parent, is decide which type of addiction program, behavior program, clinical setting, eating disorder center, intensive therapy program, learning challenge program, medical facility, wilderness adventure program or school is best suited to deal with the issues facing your pre-teen, teen or young adult. 

Make sure you do your research. Learn about the attitudes, philosophies and treatments that these different organizations will use to help a troubled teen. Whenever possible, take the time to visit facilities and meet the academic and therapeutic staff of these organizations. 

Where do I get help for my troubled teen? 

As you begin to research what avenues of help are available, you will discover that there are many, many options.

There are literally thousands of organizations designed to help troubled teens.

This blog is dedicated to those in the industry that may meet your needs.  You can find out more information on www.familysolutionsteenhelp.com.