The Adolescent Brain: Behavior, Problem Solving, and Decision Making

Many moms and dads do not understand why their adolescents occasionally behave in an impulsive, irrational, or dangerous way. At times, it seems like they don’t think things through or fully consider the consequences of their actions. Adolescents differ from adults in the way they behave, solve problems, and make decisions. There is a biological explanation for this difference. Studies have shown that brains continue to mature and develop throughout childhood and adolescence and well into early adulthood.

Scientists have identified a specific region of the brain called the amygdala which is responsible for instinctual reactions including fear and aggressive behavior. This region develops early. However, the frontal cortex, the area of the brain that controls reasoning and helps us think before we act, develops later. This part of the brain is still changing and maturing well into adulthood.

Other specific changes in the brain during adolescence include a rapid increase in the connections between the brain cells and pruning (refinement) of brain pathways. Nerve cells develop myelin, an insulating layer which helps cells communicate. All these changes are essential for the development of coordinated thought, action, and behavior.

Changing Brains mean that Adolescents Act Differently From Adults—

Pictures of the brain in action show that adolescents’ brains function differently than adults when decision-making and problem solving. Their actions are guided more by the amygdala and less by the frontal cortex. Research has also demonstrated that exposure to drugs and alcohol before birth, head trauma, or other types of brain injury can interfere with normal brain development during adolescence.

Based on the stage of their brain development, adolescents are more likely to:

• act on impulse
• engage in dangerous or risky behavior
• get into accidents of all kinds
• get involved in fights
• misread or misinterpret social cues and emotions

Adolescents are less likely to:

• modify their dangerous or inappropriate behaviors
• pause to consider the potential consequences of their actions
• think before they act

These brain differences don’t mean that young people can’t make good decisions or tell the difference between right and wrong. It also doesn’t mean that they shouldn’t be held responsible for their actions. But an awareness of these differences can help moms and dads, teachers, advocates, and policy makers understand, anticipate, and manage the behavior of adolescents.

Normal Adolescent Development

Middle School and Early High School Years—

Moms and dads are often worried or confused by changes in their adolescents. The following information should help moms and dads understand this phase of development. Each adolescent is an individual with a unique personality and special interests, likes and dislikes. However, there are also numerous developmental issues that everyone faces during the adolescent years. The normal feelings and behaviors of the middle school and early high school adolescent are described below.

Movement Towards Independence—

• Complaints that moms and dads interfere with independence
• Feeling awkward or strange about one's self and one's body
• Focus on self, alternating between high expectations and poor self-esteem
• Improved ability to use speech to express one's self
• Interests and clothing style influenced by peer group
• Less overt affection shown to moms and dads, with occasional rudeness
• Moodiness
• Realization that moms and dads are not perfect; identification of their faults
• Struggle with sense of identity
• Tendency to return to childish behavior, particularly when stressed

Future Interests and Cognitive Changes—

• Greater ability to do work (physical, mental, emotional)
• Intellectual interests expand and gain in importance
• Mostly interested in present, with limited thoughts of the future

Sexuality—

• Concerns regarding physical and sexual attractiveness to others
• Display shyness, blushing, and modesty
• Frequently changing relationships
• Girls develop physically sooner than boys
• Increased interest in sex
• Movement toward heterosexuality with fears of homosexuality
• Worries about being normal

Morals, Values, and Self-Direction—

• Capacity for abstract thought
• Development of ideals and selection of role models
• Experimentation with sex and drugs (cigarettes, alcohol, and marijuana)
• More consistent evidence of conscience
• Rule and limit testing

Young adolescents do vary slightly from the above descriptions, but the feelings and behaviors are, in general, considered normal for each stage of adolescence.

Late High School Years and Beyond—

Moms and dads are often worried or confused by changes in their adolescents. The following information should help moms and dads understand this phase of development. Each adolescent is an individual with a unique personality and special interests, likes and dislikes. However, there are also numerous developmental issues that everyone faces during the adolescent years. The normal feelings and behaviors of the late high school adolescent are described below.

Movement towards Independence—

• Ability to think ideas through
• Conflict with moms and dads begins to decrease
• Examination of inner experiences
• Firmer and more cohesive sense of identity
• Increased ability for delayed gratification and compromise
• Increased concern for others
• Increased emotional stability
• Increased independent functioning
• Increased self-reliance
• Peer relationships remain important and take an appropriate place among other interests

Future Interests and Cognitive Changes—

• Increased concern for the future
• More importance is placed on one's role in life
• Work habits become more defined

Sexuality—

• Development of more serious relationships
• Feelings of love and passion
• Firmer sense of sexual identity
• Increased capacity for tender and sensual love

Morals, Values, and Self-Direction—

• Capacity to use insight
• Greater capacity for setting goals
• Increased emphasis on personal dignity and self-esteem
• Interest in moral reasoning
• Social and cultural traditions regain some of their previous importance

Older adolescents do vary slightly from the above descriptions, but the feelings and behaviors are, in general, considered normal for each stage of adolescence.

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Talking to Your Child about S E X

Talking to your kids about love, intimacy, and sex is an important part of parenting. Moms and dads can be very helpful by creating a comfortable atmosphere in which to talk to their kids about these issues. However, many moms and dads avoid or postpone the discussion. Each year about one million teenage girls become pregnant in the United States and three million teens get a sexually transmitted disease. Kids and teenagers need input and guidance from moms and dads to help them make healthy and appropriate decisions regarding their sexual behavior since they can be confused and over-stimulated by what they see and hear. Information about sex obtained by kids from the Internet can often be inaccurate and/or inappropriate.

Talking about sex may be uncomfortable for both moms and dads and kids. Moms and dads should respond to the needs and curiosity level of their individual child, offering no more or less information than their youngster is asking for and is able to understand. Getting advice from a clergyman, pediatrician, family physician, or other health professional may be helpful. Books that use illustrations or diagrams may aid communication and understanding.

Kids have different levels of curiosity and understanding depending upon their age and level of maturity. As kids grow older, they will often ask for more details about sex. Many kids have their own words for body parts. It is important to find out words they know and are comfortable with to make talking with them easier. A 5-year-old may be happy with the simple answer that babies come from a seed that grows in a special place inside the mother. Dad helps when his seed combines with mom's seed which causes the baby to start to grow. An 8-year-old may want to know how dad's seed gets to mom's seed. Moms and dads may want to talk about dad's seed (or sperm) coming from his penis and combining with mom's seed (or egg) in her uterus. Then the baby grows in the safety of mom's uterus for nine months until it is strong enough to be born. An 11-year-old may want to know even more and moms and dads can help by talking about how a man and woman fall in love and then may decide to have sex.

It is important to talk about the responsibilities and consequences that come from being sexually active. Pregnancy, sexually transmitted diseases, and feelings about sex are important issues to be discussed. Talking to your kids can help them make the decisions that are best for them without feeling pressured to do something before they are ready. Helping kids understand that these are decisions that require maturity and responsibility will increase the chance that they make good choices.

Teenagers are able to talk about lovemaking and sex in terms of dating and relationships. They may need help dealing with the intensity of their own sexual feelings, confusion regarding their sexual identity, and sexual behavior in a relationship. Concerns regarding masturbation, menstruation, contraception, pregnancy, and sexually transmitted diseases are common. Some teenagers also struggle with conflicts around family, religious or cultural values. Open communication and accurate information from moms and dads increases the chance that teens will postpone sex and will use appropriate methods of birth control once they begin.

In talking with your youngster or teenager, it is helpful to:

• Be open in sharing your values and concerns.
• Discuss the importance of responsibility for choices and decisions.
• Encourage your youngster to talk and ask questions.
• Help your youngster to consider the pros and cons of choices.
• Keep your sense of humor and don't be afraid to talk about your own discomfort.
• Maintain a calm and non-critical atmosphere for discussions.
• Relate sex to love, intimacy, caring, and respect for oneself and one's partner.
• Try to determine your youngster's level of knowledge and understanding.
• Use words that are understandable and comfortable.

By developing open, honest and ongoing communication about responsibility, sex, and choice, moms and dads can help their youngsters learn about sex in a healthy and positive manner.

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Stepfamilies

A stepfamily forms when one or both adults in a new couple bring kids from a previous relationship. Although stepfamilies look like first-time families on the outside, they are very different on the inside. The first step toward making a successful stepfamily is understanding the differences between stepfamilies and first-time families. The previous marriage may have ended in divorce or in death. The original parent may be a never-married single parent or an adoptive parent. The new couple may be gay or straight.

How Stepfamilies Are Different—

Stepfamilies have "insiders" and "outsiders." In a first-time family, the adult couple is considered the "insider unit," but insider and outsider roles shift. Sometimes mom is closer to Danny. Next month, dad and Danny are closer.

In stepfamilies, insider and outsider positions start out painfully stuck. Agreements about every day issues lie within the parent-youngster unit, not between the adult couple. And single parent families usually have become a very tight unit. All of this makes stepparents outsiders in their new families. This outsider position often leaves stepparents feeling invisible, powerless, rejected and lonely. Biological (or adoptive) moms and dads begin as the stuck insiders. They are most connected to their own kids, to their new partner, and to their ex-spouse. Insider moms and dads often feel torn and anxious trying to balance everyone's needs.

Kids, too, occupy stuck insider and outsider positions. When Mike's 13-year-old son, Johnny, visits his dad's new family on weekends, Johnny enters as an outsider. David and Jenny, Mike's new stepkids, are stuck insiders. They must share their space with a new stepbrother they did not choose and may not even like.

Letting Go of Unrealistic Expectations—

New couples naturally wish for their new families to blend right away. Stepparents want their stepkids to love them. Straining to make the impossible happen, however, creates constant failure. Stepcouples need at least two years to begin to function as a unit. Some stepkids will need even more time and some will need less. Letting go of understandable, but unrealistic wishes frees you to meet the challenges.

Kid's Losses and Conflicting Loyalties—

For adults, new partners are thrilling. For kids, however, the entry of a new stepparent often creates loss and change. Mom spends the evening with her new boyfriend. Dad's new girlfriend bans a youngster's favorite sugar cereal. Stepparents also create conflicts of loyalty for kids. A youngster may think, If I care about my new stepmom, I am disloyal to my mom. Arguing moms and dads make this situation even worse for kids. For all these reasons, kids need time to adjust.

Spending regular time in pairs helps shift insider-outsider roles. Carve out couple time, without kids, to form a bond and to give stepparents time in the insider role with their new partner. Balance this with reliable parent-youngster alone time, including some vacation time. Re-establishing consistent parent-youngster time can improve the behavior of an acting-out or depressed youngster. Outsider stepparents maintain well-being and sanity by continuing activities with friends outside the new family. Develop stepparent-stepchild relationships by engaging in "shoulder-to-shoulder" activities, without the parent present.

A stepparent might say to his stepchild: "I will never take the place of your dad. His place in your heart is permanent. You have a big heart. Sometime, I hope there will be room in it for me. Even then, it will be a different place from your dad's place."

Further, expect civility-but not love. We can expect stepparents and stepkids to treat each other with respect and decency. We cannot, however, demand love of people who did not choose each other. A parent might say to her son: "You have a right to be upset with all these changes. I will really try to listen. But you do need to be respectful to Mike, like any other stranger."

Recognize that Stepparents are Not Parents—

Kids benefit when stepparents can help moms and dads become firmer. Biological moms and dads need to help stepparents become more kind. However, stepkids cannot initially accept any parenting from stepparents. The parent must remain in charge until kids are ready. Stepparents can give input, but the original parent retains final say. Stepparents may consider expressing caring and encouragement: "How was that test?" And reporting concerns to the parent: "I think Johnny didn't do his homework." When moms and dads are absent, stepparents aim for "adult babysitter," not parent. "While I am out tonight, Mike is in charge." Stepparents then enforce the rules of the house.

The "Other" Household—

Decrease conflict with the "other" household. Parental conflict seriously compromises kid's adjustment. Keep drop-offs and pickups peaceful. Handle differences between households calmly and neutrally: "You drink Coke at mom's house. We drink milk here." Address problems with your ex out of kid's earshot. In conflicted divorces, stick to a detailed, iron clad visitation schedule.

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Children and "Cliques"

Given how prevalent cliques are throughout middle and high school, at some point your youngster is likely to face the prospect of being in one or being excluded from them. There's little you can do to shield children from cliques, but plenty you can do to help them maintain confidence and self-respect while negotiating cliques and understanding what true friendship is all about.

What's a Clique?

Friendship is an important part of a child’s development. Having friends helps them be independent beyond the family and prepares them for the mutual, trusting relationships we hope they'll establish as adults.

Groups of friends are different from cliques in some important ways. Friendships grow out of shared interests, sports, activities, classes, neighborhoods, or even family connections. In groups of friends, members are free to socialize and hang out with others outside the group without worrying about being cast out. They may not do everything together — and that's OK.

Cliques sometimes form around common interests, but the social dynamics are very different. Cliques are usually tightly controlled by leaders who decide who is "in" and who is "out." The children in the clique do most things together. Someone who has a friend outside the clique may face rejection or ridicule.

Members of the clique usually follow the leader's rules, whether it's wearing particular clothes or doing certain activities. Cliques usually involve lots of rules — implied and clearly stated — and intense pressure to follow them. Children in cliques often worry about whether they'll continue to be popular or whether they'll be dropped for doing or saying the wrong thing or for not dressing in a certain way. This can create a lot of pressure, particularly for girls, who might be driven to extreme dieting and eating disorders or even to ask for plastic surgery. Others may be pressured to take risks like steal, pull pranks, or bully other children in order to stay in the clique.

When Cliques Cause Problems—

For most children, the pre-teenage and teenage years are a time to figure out how they want to fit in and how they want to stand out. It's natural for children to occasionally feel insecure; long to be accepted; and hang out with the children who seem more attractive, cool, or popular.

But cliques can cause long-lasting trouble when:

• a youngster is rejected by a group and feels ostracized and alone
• a group becomes an antisocial clique or a gang that has unhealthy rules, such as weight loss or bullying others based on looks, disabilities, race, or ethnicity
• children behave in a way they feel conflicted about or know is wrong in order to please a leader and stay in the group

How Moms and Dads Can Help—

As children navigate friendships and cliques, there's plenty moms and dads can do to offer support. If your youngster seems upset, or suddenly spends time alone when usually very social, ask about it.

Here are some tips:

• Find stories they can relate to. Many books, TV shows, and movies portray outsiders triumphing in the face of rejection and send strong messages about the importance of being true to your own nature and the value of being a good friend, even in the face of difficult social situations. For school-age children, books like "Blubber" by Judy Blume illustrate how quickly cliques can change. Older children and teenagers might relate to movies such as "Mean Girls," "Angus," "The Breakfast Club," and "Clueless" or the new TV show "Aliens in America."

• Foster out-of-school friendships. Get children involved in extracurricular activities (if they aren't already) — art class, martial arts, horse riding, language study — any activity that gives them an opportunity to create another social group and learn new skills.

• Help put rejection in perspective. Remind your youngster of times he or she has been angry with moms and dads, friends, or siblings — and how quickly things can change.

• Shed some light on social dynamics. Acknowledge that people are often judged by the way a person looks, acts, or dresses, but that often people act mean and put others down because they lack self-confidence and try to cover it up by maintaining control.

• Talk about your own experiences. Share your own experiences of school — cliques have been around for a long time!

If your youngster is part of a clique and is one of the children bullying or rejecting others, it's important to address that right away. With popular TV shows from talent contests to reality series glorifying rude behavior, it's an uphill battle for families to promote kindness, respect, and compassion. Discuss the role of power and control in friendships and try to get to the heart of why your youngster feels compelled to be in that position. Discuss who is in and who is out, and what happens when children are out (are they ignored, shunned, bullied?). Challenge children to think and talk about whether they're proud of the way they act in school.

Ask teachers, guidance counselors, or other school officials for their perspective on the social dynamics in and out of class. They might be able to tell you about any programs the school has to address cliques and help children with differences get along.

Encouraging Healthy Friendships—

Here are some ways to encourage children to have healthy friendships and not get too caught up in cliques:

• Take responsibility for your own actions. Encourage sensitivity to others and not just going along with a group. Remind children that a true friend respects their opinions, interests, and choices, no matter how different they are. Acknowledge that it can be difficult to stand out, but that ultimately children are responsible for what they say and do.

• Stick to your likes. If your youngster has always loved to play the piano but suddenly wants to drop it because it's deemed "uncool," discuss ways to help resolve this.

• Speak out and stand up. If they're feeling worried or pressured by what's happening in the cliques, encourage your children to stand up for themselves or others who are being cast out or bullied. Encourage them not to participate in anything that feels wrong, whether it's a practical joke or talking about people behind their backs.

• Keep social circles open and diverse. Encourage children to be friends with people they like and enjoy from different settings, backgrounds, ages, and interests.

• Find the right fit — don't just fit in. Encourage children to think about what they value and are interested in, and how those things fit in with the group. Ask questions like: What is the main reason you want to be part of the group? What compromises will you have to make? Is it worth it? What would you do if the group leader insisted you act mean to other children or do something you don't want to do?

Remember to provide the big-picture perspective too. As hard as cliques might be to deal with now, things can change quickly. What's more important is making true friends — people they can confide in, laugh with, and trust. And the real secret to being "popular" — in the truest sense of the word — is for them to be the kind of friend they'd like to have: respectful, fair, supportive, caring, trustworthy, and kind.

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Sibling Rivalry

While many children are lucky enough to become the best of friends with their siblings, it's very common for brothers and sisters to fight. (It's also common for them to swing back and forth between adoring and detesting one other!)

Often, sibling rivalry starts even before the second youngster is born, and continues as the children grow and compete for everything from toys to attention. As children reach different stages of development, their evolving needs can significantly affect how they relate to one another.

It can be frustrating and upsetting to watch — and hear — your children fight with one another. A household that's full of conflict is stressful for everyone. Yet often it's hard to know how to stop the fighting, and or even whether you should get involved at all. But you can take steps to promote peace in your household and help your children get along.

Why Do My Children Fight?

Many different things can cause siblings to fight. Most brothers and sisters experience some degree of jealousy or competition, and this can flare into squabbles and bickering. But other factors also might influence how often children fight and how severe the fighting gets. These include:

• Special needs/sick children. Sometimes, a youngster's special needs due to illness or learning/emotional issues may require more parental time. Other children may pick up on this disparity and act out to get attention or out of fear of what's happening to the other youngster.

• Role models. The way that moms and dads resolve problems and disagreements sets a strong example for children. So if you and your spouse work through conflicts in a way that's respectful, productive, and not aggressive, you increase the chances that your youngsters will adopt those tactics when they run into problems with one another. If your children see you routinely shout, slam doors, and loudly argue when you have problems, they're likely to pick up those bad habits themselves.

• Individual temperaments. Your children's individual temperaments — including mood, disposition, and adaptability — and their unique personalities play a large role in how well they get along. For example, if one youngster is laid back and another is easily rattled, they may often get into it. Similarly, a youngster who is especially clingy and drawn to moms and dads for comfort and love might be resented by siblings who see this and want the same amount of attention.

• Evolving needs. It's natural for children' changing needs, anxieties, and identities to affect how they relate to one another. For example, toddlers are naturally protective of their toys and belongings, and are learning to assert their will, which they'll do at every turn. So if a baby brother or sister picks up the toddler's toy, the older youngster may react aggressively. School-age children often have a strong concept of fairness and equality, so they might not understand why siblings of other ages are treated differently or feel like one youngster gets preferential treatment. Teenagers, on the other hand, are developing a sense of individuality and independence, and might resent helping with household responsibilities, taking care of younger siblings, or even having to spend time together. All of these differences can influence the way children fight with one another.

What Can I Do When the Fighting Starts?

While it may be common for brothers and sisters to fight, it's certainly not pleasant for anyone in the house. And a family can only tolerate a certain amount of conflict. So what should you do when the fighting starts?

Whenever possible, don't get involved. Step in only if there's a danger of physical harm. If you always intervene, you risk creating other problems. The children may start expecting your help and wait for you to come to the rescue rather than learning to work out the problems on their own. There's also the risk that you — inadvertently — make it appear to one youngster that another is always being "protected," which could foster even more resentment. By the same token, rescued children may feel that they can get away with more because they're always being "saved" by a parent.

If you're concerned by the language used or name-calling, it's appropriate to "coach" children through what they're feeling by using appropriate words. This is different from intervening or stepping in and separating the children.

Even then, encourage them to resolve the crisis themselves. If you do step in, try to resolve problems with your children, not for them.

When getting involved, here are some steps to consider:

• Don't put too much focus on figuring out which youngster is to blame. It takes two to fight — anyone who is involved is partly responsible.

• Separate children until they're calm. Sometimes it's best just to give them space for a little while and not immediately rehash the conflict. Otherwise, the fight can escalate again. If you want to make this a learning experience, wait until the emotions have died down.

• Try to set up a "win-win" situation so that each youngster gains something. When they both want the same toy, perhaps there's a game they could play together instead.

Remember, as children cope with disputes, they also learn important skills that will serve them for life — like how to value another person's perspective, how to compromise and negotiate, and how to control aggressive impulses.

Helping Children Get Along—

Simple things you can do every day to prevent fighting include:

• Be proactive in giving your children one-on-one attention directed to their interests and needs. For example, if one likes to go outdoors, take a walk or go to the park. If another youngster likes to sit and read, make time for that too.

• Don't let children make you think that everything always has to be "fair" and "equal" — sometimes one kid needs more than the other.

• Have fun together as a family. Whether you're watching a movie, throwing a ball, or playing a board game, you're establishing a peaceful way for your children to spend time together and relate to each other. This can help ease tensions between them and also keeps you involved. Since parental attention is something many children fight over, fun family activities can help reduce conflict.

• If fights between your school-age youngsters are frequent, hold weekly family meetings in which you repeat the rules about fighting and review past successes in reducing conflicts. Consider establishing a program where the children earn points toward a fun family-oriented activity when they work together to stop battling.

• If your youngsters frequently squabble over the same things (such as video games or dibs on the TV remote), post a schedule showing which youngster "owns" that item at what times during the week. (But if they keep fighting about it, take the "prize" away altogether.)

• Let them know that they are safe, important, and needed, and that their needs will be met.

• Make sure children have their own space and time to do their own thing — to play with toys by themselves, to play with friends without a sibling tagging along, or to enjoy activities without having to share 50-50.

• Recognize when children just need time apart from each other and the family dynamics. Try arranging separate play dates or activities for each kid occasionally. And when one youngster is on a play date, you can spend one-on-one time with another.

• Set ground rules for acceptable behavior. Tell the children that there's no cursing, no name-calling, no yelling, no door slamming. Solicit their input on the rules — as well as the consequences when they break them. This teaches children that they're responsible for their own actions, regardless of the situation or how provoked they felt, and discourages any attempts to negotiate regarding who was "right" or "wrong."

• Show and tell your children that, for you, love is not something that comes with limits.

Keep in mind that sometimes children fight to get a parent's attention. In that case, consider taking a time-out of your own. When you leave, the incentive for fighting is gone. Also, when your own fuse is getting short, consider handing the reins over to the other parent, whose patience may be greater at that moment.

Getting Professional Help—

In a small percentage of families, the conflict between brothers and sisters is so severe that it disrupts daily functioning, or particularly affects children emotionally or psychologically. In those cases, it's wise to get help from a mental health professional. Seek help for sibling conflict if it:

• creates a real danger of physical harm to any family member
• is damaging to the self-esteem or psychological well-being of any family member
• is so severe that it's leading to marital problems
• may be related to another psychiatric disorder, such as depression

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Oppositional Defiant Disorder

What is Oppositional Defiant Disorder?

It is common for kids and teenagers to display bouts of irritability, frustration, and disobedience over the course of their growth and development. For example, the 4 year old who throws a tantrum because she has to stop playing; the 8 year old who picks on his younger sister; the 13 year old who argues with her mother about going to a movie. Still, there are many families who struggle with child behavior that goes beyond stubbornness or occasional talking back. Some kids and teenagers have such an inflexible and hostile nature and their behavior can be so uncooperative and defiant that they disrupt the functioning of whole households and classrooms, not to mention their own learning and well-being in relationships. One out of every ten kids or teenagers displays this type of disposition and behavior with such regularity that they are thought to have Oppositional Defiant Disorder (ODD).

According to the American Psychiatric Association, OPPOSITIONAL DEFIANT DISORDER is characterized by a chronic pattern of negativity, hostility, and non-compliant child behavior that is most often directed toward authority figures and has existed for at least 6 months. This behavior is severe enough that it interferes with everyday functioning at home and, in some cases, at school and other activities, and it stands out as more severe compared with kids of the same age and developmental level. Signs and symptoms of OPPOSITIONAL DEFIANT DISORDER:

• Act angry or resentful toward others
• Act spiteful or seek revenge on others
• Actively defy or refuse to comply with adults’ requests or rules
• Argue with adults
• Be touchy or easily annoyed by others
• Blame others for his or her mistakes or misbehavior
• Deliberately try to annoy or upset other people
• Lose his or her temper and throw tantrums

The exact cause of OPPOSITIONAL DEFIANT DISORDER is not known. Research suggests that it evolves out of a complex interaction of many different factors related to the basic biological, psychological, and social nature of the youngster and his or her relationships with the family and other environments, such as school. Also, it is not uncommon for kids with Attention Deficit/Hyperactivity Disorder (AD/HD), depression, or anxiety to display symptoms of OPPOSITIONAL DEFIANT DISORDER.

Effect on Families & Relationships—

Parenting a youngster with OPPOSITIONAL DEFIANT DISORDER can be a tremendous challenge not only because he or she may seem so willing to defy adult authority, but also because intervention strategies that work with most kids, such as time-outs, removal of privileges, and grounding, often do not work with OPPOSITIONAL DEFIANT DISORDER. Studies actually indicate that these kids may not respond well to punishments. Other studies have found that kids and teenagers with severe cases of OPPOSITIONAL DEFIANT DISORDER and/or aggression may feel threatened by situations where there are unclear messages, rules, or expectations, which can trigger hostile reactions. In addition, they often have poor frustration tolerance, which only makes it more difficult for them to get through situations where they feel uncomfortable, threatened, or where they may see little pay-off for their efforts. The result of these factors are kids and teenagers who seem to be easily annoyed or angered, yet are difficult to soothe and calm.

This pattern of behavior can leave many families feeling powerless, as if they have to “walk on eggshells” out of fear that one wrong move can cause a serious tantrum. It can also leave the youngster or teenager feeling isolated, anxious, and unsure of herself as others anticipate her irritability and explosive behavior even before it occurs. They likely will be aware of any feelings of disappointment and resentment that other family members feel toward them due to their oppositional and defiant behavior. Unfortunately, it is not enough to help change the behavior.

Parenting Tip: Be Decisive

It is easy for moms and dads who feel like they have to walk on eggshells to become wishy-washy; they are often unsure of when, where, and how, to give directions or enforce rules with their kids and teenagers. However, wishy-washiness can actually be a trigger for OPPOSITIONAL DEFIANT DISORDER behavior. It is important to be decisive!

Most parents with kids and teenagers with OPPOSITIONAL DEFIANT DISORDER have learned the hard way that it is much better to say “no” than to say “we’ll see” if “no” is the answer they really mean. The youngster may throw a tantrum with either response; however, telling the youngster “we’ll see” only heightens the intensity of her reaction because it gives her hope that she can still get what she wants. She is then likely to badger the parents until she gets her way or is finally told “no,” with the meltdown that follows being even more intense. So, go ahead and say “no” and stick to it; your youngster will learn over time that you mean what you say and that goes a long way to curbing anxiety and increasing compliant behavior. This also applies to setting plans for any activity, such as going to school, taking a trip, or running errands. Be clear about what is going to happen and alert and prepare the youngster before any changes to the plan take effect.

When to Seek Help—

It may never be too soon to seek help for your youngster or teenager if they are displaying the type of behavior associated with OPPOSITIONAL DEFIANT DISORDER, as it can be difficult to know whether it is a part of typical development or a problem that needs treatment. The more frequent and severe your youngster displays the symptoms listed above, the more likely there is to be intense family conflict and the more likely he or she is to have problems with peers, have difficulty maintaining friendships, and suffer academic problems.

Intervention—

The key to successful interventions for OPPOSITIONAL DEFIANT DISORDER is parent involvement. It is critical that moms and dads be firm and consistent not only with their discipline strategies, but also with the love and acceptance in their responses to the youngster. The most effective interventions are considered to be those that emphasize Parent Training, which provide a framework for understanding the nature of OPPOSITIONAL DEFIANT DISORDER in kids and teenagers and help reinforce specific parenting skills, as well as teach creative strategies for managing OPPOSITIONAL DEFIANT DISORDER behavior.

Moms and dads who are not able to respond to OPPOSITIONAL DEFIANT DISORDER behavior in a manner that can calm and soothe the youngster only add fuel to the fire. It is a lot to ask of a parent who is constantly under attack from oppositional behavior to react calmly, and it probably seems impossible if you are feeling demoralized and exasperated. This is why it is often a good idea to seek the help of a mental health professional who can not only help you learn strategies to confront this kind of extreme behavior, but also learn ways of coping with the stress of parenting in the face of such difficult circumstances.

My Out-of-Control Child

Body-focused Repetitive Disorders: Hair Pulling, Skin Picking and Biting

Body-focused Repetitive Behaviors (BFRBs) have long been among the most poorly understood, misdiagnosed, and undertreated groups of disorders. The term BFRBs refers to a group of disorders that include hair pulling, compulsive skin picking, compulsive nail biting, biting the insides of the cheeks, lip picking, blemish squeezing, nose picking, etc. Although lightly regarded as “nervous habits” by many, they can have serious negative impact upon sufferers.

What Exactly Are BFRBs?

These are a group of behaviors in which an child damages his or her appearance or causes physical injury through:

• Biting the inside of the cheek
• Blemish picking or squeezing, causing scarring and infections
• Hair pulling to the point of having seriously thinned hair or bald spots, missing eyebrows, or eyelashes
• Nail and/or cuticle biting, causing bleeding or infected fingertips
• Skin picking, resulting in scabs, sores that never heal, holes in the skin, and scarring

These behaviors may be performed when the child is stressed or excited, or bored or inactive. Hours may be spent in these activities, taking children away from family or school activities. Depression, shame, and isolation can also result. BFRBs most often begin in late childhood or in the early teens, and may affect at least 1 out of 20 people. While once thought to be rare and impossible to treat, we now know that neither of these ideas is true. While it is not always easy to find practitioners who can treat these disorders, there are a growing number of resources, and the picture is gradually improving.

BFRBs and the Family—

BFRBs can seem extremely mysterious to family members and spouses, who at first, view them merely as bad habits, but then become more concerned when they begin to seriously damage the sufferer's appearance or cause emotional problems. The fact that many sufferers seem to be unaware they are doing these things, or report that the behaviors can be pleasurable or relaxing, can be even more puzzling and upsetting. Fighting sometimes occurs in families over the issue of these seemingly uncontrollable behaviors. Parents may scold or punish children who persist in doing these things, and spouses or significant others, at times, seem to take the sufferer's disorder personally, blaming them for an unsightly appearance. They can sometimes react as if the sufferer is having this problem just to make their lives difficult. These others may take it upon themselves to get the sufferer to stop, constantly calling the behavior to their attention, or simply telling them they must stop, leading to angry scenes and disputes.

As one patient told their angry and impatient spouse, "Do you actually imagine for one moment that I want to do these things? Don't you think I'd stop if I could?" Having a BFRB is a frustrating and upsetting experience, and negative attention from others can add to the stress.

Denial is another approach families take, and has prevented many sufferers, especially children, from being allowed to get the help they badly need. When it is impossible to ignore symptoms in a child or an adult, they may be minimized or explained away as being nervous habits, laziness, childish behavior, attempts to get attention, or get even. In the case of children, pediatricians or family physicians can unwittingly aid in this, telling families to "wait and see" or "they will grow out of it."

What Are Other Signs of BFRBs?

Many of the signs of BFRBs can be well hidden, and only revealed by accident. Many sufferers do such things as styling their hair to cover bald spots, wearing wigs or hair weaves, penciling in eyebrows, wearing clothing that hides skin damage, or keeping their hands behind their backs or in their pockets as much as possible, to name a few. Sufferers may go to great lengths to not undress or take their hair down in front of spouses. Children may suddenly refuse to go to school, to avoid being teased or reprimanded by their teachers. Adults may shy away from social situations, work, or job interviews. Feelings of depression are also very common.

When Should Someone Seek Help?

It is important for sufferers to find help when it becomes evident that the behavior is out of control and is starting to limit their lives or affect the sufferer's relationships. It may be clear at this point, that different attempts at stopping have not worked, and are not going to work. Along with these, there may also be emotional problems such as depression, substance abuse, or the avoidance of school, social events, or work that can also be warning signs. Frequent family fights or disputes over the behavior should also be indicators that some type of help is needed.

How Are BFRBs Treated?

There are three main types of help. These are behavioral therapy, medication, and family therapy. Ordinary talk therapy alone has not been shown to be of much help. Behavioral therapy usually consists of two approaches: Habit Reversal Therapy (HRT), which teaches the sufferer a set of alternative behaviors that can help them focus themselves, interrupt, and block the behavior, and Stimulus Control (SC), which teaches them how to identify, change, and control the different triggers present in their routines, environments, and moods that lead to the behaviors. Medication can be of help in some cases, although it does not seem to be equally effective for everyone. It should be regarded as a tool to help with behavior therapy. Medicinal use is advised when the urge to do the behaviors is so strong that the child feels it's irresistible and cannot follow behavioral therapy instructions.

Family therapy can be extremely valuable in a number of ways, and can make important contributions in healing the family, and aiding the sufferer's recovery. First, it can help family members to accept the problem, to not blame the sufferer, and to not become over-involved in the symptoms or treatment. It can also be of help in calming situations where fighting and conflict have resulted. Another contribution family therapy can make is to help those close to the sufferer to be patient about setbacks and lapses, which are not unusual.

How Do You Find Treatment?

When seeking help for BFRBs, it is extremely important to find practitioners who specialize in these disorders, and have the experience necessary to design a treatment program. Many kids begin with behavioral therapy, usually done by a behaviorally trained marriage and family therapist, psychologist, or social worker, and if medication is necessary, they will then seek out a psychiatrist who understands these problems. There are not great numbers of specialists out there, and a good place to begin seeking referrals is with the Trichotillomania Learning Center (www.trich.org) in Santa Cruz, CA.

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Resources—

• "Bad Hair Life," Without question, the definitive video documentary on TTM. This is a must-see for all those with the disorder, and their significant others. It is available from Fanlight Productions (www.fanlight.com) 800-937-4113.
• Help for Hair Pullers: Understanding and Coping with Trichotillomania, Nancy J. Keuthen, Ph.D., Dan J. Stein, M.D., and Gary A. Christenson, M.D., New Harbinger Publications, Oakland, CA, 2001. An excellent guide written by three acknowledged experts and top researchers in the field of TTM.
• Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well, Fred Penzel, Ph.D., Oxford University Press, New York, 2000. A compendium of self-help information for those who suffer from OCD, BDD, Trichotillomania, Compulsive Skin Picking, and Compulsive Nail Biting.
• The Hair Pulling Problem: A Complete Guide to Trichotillomania, Fred Penzel, Ph.D., Oxford University Press, New York, 2003. This represents the latest, largest, and most comprehensive self-help book for hair pullers now available.
• The Hair-Pulling "Habit" and You (Revised Ed.), Ruth Golomb and Sherrie Vavrichek, Writers' Cooperative of Greater Washington, Silver Spring, Maryland, 2000. A very good self-help workbook for children with trichotillomania.
• The Trichotillomania Learning Center (TLC) (www.trich.org), Santa Cruz, CA. A nonprofit foundation, TLC is the premiere organization for BFRB sufferers, and provides support, information, and referrals.

Talking to Children & Teens about Drugs

Just as you inoculate your children against illnesses like measles, you can help "immunize" them against drug use by giving them the facts before they're in a risky situation.

When children don't feel comfortable talking to moms and dads, they're likely to seek answers elsewhere, even if their sources are unreliable. Children who aren't properly informed are at greater risk of engaging in unsafe behaviors and experimenting with drugs.

Preschool to Age 7—

Before you get nervous about talking to young children, take heart. You've probably already laid the groundwork for a discussion. For instance, whenever you give a fever medication or an antibiotic to your youngster, you have the opportunity to discuss the benefits and the appropriate and responsible use of those drugs. This is also a time when your youngster is likely to be very attentive to your behavior and guidance.

Start taking advantage of "teachable moments" now. If you see a character on a billboard or on TV with a cigarette, talk about smoking, nicotine addiction, and what smoking does to a person's body. This can lead into a discussion about other drugs and how they can potentially cause harm.

Keep the tone of these discussions calm and use terms that your youngster can understand. Be specific about the effects of the drugs: how they make a person feel, the risk of overdose, and the other long-term damage they can cause. To give your children these facts, you might have to do a little research.

Ages 8 to 12—

As your children grow older, you can begin conversations with them by asking them what they think about drugs. By asking the questions in a nonjudgmental, open-ended way, you're more likely to get an honest response.

Children this age usually are still willing to talk openly to their moms and dads about touchy subjects. Establishing a dialogue now helps keep the door open as children get older and are less inclined to share their thoughts and feelings.

Even if your question doesn't immediately result in a discussion, you'll get your children thinking about the issue. If you show your children that you're willing to discuss the topic and hear what they have to say, they might be more willing to come to you for help in the future.

News, such as steroid use in professional sports, can be springboards for casual conversations about current events. Use these discussions to give your children information about the risks of drugs.

Ages 13 to 17—

Children this age are likely to know other children who use alcohol or drugs, and to have friends who drive. Many are still willing to express their thoughts or concerns with moms and dads about it.

Use these conversations not only to understand your youngster's thoughts and feelings, but also to talk about the dangers of driving under the influence of drugs or alcohol. Talk about the legal issues — jail time and fines — and the possibility that they or someone else might be killed or seriously injured.

Consider establishing a written or verbal contract on the rules about going out or using the car. You can promise to pick your children up at any time (even 2:00 AM!) no questions asked if they call you when the person responsible for driving has been drinking or using drugs.

The contract also can detail other situations: For example, if you find out that someone drank or used drugs in your car while your son or daughter was behind the wheel, you may want to suspend driving privileges for 6 months. By discussing all of this with your children from the start, you eliminate surprises and make your expectations clear.

Laying Good Groundwork—

No parent, youngster, or family is immune to the effects of drugs. Some of the best children can end up in trouble, even when they have made an effort to avoid it and even when they have been given the proper guidance from their moms and dads.

However, certain groups of children may be more likely to use drugs than others. Children who have friends who use drugs are likely to try drugs themselves. Those feeling socially isolated for whatever reason may turn to drugs.

So it's important to know your youngster's friends — and their moms and dads. Be involved in your children's lives. If your youngster's school runs an anti-drug program, get involved. You might learn something! Pay attention to how your children are feeling and let them know that you're available and willing to listen in a nonjudgmental way. Recognize when your children are going through difficult times so that you can provide the support they need or seek additional care if it's needed.

A warm, open family environment — where children are encouraged to talk about their feelings, where their achievements are praised, and where their self-esteem is bolstered — encourages children to come forward with their questions and concerns. When censored in their own homes, children go elsewhere to find support and answers to their most important questions.

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Children's Attachment Relationships

A number of childhood problems are particularly worrisome to moms and dads. Lying, stealing, anger or aggression, refusal to follow family rules, withdrawal, and depression are just a few of them. In addition, parents may be troubled because they do not feel a sense of connection with their youngster even at a very early age, or they secretly find their youngster unusually frustrating or even unlikable.

A common feature of parent-child relationships that underlies or runs parallel to many of these troublesome problems is an insecure attachment. Because kid’s early attachment relationships govern other relationships throughout life, early intervention is a key to reducing the long-term effects of attachment difficulties.

What Should I Know About Attachment Relationships?

Attachment is a biologically based strategy that provides emotional and physical protection for kids. Even before birth, a foundation is laid for the bond between a mother and her infant. Attachment relationships begin developing at birth and are generally fully established by eighteen months of age. Infant behaviors such as crying when separated from the parent, seeking proximity to the parent, using the parent as a secure base, and joyfully greeting the parent after separation are attachment-based. Secure attachment results when moms and dads respond sensitively to their kid’s cues and responses.

Research has indicated that school-age kids who are securely attached are more cooperative with their parents, more inclined to competently explore the environment, and more likely to get along with their peers.

Unfortunately, as many as 30% of kids develop insecure attachment relationships with their moms and dads. Insecure attachment may take the form of avoidant, distant behavior or anxious clinging behavior. When kids have insecure attachments with their parents, any number of negative consequences can follow, such as depression, anxiety, a lowered ability to cope with stress, and poor relationships with others.

A disruption in the development of secure attachment could occur due to parental illness, parental unavailability because of other life commitments, or the serious illness of the youngster. Kids who move from foster home to foster home or spend the early years of their lives in orphanages can experience long-term attachment difficulties. In addition, kids sometimes have inborn temperaments or disabilities that can impede the attachment process. Finally, kids who are abused or neglected or otherwise traumatized will often show signs of impaired attachment.

When Should I Seek Help?

Therapy for attachment difficulties may be the primary treatment or may be used along with other therapy. The following are signs of distress that should not be ignored:

When your youngster-

• Defiantly opposes your efforts to set limits more often than not.
• Displays anger that does not seem normal.
• Has difficulty regulating strong emotions.
• Is constantly manipulative, beyond the normal range for kids.
• Is exceptionally clingy to you most of the time, to the point of distress, and there are no other circumstances to explain the clinginess.
• Is frequently distant and doesn’t accept help from you.
• Is hurtful to animals or threatening to other kids or adults.
• Lies or steals despite your interventions and beyond the normal testing of kids.
• Seems more affectionate with strangers than with family members.
• When you feel disconnected from your youngster for long periods of time.

Moms and dads should also consider treatment for a youngster who is affected by autism and other pervasive developmental disorders such Aspergers; for a youngster who experiences Attention-Deficit/Hyperactivity Disorder (ADHD); as well as for a foster or adoptive youngster who is having difficulty forming relationships. In all of these childhood problems, kids have difficulties interacting with other people, and attachment therapies can effectively address and treat these problems.

What Is Therapy Like?

There are various models of therapy that are used for treating attachment problems. Moms and dads should explore the treatment options available by consulting with a licensed marriage and family therapist. Because attachment has to do with family relationships, therapists with degrees and licenses in family therapy are an excellent choice.

Typical therapy for attachment problems will include both the parent(s) and youngster. Initially, moms and dads meet with the therapist or, in some models, a team of two therapists, who will ask the parents to describe their experiences with the youngster during pregnancy, and from birth to the present. Parents will also discuss their current concerns regarding the youngster. Therapists may meet with the individual youngster for a period of time while the parents observe, meet with the moms and dads alone, or with parents and the youngster together, but parents fully participate in attachment therapy from beginning to end.

Attachment therapies often involve fun and rewarding activities that enhance the attachment bond while dealing with serious issues. In some cases, attachment therapies can reach their therapeutic goals within approximately twenty sessions.

Secure and insecure attachment relationships are present in every racial and ethnic group. However, how attachment relationships are expressed within these groups can vary greatly. A sensitive therapist will recognize that your youngster’s attachment relationship may well be influenced by cultural differences and adapt their therapy accordingly.

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Teen Substance Abuse

Being an adolescent and raising a adolescent are individually, and collectively, enormous challenges. For many adolescents, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug/alcohol use and abuse.

One of the most telling signs of an adolescent's increasing involvement with drugs is when drug use becomes part of the adolescent's daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the adolescent views him or herself may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug/alcohol use in adolescence are a sign that problems in that adolescent's environment exist and need to be addressed immediately.

What causes adolescent substance abuse?

There is no single cause of adolescent drug/alcohol problems. Drug/alcohol abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of an adolescent's drug/alcohol problems. Some of the factors that may place adolescents at risk for developing drug/alcohol problems include:

• family conflict
• favorable parental attitudes toward adolescent alcohol and drug/alcohol use, and parental alcoholism or drug use
• inconsistent and excessively severe discipline
• insufficient parental supervision and monitoring
• lack of communication and interaction between moms and dads and kids
• poorly defined and poorly communicated rules and expectations
against drug/alcohol use

It is important to also pay attention to individual risk factors. These include:

• difficulty maintaining emotional stability
• high sensation seeking
• impulsiveness
• perceived low harmfulness to use
• perceptions of extensive use by peers
• psychological distress

How do you know when to seek help?

The earlier one seeks help for their adolescent's behavioral or drug/alcohol problems, the better. How is a parent to know if their adolescent is experimenting with or moving more deeply into the drug culture? Above all a parent must be a good and careful observer, particularly of the little details that make up an adolescent's life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble. If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:

 Physical evidence of drugs and drug paraphernalia
 Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss
 Lying or increased evasiveness about after school or weekend whereabouts
 Hostility, irritability, or change in level of cooperation around the house
 Emotional distancing, isolation, depression, or fatigue
 Dizziness and memory problems
 Decrease in interest in personal appearance
 Changes in mood, eating, or sleeping patterns
 Change in friendships or extreme influence by peers
 Behavior problems and poor grades in school

What kinds of treatment will work?

Evidence shows that certain forms of family therapy are the most effective treatments for drug/alcohol problems. A qualified Marriage and Family Therapist can evaluate and assess an adolescent's substance abuse problem, and will then provide appropriate treatment for the adolescent, which may include outpatient therapy or therapy in a residential treatment facility. Therapy will focus on a number of important life areas of the adolescent, in addition to his or her relationships with moms and dads. It is essential for parents to be involved in the adolescent's treatment. Relationships are a critical ingredient to combat an adolescent's drug/alcohol problems.

How can I help my adolescent avoid substance abuse?

Parents and guardians need to be aware of the power they have to influence the development of their kids throughout the teenage years. Adolescence brings a new and dramatic stage to family life. The changes that are required are not just the adolescent's to make; moms and dads need to change their relationship with their adolescent. It is best if moms and dads are proactive about the challenges of this life cycle stage, particularly those that pertain to the possibility of experimenting with and using alcohol and drugs.

Parents cannot be afraid to talk directly to their kids about drug/alcohol use, even if they have had problems with drugs or alcohol themselves. An excellent resource on how to talk to kids about drugs is Parents - The Anti-Drug (www.theantidrug.com). Moms and dads are encouraged to give clear, no-use messages about smoking, drugs, and alcohol. It is important for kids and adolescents to understand that the rules and expectations set by parents are based on parental love and concern for their well being. Parents should also be actively involved and demonstrate interest in their adolescent's friends and social activities. Spending quality time with adolescents and setting good examples are essential. Even if problems such as substance abuse already exist in the adolescent's life, parents and families can still have a positive influence on their adolescent's behavior.


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Books:

· Boys into Men: Raising our African American Teenage Sons. By Nancy Boyd Franklin and AJ Franklin. EP Dutton (2000).

· Field Guide to the American Teenager: A Parent's Companion. By Joseph DiPrisco and Michael Riera. NY: Perseus Book Group (2000).

· Raising Emotionally Intelligent Teenagers: Parenting with Love, Laughter, and Limits. By Maurice Elias, Steven Tobias, Brian Friedlander, and Gotham Chopra. NY: Harmony Books (2000).

· Reviving Ophelia: Saving the Selves of Adolescent Girls. By Mary Pipher. NY: Ballantine Books (1995).

· When Nothing Matters Anymore: A Survival Guide for Depressed Teens. By Bev Cobain and Elizabeth Verdick. NY Free Spirit Publishing (1998).

· You and Your Adolescent. By Laurence Steinberg and Ann Levine. NY: Harper/Collins (1997).

Organizations and Internet Sites:

Marijuana: Facts for Teens
http://165.112.78.61/MarijBroch/Marijteens.html
Provides information about marijuana on a level that teens can relate to, such as its effects on school activities and how to quit using the drug.

Marijuana: Facts Parents Need to Know:
http://165.112.78.61/MarijBroch/MarijParentsN.html
Gives information for parents about marijuana, its uses and effects, as well as tips on talking to your child about marijuana.

Parents - The Anti-Drug
www.theantidrug.com
Provides advice, information, and resources for parents who are battling adolescent drug abuse.

Partnership for a Drug-Free America
www.drugfreeamerica.org
Latest news on drugs, stories of recovery and treatment, as well as help for teens and parents.

Talking with Kids about Tough Issues
www.talkingwithkids.org
Provides instructions and information for parents when talking to their children about issues such as drug and alcohol use, HIV and AIDS, violence, and sex.

Teen Drug Use and Abuse Prevention
www.parentingteens.com
Gives parents information on drugs, as well as how to talk to their teens about certain substances.

Tips 4 Youth
www.cdc.gov/tobacco/tips4youth.htm
Details reasons why smoking is such a health risk, as well as how youth can find help to quit smoking.