Sue Scheff: Teen Depression

Source: USA Today

Experts: Doctors should screen teens for depression.

If you have teens or tweens, government-appointed experts have a message: U.S. adolescents should be routinely screened for major depression by their primary care doctors. The benefits of screening kids 12 to 18 years old outweigh any risks if doctors can assure an accurate diagnosis, treatment and follow-up care, says the independent U.S. Preventive Services Task Force.
It’s a change from the group’s 2002 report concluding there wasn’t enough evidence to support or oppose screening for teens. The task force, though, says there’s still insufficient proof about the benefits and harms of screening children 7 to 11 years old.

Depression strikes about 1 out of 20 teens, and it’s been linked to lower grades, more physical illness and drug use, as well as early pregnancy.

Questionnaires can accurately identify teens prone to depression, plus there’s new evidence that therapy and/or some antidepressants can benefit them, the expert panel says in a report in today’s Pediatrics . But careful monitoring is vital since there’s “convincing evidence” that antidepressants can increase suicidal behavior in teens, the report says.

Accompanying the task force advisory in Pediatrics is a research review saying there have been few studies on the accuracy of depression screening tests, but the tests “have performed fairly well” among adolescents. Treatment can knock down symptoms of depression, say the reviewers from Kaiser Permanente and the Oregon Evidence-Based Practice Center in Portland, Ore.

In a “show me the money” volley back, pediatricians also weigh in on the topic in today’s issue of their journal. Insurance plans and managed care companies that stiff or under-pay pediatricians for mental health services throw up barriers to mental health care in doctors’ offices, says the American Academy of Pediatrics. Kids’ doctors should be compensated for screenings, as well as consults with mental health specialists and parents, AAP recommends.

Sue Scheff: Teen Stress

School is winding down, finals are piling up - the stress of getting good grades as well as keeping your GPA up to be able to get into that college or university you dream to go to, can be stressful. Compound that with summer coming and if you are like many teens, looking for a summer job is in the plan but may be more difficult than last summer. The economy is hitting all levels of employment, and parents are not the only ones having stressful times.





Here is a great article I found on TeensHealth. Take the time to learn more about your teen and how stress can effect them.



What Is Stress?



Stress is a feeling that’s created when we react to particular events. It’s the body’s way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness.



The events that provoke stress are called stressors, and they cover a whole range of situations - everything from outright physical danger to making a class presentation or taking a semester’s worth of your toughest subject.



The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body’s energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment.

Read more: http://kidshealth.org/teen/your_mind/emotions/stress.html#a_Good_Stress_and_Bad_Stress

Sue Scheff - Teenage Depression

Source: Connect with Kids

“Just this gloom was like hanging over my head and I knew something wasn’t right but I wasn’t exactly sure what it was.”

– Amy, 16 years old

New research from Columbia University finds that nearly 50 percent of teens suffer from some form of depression, anxiety, or a number of other psychiatric disorders.

“A lot of people I know get depressed all the time about lots of stuff,” says 15-year-old Meagan.

“It’s like everything’s all on your shoulders and you have to take everything at once,” says Meredith, 14.

Sixteen-year-old Amy agrees, “Just this gloom was like hanging over my head and I knew something wasn’t right but I wasn’t exactly sure what it was.”

“My parents went through an awful divorce my ninth grade year and I was devastated, worse than my heart could ever imagine,” says 18-year-old Brittany, “and it hurts a lot, and I still hurt to this day and I’m a senior in H.S.”

The symptoms vary: some kids may be lethargic and withdrawn; others may show agitation and frustration, even aggression. Often, there is a drop in grades.

And sometimes these symptoms can cause parents to punish the child, instead of providing treatment.

“Rather than thinking of children’s misbehaviors as discipline problems or misbehaviors as deliberate,” says psychologist Sunaina Jain, Ph.D., “it’s important to see them as communications from the child.”

Experts say lots of kids experience depression or anxiety, often mild and temporary, but not always. And that’s why parents need to constantly check their child’s emotional pulse.

“You know it doesn’t take hours and hours. Even a few minutes of checking in with each other every day is a great way of saying you know I’m here, I’m interested in you,” says Jain.

Tips for Parents

All teens experience ups and downs. Every day poses a new test of their emotional stability – fighting with a friend, feeling peer pressure to “fit in” with a particular crowd or experiencing anxiety over a failed quiz – all of which can lead to normal feelings of sadness or grief. These feelings are usually brief and subside with time, unlike depression, which is more than feeling blue, sad or down in the dumps once in a while.

According to the Nemours Foundation, depression is a strong mood involving sadness, discouragement, despair or hopelessness that lasts for weeks, months or even longer. It also interferes with a person’s ability to participate in normal activities. Often, depression in teens is overlooked because parents and teachers feel that unhappiness or “moodiness” is typical in young people. They blame hormones or other factors for teens’ feelings of sadness or grief, which leaves many teens undiagnosed and untreated for their illness.

The Mayo Clinic reports that sometimes a stressful life event triggers depression. Other times, it seems to occur spontaneously, with no identifiable specific cause. However, certain risk factors may be associated with developing the disorder. Johns Hopkins University cites the following risk factors for becoming depressed:

Children under stress who have experienced loss or who suffer attention, learning or conduct disorders are more susceptible to depression.
Girls are more likely than boys to develop depression.
Youth, particularly younger children, who develop depression are likely to have a family history of the disorder.

Possible Symptoms:

Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation or anxiety
Pessimism or indifference
Loss of energy or persistent lethargy
Feelings of guilt and worthlessness
Inability to concentrate and indecisiveness
Inability to take pleasure in former interests or social withdrawal
Unexplained aches and pains
Recurring thoughts of death or suicide

It is important to acknowledge that teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression. According to the National Mental Health Association, teens may also express their depression through other hostile, aggressive, risk-taking behaviors. These behaviors will only lead to new problems, deeper levels of depression and destroyed relationships with friends and family, as well as difficulties with law enforcement or school officials.

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression. According to the Mayo Clinic, medication can relieve the symptoms of depression, and it has become the first line of treatment for most types of the disorder. Psychotherapy may also help teens cope with ongoing problems that trigger or contribute to their depression. A combination of medications and a brief course of psychotherapy are usually effective if a teen suffers from mild to moderate depression. For severely depressed teens, initial treatment usually includes medications. Once they improve, psychotherapy can be more effective.

Immediate treatment of your teen’s depression is crucial. Adolescents and children suffering from depression may turn to suicide if they do not receive proper treatment. Suicide is the third leading cause of death for Americans aged 10-24. The National Association of School Psychologists suggests looking for the following warning signs that may indicate your depressed teen if contemplating suicide:

Suicide notes: Notes or journal entries are a very real sign of danger and should be taken seriously.

Threats: Threats may be direct statements (“I want to die.” “I am going to kill myself”) or indirect comments (“The world would be better without me.” “Nobody will miss me anyway”). Among teens, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.

Previous attempts: If your child or teen has attempted suicide in the past, a greater likelihood that he or she will try again exists. Be very observant of any friends who have tried suicide before.

Depression (helplessness/hopelessness): When symptoms of depression include strong thoughts of helplessness and hopelessness, your teen is possibly at greater risk for suicide. Watch out for behaviors or comments that indicate your teen is feeling overwhelmed by sadness or pessimistic views of his or her future.

“Masked” depression: Sometimes risk-taking behaviors can include acts of aggression, gunplay and alcohol or substance abuse. While this behavior may not appear to be depression, in fact it may suggest that your teen is not concerned about his or her own safety.

Final arrangements: This behavior may take many forms. In adolescents, it might be giving away prized possessions, such as jewelry, clothing, journals or pictures.

Efforts to hurt himself or herself: Self-injury behaviors are warning signs for young children as well as teens. Common self-destructive behaviors include running into traffic; jumping from heights; and scratching, cutting or marking his or her body.

Changes in physical habits and appearance: Changes include inability to sleep or sleeping all the time, sudden weight gain or loss and lack of interest in appearance or hygiene.

Sudden changes in personality, friends or behaviors: Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important and avoiding friends.

Plan/method/access: A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide.

Death and suicidal themes: These themes might appear in classroom drawings, work samples, journals or homework.

If you suspect suicide, it is important to contact a medical professional immediately. A counselor or psychologist can also help offer additional support.

References
American Academy of Child and Adolescent Psychiatry
American Foundation for Suicidal Prevention
Columbia University
Johns Hopkins University
Mayo Clinic
National Association of School Psychologists
National Depressive and Manic-Depressive Association
National Institute of Mental Health
National Mental Health Association
Nemours Foundation
Thomson-Reuters

Sue Scheff: Teens and Sleeping Pills

Source: Connect with Kids

“Part of it I think now is there is so much more pressure in the academic settings. There are kids who are working tremendous numbers of hours each evening to get their schoolwork done. I get a sense that many of them worry about how they are doing academically, and that tends to spill over into difficulties with sleep.”

– Richard Winer, M.D., Psychiatrist

Whether it’s an over-the-counter medication like Nyquil, or a prescription drug like Ambien or Sonata, more and more teens say they often take something to get to sleep.

“It’s mainly just stress… you want to study and then you realize you need to sleep because you have a test the next day and then you just take something,” says Chelsea, 19.

“An Ambien to knock me out,” adds 19-year-old Jessica.

“I’ll take Nyquil or something like that, just to help me get to sleep easier,” explains Allison, 19.

Why do kids today need help getting to sleep? Experts say there are several answers: greater academic pressure, more stimulation late at night, with cell phones, TV, computer games, instant messaging, more kids with ADHD taking stimulants like Ritalin, and an explosion in the use of caffeine drinks.

The result: at bedtime, many kids are looking for help in a pill.

“Our culture is certainly turned more toward a living better through chemistry approach,” say Psychiatrist Richard Winer, M.D.

He says the problem is the obvious: Sleeping aids can be habit forming. “My bias is toward keeping kids away from medication for sleep if at all possible. Because you don’t want to create some habits that’ll be even harder to break as time goes on in adulthood.”

He says for many kids, the solution is routine: Relax for a while, and then go to bed at the same time every night.

But, for some, the problem is more serious.

“There are a number of kids out there that have honest to goodness insomnia difficulties,” says Dr. Winer, “They have sleep disorders that do require treatment.”

Tips for Parents

A study performed by researchers at Stanford University found that teenagers require approximately one to two hours more sleep than 9- and 10-year-olds, who only require about eight hours of sleep. This goes against the school of thought that allows older kids to stay up later. Parents may want to be on the lookout for the following things, which could be caused from sleep deprivation:

Difficulty waking in the morning
Irritability in the afternoon
Falling asleep during the day
Oversleeping on the weekend
Having difficulty remembering or concentrating
Waking up often and having trouble going back to sleep
Sleep deprivation also can lead to extreme moodiness, poor performance in school and depression. Teens who aren’t getting enough sleep also have a higher risk of having car accidents because of falling asleep behind the wheel.


As the lives of children seem to be getting busier, their sleeping habits may be one of the first things impacted. Sleep, though being something that often gets sacrificed, is actually one of the most important things in a child’s life. Experts say taking sleep medications unauthorized by the FDA for teenage consumption is not the answer, however. Here are some suggestions about sleep:

Sleep is as important as food and air. Quantity and quality are very important. Most people need between seven-and-a-half to eight-and-a-half hours of uninterrupted sleep. If you want to press the snooze alarm in the morning you are not getting the sleep you need. This could be due to not enough time in bed, external disturbances or a sleep disorder.

Keep regular hours. Try to go to bed at the same time and get up at the same time every day. Getting up at the same time is most important. Getting bright light, like the sun, when you get up will also help. Try to go to bed only when you are sleepy. Bright light in the morning at a regular time should help you feel sleepy at the same time every night.

Stay away from stimulants like caffeine. This will help you get deep sleep, which is most refreshing. If you take any caffeine, take it in the morning. Avoid all stimulants in the evening, including chocolate, caffeinated sodas and caffeinated teas. They will delay sleep and increase awakenings during the night.

Use the bed just for sleeping. Avoid watching television, using laptop computers or reading in bed. Bright light from these activities and subject matter may inhibit sleep. If it helps to read before sleeping, make sure you use a very small wattage bulb to read. A 15-watt bulb should be enough.

Avoid bright light around the house before bed. Using dimmer switches in living rooms and bathrooms before bed can be helpful. Dimmer switches can be set to maximum brightness for morning routines.

Don't stress if you feel you are not getting enough sleep. It will just make matters worse. Know you will sleep eventually.

Avoid exercise near bedtime. No exercise at least three hours before bed.

Don't go to bed hungry. Have a light snack, but avoid a heavy meal before bed.

Bedtime routines are helpful for good sleep.

Avoid looking at the clock if you wake up in the middle of the night. It can cause anxiety.
If you can't get to sleep for over 30 minutes, get out of bed and do something boring in dim light till you are sleepy.

Keep your bedroom at a comfortable temperature.
If you have problems with noise in your environment, you can use a white noise generator. A fan will work.

References
American Sleep Apnea Association
National Sleep Foundation
Shuteye
Thomson Reuters

Sue Scheff: Low Self Esteem - Teen Depression

Teen low self esteem can lead to teen depression. Author Gary Nelson has written a most compelling story of his journey with his son and family dealing with teen depression in his new book.

Read his recent post - that can help many parents take a moment to pause and consider their own teens and how they are feeling.

Source: Dr. Gary Nelson - Author of “A Relentless Hope, Surviving Teen Depression’
Depression hides under a lot of rocks, including “low self-esteem.” It is truly amazing how many different ways depression can hide and fail to be recognized for what it is - a potentially very dangerous illness that can wreck and even take the lives of teens and adults. Many times I’ve listened as a pastoral counselor and pastor as teens have told me that they believed for a long time that they had suffered from “low self-esteem.” In most cases that meant they had been suffering from depression but never knew it. They and others around them simply thought they had “low self-esteem.” That also means the teen went all that time suffering instead of getting the necessary help. Learn to look under the rocks. When you hear a teen say they just suffer from “low self-esteem,” take a closer look. You might just lead them toward the help they need.
For more information on teen depression check my website: www.survivingteendepression.com

My new book, “A Relentless Hope: Surviving the Storm of Teen Depression” is available at Amazon and other outlets.

Depressed Teens and New Years Resolution by Gary Nelson

Teens suffering from depression and related illnesses like anxiety and bipolar disorder find it very difficult to even make New Year's resolutions, let alone keep them. Depression and its relatives very quickly tend to overwhelm teens. When faced with the idea of change depressed teens often see a mountain so huge that it seemingly can never be climbed or chiseled slowly into a molehill. They quickly feel overwhelmed and often respond with some thought or statement like, "It's too big. I'll never be able to do it... so why bother to even try." The teen then falls deeper into their pit of despair. One of the first things that the depression "steals" from the depressed teen is their ability to take large, seemingly impossible tasks and break them into smaller, manageable pieces. Most of us take this ability for granted and practice this making of mountains into manageable molehills everyday. Depressed teens want to change. They want healing. They just don't see a way over the mountain. The depression has them hog-tied, leaving the teens looking like they're just lazy and don't "want" to try. These depressed teens need help, not judgement. They need hope. For more information on this and other aspects of teen depression check out my new book, A Relentless Hope: Surviving the Storm of Teen Depression. If you have a teen who is struggling you might also want to check out Sue Scheff's new book, Wit's End.

Sue Scheff - Teen Depression and Inhalant Abuse

As the new year has started, parents need to become more educated and informed about today's teens and the issues they face.

Many parents know about substance abuse, and teach our kids to say no to drugs - but do you know about Inhalants? Ordinary household items that can be lethal to teens looking for a quick and inexpensive high? More importantly, sometimes deadly high.

Parent learn more about Inhalant Abuse.

Here is a great "talking tips" page from The Alliance for Consumer Education (ACE) - take the time to learn more today. You could save a child's life.

Sue Scheff - Teen Depression and the Holidays

We hear about many people that are suffering this year with saddness and depression. Whether it is an economy that leaves us frustrated we can’t give our kids what we would like to, or simply the feeling of hopefulessness.

Teens can suffer too. Teen Depression can lead to negative behavior and sometimes worse.
Learn more about Teen Depression.

Teenage depression is more than just bad moods or broken hearts; it is a very serious clinical illness that will affect approximately 20% of teens before they reach adulthood. Left untreated, depression can lead to difficult home situations, problems at school, drug abuse, and worse, violence toward themselves and others.

Certain young teens suffer from depression as result of situations surrounding their social or family life, but many are succeptable to the disease regardless of race, gender, income level or education. It is very important for parents to keep a watch on their teens - and to maintain a strong level of communication. Understanding the causes and warning signs of the illness can help parents prevent their teens from falling in to depression.

Learn more about surviving Teen Depression in Gary E. Nelson’s book, A Relentless Hope: Suviving the Storm of Teen Depression.

Sue Scheff - Parenting Teens - Teen Runaways

Teen Runaways are on the increase. Many teens think that the grass is greener on the other side.

They are confused and following the crowd of peers making poor choices. Teens want to escape the "rules of a household" and we as parents, become their number one enemy. They feel that they are fearless and can prove they can survive without their parents and our rules. Rules are put in place for a reason; we love our children and want them to grow up with dignity and respect we try to instill in them. Their flight plan, in some ways, is a cry for attention. Many times runaways are back home shortly, however there are other situations that can be more serious. This is not to say any child that runs away is not serious, but when this becomes a habit and is their way of rebelling, a parent needs to intervene.

So many times we hear how "their friend’s parents" allow a much later curfew or are more lenient, and you are the worst parents in the world. This is very common and the parent feels helpless, hopeless and alone. It is all part of the manipulation the teens put us through. With their unappreciative thoughts of us, they will turn to this destructive behavior, which, at times, results in them leaving the home.

Some teens go to a friend's house or relative they believe they can trust and make up stories about their home life. This is very common, a parent has to suffer the pain and humiliation that it causes to compound it with the need to get your child help that they need. If you fear your child is at risk of running, the lines of communication have to be open. We understand this can be difficult, however if possible needs to be approached in a positive manner. Teen help starts with communication.

If you feel this has escalated to where you cannot control them, it may be time for placement and possibly having your child escorted. Please know that the escorts (transports) are all licensed and very well trained in removing children from their home into safe programs. These escorts are also trained counselors that will talk to your child all the way, and your child will end his/her trip with a new friend and a better understanding of why their parents had to resort to this measure.

Helpful Hint if you child has runaway and you are using all your local resources – offer a cash reward to their friends privately, of course promising their anonymity and hopefully someone will know your child’s whereabouts.

Having a teen runaway is very frightening and it can bring you to your wits end. Try to remain positive and hopeful and do all you can to help understand why your child is acting out this way. These are times when parents need to seek help for themselves. Don’t be ashamed to reach out to others. We are all about parents helping parents.

Learn more visit www.helpyourteens.com.

Parents Universal Resource Experts - Sue Scheff - Teen Depression

Teenage depression is more than just bad moods or broken hearts; it is a very serious clinical illness that will affect approximately 20% of teens before they reach adulthood. Left untreated, depression can lead to difficult home situations, problems at school, drug abuse, and worse, violence toward themselves and others.

Certain young teens suffer from depression as result of situations surrounding their social or family life, but many are succeptable to the disease regardless of race, gender, income level or education. It is very important for parents to keep a watch on their teens - and to maintain a strong level of communication. Understanding the causes and warning signs of the illness can help parents prevent their teens from falling in to depression.

My name is Sue Scheff™ and I understand how difficult it can be dealing with a troubled teenager because I have been there! My experiences lead to the founding Parents Universal Resource Experts, an organization dedicated to parental support, education and resources. I work with parents like you every day, looking for help and answers in desperation. You are not alone!This website is dedicated to the bringing parents the best information about teenage depression; causes, symptoms, statistics and preventative measures.

Please visit our newly added informative section on teenage anxiety, the lesser known, but equally serious, relative of depression.Learn more click here.

Sue Scheff: Mistreated Depression

Source: Connect with Kids

“Basically, psychiatrists are pretty busy. They don’t want to spend a lot of time with people. They want to get people in and out, maybe two or three an hour. … It pays better to do that than spending an hour doing psychotherapy.”

– David Gore, Ph.D., clinical psychologist

Fifteen-year-old Sarah McMenamin suffers from depression. It started a year ago with the death of her father.

“I was just like, ‘I just want to die,’” she says, describing her feeling before seeing a therapist. “I would never kill myself, but I just wish I was dead, I just wish I was never going to wake up.”

For depressed teens, experts at the American Academy of Child and Adolescent Psychiatry say what can help is medicine – combined with talk therapy.

“I think the therapist helped me,” explains Sarah, “’cause it was talking, you know, I got it out. I didn’t bottle everything up.”

“The advantage to getting some therapy along with medication is that you get to the root of the problem,” explains Dr. David Gore, clinical psychologist. “You get to see why you’re feeling that way. And if you start understanding why you’re feeling that way, chances are pretty good you’ll stop feeling that way.”

But according to a new study from Thomson-Reuters, more teens than ever are getting medication without psychotherapy. Why? Gore has an answer.

“Basically, psychiatrists are pretty busy,” Dr. Gore says. “They don’t want to spend a lot of time with people. They want to get people in and out, maybe two or three an hour. … It pays better to do that than spending an hour doing psychotherapy.”

Three months ago, Sarah started seeing a new doctor.

“Right away he put me on Zoloft,” she says. “He didn’t even know me for an hour and he put me on it.”

But psychologists say medicine alone just won’t work as well.

“You take your pill, you’ll get some immediate relief,” explains Dr. Gore, “but the problem’s going to crop up again in two months or four months or six months. You’ve got to get to the root of the problem.”

Sarah will resume talk therapy again in a few months. She says she is looking forward to it.

“You get it out on the table and you know your feelings’” she says, “and you go in thinking it’s one thing and you come out finding out it’s like 10 different things and you’re like, ‘Wow.’”

Tips for Parents

All teens experience ups and downs. Every day poses a new test of their emotional stability – fighting with a friend, feeling peer pressure to “fit in” with a particular crowd or experiencing anxiety over a failed quiz – all of which can lead to normal feelings of sadness or grief. These feelings are usually brief and subside with time, unlike depression, which is more than feeling blue, sad or down in the dumps once in a while.

According to the Nemours Foundation, depression is a strong mood involving sadness, discouragement, despair or hopelessness that lasts for weeks, months or even longer. It also interferes with a person’s ability to participate in normal activities. Often, depression in teens is overlooked because parents and teachers feel that unhappiness or “moodiness” is typical in young people. They blame hormones or other factors for teens’ feelings of sadness or grief, which leaves many teens undiagnosed and untreated for their illness.

The Mayo Clinic reports that sometimes a stressful life event triggers depression. Other times, it seems to occur spontaneously, with no identifiable specific cause. However, certain risk factors may be associated with developing the disorder. Johns Hopkins University cites the following risk factors for becoming depressed:

Children under stress who have experienced loss or who suffer attention, learning or conduct disorders are more susceptible to depression.

Girls are more likely than boys to develop depression.

Youth, particularly younger children, who develop depression are likely to have a family history of the disorder.

If you suspect that your teen is clinically depressed, it is important to evaluate his or her symptoms and signs as soon as possible. The National Depressive and Manic-Depressive Association cites the following warning signs indicating that your teen may suffer from depression:

Prolonged sadness or unexplained crying spells
Significant changes in appetite and sleep patterns
Irritability, anger, worry, agitation or anxiety
Pessimism or indifference
Loss of energy or persistent lethargy
Feelings of guilt and worthlessness
Inability to concentrate and indecisiveness
Inability to take pleasure in former interests or social withdrawal
Unexplained aches and pains
Recurring thoughts of death or suicide

It is important to acknowledge that teens may experiment with drugs or alcohol or become sexually promiscuous to avoid feelings of depression. According to the National Mental Health Association, teens may also express their depression through other hostile, aggressive, risk-taking behaviors. These behaviors will only lead to new problems, deeper levels of depression and destroyed relationships with friends and family, as well as difficulties with law enforcement or school officials.

The development of newer antidepressant medications and mood-stabilizing drugs in the last 20 years has revolutionized the treatment of depression. According to the Mayo Clinic, medication can relieve the symptoms of depression, and it has become the first line of treatment for most types of the disorder. Psychotherapy may also help teens cope with ongoing problems that trigger or contribute to their depression. A combination of medications and a brief course of psychotherapy are usually effective if a teen suffers from mild to moderate depression. For severely depressed teens, initial treatment usually includes medications. Once they improve, psychotherapy can be more effective.

Immediate treatment of your teen’s depression is crucial. Adolescents and children suffering from depression may turn to suicide if they do not receive proper treatment. Suicide is the third leading cause of death for Americans aged 10-24. The National Association of School Psychologists suggests looking for the following warning signs that may indicate your depressed teen if contemplating suicide:

Suicide notes: Notes or journal entries are a very real sign of danger and should be taken seriously.

Threats: Threats may be direct statements (“I want to die.” “I am going to kill myself”) or, unfortunately, indirect comments (“The world would be better without me.” “Nobody will miss me anyway”). Among teens, indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.

Previous attempts: If your child or teen has attempted suicide in the past, a greater likelihood that he or she will try again exists. Be very observant of any friends who have tried suicide before.

Depression (helplessness/hopelessness): When symptoms of depression include strong thoughts of helplessness and hopelessness, your teen is possibly at greater risk for suicide. Watch out for behaviors or comments that indicate your teen is feeling overwhelmed by sadness or pessimistic views of his or her future.

“Masked” depression: Sometimes risk-taking behaviors can include acts of aggression, gunplay and alcohol or substance abuse. While your teen does not act “depressed,” his or her behavior suggests that he or she is not concerned about his or her own safety.

Final arrangements: This behavior may take many forms. In adolescents, it might be giving away prized possessions, such as jewelry, clothing, journals or pictures.

Efforts to hurt himself or herself: Self-injury behaviors are warning signs for young children as well as teens. Common self-destructive behaviors include running into traffic, jumping from heights and scratching, cutting or marking his or her body.

Changes in physical habits and appearance: Changes include inability to sleep or sleeping all the time, sudden weight gain or loss and disinterest in appearance or hygiene.

Sudden changes in personality, friends or behaviors: Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important and avoiding friends.

Plan/method/access: A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide.
Death and suicidal themes: These themes might appear in classroom drawings, work samples, journals or homework.

If you suspect suicide, it is important to contact a medical professional immediately. A counselor or psychologist can also help offer additional support.

References
American Academy of Child and Adolescent Psychiatry
American Foundation for Suicidal Prevention
Johns Hopkins University
Mayo Clinic
National Association of School Psychologists
National Depressive and Manic-Depressive Association
National Institute of Mental Health
National Mental Health Association
Nemours Foundation
Thomson-Reuters

Sue Scheff: Teens, Sex and Depression

Source: Connect with Kids

“It hurts, because I care so much about him.”

– Teagan, 15 years old

Fifteen-year-old Teagan says her new boyfriend is wonderful. “I never thought anyone like Preston could come along,” Teagan says. “He’s the greatest guy I’ve ever known.”

But is she as lucky as she thinks?

Studies show that romantic involvement brings adolescents down, rather than up. What’s more, researchers at the University of North Carolina find that teen girls who are sexually active are twice as likely to be depressed compared to girls not having sex.

But, even among abstinent teens who date, one of the problems is trust.

“Say your boyfriend went off to work and never called you that day,” Teagan says. “And you talked every single day on the phone. I mean you’d be kind of concerned and kind of wondering why. And then someone comes along and says ‘well maybe he’s cheating on you…’”

Combine adolescent insecurity with imagination and the result is a lot of questions: Where is he? Why doesn’t she call? Does he really like me? Why is she talking to that other boy?

That’s where most of the stress comes in,” Teagan says. “Getting thoughts in your head about what might be going on, when it probably isn’t going on at all.”

Experts say parents can help ease their child’s pain by listening and taking them seriously. It’s not puppy love to them, it’s real. “It hurts,” Teagan says, “because I care so much about him.”

Experts also advise teaching your child that early relationships may hurt, but they’re indispensable. “They will have many relationships before they finally settle on a life mate,” says Cheryl Benefield, a school counselor. “Let them know that when things happen, it’s maybe just preparing them for a better relationship in the future.”

Tips for Parents
According to the National Institute of Mental Health, boys and girls seem to be equally at risk for depressive disorders during childhood, but during adolescence, girls are twice as likely as boys to develop depression. Family history and stress are listed as factors, but another factor that often causes depression in girls is the break-up of a romantic relationship.

The authors of a study conducted at Cornell University titled “You Don’t Bring Me Anything but Down: Adolescent Romance and Depression,” found that females become “more depressed than males in adolescence partly as a consequence of their involvement in romantic relationships.” The reason? According to the study, “females’ greater vulnerability to romantic involvement explains a large part of the emerging sex difference in depression during adolescence.”

At any given time, five percent of children suffer from depression. Children under stress, who have experienced a loss, or who suffer from other disorders are at a higher risk for depression. Here are some signs of depression from the American Academy of Child and Adolescent Psychiatry (if one or more of these signs of depression persist, parents should seek help):

Frequent sadness, tearfulness, crying
Hopelessness
Decreased interest in activities, or inability to enjoy previously favorite activities
Persistent boredom; low energy
Social isolation, poor communication
Low self-esteem and guilt
Extreme sensitivity to rejection or failure
Increased irritability, anger or hostility
Difficulty with relationships
Frequent complaints of physical illnesses such as headaches and stomachaches
Frequent absences from school or poor performance in school
Poor concentration
A major change in eating and/or sleeping patterns
Talk of or efforts to run away from home
Thoughts or expressions of suicide or self destructive behavior
Getting an early diagnosis and medical treatment are critical for depressed children.

Depression is a serious condition, which, if left untreated, can even become life threatening. Suicide is the third leading cause of death among young people, leading to nearly 4,000 deaths a year. The rate has tripled since 1960. Therapy can help teenagers understand why they are depressed and learn how to handle stressful situations. Treatment may consist of individual, group or family counseling. Medications prescribed by a psychiatrist may be needed to help teens feel better.

Ways of treating depression include:

Psychotherapy: to explore events and feelings that are painful and troubling. Psychotherapy also teaches coping skills.
Cognitive-behavioral therapy: to help teens change negative patterns of thinking and behaving.
Interpersonal therapy: to focus on ways of developing healthier relationships at home and school.
Medication: to relieve some symptoms of depression (often prescribed along with therapy).
References
Journal of Health and Social Behavior
National Institute of Mental Health
American Academy of Child and Adolescent Psychiatry
National Mental Health Association
University of North Carolina

Sue Scheff: Following the Rules

By Lisa Medoff


Nina posted some questions about her 10-year-old daughter lying about eating and drinking in the bedroom and watching TV with the door closed. Nina wants to how she can tell if her daughter is deliberately lying or simply forgetful, as her daughter was a micro-preemie, and Nina is worried that her premature birth has affected her behavior and memory.

Nina is also wondering about the best way to encourage her daughter to tell the truth about her behavior.

Her husband feels that their daughter plays both of her parents against each other, and he punishes her by saying that he is not going to take her anywhere for the summer; she won’t be allowed to go bike riding or have other interesting adventures. Nina wants to know if these are apt punishments for her daughter’s behavior.

Unfortunately for parents, there is no absolute, surefire way to determine if your child is deliberately lying or has simply forgotten the rules. Therefore, instead of spending your time trying to figure out if your daughter is lying, shift your focus to trying to help her remember the rules.

Tell your daughter, “I can see that it has been hard for you to remember our rules about not eating in the bedroom and watching TV with the door closed. Let’s see if we can figure out a way to help you remember.”
Try different ways to help her with her memory, such as having her write sticky notes with the rules and posting them near the TV, or making poster collages with pictures of food that is crossed out.

Any extra practice with memory tricks will be helpful for children who have experienced developmental difficulties.

Tell her that even though it may be hard for her to remember, she will still need to learn the consequences for breaking the rules.

Discuss what those consequences will be and follow through on them every time. She needs to see that the end result is the same, whether she lies or forgets, and you won’t have to waste time or energy trying to figure out if she is lying.

Be on the lookout for times when she does remember the rules. Give lots of positive attention, such as saying, “I noticed that you finished your snack in the kitchen before you went in to watch television. You must feel good about remembering to follow the rules. I’m really proud of you.”

Make a behavior chart to keep track of days where she was able to follow the rules.

Think of rewards that she can earn after a week or a month of good days.

In terms of the consequences, discipline works better if it is specific, immediate, is appropriate for the situation, and allows the child to make up for breaking the rules.

For example, a consequence of eating where she is not supposed to could be having to clean and vacuum the area.

Read entire article here: http://www.education.com/magazine/column/entry/Following_the_Rules/

Parents Universal Resource Experts - Sue Scheff - Tips for When Your Child Starts Dating

Source: OneToughJob

Your Child's Behavior at 12 -15 years old

As your child moves from childhood into the teenage years, she will encounter many social and cultural challenges. It is an exciting time and yet a scary time for your child. As she moves more toward independence, she will be convinced she knows everything, you know nothing and you were literally born yesterday. In fact, at this time, she needs you more than ever. By knowing what to expect at this stage of your child's life, you are better equipped to interact effectively with her. By communicating clearly with your child and listening to what she has to say and the emotions she is expressing, you can help your child through this stage.

Tips for Dating

1.Talk with your child about what she hopes for from dating and from relationships.2.Let her know your concerns and hopes for her as she goes out on dates.3.Know who your child is hanging out with and dating.4.Talk with the parents of those kids.5.Set clear rules about who can be with her in your home when there are no adults present.6.Teach manners and how to be respectful of others.8.Let your child know she can always call home if she is uncomfortable or feels worried.9.Tell your child to have fun—dating should be fun.

SOS - Teen Peer Pressure

I was just recommended this dynamic book by Dr. Lisa Medoff and can’t wait to read it! As a Parent Advocate, this can be one of the most trying times for parents as school is opening. Today with issues surrounding social networking, compounded with peer pressure - “Stressed Out Students” are at risk of making not so good choices.

Here is the recent Press Release about “SOS” - which can be purchased on Amazon today!

SOS: STRESSED OUT STUDENT’S

GUIDE TO HANDLING PEER PRESSURE



Lisa Medoff, PhD



In a society overloaded with media that glamorizes sex, drinking, and drugs, and where any outrageous, dangerous, humiliating thing a person does can be caught on a cell phone and posted on the internet for all to see, teens are feeling forced to succumb to peer pressure like never before. As peers become the pseudo “paparazzi,” teens need somewhere to turn for answers that give them the strength to reject the constant pressure to “fit in.”



Now Kaplan - widely respected for helping millions of students prepare for every aspect of academic life - steps outside the classroom to guide teens, parents, and educators on the ever-increasing pressure-cooker of adolescence. Its SOS: Stressed Out Student’s Guide series offers realistic advice written by students, for students, on the topics of most concern to today’s teens. Every book in the motivational series also features advice from Education.com columnist, educator, and psychologist Lisa Medoff, PhD, who works with troubled teens and teachers in high-risk school districts.



SOS: STRESSED OUT STUDENT’S GUIDE TO HANDLING PEER PRESSURE (Kaplan Publishing; September, 2008) hones in on and tackles the scourge of peer pressure and its effects on teenagers. As Dr. Medoff assures readers, “This book will help teens sort out the different influences that peer pressure is having on them. It will show them how peer pressure can manipulate them into making some very bad, life altering decisions about drugs, sex, cheating, stealing, and being cruel to others. They’ll learn to trust themselves and be proud of who they are.”



Featuring frank, realistic language plus an engaging, highly illustrated layout, SOS: STRESSED OUT STUDENT’S GUIDE TO HANDLING PEER PRESSURE is designed to appeal to the modern teenager’s eye, attention span, and need for quick gratification. It is also an imperative handbook for adults who want to understand and open the lines of communication with the adolescents in their lives.



Without preaching, each of the ten easy to read chapters in SOS: STRESSED OUT STUDENT’S GUIDE TO HANDLING PEER PRESSURE is packed with explanations, scenarios, stats, and fascinating facts such as:



· 1 in 4 sexually active teens becomes infected with an STD each year.

· Nationally, 6 out of 10 girls who had sex before the age of 15 report that it was involuntary.

· Teens and juveniles make up 25% of all shoplifters, though not all steal because they want something. Many teens shoplift compulsively because of stress, anxiety, psychological problems, or abuse.

· Teens with a history of habitually ditching school are also found to be at greater risk for involvement with gangs, drugs, alcohol, or violence.



Along with SOS: Stressed Out Student’s Guide to Saying No to Cheating and SOS: Stressed Out Student’s Guide to Dealing With Tests, SOS: STRESS OUT STUDENT’S GUIDE TO HANDLING PEER PRESSURE is one of the exciting books in Kaplan’s new series SOS: Stressed Out Student’s Guides.



ABOUT THE AUTHOR



Lisa Medoff, PhD holds a B.A. in psychology, a Masters degree in school counseling and a PhD in child and adolescent development. She has taught courses at Stanford University, Santa Clara University, San Jose State University and DeAnza College. She has worked with all types of children including students with special needs, ADHD, learning disabilities, depression, and anxiety. Lisa Medoff, understands the needs and mind-set of modern teenagers, and has mastered the difficult task of appropriately reaching out to them at their tumultuous life stage.

The Ballad of the Adopted Child by Jeanne Droullard

DOES your teen,

- always seem angry?
- have anger that turns into rage?
- show signs of depression, i.e., withdrawal, slipping grades?
- show disrespect to you or disrespect people in authority?
- self-protect by keeping people at a distance?
- lie, manipulate and steal?
- ever talk about his/her biological parents?
- want to find his/her biological parents?

DO you,

- feel comfortable about your teen's behavior?
- recognize signs of RAD (Reactive Attachment Disorder)?
- believe you must be adopted to show signs of RAD?
- understand what is meant by the Primal Wound?
- think it makes a difference at what age a child is adopted?
- understand bonding and how it can be disrupted?
- understand the fear and pain of an adoptee?
- understand adoptee' difficulty in trusting and showing love


It can be difficult to know if your adopted teen's anger is normal and within the range of typical teenage behavior. Most teenagers get angry, especially during the years when their bodies are changing and the hormones can bring quick and severe mood swings. All teenagers are searching the world trying to find out who they are and what they want to become. They all want to know how the world will affect them and how they will affect the world.

If not addressed as a child, an adopted teenager has a duality of conflicts to overcome. Whether adopted as a baby or as an older child, this teenager has had a separation from the birth mother and this is a strong link that is not forgotten. Nancy Verrier calls this the Primal Wound. In the womb, Psychologists now agree that the child is very aware of the mother, how she smells, how she laughs and feels, even how she sounds. The baby has been inside the womb for nine months. This baby even realizes if it was a wanted pregnancy or an unwanted pregnancy - this baby knows. It also has an awareness of the physical, mental and emotional connection with the mother. Bonding begins before physical birth and possibly shortly after conception. Many professionals used to laugh at this idea and thought it impossible for a little baby to know and remember being separated from its birth mother. Alas, the tide has changed and the professionals now believe that this child couldn't help but know the separation from the birth mom that carried it - and this is the primal wound that stays with that child forever.

Read entire article here: http://www.helpyourteens.com/adoption/index.html

Teens Say School Pressure Is Main Reason For Drug Use

Source: digtriad.com, Triad, NC

New York — A new study reveals a troubling new insight into the reasons why teens use drugs.The study conducted by the Partnership for a Drug-free America shows that of 6,511 teens, 73% report that school stress and pressure is the main reason for drug use.

Ironically, only 7% of parents believe that teens use drugs to cope with stress.


Second on the list was to “feel cool” (73%), which was previously ranked in the first position. Another popular reason teens said they use drugs was to “feel better about themselves”(65%).Over the past decade, studies have indicated a steady changing trend in what teens perceive as the motivations for using drugs. The “to have fun” rationales are declining, while motivations to use drugs to solve problems are increasing.

On the positive side, the study confirms that overall abuse remains in a steady decline among teens. Marijuana, ecstasy, inhalants, methamphetamine alcohol and cigarette usage continue to decrease.

Additional findings show:

- 1 in 5 teens has abused a prescription medication- Nearly 1 in 5 teens has already abused a prescription painkiller- 41% of teens think it’s safer to abuse a precription drug than it is to use illegal drugs.

Teens continue to take their lives into their own hands when they intentionally abuse prescribed medications, said Pasierb. “Whether it’s to get high or deal with stress, or if they mistakenly believe it will help them perform better in school or sports, teens don’t realize that when used without a prescription, these medicines can be every bit as harmful as illegal street drugs.”

Sue Scheff: Inactive Teens by Connect with Kids

“Make time for [exercise] because once you get out of it, it’s so hard to get back in.”

– Tori, 16 years old

They run and play and participate in all sorts of sports. But what happens when little kids become teens?

“After a while, you just become like a couch potato,” says Tori, 16.

When she was a cheerleader in middle school, Tori got plenty of exercise. Now she’s 16, and she admits she hasn’t exercised regularly in years.

“I’m not physically fit,” she says. “I mean, I’m skinny, but I guess it’s just because I have a fast metabolism. But physically fit? Noooo!”

A study in the Journal of the American Medical Association followed more than one thousand children aged 9 to 15.

97% were active when they were 9-years-old, but by the time they were 15, only 31% of teens were meeting the recommended sixty minutes of vigorous physical activity during the week. And only 17% met that target on the weekend.

The older they got, the less they exercised!

Experts speculate, for some it’s just laziness, for other, interests change, or they’re simply too busy.

Tori agrees: “School starts to get harder, and you get more homework, and you want to spend more time with your friends and you need more sleep.”

Still, experts warn that teens must find a way to remain active otherwise they risk becoming obese or sick later in life. Parents can help by getting involved in activities with their children.

“Whether it’s running and pulling a kite in the wind or going out throwing a Frisbee or going for a walk with your dog, if you incorporate those things, you’re just gonna have a better quality of life,” says Jon Crosby, an Atlanta-based sports and fitness trainer.

Tori’s advice to fellow teens: “Make time for [exercise] because once you get out of it, it’s so hard to get back in.”

Tips for Parents
Many studies have found similar results to the UC- San Diego study. University of Pittsburgh researchers report that as girls age, they increasingly get less and less exercise. In their study, published in The New England Journal of Medicine, the researchers evaluated the exercise habits of 1,213 black girls and 1,166 white girls for 10 years, beginning at age 9 or 10. By the time the girls were 16 or 17, nearly 56% of the black girls and nearly 31% of the white girls reported no regular exercise participation at all outside of school.

While this study focused on teenage girls, other research shows that participation in physical activity is decreasing among all American children. The National Association for Sport & Physical Education reports that only 25% of all U.S. kids are physically active. And while most parents believe that their children are getting enough exercise during school hours, the President’s Council on Physical Fitness and Sports (PCPFS) says that only 17% of middle or junior high schools and 2% of senior high schools require daily physical activity for all students.

As a result of this physical inactivity, more and more children are becoming obese. According to the Centers for Disease Control and Prevention, 13% of children aged 6 to 11 and 18% of teens aged 12 to 19 are overweight. These same overweight adolescents also have a 70% chance of becoming overweight or obese adults and are at an increased risk for developing health problems, such as heart disease, type 2 diabetes, high blood pressure and some forms of cancer. In fact, the PCPFS reports that physical inactivity contributes to 300,000 preventable deaths a year in the United States.

Besides preventing the onset of certain diseases, regular physical exercise can also help your child in the following ways, according to the Centers for Disease Control and Prevention:

Helps control weight
Helps build and maintain healthy bones, muscles and joints
Improves flexibility
Helps burn off stress
Promotes psychological well-being
Reduces feelings of depression and anxiety
As a parent, you need to emphasize to your child the importance of physical activity. This can often be a difficult task, as you may encounter some resistance from a child who enjoys sedentary activities like watching television and surfing the Internet. The American Council on Exercise (ACE) recommends the following guidelines for easing your child into an active lifestyle:

Don’t just tell your child that exercise is fun; show him or her! Get off the couch and go biking, rock climbing or inline skating with your child. Skip rope or shoot baskets with him or her.
Invite your child to participate in vigorous household tasks, such as tending the garden, washing the car or raking leaves. Demonstrate the value of these chores as quality physical activity.
Plan outings and activities that involve some walking, like a trip to the zoo, a nature hike or even a trip to the mall.
Set an example for your child and treat exercise as something to be done on a regular basis, like brushing your teeth or cleaning your room.
Concentrate on the positive aspects of exercise. It can be a chance for your family to have some fun together. Avoid competition, discipline and embarrassment, which can turn good times into bad times. Praise your child for trying and doing.
Keep in mind that your child is not always naturally limber. His or her muscles may be tight and vulnerable to injury during growth spurts. Be sure to include stretching as part of your child’s fitness activities.
Exercise and nutrition go hand in hand. Instead of high-calorie foods and snacks, turn your child on to fruits and low- or non-fat foods.
If you discover that your teen is having trouble staying motivated to exercise, the American Academy of Family Physicians suggests these strategies:

Choose an activity that your child likes to do. Make sure it suits him or her physically, too.
Encourage your child to get a partner. Exercising with a friend can make it more fun.
Tell your child to vary his or her routine. Your child may be less likely to get bored or injured if he or she changes his or her exercise routine. Your child could walk one day and bicycle the next.
Ensure that your child is active during a comfortable time of day. Don’t allow him or her to work out too soon after eating or when it’s too hot or cold outside. And make sure your child drinks plenty of fluids to stay hydrated during physical activity.
Remind your child not to get discouraged. It can take weeks or months before he or she notices some of the changes from and benefits of exercise.
Tell your child to forget “no pain, no gain.” While a little soreness is normal after your child first starts exercising, pain isn’t. He or she should stop if hurt.
With a little encouragement and help from you, your child will be up and moving in no time!

References
American Academy of Family Physicians
American Council on Exercise
Centers for Disease Control and Prevention
National Association for Sport & Physical Education
Office of the Surgeon General
President’s Council on Physical Fitness and Sports
The New England Journal of Medicine

The Dangers of Inhalant Abuse

I know I have Blogged a lot about Inhalant Abuse and I will continue to do so - especially after reading about the recent senseless deaths. Take a moment to read their Blog at http://inhalant-info.blogspot.com/ - Take the time to learn more and you never know when this knowledge will be necessary. http://www.inhalant.org/

What is Inhalant Abuse? The Dangers...

Inhaled chemicals are rapidly absorbed through the lungs into the bloodstream
and quickly distributed to the brain and other organs. Within minutes, the user
experiences intoxication, with symptoms similar to those produced by drinking
alcohol. With Inhalants, however, intoxication lasts only a few minutes, so some
users prolong the “high” by continuing to inhale repeatedly.


Short-term effects include:

headaches, muscle weakness, abdominal pain, severe
mood swings and violent behavior, belligerence, slurred speech, numbness and
tingling of the hands and feet, nausea, hearing loss, visual disturbances, limb
spasms, fatigue, lack of coordination, apathy, impaired judgment, dizziness,
lethargy, depressed reflexes, stupor, and loss of consciousness.
The Inhalant user will initially feel slightly stimulated and, after successive
inhalations, will feel less inhibited and less in control. Hallucinations may
occur and the user can lose consciousness. Worse, he or she, may even die.
Please see Sudden Sniffing Death Syndrome below.


Long-term Inhalant users generally suffer from:

weight loss, muscle weakness,
disorientation, inattentiveness, lack of coordination, irritability and depression.
Different Inhalants produce different harmful effects, and regular abuse of these
substances can result in serious harm to vital organs. Serious, but potentially
reversible, effects include liver and kidney damage. Harmful irreversible effects
include: hearing loss, limb spasms, bone marrow and central nervous system
(including brain) damage.


Sudden Sniffing Death Syndrome:

Children can die the first time, or any time, they try an Inhalant. This is
known as Sudden Sniffing Death Syndrome. While it can occur with many
types of Inhalants, it is particularly associated with the abuse of air conditioning
coolant, butane, propane, and the chemicals in some aerosol products. Sudden Sniffing Death Syndrome is usually associated with cardiac arrest. The Inhalant causes the heart to beat rapidly and erratically, resulting in cardiac arrest.

www.helpyourteens.com

www.inhalant.org