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The Lingering Effects of Trauma: Helping Youth Cope With Violence

By Debra Whiting Alexander for The Bureau For At-Risk Youth

Karla had just taken a seat in the high school auditorium when the lights went out. The curtains slowly opened and the cast of 12 were standing on the stage with their backs to the audience. It was an eerily quiet opening for a musical production but Karla remembers thinking it was a cool dramatic effect. There was a hush across the audience waiting in anticipation. When the cast suddenly turned and faced the audience, Karla saw what she thought were play guns in their hands. But when they opened fire and bullets sprayed from one end of the auditorium to the other, she realized the screams of the victims were real. It was no act and there would be no play.

Karla was shot in the leg. She crouched to the floor with other screaming students and their families, dragging her leg in a desperate attempt to find her dad. She tried frantically to remember which section of the auditorium he had chosen to sit in. It was becoming difficult to breathe when deep heavy sobs began to overtake her. And then she lunged awake screaming for her father in the pitch-black night of her bedroom.

"The nightmares are back", Karla announced. "I can't believe this is happening again. They aren't dreams of what really happened, but I feel the same terror. This time I was afraid for my dad." Karla sat in my counseling office trembling as she described her nightmare to me. She would be the first of four students that day to share post trauma reactions with me. It was nearing the second "anniversary" date of the school shooting that changed their lives forever. On that morning, a total of four people were murdered and more than 20 students were wounded. Physical wounds will be life long for some, and for many others the psychological wounds will be too. For most, the lingering effects of that traumatic morning will continue to come and go.

What To Expect

It is normal for children as well as adults to experience a wide range of reactions following a traumatic event. Although not everyone will experience post trauma reactions, given enough stress, everyone will have reactions to it. Some will experience symptoms immediately while others find symptoms emerging later. There is no right or wrong way to move through the process you must go through to resolve such an event.

Exposure to murder or the threat of murder is among the most difficult traumas people can face. Students tell me they can't concentrate in class, are easily startled and complain of nausea, loss of appetite and sleep problems. All ages regress developmentally and some survivor's go to great lengths to avoid reminders of the event. Reliving memories through flashbacks, intrusive thoughts and images and nightmares is common. Physical complaints of headaches, diarrhea and severe anxiety also happen frequently. Research indicates that exposure to trauma can even cause profound physiological changes to the brain and central nervous system.

Most survivors experience intense feelings of fear and worry that the incident will happen again. The sense of safety and security they once had in the world has been stolen from them. Questioning spiritual beliefs and the meaning to life is an important part of trying to make sense of something that may have completely shifted the foundation of values and beliefs one was raised on.

Daily routines and activities are difficult for trauma survivor's to follow and life often feels as though it will be permanently disrupted. Teens often say they feel like they're going "crazy." The roller coaster of emotions they experience makes them feel as though they are "losing their mind." You can assure them they are not crazy. What happened was.

Trauma reactions can and do happen to emotionally healthy people. They cannot be prevented by maturity, strength, courage or good mental health. The temptation to self-medicate disturbing thoughts, feelings and physical sensations is especially high for adolescents. Many believe if they can numb and block out frightening reactions they will go away on their own. Clearly, using the distractions of drugs, alcohol, sex or food only complicates the survivor's ability to move on. They often get "stuck" on the emotional roller coaster that can cause one to feel so "crazy." .

Traumatic memories can replay themselves and interfere with daily living. They are memories like no others. They are difficult to shake and impossible to erase. Like adults, children and adolescents need to talk about them, understand what they went through and learn ways to cope with distressing symptoms. It's been said what you can't put to words, you can't put to rest. Professional debriefing is an opportunity for those involved or impacted by a trauma to talk about what they went through, gain an understanding about the range of normal responses they can expect and learn techniques for coping with distressing symptoms. The sooner survivor's of trauma receive emotional first aid the better.

Adolescents may refuse help from others for many of the same reasons adults do. They may be afraid of becoming too overwhelmed by talking about it. If they start to cry, many fear they won't be able to stop. Reviving troublesome memories that evoke difficult feelings and symptoms is extremely painful. Others simply feel it is just impossible to explain what they went through. Some may be struggling with feelings of guilt and anger about their role in the event. Others believe in order to forget what happened, it's better not to talk about it. By disclosing their true thoughts and feelings survivor's often say they fear they will be seen as having a "mental condition." Many also fear they may upset others by sharing the graphic parts of the experience they continue to be most troubled by.

A pre-teen once asked me; "Don't you have a pill or something you can give me to just make me forget?" Part of successful counseling involves helping survivor's understand the value of remembering. Techniques can be taught to help survivor's learn to live with the images and find a reason to go on.

What You Can Do

Parents and concerned adults can do a lot to help children and teens survive traumatic experiences. Victims must find their own way to go on but with support and guidance you can help them find relief from distressing symptoms. You can also help them figure out how to endure profound suffering and loss. Remember the following:

• Be willing to listen when the child is ready to talk.
• Openly acknowledge the trauma and what happened honestly.
• Help reestablish a sense of safety and security.
• Increase comfort and adjust for your child's own unique fears.
• Tolerate temporary behavioral and mood changes.
• Educate yourself and your family about the normal responses to trauma.
• Give hope and be prepared to address spiritual questions and concerns.
• Seek professional help if stress is prolonged or cannot be alleviated.
• Seek support and consultation from a trained trauma specialist who can provide you with a variety of helpful strategies.

Moving through the myriad of experiences following a traumatic event is never an easy process and there are no quick fixes. A traumatic memory for most can only be integrated through a painfully slow process. Understanding this is the first step. Love, empathy, support and professional assistance, if necessary, can help take you the rest of the way.

Reaffirm The Future With Hope

I tell people the trauma they suffered will always be a part of their life but it is not all of life. It may be a sentence, page or chapter in their life story, but it's not the whole book. No doubt there will be more tragedies to endure in the chapters yet to be written, but there will be many good memories too. How they transform their suffering from this tragedy can help them respond to stress in the future. I ask my clients, "How has this changed you? In what ways are you different?" Children and adolescents often say the same thing; "I appreciate everything about my life more", "I don't take things or people for granted" and "My beliefs and goals have grown stronger."

The evening following Karla's visit to my office, a school performance was taking place in the auditorium of her high school. Her dreams had turned the same event into a horror story just one night earlier. After she shared the nightmare with her father he asked if it might be better if she didn't attend. Karla told her dad, "No, it wouldn't be better. I can't stop living my life. It was a dream about the past. Not my future." That evening, Karla and the rest of her school enjoyed a terrific performance. It was a good memory all could add to their life stories.

We must acknowledge to our children that a part of life is not good or secure. But that trauma is not all of life. It is just a part. Eventually what's good about life returns to help balance what's not.

About Debra Whiting Alexander, Ph.D.

Debra Whiting Alexander, Ph.D. is the author of Children Changed by Trauma: A Healing Guide (New Harbinger Publications, 1999) and two series of creative healing books for children and teens recovering from post trauma stress; Something Bad Happened series and The Way I Feel series (The Bureau For At-Risk Youth, 1991).

She consulted on the video Saving Our Schools: From Hate And Violence (Heartland Media, 1999) and is currently working on a video project regarding the emotional aspects of emergency care (EMP International, Inc., 2000).

She is currently a Trauma Consultant and Counselor for the Springfield School District and Professor at Northwest Christian College in Eugene, Oregon.

Bullying: What Schools and Parents Can Do

By Cohn and Canter for National Association Of School Psychologists

Bullying is a widespread problem in our schools and communities. This behavior encompasses physical aggression, threats, teasing, and harassment. Although it can lead to violence, bullying typically is not categorized with more serious forms of school violence involving weapons, vandalism, or physical harm. It is, however, an unacceptable anti-social behavior that is learned through influences in the environment, e.g., home, school, peer groups, even the media. As such, it also can be unlearned or, better yet, prevented.

A bully is someone who directs physical, verbal, or psychological aggression or harassment toward others, with the goal of gaining power over or dominating another individual. Research indicates that bullying is more prevalent in boys than girls, though this difference decreases when considering indirect aggression (such as verbal threats).

A victim is someone who is repeatedly exposed to aggression from peers in the form of physical attacks, verbal assaults, or psychological abuse. Victims are more likely to be boys and to be physically weaker than peers. They generally do not have many, if any, good friends and may display poor social skills and academic difficulties in school.

Facts about Bullying

• Bullying is the most common form of violence in our society; between 15% and 30% of students are bullies or victims.
• A recent report from the American Medical Association on a study of over 15,000 6th-10th graders estimates that approximately 3.7 million youths engage in, and more than 3.2 million are victims of, moderate or serious bullying each year.
• Since 1992, there have been 250 violent deaths in schools that involved multiple victims. In virtually every school shooting, bullying has been a factor.
• Membership in either bully or victim groups is associated with school drop-out, poor psychosocial adjustment, criminal activity and other negative long-term consequences.
• Direct, physical bullying increases in elementary school, peaks in middle school, and declines in high school. Verbal abuse, on the other hand, remains constant. The U.S. Department of Justice reports that younger students are more likely to be bullied than older students.
• Over two-thirds of students believe that schools respond poorly to bullying, with a high percentage of students believing that adult help is infrequent and ineffective.
• 25% of teachers see nothing wrong with bullying or putdowns and consequently intervene in only 4% of bullying incidents.

Why Do Some Children and Adolescents Become Bullies?

Most bullying behavior develops in response to multiple factors in the environment -- at home, school and within the peer group. There is no one cause of bullying. Common contributing factors include:

• Family factors: The frequency and severity of bullying is related to the amount of adult supervision that children receive -- bullying behavior is reinforced when it has no or inconsistent consequences. Additionally, children who observe parents and siblings exhibiting bullying behavior, or who are themselves victims, are likely to develop bullying behaviors. When children receive negative messages or physical punishment at home, they tend to develop negative self concepts and expectations, and may therefore attack before they are attacked; bullying others gives them a sense of power and importance.
• School factors: Because school personnel often ignore bullying, children can be reinforced for intimidating others. Bullying also thrives in an environment where students are more likely to receive negative feedback and negative attention than in a positive school climate that fosters respect and sets high standards for interpersonal behavior.
• Peer group factors: Children may interact in a school or neighborhood peer group that advocates, supports, or promotes bullying behavior. Some children may bully peers in an effort to "fit in," even though they may be uncomfortable with the behavior.

Why Do Some Children and Adolescents Become Victims?

• Victims signal to others that they are insecure, primarily passive and will not retaliate if they are attacked. Consequently, bullies often target children who complain, appear physically or emotionally weak, and seek attention from peers.
• Studies show that victims have a higher prevalence of overprotective parents or school personnel; as a result, they often fail to develop their own coping skills.
• Many victims long for approval; even after being rejected, some continue to make ineffective attempts to interact with the victimizer.

How Can Bullying Lead to Violence?

• Bullies have a lack of respect for others` basic human rights; they are more likely to resort to violence to solve problems without worry of the potential implications.
• Both bullies and victims show higher rates of fighting than their peers.
• Recent school shootings show how victims` frustration with bullying can turn into vengeful violence.

What Can Schools Do?

Today, schools typically respond to bullying, or other school violence, with reactive measures. However, installing metal detectors or surveillance cameras or hiring police to patrol the halls have no tangible positive results. Policies of "Zero Tolerance" (severe consequence for any behavior defined as dangerous such as bullying or carrying a weapon) rely on exclusionary measures (suspension, expulsion) that have long-term negative effects.

Instead, researchers advocate school-wide prevention programs that promote a positive school and community climate. Existing programs can effectively reduce the occurrence of bullying; in fact, one program decreased peer victimization by 50%. Such programs require the participation and commitment of students, parents, educators and members of the community. Effective school programs include:

• Early intervention. Researchers advocate intervening in elementary or middle school, or as early as preschool. Group and building-wide social skills training is highly recommended, as well as counseling and systematic aggression interventions for students exhibiting bullying and victim behaviors.
• Parent training. Parents must learn to reinforce their children`s positive behavior patterns and model appropriate interpersonal interactions.
• Teacher training. Training can help teachers identify and respond to potentially damaging victimization as well as to implement positive feedback and modeling to address appropriate social interactions.
• Attitude change. Researchers maintain that society must cease defending bullying behavior as part of growing up or with the attitude of "kids will be kids." Bullying can be stopped! School personnel should never ignore bullying behaviors.
• Positive school environment. Schools with easily understood rules of conduct, smaller class sizes, and fair discipline practices report less violence. A positive school climate will reduce bullying and victimization.

What Can Parents Do?

• Contact the school`s psychologist, counselor or social worker and ask for help around bullying or victimization concerns. Become involved in school programs to counteract bullying.
• Provide positive feedback to children for appropriate social behaviors and model interactions that do not include bullying or aggression.
• Use alternatives to physical punishment, such as the removal of privileges, as a consequence for bullying behavior.
• Stop bullying behavior as it is happening and begin working on appropriate social skills early.

RESOURCES

Batsche, G. (1997). Bullying. In Bear, Minke & Thomas (Eds.), Children`s Needs: Development, Problems and Alternatives (pp. 171-180). Bethesda, MD: National Association of School Psychologists.

Bonds, M & Stoker, S. (2000). Bully-proof Your School. Longmont, CO: Sopris West.

Webster-Stratton, C. (1999). How to Promote Children`s Social and Emotional Competence. Sage.

Online Resources

National Mental Health and Education Center for Children and Families
www.naspcenter.org

Safe and Responsive Schools Project
www.indiana.edu/~safeschl/

Safe Schools/Healthy Students Action Center
www.sshsac.org/

National Resource Center for Safe Schools
www.nwrel.org/safe

This article was developed from a number of resources including the chapter by George Batsche.

Changed By Trauma: Helping Youth Cope In The Aftermath Of Tragedy

By Debra Whiting Alexander for The Bureau For At-Risk Youth

City bombings, random acts of crime, wars, violence at home and school…today, a growing number of children are victims and witnesses to acts of human cruelty -- and even second-hand exposure to trauma can be problematic. Children have experienced more and more events that are beyond normal human experience, and what they have learned is that life is not safe.

Most adults are not prepared for the experience of helping youth through such intense emotional, psychological, physical and spiritual injuries. The effects can be far-reaching. Not only does trauma impact learning (students can't learn when they aren't relaxed), it can change the whole course of a child's or adolescent's continued healthy development. Schools have the unique opportunity to respond to traumatized children in a number of helpful ways, but it can be difficult to know where to begin and what to do.

Common Reactions

It's natural for all children impacted by trauma to feel, think and behave differently in response to an abnormal event in their lives. Intense emotions, frightening thoughts, physical symptoms, and spiritual confusion are all normal reactions following a life-changing event.

Children and teens cope in a variety of ways to overwhelming stress. A few of the more common symptoms include: anxiety, worry, anger, sadness, nightmares, and fear. Some kids become overactive, while others appear lethargic and withdrawn. They may complain of physical aches and pains, have difficulty concentrating in class, and have trouble sleeping or eating. They may want to avoid friends, social activities and school. Some children will talk repeatedly about what happened, while others will refuse to discuss it at all. They may display aggressive behaviors, and express distressing and repeated themes in play, art or writing. All ages may act younger than they are. Separation anxiety and clinginess are especially common.

Encourage Open Discussion

The more children and teens are able to talk about and/or express what happened with people who understand, the sooner the difficulties will diminish. Most children, however, regardless of their age, need help identifying their thoughts and feelings following a tragedy. They also benefit from a structured environment in which they are permitted to talk directly about what happened and learn effective coping skills.

What you can do:

• Help kids feel safe. Address common fears and adjust for them in daily routines.
• Provide physical comfort. It's especially important for younger children, but everyone benefits from a nurturing environment.
• Take time to listen. Allow for structured opportunities to listen to all thoughts and feelings that students want to voluntarily share. Teens especially may have a need to analyze and fully discuss with one another what happened and why.
• Address concerns and answer questions. Keep your answers and explanations simple and direct. Children want real facts. Be honest without sharing graphic or disturbing details. If you don't know the answer to a question, be honest about that too. Correct any distortions and misinformation you hear.
• Remain composed. Provide a calm, serious and undramatic response to what children say and ask.
• Use open questions. To help facilitate discussions ask questions like, "What is your understanding about what happened?" "What would you like to know?"
• Create a climate of acceptance. Don't criticize, judge or shame a child for anything they say or do and make sure everyone in your group or class understands this rule. Accept and validate everything that is expressed.
• Understand cultural differences. Some behaviors and styles of expression within your student population may be common to their culture. Be careful not to assume that behaviors different from your own mean they are trauma-induced problems.
• Educate. Reassure students that the more they tell the story, the less intense and frightening the emotions become. Help them understand the wide range of normal reactions they can expect to see and prepare them for what may be different in the days, weeks and months ahead. Remind younger children that thoughts and feelings can't make bad things happen.
• Talk about changes. Ask children about the ways they feel different and what they notice in those around them. Normalize their examples and acknowledge the common and unique ways all have felt changed by the experience.

Decrease Stress

Like adults, children and youth will react to stress differently and have varying thresholds for it. Minimize stress whenever you can.

What you can do:

• Take time to relax. Be flexible and lower your expectations of children for a while. Take breaks through the day and help children relax through simple breathing exercises, silent meditation/prayer, classical music or taking walks where the sounds of nature can be heard.
• Model coping tools. Explain what you do to help yourself. Brainstorm with kids other ways they can take care of themselves.
• Hold parent meetings. Educate families about trauma reactions and ways families and caregivers can help. Your job as a teacher, administrator or counselor will be made easier when parents have the tools and understanding of how best to support their kids.
• Maintain routines. There is comfort in the predictable routines in life. Make sure children know what to expect throughout the day.
• Monitor media. Review for age-appropriate content and themes. Even some family movies can restimulate post-trauma stress.
• Increase supervision. Prevent unsupervised gatherings and emotional drama at school by monitoring halls closely and having supportive adults available to all kids throughout the day.
• Be proactive. Provide a way to channel energies into constructive activities like helping others.

Reassure And Remind

All children need the loving support of the adults around them in order to regain a sense of security and trust. They need to know that no matter what happens, the adults around them will do everything in their power to keep them safe.

What you can do:

• Remind children of what went right. You might ask, "Who helped?" "What good things happened when we needed them to?" "What unexpected things have people done to help others?"
• Address issues of death concretely. Let kids know the greater the loss, the longer the time it will take to feel better again. Acknowledge that death is permanent and sad and that grieving is a process. Reassure them that it won't always feel as sad as it does right now.
• Empower. Give children choices and outlets for expressing thoughts and feelings. Help them regain a sense of power and control. Review general safety rules and precautions and practice problem-solving skills.
• Identify resources. Help students think about all the outside resources they have to support their continued healing. Family members, counselors, nurses, doctors, friends, clergy and spiritual beliefs and values can be helpful resources to seek out for extra help.
• Renew hope. Help kids understand that trauma is a part of life, but not all of it. Explain that they won't forget what happened, but can survive the memory. Reassure them that healing happens even in the hurt.

Most kids recover from a trauma without professional assistance, but others may develop post-traumatic stress disorder (PTSD) or other persistent problems that will require help from someone trained in treating post-trauma stress.

Children are changed by trauma and although the emotional recovery process isn't easy or quick, it is possible to find hope and healing in the aftermath. The support children receive from caring adults after a tragedy can help them avoid long-term emotional harm. The school environment is an important, if not critical piece to children's adjustment and full recovery.

Media Literacy: Saving Children From Self-Hate and Destructive Behavior

By Dr. Peter DeBenedittis for The Bureau For At-Risk Youth

In mid-March, my friend and I sat in the front row of a minor league ballpark in Tucson, Arizona, watching a spring training game between the Diamondbacks and the Rockies. A woman in her early twenties sat next to us. She asked my friend if he liked her shoes, a pair of bright orange suede Adidas with nifty white stripes. He told her they were all right. Even though he affirmed her, she replied, "I know, but at least my socks are Nike."

By age 18 the average child in America has seen 100,000 commercials on TV. Counting logos, signs, promotions, and all the other mass mediums, this figure soars to nearly twenty million. Behind each ad exposure is a simple message that every child internalizes - you're a loser because you don't own this. No advertising tells us we're okay and don't need to buy anything. Advertising tells us we're uncool, missing what's in style, too fat, too bored, or too boring.

Although our political leaders choose to ignore it, over 4,000 scholarly studies have found that mass media causes societal violence. The Surgeon General wrote in 1972, that "the debate is over." Recent research has found that higher amounts of television viewing is correlated with underage drinking. Teens that see R-rated movies are three times more likely to drink and smoke. And despite all the blame that alcohol and tobacco companies put on parents they depict as not doing enough in their so-called prevention spots, advertising influences children to smoke twice as much as does peer pressure. The same holds true with alcohol. Grube & Wallach (1994) found that children who are more aware of beer advertisements have more favorable attitudes toward drinking, and are more likely to report an intention to drink beer once they are adults.

Media literacy is a powerful tool to inoculate youth against the destructive values being sold to them. The National Office on Drug Control Policy (June 2001) reported that "because the(ir) Campaign's entire strategy acknowledges the power and influence of media on America's youth, it is important and appropriate for the initiative to help young people develop their critical thinking skills by further investing in media literacy."

Media literacy is the ability to "read" television and mass media. Media literacy education teaches people to access, analyze, evaluate, and produce media. Children who understand the motivations and production techniques of media are less likely to adopt the unhealthy attitudes or behaviors that mass media depict.

What makes media literacy a powerful prevention tool is that it takes children's natural tendency to rebel, and redirects it towards those selling them addictive lifestyles. Media education represents a new and exciting approach to protecting youth from the unhealthy effects of media -- an approach that is not dependent on Hollywood's or Madison Avenue's willingness to accept responsibility for its programming and advertising.

In conversations with some of the 50,000 students I give presentations to each year, I continually hear about the impact media literacy education can have. I've had young girls break into tears after seeing me show how actresses and models are computer enhanced in such ridiculously fake ways. I've gotten letters from ex-smokers expressing their gratitude for saving their lives by showing how tobacco ads can manipulate teens into addiction. The impact of media literacy on prevention is more than anecdotal. Post-tests from tobacco prevention talks I gave show that a third of teen smokers attending make an immediate attempt to quit their habit.

At the 2000 Alcohol Policy XII Conference, I presented the results of a study that found a single 45-minute presentation deconstructing alcohol advertising led to significant changes in the social expectancies middle school students had about drinking. Several peer reviewed studies have been published that found similar results with children as young as the third grade. While at Washington State University, Erica Austin (1997) published two studies showing a change in children's intention to drink alcohol after a media education program. Participating students were less likely to rate alcohol ads positively, were less attracted to alcohol promotional material, and showed greater disdain for alcohol commercials

As with alcohol prevention, researchers are beginning to find that media literacy is an effective tool in helping prevent and treat eating disorders. Stormer & Thompson (1995) found that very brief instruction in media literacy given to women in college produced significant pre-to-post program reductions in appearance- and weight-related anxiety. The students were less likely to idealize the slenderness embodied by fashion models and actresses. Irving, DuPen, & Berel (1998) found that high school girls viewing a media literacy film on body image and discussing it reported less internalization of a "thin" beauty standard and lower perceived realism of media images than did their comparison group.

Media literacy education can also reduce children's susceptibility to violence. A study conducted with English 8- and 9-year-olds demonstrated changes in children's comprehension and awareness of media violence. In 1983, Huesmann, et al., found statistically significant changes in children's attitudes about media violence using media literacy. Their treatment simply consisted of two training sessions within a 2-week period where third graders wrote essays for a video about how harmful television violence can be.

Parents and teachers can take back control of the values being taught to our children. It doesn't take a lot of effort either to teach a child to be media literate. One study found that parents who talk back to their TV sets had children who were less likely to drink in their teens. The American Academy of Pediatrics has a wonderful website with tips for teachers and parents called Media Matters.

The beauty of teaching media literacy for prevention is that students love learning about media. Schools also embrace media literacy because, ultimately, students are being taught critical thinking skills. And if these are not reasons enough, the preventive value of media literacy is not substance or behavior specific. The media literacy skills used to deconstruct and build resistance to tobacco advertising are the same ones used to prevent underage drinking, violence, eating disorders and other risky behaviors. I encourage you to become a cultural revolutionary and begin to learn and promote media literacy.

Healthy Bodies And A Healthy Body Image: Opportunities For Wellness

By Peggy Wouts R.N, B.N, M.N, Calgary Eating Disorder Program at Alberta Children’s Hospital

The cultural climate today, predominantly within North America, is one which harbors a "fear of fat." A variety of factors influence this climate and have implications for our population’s mental and physical health. For example, our cultural idealization of thinness has created a standard of female beauty and worth. This idealization not only encourages but also normalizes dieting as a strategy to achieve this standard (Austin, 2000). The diet industry is a multi-billion dollar industry because its profitability resides in the predominant belief that our bodies must change in size and form in order to succeed and achieve. Further, the media and fashion industries form feminine and masculine standards, which are unrealistic and predominantly unattainable. These factors are highly associated with body dissatisfaction, unhealthy eating behaviors, unhealthy weight control behaviors, and eating disorders (Austin, 2000).

Dieting, fear of fatness and unhealthy eating behaviors have been reported in girls as young as nine years old (Mellin, Scully, & Irwin, 1992). Thirty to forty percent of 9-year-old girls and eighty percent of 10 to 11-year-old girls have dieted. Young girls have indicated in surveys that they are more afraid of becoming fat than they are of cancer, nuclear war, or losing their parents (Berzins, 1999; National Eating Disorder Information Center [NEDIC], 1999). While females attempt to reduce their body size, males more often report an obsessive preoccupation with their muscularity to the point where they spend more time at the gym or take steroids and other performance-enhancing drugs in the face of serious side-effects (Pope, Olivardia, Gruber, & Borowiecki, 1999).

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, rank as the third most common chronic illness among adolescent females in the United States (Neumark-Sztainer, 1996). Common features of these disorders include abnormal eating and an over-concern with weight and shape (Russell & Ryder, 2001). According to the American Psychiatric Association (2000), prevalence rates of Anorexia Nervosa are between 1-3.7% of the population and the rates for Bulimia Nervosa are between 1.1-4.2%. What is most concerning is that eating disorders have the highest mortality rates of all psychiatric illnesses, with 10-20% eventually dying, approximately half by suicide and half by physiological breakdown (Garner, Vitousel, & Pike, 1997).

While a large percentage of the population is dissatisfied with their bodies and engage in unhealthy weight control behaviors, childhood obesity is also becoming alarmingly prevalent. The prevalence of overweight youth in the United States has more than doubled over the past two to three decades. It has increased by 54% among 6 to 11-year-old children and 39% among 12 to 17-year-olds (Kendall & Wilken, 1998). Approximately 18% to 25% of all adolescents are overweight (Hill & Townbridge, 1998). It is also reported in the Youth Risk Behavior Survey that more than 25% of students felt they were overweight and used dangerous methods such as pills, laxatives, and vomiting to lose weight (Illuzi & Cinelli, 2000).

The prevention of obesity is currently at the top of the public health agendas of North America and much of Europe (Study Group, European Atheroschlerosis Society, 1987; USDHHS, 1990, 1996; Aggett et al. 1994; CDC, 1996; Seidell, 1999). Prevention programs to date have predominantly focused on nutrition and physical activity for children, however those factors associated with eating disorders have not been integrated into these programs. Further, there is concern with regard to the potential impact on disordered eating when the ultimate goal is to reduce the incidence of obesity and losing weight becomes the only focus and weight is recognized as the only indicator of health.

It is important to acknowledge the relationship between eating disorders, unhealthy eating behaviors, weight control behaviors, and unhealthy attitudes towards our bodies. Dieting for weight loss and a preoccupation with weight is associated with the later development of eating disorders (Neumark-Sztainer, 1996). Dieting may be associated with eating behaviors such as meal skipping, binge eating, and lower intake of those nutrients, which are essential to the healthy growth of adolescents. Obesity involves physical consequences and may influence social and economic development within a society which values “thinness” (Neumark-Sztainer, 1996). The similarities between those who struggle with eating disorders and obesity and those who engage in dangerous weight control behaviors, and unhealthy eating behaviors highlight the potential for collaborative promotion and prevention programs. Attentiveness and intervention is needed throughout a wide a range of unhealthy attitudes and behaviors associated with weight preoccupation.

Preventing illness, such as eating disorders and chronic disease associated with obesity, must incorporate the promotion of healthy body image and the prevention of eating disturbances. The high cost and relatively low success rates of treatment for these disturbances justify investment of time and resources in prevention efforts (Neumark-Sztainer, 1996). Further, most experts agree that for every $1 spent on promotion and prevention programming, approximately $7 is saved in later health care costs (Steinhauer, 1999).

Effective prevention and promotion programs foster the participation and collaboration of professionals, parents, and youth. For example, school programs, which are targeted towards changing individual perceptions and the social environment, create the potential for healthier behaviors. Programs that address eating disorders through didactic teaching of signs and symptoms have been shown to be minimally effective in behavioral change and may even do more harm (Roesen & Newmark-Sztainer, 1998). It is imperative therefore that the emphasis be placed on positive body image and the dangers of unhealthy eating behaviors -- not on specific eating disorders or their causes (Russell & Ryder, 2001).

While it is important to educate the public about nutrition and healthy active living, it is also important to consider our cultural climate. Unhealthy eating behaviors associated with weight disturbances are unlikely to change with the delivery of information focusing only on nutrition and active living. Programs must provide the opportunity for youth, parents, and professionals to critically think about their own attitudes related to their bodies in relation to peer groups, communities, and culture. Devoting time for discussion about these influences is a valuable way for individuals to learn from one another and learn about one’s own perception of reality. The underlying issue of bullying and put-downs about bodies is important to address as a form of harassment and must be addressed as part of creating a healthy environment for youth. The development of acceptance of all body sizes and shapes and the acknowledgement that there is more than appearance contributes to healthy environments and healthy behaviors. Overall it is imperative that prevention and promotion initiatives shift the focus from only weight to wellness with an emphasis on maximizing health (Russell & Ryder, 2001).

While it may appear that obesity and eating disorders exist at opposite ends of the health-care spectrum, the prevention of both share significant commonalties. Issues such as unhealthy body image, disordered eating, and unhealthy and dangerous weight reduction behaviors are prevalent in both obesity and eating disorders. Integrating these commonalties into the prevention of both obesity and eating disorders involves a wellness approach. This approach considers the development of self-esteem, resiliency in children and youth, and resiliency within our communities. To date the prevention of obesity and eating disorders have remained as separate fields of practice, however there is clearly opportunity for collaboration. To remain as separate practices neglects valuable approaches which would only enhance health.

REFERENCES

Aggett, T.J., Haschke, F., Heine, W., Hernell, O., Koletzko, B., Lafeber, H., Ormission, A., Rey, J. & Tormo, R. (1994). Committee Report: Childhood Diet And Prevention of Coronary Heart Disease. ESPGAN Committee on Nutrition. European Society of Pediatric Gastroenterology and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 19, 261-269.

American Psychiatric Association (2000). Practice Guideline for the Treatment of Patients with Eating Disorders. (2end edition). APA: Washington, DC.

Austin, S.B.(2000). Prevention Research In Eating Disorders: Theory And New Directions. Psychological Medicine, 2000, 30, 1249-1262.

Berzins, L. (1999). A Congressional Briefing: Dying To Be Thin: The Prevention Of Eating Disorders And The Role Of Federal Policy. Washington, DC: American Psychological Association: Public Policy Office.

Centers for Disease Control (1996). Guidelines For School Health Programs To Promote Lifelong Healthy Eating, Morbidity and Mortality Weekly Report 45(RR-9), 1-41.

Garner, D.M, Vitousek, K.M, & Pike, K.M (1997). Cognitive-behavioral Therapy For Anorexia Nervosa. In D.M Garner, & P.E. Garfinkel (eds.), Handbook of Treatment For Eating Disorders. New York: The Guilford Press

Hill, J.O. & Townbridge, F.L. (1998). Childhood Obesity: Future Directions And Research Priorities. The Causes And Health Consequences Of Obesity In Children And Adolescents. Pediatrics, 101(3), 554-571.

Illuzzi, S. (2000). A Coordinated School Health Program Approach To Adolescent Obesity. Journal of School Nursing, 16(1), 12-18.

Kendall, R.D & Wilken, K. (1998, May 8). Childhood Obesity No.9.317. Colorado State University Cooperative Extension c Colorado State University Cooperative Extension. 1995-1999. Contact Cooperative Extension Web Manager online at www.colostate.edu/Depts/CoopExt.

Mellin, L.M., Scully, S., & Irwin, C.E. (1992). Prevalence Of Disordered Eating In Girls: A Survey Of Middle Class Children. Journal of the American Dietetic Association, 92, 851-853.

National Eating Disorder Information Center. (1999). National Eating Disorder Awareness Week Campaign. Toronto.

Neumark-Sztainer, D. (1996). School-based Programs For Preventing Eating Disturbances. Journal of School Health, 66(2), 64-70.

Pope, H.G., Olivardia, R., Gruber, A., & Borowiecki, J. (1999). Evolving Ideals Of Male Body Image As Seen Through Action Toys. International Journal of Eating Disorders, 26, 65-72.

Rosen, D.S., & Neumark-Sztainer, D. (1998). Review Of Options For Primary Prevention Of Eating Disturbances Among Adolescents. Journal of Adolescent Health, 23(6), 354-363.

Russell, S. & Ryder, S. (2001). BRIDGE (Building The Relationship Between Body Image And Disordered Eating Graph And Explanation): A Tool For Parents And Professionals. Eating Disorders, 9, 1-14.

Seidell, J.C (1999). Obesity: A Growing Problem. Acta Paediatrica 88(suppl.428), 46-50.

Steinhauer, P.D. (1999). Review Of The Organization And Delivery Of Children’s Mental Health Services In Edmonton And Calgary: Prepared For The Alberta Mental Health Board, The Capital Health Authority and the Calgary Regional Health Authority. Unpublished manucript.

Study Group, European Atherosclerosis Society (1987). Strategies For The Prevention Of Coronary Heart Disease: A Policy Statement Of The European Atherosclerosis Society. European Heart Journal 8, 77-88.

US Department of Health and Human Services (1990). Healthy People 2000: National Health Promotion and Disease Prevention Objectives. USDHHS: Washington, DC.

US Department of Health and Human Services (1996). Physical Activity and Health: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion: Atlanta, Georgia.

Exploring The Dynamics Of Test Anxiety

By Janis Wallender, M.Ed., L.P.C. for American School Counselor Association

anx ie ty n 1. nervousness or agitation, often about something that is going to happen.

For many young people, as well as for educators and parents, the word "test" brings on a feeling of anxiety. Depending on the test and the state one is in, performance can carry significant consequences for the student and even the school. In some states with high-stakes testing, a comprehensive exam determines a student's placement for the following year, while in other states it may be used as an indicator of a low-performing school which will affect the entire staff at that school.

For example, in school A, students take the state comprehensive exam, which is used to determine grade placement for the following year. In school B, students take the state comprehensive exam, which is used to determine schools that will be targeted for school improvement. In school A, many students suffer from test anxiety because they realize that if they do not perform well on the state exam, they may not move on with their peers. In school B, students may suffer from test anxiety because the teachers place a great deal of pressure on student performance so that their school will not be targeted as being a poor-performing school.

anx i e ty n 2. a subject or concern that causes worry.

As we consider high stakes testing which determines placement or schools in need of improvement, we must first and foremost consider the students taking these tests. In order for most students to do well on a test, they must commit a good portion of what they have learned to memory. This does not mean "memorizing the text or notes," but rather being able to bring forth enough information about the test material to answer the questions. Yet test anxiety can interfere with this process in a variety of ways.

Low-performing students who normally perform poorly on tests often have some level of anxiety each time they take a test due to their continual low performance. They will often give up, as it is easier to fail because they haven't tried than to fail after trying their hardest. Even a student who performs at a high level in her daily academic work can suffer from test anxiety. When facing a test, her test anxiety causes her memory to "turn to mush." She becomes unable to concentrate, nor can she recall the answers she knows. If she fails the test and does not progress to the next level, she may begin to doubt her abilities, which may increase her test anxiety because of low self-esteem. In both instances, the students may not progress, and their scores combined with those of other students may cause the school to be targeted for low performance. Although in both instances the students' low performance may be related to test anxiety, each student was a totally different person with differing performance in the classroom.

anx i e ty n 3. a state of intense apprehension or fear of real or imagined danger, manifested physiologically as increased heart rate, sweating, trembling, weakness, and stomach or intestinal discomfort.

When we look at testing, the fear of real or imagined "danger" that manifests itself in somatic illnesses can often be related to personal, parental, or school expectations. With the cost of a college education on the rise, many students are working hard to be admitted to a college, as well as to be eligible for college scholarships. Many of these scholarships are based on a student's academic grade point average and class rank, which is based on a student's performance in school, which in turn is based on a student's performance on tests.

As an example, let's take a student entering his senior year. The student is at a high school that has a no-drop policy. Once enrolled in a class, the student must complete the class or receive a failing grade. The student is currently ranked number one in his class. At a number of the state universities, this student would be eligible for a full-tuition scholarship based on his class rank.

The student registers for a number of dual-credit classes his senior year, one of which is an AP Calculus class. As the beginning of the year progresses, this student realizes that although he is working hard, he is not doing very well in this class and his grade may drop his class rank by one or two. If he graduates number two in his class, his opportunity for the full-tuition scholarship is lost. Each test that this student takes brings on the anxiety related to the possibility of a lost scholarship opportunity.

A second student at a school with a similar no-drop policy is also ranked number one in her class. She has been anxious over how she will be able to afford to go to college. This student realizes that the full-tuition scholarship is going to open many doors for her in her future. She is not willing to risk losing her class rank. Because of her anxiety about the cost of college, she chooses to take classes that will allow her to maintain her grade point average. Upon entering the university, she realizes that she has not adequately prepared for the rigorous academic requirements and now suffers from test anxiety with each test as she tries to maintain her scholarship.

anx i e ty n 4. The strong wish to do a particular thing, especially if the wish is unnecessarily or unhealthily strong.

To help our young people deal with test anxiety, we must discover the underlying causes of their test anxiety. Are they anxious because of low performance on tests, unrealistic expectations, perfectionistic tendencies or fear of failure? Or is it because they don't know how to study or are just not studying?

Often students have negative thoughts in their heads when it comes to test taking. Teachers can often tell because of the "groans" they hear when the word test comes up. One professor years ago attempted to reverse these negative thoughts by telling his students they would never have a test in his class. Of course, this brought a multitude of cheers. He said, "You will have many opportunities to show me what you have learned." Helping a student reframe a negative image of a "test" into an opportunity to show the teacher what he has learned is one way to help reduce test anxiety.

Test preparation can be extremely difficult for students who have not learned techniques to study for tests. Students are often expected to do well on tests, but are never given any formal instruction on how to best prepare for a test. Schools that have study skills classes which include test-taking strategies as an integral component for all students will often see a reduction in test anxiety in those students who use the skills learned.

What may appear as test anxiety may actually be a cover for other difficulties a student may be encountering in her life. Students who go to schools that employ full-time counselors who are available to work with students in the classroom, in small groups, or in individual settings have a definite edge. Counselors may be able to help students discover ways to deal with the many stresses in their life, which will also aid them in handling test anxiety.

Whether it is the pressure of a test to determine placement, a test that places a school on school improvement list, a test that determines acceptance to a college or receipt of a scholarship, or a test that may determine the loss of a scholarship, test anxiety is real for many young people today. It is also becoming common for educators as they worry about student performance as it relates to school success. We as educators, advocates of educational reform, and leaders of our country must carefully consider what test anxiety can do to young people and how we can best evaluate student and school performance while keeping all of our children mentally and emotionally healthy.

Reflections on the Transition to Middle School

By Dr. Paula Sachs Wise for National Association Of School Psychologists

I still remember spending the summer of 1960 worrying. I had just graduated from sixth grade and even though I would be going to a junior high in the fall with many of the same kids I had been with in elementary school, the thought of junior high seemed so foreboding. I had heard rumors of eighth and ninth graders trying to fool lowly seventh graders into buying (non-existent) elevator passes; of not enough time to get from one class to another; of not enough time to get to the bathroom during the day; and so on and so forth. Of course I also worried about making friends, finding classrooms, and maybe even about being successful academically.

Although a lot has changed from my own school days, I venture to say that the notion of students worrying all summer before making the transition to middle school or junior high is as prevalent now as it was all those years ago. In fact various studies conducted in the 1990’s found that students were worried about getting to class on time, finding lockers, keeping up with academics, finding lunchrooms and bathrooms, getting on the right bus to go home, getting through crowded hallways, and remembering which class to go to next (Weldy, 1991; Schumacher, 1998). Newer research by Akos and Galassi (2004) questioned students, parents, and teachers about their concerns in student transitions to middle school. Similarities and differences were found among the three groups. All worried about students getting lost and having too much homework; students worried about being late to class; parents worried about students making friends and facing new pressures; and middle school teachers worried about the students finding their way in the school and making friends.

Often ignored in previous research are the positive aspects of the transition to middle school. Aikins, Bierman, and Parker (2005) found that negative expectations on the part of students translated to emotional distress during the transition. Therefore, parents and teachers may want to focus on the good things that go along with this new stage in their students’ lives. There will be increased opportunities to meet new friends and participate in extracurricular activities along with an overall increase in personal growth and independence. In the same study cited above, Akos and Galassi also asked students, parents, and teachers what they looked forward to in middle school. All three groups selected choosing classes and making new friends as positive aspects. Surprisingly perhaps, students looked forward to having lockers (possibly an indication of a need for personal space and privacy) while parents and teachers suggested that participation in sports was a positive aspect of the transition.

Another less studied variable in the transition is what actually happens after the school year begins. Although much of the focus has been about worries before the transition, do students have reason to fear the new environment? How quickly do they adjust to the new environment? Akos and Galassi (2004) suggest that students and parents rate the actual transition process as somewhat easy although teachers rated the transition as not as easy. Students found the academics themselves (e.g., classes, grades, homework, and teachers) to be the most difficult aspects of the transition, while parents found an overall increase in expectations and responsibilities as well as dealing with other students to be the hardest parts of the transition. Two-thirds of the parents found that within four weeks, their students had adjusted to their new school -- although 27% thought that it took longer than four weeks.

Strategies in adjusting to the new school also varied. The remainder of this article will address the strategies suggested by a number of researchers over the years.

General Preparation

Students need to know what to expect in the middle school environment and what will be expected of them. Tours of the new school, orientation meetings over the summer, and maps of the school can help alleviate some concerns. As mentioned above, focusing on the positive aspects of middle school can help to counterbalance some of the anxieties associated with any new situation.

Academic Preparation

Students and their parents and teachers need to know what the academic expectations are in the middle school environment. They need to work on study skills, time management, basic writing and math skills, reading proficiency, and so on. Elementary school and middle school teachers are partners with students and families in making sure that students make a smooth academic transition. Perhaps before the fall semester begins, schools could offer some sort of study skill training for entering students.

Friendships

At all stages of life, close relationships are important. They create support for students and a sense that “we’re all in this together.” The transition to middle school is no exception. Students also need friends to talk to when they are being picked on or when they are facing other problems in their lives.

Families

Family members, especially parents can serve several important roles in easing the transition process. Perhaps most importantly family members can support students through their trials and tribulations. Ask questions, listen, be available to talk things over, provide nutritious food, monitor sleeping patterns, get to know the youngsters’ friends, help students develop good study habits, etc.

Families and Schools Working Together

Family members can also help their students by communicating with school personnel. Attend parent-teacher conferences and take advantage of other opportunities to get to know your child’s teachers.

Enhancing Personal Growth

Elias (2001) makes broader suggestions for easing the transition to middle school. He notes that not only do students need specific strategies for dealing with their new educational settings they also at this point in their lives need increase opportunities for personal growth. He suggests that schools focus on four distinct areas:

Contributions

Students need to feel as though they are contributing positively to their world. Engaging in service activities in their communities (everything from helping seniors to working on the environment) not only helps fill these needs but it also may lead to self-discovery at an age when that is an important issue.

Belonging

Many students are able to form strong positive friendships on their own. Others, however, may need help in this area. Schools should provide numerous activities and groups to engage all students – especially those who have difficulty finding and making connections with others.

Talents

Some students excel in the classroom while others may have talents that are less obvious to school personnel. Defining talent broadly, schools should foster students’ artistic, theatrical, musical, literary, athletic, social, and other abilities. It is important to find at least one area in which each student excels.

Life Skills

Use teachable moments in middle school to help students learn to set goals, engage in planning, work in groups, solve problems, make decisions and develop resilience.

Overall, then there are a lot of strategies that students, parents, and school personnel can employ to make the transition to middle school a smooth and positive experience and a springboard for students to the rest of their lives.

References

Aikins, J. W., Bierman, K. L., & Parker, J. G. (2005) Navigating the transition to junior high school: The influence of pre-transition friendship and self-system characteristics. Social Development, 14 (1), 42-60.

Akos, P., and Galassi, J. P. (2004). Middle and high school transitions as viewed by students, parents, and teachers. Professional School Counseling, 7 (4), 212-221.

Elias, M. J. (2001, Winter). Middle school transition: It’s harder than you think. Making the transition to middle school successful. Middle Matters, pp 1-2.

Schumacher, D. (1998). The transition to middle school. Eric digest. Champaign, IL: ERIC Clearinghouse on Elementary and Early Childhood Education. (ERIC Document Reproduction Service No. ED422119)

Weldy, G. R. (1991). Stronger school transition to improve student achievement: A final report on a three-year demonstration project “strengthening school transitions for students k-13”. Virginia, US: (ERIC Document Reproduction Service No. ED338985)

Responding To Student Stress: Guidelines For Educators

By Ellis Copeland, Ph.D. for National Association Of School Psychologists

When children experience stress, they seldom know how to define it. They often express it by telling adults that their stomachs hurt, they have headaches, or they can’t go to school. Adults need to realize that when children describe such symptoms, they really may be trying to tell us that they are stressed out!

Basic Facts

Causes of Stress

Although demands in life are natural, we experience stress when we are unable to cope and/or believe or are unaware that we do not have the resources to meet such demands. As each of us possesses diverse abilities and levels of confidence in them, our reactions to life’s challenges vary widely. For example, a roller coaster ride may be a thrill to one child and a major stressor to another. Every person reacts to stressors (events in the environment and/or perceptions that cause stress) in different ways. The sources of stress also differ based on stages of development. For example, children in elementary school are stressed about issues related to fear of abandonment and the unknown. On the other hand, teens tend stress over fitting in with their peers and developmental changes related to puberty.

However, there are some common factors that can cause stress for all students. According to today’s children and teens, the most primary sources of stress are peer relationships, as well as school and home environments.

Peer relations are extremely important to most youth and appear to become more and more significant as children grow. While most kids want to be accepted by peers, many times they don’t and that fact is taking toll on American children. Victims of bullying experience a great deal of stress. In addition, children without a strong sense of self can be especially susceptible to negative peer pressure. They often feel the need to follow the crowd to be accepted.

Stressors specifically related to school include fear of failure, test anxiety, and/or viewing oneself as academically inadequate. A new stressor is “high stakes testing” as children sense the importance of the occasion. Moving to a new school and transitioning from elementary school to middle school are also stressful events for most youth. Other school-related stressors include unclear expectations and lack of structure in the classroom.

Although children should be able to escape stress at home, the fact is that many cannot. A large number of children experience stress due to “latchkey” situations, lack of structure, and poor boundaries. Parental expectations, whether they are too high or too low, can also cause children stress. Domestic violence can cause an enormous amount of stress -- whether or not a child is the actual target of abuse. Changes in the home environment, such as a divorce, can create a feeling of instability, as well.

In the 1970s and 1980s, major life events were considered to be the main source of stress-related illness. It was believed that we could determine whether people were under too much stress by asking if they had experienced to events such as death in the family, a job change, or a move to a new home. However, researchers later found that “hassles” or daily problems were just as likely to be predictors for emotional and/or physical illnesses as were major life events. They realized that stress is most often cumulative.

The impact of cumulative stress can be seen when we see children who handle many stressful events adequately, suddenly sick or to “lose it” over the slightest injustice. When they finally react to cumulative stress, everyone is often surprised by the response. However, when they look back at what was going on in the children’s lives, the array of contributing factors is usually clearly evident.

Identifying Students Under Stress

Stress can be both positive and negative. Helpful stress, also referred to as eustress, has the power to energize us to solve problems and accomplish goals. However, harmful stress, known as distress, can adversely affect our bodies, minds, and/or behaviors.

Reactions to stress vary from one youth to another. Children will develop individual styles of handling stress and those styles may change with age. As mentioned earlier, symptoms of stress in young children are often difficult to distinguish from symptoms of minor illnesses. Common symptoms include irritability, stomachaches, and headaches. Fearful children may use words such as "feeling bad" or "afraid” to express distress. Periods of stubbornness and/or regression to earlier behavior are often indicative of too much stress. Behavioral warning signs may include:

• Tardiness;
• Daydreaming or withdrawal;
• Excessive tears;
• Inappropriate laughter;
• Fidgeting;
• Rudeness;
• Constant need for praise and attention;
• Changes in academic performance; and
• Giving up on assignments too quickly.

As children approach or reach middle school, their responses to stress may include attention-seeking behaviors, mood changes, anger, aggressive behavior, rudeness to adults and others, avoidance of certain activities, changes in the quality of schoolwork, as well as common physical complaints (headaches and/or upset stomachs). Overt anxiety or anxiety mixed with depression is not uncommon. Children and adolescents may also react to stress by regression to behaviors of someone much younger, the pattern being somewhat like an adult who has a temper tantrum as a response to stress.

Distressed adolescents are often truant, lack commitment to schoolwork, and are indifferent to school rules and policies. They are also often unwilling to participate in school activities. Students this age are frequently exposed to alcohol and other drugs and, as a result, they run the risk of trying to cope with stress by experimenting with these substances.

Children and youth exposed to extreme stress in the form of a traumatic event such as war, violence at school, or accidental death of an immediate family member, need special care which should usually be provided by a qualified mental health professional, not the classroom teacher. After a little break from the routine and/or crisis counseling, many children appear okay -- yet they may still be in shock and exhibit some symptoms. Children, who demonstrate intense emotions after a traumatic event, need to be reassured that they are having normal reactions to an abnormal occurrence. They need to feel “normal” after a tragic event, and this can be the most valuable support a school community can offer. If symptoms of intense anxiety, irritability, or unnatural fears present themselves at a later date, be empathic. However, keep in mind that a referral to a mental health professional may be in order.

Interventions

Prevention: How Can We Inoculate Children From the Harmful Effects of Stress?

• Let children know: they can trust you (be honest, reliable, and on time); their school and classroom is safe; and they are important members of the school community.
• Encourage the expression of feelings. Awareness of feelings is one of the major building blocks to self-awareness. When listening to an account of the day`s experiences, ask children how they felt about the day, as well as what they did.
• Help children and adolescents learn how to problem solve. Taking responsibility for their decisions helps them to feel that they can be in control. Children and teens with be strongest coping skills usually have experienced the satisfaction of successfully solving problems.
• Teach and model emotional regulation. The earlier one learns to use emotions to facilitate (rather than interfere) with setbacks, the better the child’s response to stress will be.
• Develop a proactive classroom that is productive and has limited disruptions.
• Explain what is expected in your classroom and why.
• Encourage physical activity as a means of releasing stress.
• Set realistic behavioral expectations based on each child’s developmental level.
• Keep children informed of necessary and anticipated changes within the school or community. Even moving to a new classroom can be a stressor.
• Involve children as helpers and encourage them to make responsible decisions.
• Promote healthy relationships by modeling positive interactions with others. A network of friends for you and your children buffers against distress and negative peer relationships.
• Realize that children (probably in middle school) will be exposed to drugs and alcohol. Let them know that self-medicating with alcohol and drugs is not the way to cope with stress.

Teacher-based Interventions

Teachers have a powerful influence on youngsters -- both positive and negative. When stressors escalate in the classroom, the most important first step is to avoid a global personalized response (such as calling a student a “bad girl” or a group of them “disturbed kids”). Focus instead on the inappropriate behaviors (“five children are not in their seats!”). Then, as a teacher, you can proceed to:

• Evaluate your classroom schedule regularly. Consider whether it has become too demanding or not demanding enough.
• Be aware of children’s behaviors and emotions. Help them to find things that give them personal pleasure. Encourage children to talk to you if there was a problem during the day.
• If a family has “moved in” from a new neighborhood and the child is “lost” or struggling, help the child to feel a part of the school and community. A call home after the first day or week of school may be appropriate.
• Monitor the television programs that children watch in school (including news broadcasts which can produce worries and anxiety). Pay particular attention to and provide supervision for computer games and the use of the internet.
• When a child makes a poor decision, listen without being critical, encourage the child to use reflective thought, and use natural consequences as punishment.
• Over scheduling children in group activities can produce a great deal of stress. Find time for children to play alone and in smaller groups, as well.
• If a problem occurs at school that is not resolved, contact the parent. Most parents want to be informed and can help.
• If signs of stress do not disappear or a child or adolescent has been a victim of a traumatic experience, seek professional help or advice.

Spotlight On Steroids

By Julie Rosenbluth, MPH, CHES for American Council For Drug Education

From high school football players to professional athletes like baseball players and cyclists, steroid use and its acceptance seems to be on the rise. While we do our best to educate our children about the dangers of steroid use, what message do they get when their favorite role models are using them and, in many cases, getting away with it?

In the wake of baseball’s steroid scandal this year and at the start of a fresh new school year, now is a great time to make sure your students are getting the right message about steroids.

What Are Steroids?

Steroids, commonly known by their street names as Juice, Roids, Gym Candy, Pumpers, Stackers, Balls or Bulls, Weight Trainers, Arnies, A’s or Anabolics, are manufactured testosterone-like drugs that are usually taken to build muscle, enhance performance, and improve appearance. While some steroids are used medically to treat many conditions including asthma, chronic lung disease, skin conditions and allergic reactions such as poison ivy, non-medical use of steroids can have serious side effects. Using steroids for cosmetic or athletic purposes is not sanctioned in the United States.

Trends In Use

While use leans disproportionately to boys, girls are at risk as well, especially those who are active in sports or concerned about their weight. Figures from the 2004 Monitoring the Future survey demonstrate a slight decrease in use by 8th and 10th graders but a significant upward trend among 12th graders at 2.5% from 1.7% in 1999 and 2.4% in 2001. However, the findings indicate that this rise might be reflective of the effect of the younger, heavier-using cohorts aging. However, disapproval of use did continue to rise, according the 2004 survey, with as many as 88% of 12th graders surveyed indicating they disapproved of use. Studies show that disapproval by peers has a significant influence on teens’ decisions to use drugs.

Of some concern was the number of students who did not perceive risk associated with steroid use. Many teens don’t have the same inherent fear of steroid use that they might with using other drugs like cocaine or heroin because their goal is to improve their physical appearance, not break their bodies down. Efforts to educate students about steroid use must focus on the negative consequences and risk of using them.

Why Do Teens Use

Adolescents and pre-adolescents are especially at risk because of the changes their bodies are going through. Adolescents go through puberty at different rates and many will feel uncomfortable with these changes, especially if their peers look different. Many girls will desire to lose weight and look lean and toned like the models they see in magazines and many boys will wish they could take on the taller, broader appearance of a man sooner. Many feel pressure from their parents and coached to be bigger and stronger on the field or in their chosen sport.

Steroids will increase muscle mass as well as endurance meaning you are able to lift more (weights), hit harder (on the baseball field), or perform longer (running and cycling and other endurance sports). However, none of these seemingly positive effects come out without both short- and long-term consequences.

Effects

Short Term

Use of steroids can increase muscle mass, strength, and endurance, but can also cause liver tumors, jaundice, water retention, and high blood pressure. Some users show bad judgment because the drugs make them feel invincible. Other users suffer from uncontrolled aggression and violent behavior called “Roid Rage,” severe mood swings, manic episodes and depression. They often suffer from paranoid jealousy, extreme irritability and can have delusions.

Long-Term

When the body experiences a build up of steroids in its system, conditions such as hypertension; high cholesterol; kidney disease, stunted growth; and heart damage are likely to occur. Women can experience irreversible deepening of the voice, shrinking of the breasts, menstrual irregularities, baldness and hair growth on other parts of the body, and genital swelling. Men can experience baldness, breast enlargement, sterility, shrinking of testicles and impotence. Steroids such as prednisone and other synthetic steroids, can cause a rise in blood sugar by blocking the effect of insulin. Over time, users can develop diabetes.

Signs and Symptoms Of Steroid Use

Unlike other drugs, steroids are not usually taken for their psycho-altering effect but for the physical changes that they bring about.

Steroid abusers often exhibit the following symptoms:

• Rapid weight gain
• Rapid muscle development
• Acne flare up
• Fluid retention
• Yellow tint in the eyes and on skin (jaundice)
• Mood swings, depression
• Aggressive behavior
• Premature balding (boys)
• Deeper voice (girls)
• Facial hair (girls)
• Breast reduction (girls
• Breast development (boys)

Talking To Kids About Steroids

• Talk about the dangers of steroids. Use some of the recent media scandal over steroid abuse in sports. Check out a recently launched ad campaign from the Major League Baseball and the Partnership for a Drug-Free America that educates youth and their parents about the dangers of steroid use and other performance-enhancing substances.
• Help students identify healthier role models and point out those who have been successful in sports without steroid use. Talk about the courage it took for those in the media to come forward with their abuse or to get help for a friend and encourage kids to do the same if they have a problem or suspect that a friend does.
• Teach students that success doesn’t come from what we look like but who we are inside. This message goes beyond steroid use but is important for teaching teens about feeling good inside and out and avoiding eating and other body dysmorphic disorders.
• Involve parents and coaches in your prevention efforts. Students aren’t the only ones who need a lesson in the dangers of steroid use. Host a training for the athletic department or develop a social norms campaign and place ads on athletic fields and locker rooms
• Encourage students to participate in sports and healthy competition but make sure to stress the importance of other activities that will make them a more well-rounded student.
• Emphasize nutrition and stress reduction to maintain holistic wellness.
• Provide intervention resources for students who have a problem.

For more tips about talking to kids about drugs in the classroom visit the American Council for Drug Education at www.acde.org, the prevention affiliate of Phoenix House, the nation’s largest substance abuse treatment provider.

Cyberbullying: Challenges and Solutions

By Nancy Willard for The Center for Safe and Responsible Internet Use

• Middle school students created a website denigrating Raymond. They posted stories, jokes, and cartoons ridiculing his size and questioning his sexuality.
• Tyler reported to the principal that students were bullying another student. When Tyler got home, he had 35 angry messages in his email box. The anonymous cruel messages kept coming -- some from total strangers.

• Sitting around the computer with her friends, Judy asked, “Who can we mess with?” Judy started IM-ing with Sara, asking her many personal questions. The next day, the girls were passing around Sara’s IM at school.

• Brad’s blog is filled with racist profanity. Frequently, he targets black and Latino student leaders, as well as minority teachers, in his angry verbal assaults.

• Greg, an obese high school student, was changing in the locker room after gym class. Matt took a covert picture of him with his cell phone camera. Within seconds, the picture was flying around the cell phones at school.
• Sue was really angry at Kelsey, who she thought stole her boyfriend. Sue convinced Marilyn to post anonymous comments on a discussion board slamming Kelsey. Marilyn was eager to win Sue’s approval and fit into her group of friends, so she did as Sue requested.
• A group of girls at his school had been taunting Alan through instant messaging, teasing him about his small size, daring him to do things he couldn’t do, suggesting the world would be a better place if he committed suicide. One day, he shot himself. His last online message was, “Sometimes the only way to get the respect you deserve is to die.”

Young people have clearly embraced the Internet as a tool for socializing. Unfortunately, there are increasing reports of teens, and sometimes younger children, using the Internet to engage in cyberbullying -- being cruel to others by sending or posting harmful material or engaging in other forms of social cruelty.

Cyberbullying can take different forms, including:

• Flaming -- online “fights” using electronic messages with angry and vulgar language;
• Harassment -- repeatedly sending offensive, rude, and/or insulting messages;
• Denigration -- sending or posting cruel gossip or rumors about a person to damage his or her reputation or friendships;
• Impersonation -- breaking into someone’s account, posing as that person and sending messages to make the person look bad, get that person in trouble or danger, or damage that person’s reputation or friendships;
• Outing and trickery -- sharing someone’s secrets or embarrassing information or images online and/or tricking someone into revealing secrets or embarrassing information, which is then shared online;
• Exclusion -- intentionally excluding someone from an online group, like a buddy list;
• Cyberstalking -- repeatedly sending messages that include threats of harm or are highly intimidating: and
• Engaging in other online activities that make a person afraid for her or her safety.

It is widely known that face-to-face bullying can result in long-term psychological harm to targets. This harm includes low self-esteem, depression, anger, school failure, school avoidance, and, in some cases, school violence or suicide. It is possible that the harm caused by cyberbullying may be even greater. Online communications can be extremely vicious. There is no escape for those who are being cyberbullied -- victimization is ongoing, 24/7. Cyberbullying material can be distributed worldwide and is often irretrievable. Cyberbullies can be anonymous and can solicit the involvement of unknown “friends.”

Cyberbullying may be related to in-school bullying. Sometimes, the student who is victimized at school is also being bullied online. But other times, the person who is victimized at school becomes a cyberbully and retaliates online. Other times, the student who is victimized will share his or her anger or depression online as distressing material.

Frequently, cyberbullying appears to be occurring between members of the “in-crowd” and “wannabes.” Cyberbullying may involve relationships, including angry breakups or fights about relationships. It may also be based on hate or bias -- bullying others because of race, religion, obesity, or sexual orientation. Unfortunately, it also appears that many teens simply think that cyberbullying is entertaining.

Cyberbullying generally is occurring off-campus, although students may be able to engage in cyberbullying through the district Internet system or by using cell phones at school. It is more difficult for schools to respond with formal discipline if the cyberbullying is occurring off-campus due to free-speech protections. Any time there is a report of cyberbullying between students, even if it appears that the activity is occurring off-campus, an individualized search should be conducted of the Internet use activities of the involved students through the district’s Internet system. This may reveal evidence of on-campus activity that can justify a wider range of responses.

Even if the activity is totally off-campus, there is much that can be done to seek to resolve the situation. It is exceptionally important to sort out the overall relationships between the students involved and to stop any related on-campus bullying.

Schools can contact the parents of the students involved in cyberbullying, provide them with evidence of their child’s online activities, and offer to provide assistance in helping them gain better control over their children’s Internet use. In such cases, it is strongly recommended that the parents install monitoring software on their home computers. If parents know that their children causing harm to others and fail to intervene to stop the harm, they can be held financially liable in a civil court proceeding.

There are also actions that the target or target’s parents can take to seek to stop the cyberbullying and remove the material. This includes contacting the website, Internet service provider, and/or cell phone company to file a complaint. In some cases, filing a civil lawsuit may be justified or contacting the police if the actions are in violation of criminal law.

Counselors can assist the target in dealing with these situations by either helping the target disengage from the online community in which he or she is being bullied or finding a way to stop the cyberbullying while remaining in the online community. Online communications provide interesting capabilities to help “bully-proof” a student. The communications are recorded. This can allow the student and counselor review the communications to determine whether actions of the student might be precipitating the cruel behavior. Bullies are reinforced when the target loses his or her “cool.” But online communications are invisible and can be delayed. Targets can learn the importance of not responding when upset and can take the time to craft a strong and assertive response. This provides targets with the opportunity to more effectively stand up to the bully and, in so doing, hopefully get the bullying to stop.

These new technologies are clearly an important part of youth life. There is simply no way to block or prevent their use. Increased adult supervision is clearly essential. But most importantly, these new technologies present a challenge: How can we impart to young people the knowledge, skills, and values to ensure that they make good choices that demonstrate respect for others and are empowered to respond effectively if others are not demonstrating respect for them?