Girls with ADHD are at risk for a lot of problems, yet many are undiagnosed. ADHD symptoms may appear different in girls and women, than in boys. Find out how ADHD affects girls and women and how to help.

The majority of writing and research on ADHD has traditionally focused on males, who were believed to make up 80% of all those with ADHD. Now more and more females are being identified, especially now that we are more aware of the non-hyperactive subtype of ADHD. Girls and women with ADHD struggle with a variety of issues that are different from those faced by males. This article will highlight some of those differences, and will talk about the types of struggles faced by females with ADHD.

Childhood issues for girls with ADHD

Let's read the recollections of two women with ADHD in childhood and adolescence. Marie is an introverted, "primarily inattentive" ADHD female, who has struggled with anxiety and depression, in addition to ADHD, both in childhood and in adulthood.

"The thing I remember the most was always getting my feelings hurt. I was a lot happier when I played with just one friend. When someone teased me, I never knew how to defend myself. I really tried in school, but I hated it when the teacher called on me. Half the time, I didn't even know what the question was. Sometimes I would get stomach aches and beg my mother to let me stay home from school."
-Marie, age 34

These recollections are very different from those of a typical elementary school aged ADHD boy. She was hypersensitive to criticism, had difficulty with the rapid give and take of group interactions, and felt socially "out of it" except in the company of her one best friend. Secondly, she was a compliant girl whose greatest desire was to conform to teacher expectations and not to draw attention to herself. Her distractibility caused agonizing feelings for her due to teacher disapproval and embarrassment in front of her peers.

Lauren's "hyperactive-impulsive" ADHD patterns are more similar to those seen in many ADHD boys. She also recalls being stubborn, angry, defiant and rebellious and physically hyperactive. She was also hypersocial. Although we don't yet have adequate statistics for patterns in ADHD girls, it seems likely that women like Lauren are in the minority when we examine ADHD patterns.

"I can remember in grade school that everything felt frantic. I had a fight with my mom almost every morning. At school I was always jumping around, talking and passing notes. Some of my teachers liked me, but some of them - the really strict ones - didn't like me. And I hated them. I argued a lot and lost my temper. I cried really easily too, and some of the mean kids in the class liked to tease me and make me cry.
Lauren, age 27

Although we see the argumentativeness and defiance in Lauren which we see more often in ADHD boys, we also see that, like many ADHD girls, she was hyper-social and hyperemotional. Life for Lauren, as for some other girls with ADHD, was an emotional roller coaster. She was very disorganized, and had very low tolerance for stress.

ADHD adolescent girls

Let's take a look at the recollections of Marie and Lauren during their adolescence. Life, for each of them, seemed to become even more difficult. Adolescence is difficult in general. When ADHD is added to the mix, problems are amplified and stresses are intense.

"High school just overwhelmed me. None of my teachers knew me because I never spoke up in class. Exams terrified me. I hated to study and write papers. They were really hard for me and I put them off to the last minute. I didn't date at all in high school. People didn't dislike me, but I bet if I went back to a class reunion that no-one would remember who I was. I was pretty emotional, and it got ten times worse just before my period."
Mariel, age 34

"I was totally out of control in high school. I was smart, but a terrible student. I guess I worked on being a "party animal" to make up for all the things I wasn't good at. At home I was angry, totally rebellious. I snuck out of the house after my parents went to sleep at night. I lied all the time. My parents tried to control me or punish me, but nothing worked. I couldn't sleep at night, and was exhausted all day in school. Things were bad most of the time, but when I had PMS I really lost it. School meant nothing to me.
Lauren, age 27.

Marie and Lauren present very different pictures during their teenage years. Marie was shy, withdrawn, a daydreamer who was disorganized and felt overwhelmed. Lauren was hyperactive, hyperemotional, and lived her life in a high stimulation, high risk mode. What do they show in common?

ADHD teens and severe premenstrual syndrome

In teenage years, the neurochemical problems caused by ADHD are greatly compounded by hormonal fluctuations. These combined dysregulated systems result in tremendous mood swings, hyper-irritability, and emotional overreaction.

Peer problems and ADHD girls

Girls with ADHD seem to suffer more as a result of peer problems than do boys with ADD. Although Lauren had many friends her emotionality got in the way repeatedly. Marie, by contrast, felt overwhelmed, withdrew, and felt most comfortable in the company of one close friend. Both, however, had a strong sense of "being different" from their peers.

Among impulsive-hyperactive girls - a sense of shame

Adolescent boys who are impulsive and hyperactive may be viewed as simply "sowing their oats." They may even gain much peer approval as they rebel against authority, or as a result of their hard drinking, fast driving, sexually active lifestyle. Girls tend to receive much more negative feedback from parents, teachers, and peers. Later, as young women, they often join the chorus of accusation and outrage, blaming themselves and feeling a strong sense of shame for their earlier behavior.

Ways to Help Girls with ADHD

Learning to establish a "quiet zone" in their life

Whether shy and withdrawn, or hyper and impulsive, these girls often feel emotionally overwhelmed. They need to learn stress management techniques from an early age, and to understand that they need emotional "time out" to regroup after an upset.

Try to minimize corrections and criticism

Too often parents, with the best of intentions, shower ADHD girls with corrections and criticisms. "Don't let them hurt your feelings like that.'" 'You'd forget your head if it wasn't' attached to your shoulders." "How do you expect to go to college with grades like that?" These girls, whether loud and rebellious, or shy and retiring, typically suffer from low self-esteem. Home is an important place to refuel, and to rebuild the confidence that is so frequently eroded during the day at school.

Help them look for ways to excel

Girls with ADHD typically feel that they are "not good at anything."Their distractibility, impulsivity and disorganization often results in mediocre grades. Likewise, they often don't have the stick-to-itiveness to develop skills and talents like many of their friends. Helping them to find a skill or ability, and then praising them and recognizing them for it are terrific positive boosts. Often the life of an adolescent girl with ADHD reaches a positive turning-point when she is lucky enough to find an activity to feel good about.

Special Issues Faced by Women with ADHD

The same themes, related to social and physiological differences between males and females with ADHD, play themselves out again as adolescent girls become women with jobs, marriages and families.

Social expectations

Being the support system

For a woman with ADHD her most painful challenge may be a struggle with her own overwhelming sense of inadequacy in fulfilling the roles she feels are expected of her by her family and by society. Both on the job and at home, women are often placed in the role of caretakers. While men with ADHD are advised to build a support system around themselves, not only do few women have access to such a support system, society had traditionally expected women to be the support system.

Dual-career stresses

The struggles for women with ADHD have been intensified with the emergence of "dual career couples." During much of the past two decades more and more women have been required to not only fulfill most if not all of the more traditional roles of wife and mother, but also to function efficiently and tirelessly as they juggle the demands of a full time career.

Single parenting

Divorce rates are close to fifty percent among all marriages in the United States. Divorce become even more likely when ADHD is added to the list of marital stressors. Following divorce, it continues to be predominantly the mothers who are left as primary parent for children. By adding ADHD to the huge burden of single-parenting, the result is often chronic exhaustion and emotional depletion.

Physiological differences - Hormonal fluctuations in women with ADHD

The hormonal fluctuations which commence at puberty continue to play a strong role the lives of women with ADHD. The problems they experience due to ADHD are greatly exacerbated by their monthly hormonal fluctuations. Some women report that the stresses of being the primary parent of children with ADHD while attempting to struggle with their own ADHD reaches crisis proportions on a monthly basis as they go through their premenstrual phase, often lasting as long as a week.

Although the number of older women yet identified with ADHD is small, it seems quite reasonable to assume that the hormonal changes associated with menopause would be expected to, once again, exacerbate ADHD symptoms of emotional reactivity.

What can women with ADHD do to manage their lives better?

Give yourself a break!

Often the biggest struggle is an internal one. Societal expectations have been deeply ingrained in many women. Even if a loving husband said "Don't worry about it," they would place demands upon themselves. Breaking out of a mold that doesn't fit can take time and effort. Psychotherapy with a therapist who really understands your ADHD issues may be enormously helpful to shed your impossible expectations of yourself.

Educate your husband about ADHD and how it affects you.

Your husband may feel anger and resentment toward an ill-kept house or badly-behaved children, assuming that you "just don't care." He needs to appreciate the full brunt of ADHD's impact upon you. Get him on your side, strategizing about ways to make your life at home more ADHD-accommodating, and ADHD-friendly.

It's only spilled milk!

Try to create an "ADHD-Friendly" environment in your home. If you can approach your ADD, and that of your children, with acceptance and good humor explosions will decrease, and you'll save more energy for the positive side of things.

Simplify your life.

You are probably overbooked and chances are your children are too. Look for ways to reduce commitments so that you're not always pressed and hurried.

Don't hang around women who can't understand your problems.

So many women describe friends or neighbors who make them feel terrible by comparison -- whose houses are immaculate, whose children are always clean, neat and well-behaved. Don't put yourself in situations which will send you back toward impossible expectations and negative comparisons.

Build a support group for yourself.

One woman with ADHD related that housework was such drudgery for her that she often couldn't bring herself to do it. One of her techniques, however, was to invite a friend, who shared similar tendencies, to keep her company while she completed some particularly odious task.

Build in "time-outs" daily.

Time-out's are essential when you have ADHD and are raising children. It's easy to not find time for them, though, because they require planning. Make them routine so that you don't have to keep planning and juggling. For example, ask your husband to commit to two blocks of time on the weekend when he will take the kids away from the house without you. Arrange for a regular baby-sitter several times a week.

Don't place yourself in burnout.

One mother of two ADHD children, who was doing a great job of parenting her children, was also able to recognize her limitations. With two such challenging children she arranged for summer sleep away camp for a month each summer. She also arranged for brief visits, one at a time, to grandparents. This allowed her to spend time with each son without his having to compete with his brother.

Eliminate and delegate.

Look at things that you require of yourself at home. Can some of these things be eliminated? Can you find a way to afford to hire to have some of them done?

Learn child behavior management techniques.

On the outside looking in it may be easy for other parents to judge you if your children misbehave. What any parent of an ADHD child knows is that they don't respond to the usual admonishments and limits the way non-ADHD kids do. You've got a super-challenging job.Get the best training you can find.There are numerous excellent books on behavior management techniques for children with ADHD.

Get help for PMS or Menopausal Symptoms

They are likely to be more severe than in other women. Managing the destabilizing effect of your hormonal fluctuations is a critical part of managing your ADHD.

Focus more on the things you love.

There are many aspects of keeping a house and raising children which are rewarding and creative. Look for positive experiences to share with your children. Women with ADHD who feel they are "driven crazy" by the frequent interruptions of their children, who need to take time alone to ease frayed nerves, who fear being labeled as "poor housewives" and "bad mothers" need to understand and accept themselves and their ADHD. They also need to be understood and accepted by their husbands, their families and friends. These are women with ADHD struggling valiantly against demands which are difficult if not impossible to meet. They need to learn not to measure their success in terms of made beds and washed dishes, but to celebrate their gifts - their warmth, their creativity, their humor, their sensitivity, their spirit. And they need to look for people who can appreciate the best in them as well.

About the author: Kathleen Nadeau, Ph.D. is co-editor and co-publisher of ADDvance, a magazine for women with Attention Deficit Disorder. She is also the director of the Chesapeake ADHD Center of Maryland.

This article has been taken, with permission, from the website for the National Center for Gender Issues and ADHD (NCGI), the only advocacy organization for women and girls with ADHD. 

If you’re a teen with ADHD symptoms and are unsure of how to talk to your parents about ADHD, you’re not alone. A common complaint among adolescents who are having difficulties in school and in other areas of their lives is, “My parents don’t believe I have ADHD.”

This can be really frustrating, but try not to get discouraged. There are ways to talk to your parents about ADHD. Here are some ways you can do just that so you can begin to manage your symptoms of ADHD.

Preparing to Talk to Your Parents about ADHD

If you want your conversation with your parents to go well, it’s a good idea to do some prep work first. Laying some groundwork will make the journey go more smoothly.

Lay the foundation well before the actual conversation about ADHD. Without mentioning ADHD, talk about frustrations and difficulties you are having. When you bring them up during the ADHD conversation, they won’t be new and thus won’t catch your parents off guard.

Know your goals. What do you want out of the conversation? Do you just need your parents to listen and understand? Do you want them to support your desire to see a doctor or therapist? Do you want them to hire a tutor to help you learn to study? Knowing precisely what you want to achieve in your conversation will help keep you focused as you talk.

Predict potential emotional reactions you may have so you can manage them. ADHD can make people quick to anger, so if you’re aware of things that might make you fly off the handle, you can either steer clear of those topics or recognize your feelings when they happen and breathe deeply to slow down your emotional reactions.

Pick a good time to ask your parents if you can talk about something important to you. Wait until they’re not distracted. Pick a time that works for everyone and a place that is comfortable and distraction-free.

Once you’ve completed these steps, it’s time to tell your parents about ADHD.

Tips for How to Talk to Your Parents about ADHD

Talking to your parents about ADHD symptoms you’re experiencing and difficulties you’re having is a very good idea because it will help move you forward toward help and support for ADHD. You might find some or all of the following tips useful.

• Be clear and direct so your parents know exactly what you’re experiencing. It might be helpful to write down a list of your concerns so you can refer to them.
• Listen to your parents, and understand their point of view. Listening to them shows them you’re serious and allows you to respond to their concerns.
• Let them ask you questions, and give honest responses.
• Avoid getting angry by paying attention to your thoughts and emotions, breathing, and asking for a break if necessary.
• Print out an ADHD symptoms checklist and highlight areas that affect you. Talk to your parents about how these areas are keeping you from being successful and working toward your goals.
• Suggest a trial period. Ask them to let you see a doctor or therapist to try ADHD treatment for a few months. You can all see how it goes and re-evaluate things after the trial period.

Quite often, parents resist acknowledging ADHD because they don’t want to see their son or daughter labeled or put on medication. The best way to know why your parents dislike the idea of you having ADHD is to ask them. They can share their concerns with you. Then, you can acknowledge their concerns and explain why it will be helpful for you to be evaluated for ADHD and ADHD treatment.

Talking to your parents about ADHD can feel intimidating at first, but with some prep work and using these tips, you just might find that the discussion is a positive one that leads to ADHD help.

ADHD meltdowns in adults occur because ADHD is frustrating and difficult to live with. These tantrum behaviors don’t happen because of immaturity or a sense of entitlement in which someone believes she must get her way. They happen when the ADHD brain can’t take things anymore, when the stress of ADHD boils over.

ADHD emotional meltdowns can be frightening, both for the person with ADHD and those around him. When this adult reaches the end of his rope, all interactions feel like crises. He might misinterpret someone’s tone, for example, and lose it. “Losing it,” having a meltdown, looks like this:

• Angry outbursts
• Shouting
• Screaming at people, hurling profanities and insults
• Throwing things, sometimes right at people

Understanding what’s behind this behavior can help you manage ADHD meltdowns, whether they’re your own or the actions of someone in your life.

The Connection Between ADHD and Meltdowns

The very nature of ADHD sets people up for exasperation. All day every day, ADHD causes people to be easily distracted. This makes it a gargantuan effort to concentrate and to maintain focus and attention. As a result, people miss important information, parts of a conversation, and more. This inattention leads to losing things and forgetfulness, which are made worse by disorganization.

Additionally, part of ADHD involves heightened emotions and increased sensitivity. People with ADHD feel emotions much more intensely than do people without ADHD, and people tend to feel powerless to manage them (Dodson & Tuckman, 2016).

All of these challenges are exhausting, which makes regulating emotions more difficult. Stressors build on each other, things seemingly small to outsiders feel big and overwhelming to the person with ADHD. This pent-up frustration mounts until something, usually minor, causes rage and anger to erupt and the person to lash out in a powerful, frightening meltdown.

Managing ADHD Meltdowns While They Are Happening

It is ADHD that causes emotional meltdowns, and someone who has them isn’t inherently bad or a terrible person. That doesn’t mean that you have to endure your own meltdowns or that you have to accept tantrums directed at you (How to Handle ADHD and Anger in Adults).

Meltdowns involve out-of-control, intense emotions. They’re a force that seems unstoppable. While they can’t be stopped on a dime, you can manage these episodes even while they’re happening. Try these ADHD meltdown strategies:

• Reset your emotions by taking a break. You may not know what’s rational to say or do, but you do know when you’ve lost control. Learn to remove yourself from the situation. Physically remove yourself, and do something unrelated to the situation or your anger. Engage in physical activity to release tensions and negative energy.
• Breathe deeply. Taking deliberate slow, deep breaths will positively impact your brain and help calm you down. Do this during your break and during the argument itself.
• Stick to facts. Often, all frustrations, thoughts, and events that happened come bursting forth during a meltdown. This fuels the fire and keeps you from getting at the real issue. With help from your partner, continually redirect the focus to the main issue. As you address it, you’ll feel better and the meltdown will cool off.

Prevent Tantrums with ADHD Meltdown Strategies

By consistently working on your own and with people in your life to develop ADHD meltdown strategies, you can reduce the power meltdowns have over you. Dodson & Tuckman (2016) identify three main components of emotional regulation that will help you prevent meltdowns:

• Stress management
• Creating strategies to control your emotions in situations that trigger them
• Owning up to your tantrums and apologizing to those you’ve hurt (honing empathy can stop the instant rage directed at others)

Some specific strategies for preventing meltdowns include:

• Noticing when you’re overwhelmed and approaching sensory overload by paying attention to your heart rate, breathing, muscle tension, and other responses like sweating
• Take breaks when you need to; excuse yourself and step away
• Identify your triggers so you can avoid them when possible or work to reduce their impact on you (enlisting the support of a therapist is very helpful here)
• Schedule time to relax and unwind
• Go easy on yourself and others rather than demanding perfection and being angry when nobody’s perfect
• Carefully think about your daily routines and activities and identify when your tension mounts and what makes it escalate, and then concentrate your efforts on making some changes
• Get a better night's sleep
• Eat nutritiously
• Exercise by doing active things that you enjoy
• Use mindfulness training to help you acknowledge your strong emotions without impulsively acting on them (ADHD and Impulsivity: How Meditation Can Help)

Dealing with ADHD meltdowns in adults isn’t easy for anyone, but with patience and persistence, it can be done. Using strategies to deal with them at the moment as well as to prevent them will improve your quality of life.

ADHD and anger in adults are intimidating and difficult to deal with for the person with ADHD as well as others in his/her life. Adults with ADHD “can have a very short fuse—their anger can go from zero to sixty in a few seconds” (Weiss, 2005). Indeed, anger can seem to strike out of nowhere, a frightening experience for all involved.

Adult ADHD and anger involves extremely quick reactions, often to what appear to others to be insignificant little things. For someone with ADHD, when anger boils over, all perspective is lost. Attempts to de-escalate or to reason often make the situation worse.

Understanding Adult ADHD and Anger

Adults with ADHD frequently feel as though they have absolutely no control—neither of their own brain nor within their lives in the world. Surman and Bilkey (2013) report that studies of people with ADHD show that these adults have less emotional control are quicker to anger, have a higher level of frustration, and feel a less stable sense of wellbeing than adults without ADHD.

Angry outbursts, the intensity of which can make them full-blown ADHD meltdowns, happen in large part because the inability to be still, pay attention, focus, concentrate, organize, plan, and follow through creates frustrations and misunderstandings that will suddenly boil over in an explosion of anger.

Further complicating matters is the fact that people with ADHD tend to be much more sensitive than others, interpreting even innocent remarks as criticism. Underlying this hypersensitivity to “personal attack” is often low self-esteem. The result is frequently anger.

The external expression of anger seems to instantly strike out of the blue. Yet beneath the surface, the seeds of anger are planted before the Venus flytrap unfurls. This is what can happen in the ADHD brain:

• Misperceptions of external events
• Strong feelings of hurt and embarrassment
• Inability to slow down and fully process and evaluate the situation
• Activation of triggers (past memories of failure, social problems)
• Loss of perspective due to a flood of negative thoughts and emotions
• Rushed judgment based on incorrect perspectives
• Mounting pressure to act
• Angry outbursts

Adults with ADHD and anger difficulties typically feel out of control and powerless to do anything about the anger. While this belief is legitimate, it isn’t accurate. ADHD and anger management can and do go well together.

ADHD and Anger Management in Adults

Strategies exist that have been proven, through research and clinical practice, to help people handle ADHD and anger in adults. Pick and choose from the list to find things that work well for you.

• Separate yourself from your ADHD-fueled anger; you aren’t a bad person but are dealing with ADHD symptoms.
• Rather than trying hard to eliminate your anger (it’s a normal human emotion), think instead of channeling it or handling it in less destructive ways.
• In advance, ask your partner to call a time out, blow a whistle, or otherwise do something to break you out of your rage.
• When interacting with people, whether you’re angry or calm, focus on the facts and avoid letting your thoughts impose judgment.
• Give yourself a time-out and leave a situation when you feel your emotions escalating.
• Practice mindfulness regularly to decrease impulsivity and increase your emotional control
• Practice deep breathing exercises when you feel stress increase, when you’re relaxed, during an angry outburst to calm down—pretty much any time.
• Eat healthy foods, drink water, and sleep.
• Exercise vigorously and regularly to reduce stress.
• Avoid alcohol and recreational drugs (Self-Medicating for Anxiety: An Addict's Perspective).
• Create a visual cue to keep with you, a symbol that reminds you to be calm.
• Pause before communicating so you don’t blurt whatever is on your mind; similarly, you don’t have to answer your phone or send a nasty e-mail but instead, give yourself time and space to calm down.
• Identify your triggers and develop strategies to deal with them positively.
• Laugh regularly because humor defuses anger, reduces stress, and feels good.

Other Things for ADHD and Anger Management

In addition to creating a toolbox of strategies to use to reduce your anger, you can enlist outside support for adult ADHD as well.

• Work with a therapist.
• Take anger-management classes/trainings.
• Have an open, honest discussion with people in your life and ask them to help you control this anger that is part of ADHD.
• Talk to your doctor about medication; ADHD medication isn’t right or helpful for everyone, but it is available as an option.

You are not your ADHD, and you’re not a terrible, angry person. ADHD causes anger and angry outbursts. You can have control over this by working on strategies to handle adult ADHD and anger.

Learn the warning signs of suicide, how to help the suicidal person (specific ways to be helpful to someone who is threatening suicide).

Be Aware of the Warning Signs of Suicide

There is no typical suicide victim. It happens to young and old, rich and poor. Fortunately, there are some common warning signs of suicide which, when acted upon, can save lives. Here are some signs to look for:

A suicidal person might be suicidal if he or she:

• Talks about suicide and wanting to act on suicidal thoughts
• Has trouble eating or sleeping
• Experiences drastic changes in behavior
• Withdraws from friends and/or social activities
• Loses interest in hobbies, work, school, etc.
• Prepares for death by making out a will and final arrangements
• Gives away prized possessions
• Has attempted suicide before
• Takes unnecessary risks
• Has had recent severe losses
• Is preoccupied with death and dying
• Loses interest in their personal appearance
• Increases their use of alcohol or drugs

What To Do

Here are some ways to be helpful to someone who is threatening suicide:

• Be direct. Talk openly and matter-of-factly about suicide.
• Be willing to listen. Allow expressions of feelings. Accept the feelings.
• Be non-judgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.
• Get involved. Become available. Show interest and support.
• Don't dare him or her to do it.
• Don't act shocked. This will put distance between you.
• Don't be sworn to secrecy. Seek support.
• Offer hope that alternatives are available but do not offer glib reassurance.
• Take action. Remove means, such as guns or stockpiled pills.
• Get help from persons or agencies specializing in crisis intervention and suicide prevention.

Be Aware of Feelings

Many people at some time in their lives think about following through on suicide. Most decide to live because they eventually come to realize that the crisis is temporary and death is permanent. On the other hand, people having a crisis sometimes perceive their dilemma as inescapable and feel an utter loss of control. These are some of the feelings and things they experience:

• Can't stop the pain
• Can't think clearly
• Can't make decisions
• Can't see any way out
• Can't sleep, eat or work
• Can't get out of depression
• Can't make the sadness go away
• Can't see a future without pain
• Can't see themselves as worthwhile
• Can't get someone's attention
• Can't seem to get control

If you experience these suicidal thoughts and feelings, get help! If someone you know exhibits these symptoms of suicide, offer help!

Contact:

• A community mental health agency
• A private therapist or counselor
• A school counselor or psychologist
• A family physician
• A suicide prevention or crisis center

Source: American Association of Suicidology (AAS). The purpose of AAS is to understand and prevent suicide. AAS promotes research, public awareness programs, and education and training for professionals, survivors, and interested laypersons.

Introduction
The World Today
Sex Education
Drug Education
Summary

Introduction

"Slogans that teach young people to 'Say No' to drugs or sex have a nice ring to them. But . . . they are as effective in prevention of adolescent pregnancy and drug abuse as the saying 'Have a nice day' is in preventing clinical depression."
--Michael Carrera, Ed.D., testifying at the Presidential Commission on AIDS

Many parents today grew up in times when things were different; kids weren't getting shot and killed at school; underwear ads weren't as graphic as Playboy centerfolds, and using drugs meant trying a cigarette, not snorting cocaine or drugging your date. Times have changed, but we haven't. We still want teenagers to say no to early sexual intercourse. We still want teens to avoid cigarettes, alcohol, and marijuana. We still want our kids to grow up safe, healthy, and happy. But what do we say to them when they ask, "Did you and Dad ever 'do it' before you were married?" Or, "Did you ever smoke marijuana in college?" Ah, there's the rub.

The World Today

Although rates of sexual intercourse have decreased slightly during the 1990s, the average age remains around 15 years for boys and 16 years for girls. Whether you are a parent, a teacher, a physician or just a concerned adult, that seems young. Rates of drug use have apparently leveled off, but they, too, are alarmingly high.

The Monitoring the Future study, based at the University of Michigan, has involved 16,000 students in the middle and high school categories. Their latest data reports that more than half of all high school seniors have used an illicit drug, most often marijuana; two-thirds have tried smoking cigarettes, and nearly two-thirds have been drunk.

Do we really want young people to repeat the mistakes we made as teenagers? Or have our attitudes remained the same: 'Free love; tune in, turn on, drop out'?

Times have changed

Most of the parents I talk with are scared to death of what's out there confronting their children and teenagers. AIDS and HIV? Didn't exist in the 1960s or 1970s when most of us were growing up. Ecstasy, crack cocaine, handguns at school? No way. Nor were there videocassette recorders, R- and X-rated movies, e-mail, or the Internet. Times have changed, and parenting seems more difficult than ever.

What's a concerned parent to do? Stand idly by and watch their teens indulge in 'sex, drugs, and rock 'n' roll' without worrying about it? Or is this a case of, 'Do as I say, not as I did'?

The answers are easier than you think.

Sex Education

As an adolescent medicine physician, I can tell you that early sexual intercourse is not a good idea for teenagers. Never has been, never will be. Sure, we can avoid some of the problems with conscientious use of birth control. But sex is not an easy thing for teenagers to deal with (as you yourself may remember). It takes maturity, time, sophisticated thinking about people and about the world, self-knowledge, and confidence. How many 13-year-olds do you know who are 'ready' to have sex?

Okay, sounds good so far, but how do you keep YOUR 13-year-old from having sex? And what do you do when she asks you, "How old were you when you lost your virginity, Mom?"

It's ALL sex education

First and foremost, parents need to recognize that sex education occurs at home, whether you talk to you kids openly or not. How you react to something racy on TV, whether you kiss your spouse in public, whether you have an 'open' or 'closed-door' bathroom policy: it's ALL sex education.

Be an approachable parent, and start early

What matters most is that you create an atmosphere with your children in which they feel safe asking you anything that's on their minds. Being an 'askable' or 'approachable' parent is what I call it, and it takes a lot of work right from the beginning of your children's lives. Sex education should begin at home, at around 2 years of age. That may surprise you, but how you refer to your child's genitalia when you're changing their diaper is important. Use correct terminology. And don't blush when you say 'penis' or 'vagina'. Kids need to hear those body parts named and discussed just like other body parts, or they start getting the idea that there's something different 'down there' that shouldn't be discussed out loud. If you're a Harry Potter fan, it's like the difference between saying Voldemort and 'He-Who-Must-Not-Be Named!' By age 7-8, kids should know all about the basic plumbing, and what it's used for. By age 10-12, they should have a good idea about your attitudes and beliefs about sex. Then, hopefully, sex education classes in the school will reinforce what you've been teaching them already.

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Be flattered, not angry

If your kids ask you about your sex life, you should be flattered, not angry. It means that you've reached that lofty plateau of 'askability'. But how should you respond? You need to know that your kids are not prying. In fact, they are probably not very interested at all in your sexual history (many years ago, a survey of college students found that two-thirds of them thought their parents no longer even had sex). The real question they want answered is, 'When is it okay for me to have sex?' So respond to the subtext, and don't get upset that your kids are being disrespectful or trying to pry. In fact, it's the perfect time to give them a dose of your values.

If you don't educate them, someone else will

Remember that if you don't educate your kids about sex, someone else will: their peers, the media, or both, and they won't do a very good or responsible job. Kids see an average of 15,000 sexual references in the media per year. Less than 10% of these references are about abstinence, birth control, or the risk of pregnancy or sexually transmitted disease. In a sense, we are trying to get our kids to say 'yes' to sex at the same time that we want them to say no. The cues they get from their friends and from the media indicate that 'sex is fun, sex is sexy, everyone is having sex but you, and there's no downside to it'. So if you don't counteract those myths at home, who is going to?

The choice is really theirs

Parent-child communication is highly effective in preventing early sexual activity, and the more explicit you are, the better. That means telling your kids that you would prefer they not have sex until they are older (the age is up to you), but if they do start early, they should use birth control. Is that a double message? You bet it is. Is it a message that a teenager has difficulty understanding? No. In fact, it plays right into normal adolescent psychology. 'Don't have sex' is what they expect to hear. It's very authoritarian, very parental. 'But if you do . . .' is something they don't expect to hear. It acknowledges that they may not listen to you. It tells them that you know that they are going to have to make up their minds themselves.

Politics and poor science, sex education today

What about sex education in schools? Unfortunately, the Federal government has embarked on the 'abstinence-only' bandwagon and local school systems are signing up in droves. The government will spend $50 million a year for the next 5 years trying to encourage abstinence-only sex education programs, despite the fact that there is precious little evidence that such programs actually work. What's worse, there is strong evidence that a comprehensive sex education program, spanning the topic areas from abstinence through birth control, does work. Why has the government decided to go with a program that has not been successful? Politics, and poor science, pure and simple.

Where is the birth control?

The United States has the highest teen pregnancy rate in the western world, despite the fact that our teens are not more sexually active than Swedish teens, or Canadian teens, or British teens. Why? Because we don't educate about birth control in sex education classes, we don't discuss it at home, we don't give teens good access to it, and we don't advertise it in our media. Other countries do, and they are rewarded with low rates of teen pregnancy and teen abortions. But, you say, making condoms available in school-based clinics would 'give kids the wrong idea'. In fact, 5 recent research studies indicate that it doesn't. Educating teenagers about contraception makes them more likely to use contraception when they begin having sex, but it doesn't lower the age at first intercourse. Why? Probably because the decision where and with whom to become sexually active is a very complicated one, rooted in family, peers, religion, the media, and individual personality factors. But the decision whether to contracept or not is a very simple one: is it available? If so, I'll use it. If not, I'm still going to have sex, but I'm not going to go out of my way to get birth control. Until Americans get over their hysteria about giving young people access to birth control, we will continue to have the highest teen pregnancy rates in the western world. It's really that simple.

Drug Education

We must educate our kids about sex - because we want them to enjoy happy and successful sexual lives, just not when they are 13 years old! On the other hand, with perhaps the exception of alcohol, we never want our children to use drugs.

Honesty is the best policy

So, did you smoke marijuana in the 1960s or 1970s, folks? By 1979, 60% of you had, as teenagers. Some of you are going to be trapped in a lie by your kids, especially if you swear that you never touched the 'evil weed' and your college roommate pays a surprise visit and regales your kids with what a 'cool smokin' surfer dude' you were. Here, I think honesty is the best policy. But again, there is no unwritten parental law that you have to tell the whole truth and nothing but the truth. You may have experimented with several illegal substances as a teenager. Do you really want to go into the gory details with your kids? I don't think so. Remember to answer the question that they are really asking: When is it okay for me? If you tried marijuana, here's your chance to tell your kids that:

• If you had it to do all over again, you wouldn't do it

• Marijuana is a different substance now than it was then (approximately 15 times more potent)

• We now know far more about the dangers of marijuana than we did back then

• You hope they won't even feel the need to try it (a perfect opportunity to discuss peer pressure)

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The whole 9 yards

Other drugs? Fuggetabouttit. Make it clear that there is no way they should ever touch cocaine, inhalants, uppers, downers, LSD, ecstasy, or heroin. They don't even know who Timothy Leary was.

Role modeling

Like sex education, drug education starts at a very early age. Do you drink alcohol in front of your children? Do you laugh at drunkenness on TV or in the movies? What is your reaction to people who smoke, or do you or your spouse smoke? Studies show that parental role modeling is a powerful influence on children, long before they hit adolescence, with its own unique form of peer pressure.

Media as 'super peer'

Again, think of the media as a sort of 'super peer'. Tobacco and alcohol manufacturers are spending $9 billion a year advertising their products in the media. Hollywood is contributing to unprecedented numbers of smoking, drinking, and drug use portrayals in its contemporary films. If you, or your school system, don't do something to counteract this form of drug education, then your kids are in potential danger.

Demand SUCCESSFUL drug education

It may surprise you to know that physicians have known for the past 25 years how to decrease the amount of drug use among teenagers through drug education programs in school. Successful curricula involve life skills training, peer resistance skills, and media education. Not scare tactics. Of course, it's easier for school administrators to pick up the phone and dial the local police department to sign up for one of the many drug and alcohol 'scare programs' (DARE, for example). It would be far more effective, however, if they would invest in a full-blown drug prevention program that's been scientifically tested and shown to be effective.

Summary

Raising a teenager has never been more difficult than it is now. It takes time, courage, perseverance, and wisdom. Getting them to say 'no' to sex and drugs is important, but it requires your attention and help from your school system and your pediatrician or family practitioner. It is not impossible. Not all teenagers have sex at age 14. Most teens do not smoke regularly. And many teens abstain from alcohol, marijuana, and other drugs. You can make a difference. But 'Just Say No' just won't work, not with today's savvy, skeptical, media-soaked teenagers. Good sex and drug education programs, and good communications with parents will go a long way in creating healthier kids. As Crosby, Stills, and Nash used to sing in the 1960s and '70s, "teach your children well."

Why there is stigma related to HIV and AIDS? Discover more about the prejudice against those living with HIV or AIDS.

From the moment scientists identified HIV and AIDS, social responses of fear, denial, stigma and discrimination have accompanied the epidemic. Discrimination has spread rapidly, fueling anxiety and prejudice against the groups most affected, as well as those living with HIV or AIDS. It goes without saying that HIV and AIDS are as much about social phenomena as they are about biological and medical concerns. Across the world the global epidemic of HIV/AIDS has shown itself capable of triggering responses of compassion, solidarity and support, bringing out the best in people, their families and communities. But AIDS is also associated with stigma, repression and discrimination, as individuals affected (or believed to be affected) by HIV have been rejected by their families, their loved ones and their communities. This rejection holds as true in the rich countries of the north as it does in the poorer countries of the south.

Stigma is a powerful tool of social control. Stigma can be used to marginalize, exclude and exercise power over individuals who show certain characteristics. While the societal rejection of certain social groups (e.g. 'homosexuals, injecting drug users, sex workers') may predate HIV/AIDS, the disease has, in many cases, reinforced this stigma. By blaming certain individuals or groups, society can excuse itself from the responsibility of caring for and looking after such populations. This is seen not only in the manner in which 'outsider' groups are often blamed for bringing HIV into a country, but also in how such groups are denied access to the services and treatment they need.

Why there is stigma related to HIV and AIDS?

In many societies, people living with HIV and AIDS are often seen as shameful. In some societies the infection is associated with minority groups or behaviors, for example, homosexuality, In some cases HIV/AIDS may be linked to 'perversion' and those infected will be punished. Also, in some societies HIV/AIDS is seen as the result of personal irresponsibility. Sometimes, HIV and AIDS are believed to bring shame upon the family or community. And whilst negative responses to HIV/AIDS unfortunately widely exist, they often feed upon and reinforce dominant ideas of good and bad with respect to sex and illness, and proper and improper behaviors.

Factors which contribute to HIV/AIDS-related stigma:

• HIV/AIDS is a life-threatening disease
• People are scared of contracting HIV
• The disease's association with behaviors (such as sex between men and injecting drug-use) that are already stigmatized in many societies
• People living with HIV/AIDS are often thought of as being responsible for becoming infected.
• Religious or moral beliefs that lead some people to believe that having HIV/AIDS is the result of moral fault (such as promiscuity or 'deviant sex') that deserves to be punished.

"My foster son, Michael, aged 8, was born HIV-positive and diagnosed with AIDS at the age of 8 months. I took him into our family home, in a small village in the south-west of England. At first, relations with the local school were wonderful and Michael thrived there. Only the head teacher and Michael's personal class assistant knew of his illness."

"Then someone broke the confidentiality and told a parent that Michael had AIDS. That parent, of course, told all the others. This caused such panic and hostility that we were forced to move out of the area. The risk is to Michael and us, his family. Mob rule is dangerous. Ignorance about HIV means that people are frightened. And frightened people do not behave rationally. We could well be driven out of our home yet again."
'Debbie' speaking to the National AIDS Trust, UK, 2002

Sexually transmitted diseases are well known for triggering strong responses and reactions. In the past, in some epidemics, for example TB, the real or supposed contagiousness of the disease has resulted in the isolation and exclusion of infected people. From early in the AIDS epidemic a series of powerful images were used that reinforced and legitimized stigmatization.

• HIV/AIDS as punishment (e.g. for immoral behavior)
• HIV/AIDS as a crime (e.g. in relation to innocent and guilty victims)
• HIV/AIDS as war (e.g. in relation to a virus which need to be fought)
• HIV/AIDS as horror (e.g. in which infected people are demonized and feared)
• HIV/AIDS as otherness (in which the disease is an affliction of those set apart)

Together with the widespread belief that HIV/AIDS is shameful, these images represent 'ready-made' but inaccurate explanations that provide a powerful basis for both stigma and discrimination. These stereotypes also enable some people to deny that they personally are likely to be infected or affected.

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Forms of HIV/AIDS-related stigma and discrimination

In some societies, laws, rules and policies can increase the stigmatization of people living with HIV/AIDS. Such legislation may include compulsory screening and testing, as well as limitations on international travel and migration. In most cases, discriminatory practices such as the compulsory screening of 'risk groups', both furthers the stigmatization of such groups as well as creating a false sense of security among individuals who are not considered at high-risk. Laws that insist on the compulsory notification of HIV/AIDS cases, and the restriction of a person's right to anonymity and confidentiality, as well as the right to movement of those infected, have been justified on the grounds that the disease forms a public health risk.

Perhaps as a response, numerous countries have now enacted legislation to protect the rights and freedoms of people living with HIV and AIDS and to safeguard them from discrimination. Much of this legislation has sought to ensure their right to employment, education, privacy and confidentiality, as well as the right to access information, treatment and support.

Governments and national authorities sometimes cover up and hide cases, or fail to maintain reliable reporting systems. Ignoring the existence of HIV and AIDS, neglecting to respond to the needs of those living with HIV infection, and failing to recognize growing epidemics in the belief that HIV/AIDS 'can never happen to us' are some of the most common forms of denial. This denial fuels AIDS stigma by making those individuals who are infected appear abnormal and exceptional.

Stigma and discrimination can arise from community-level responses to HIV and AIDS. The harassing of individuals suspected of being infected or of belonging to a particular group has been widely reported. It is often motivated by the need to blame and punish and in extreme circumstances can extend to acts of violence and murder. Attacks on men who are assumed gay have increased in many parts of the world, and HIV and AIDS related murders have been reported in countries as diverse as Brazil, Colombia, Ethiopia, India, South Africa and Thailand. In December 1998, Gugu Dhlamini was stoned and beaten to death by neighbors in her township near Durban, South Africa, after speaking out openly on World AIDS Day about her HIV status.

Women and stigma

The impact of HIV/AIDS on women is particularly acute. In many developing countries, women are often economically, culturally and socially disadvantaged and lack equal access to treatment, financial support and education. In a number of societies, women are mistakenly perceived as the main transmitters of sexually transmitted diseases (STDs). Together with traditional beliefs about sex, blood and the transmission of other diseases, these beliefs provide a basis for the further stigma of women within the context of HIV and AIDS

HIV-positive women are treated very differently from men in many developing countries. Men are likely to be 'excused' for their behavior that resulted in their infection, whereas women are not.

"My mother-in-law tells everybody, 'Because of her, my son got this disease. My son is a simple as good as gold-but she brought him this disease."

- HIV-positive woman, aged 26, India

In India, for example, the husbands who infected them may abandon women living with HIV or AIDS. Rejection by wider family members is also common. In some African countries, women, whose husbands have died from AIDS-related infections, have been blamed for their deaths.

Families

In the majority of developing countries, families are the primary caregivers to sick members. There is clear evidence of the importance of the role that the family plays in providing support and care for people living with HIV/AIDS. However, not all family response is positive. Infected members of the family can find themselves stigmatized and discriminated against within the home. There is also mounting evidence that women and non-heterosexual family members are more likely to be badly treated than children and men.

"My mother-in-law has kept everything separate for me-my glass, my plate, they never discriminated like this with their son. They used to eat together with him. For me, it's don't do this or don't touch that and even if I use a bucket to bathe, they yell- 'wash it, wash it'. They really harass me. I wish nobody comes to be in my situation and I wish nobody does this to anybody. But what can I do? My parents and brother also do not want me back."

- HIV-positive woman, aged 23, India

Employment

While HIV is not transmitted in the majority of workplace settings, the supposed risk of transmission has been used by numerous employers to terminate or refuse employment. There is also evidence that if people living with HIV/AIDS are open about their infection status at work, they may well experience stigmatization and discrimination by others.

"Nobody will come near me, eat with me in the canteen, nobody will want to work with me, I am an outcast here."

- HIV positive man, aged 27, U.S.

Pre-employment screening takes place in many industries, particularly in countries where the means for testing are available and affordable.

In poorer countries screening has also been reported as taking place, especially in industries where health benefits are available to employees. Employer-sponsored insurance schemes providing medical care and pensions for their workers have come under increasing pressure in countries that have been seriously affected by HIV and AIDS. Some employers have used this pressure to deny employment to people with HIV or AIDS.

Even the healthcare system is engaged in HIV-related stigma and discrimination

"Though we do not have a policy so far, I can say that if at the time of recruitment there is a person with HIV, I will not take him. I'll certainly not buy a problem for the company. I see recruitment as a buying-selling relationship. If I don't find the product attractive, I'll not buy it."

- A Head of Human Resource Development, India

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Health Care

Many reports reveal the extent to which people are stigmatized and discriminated against by health care systems. Many studies reveal the reality of withheld treatment, non-attendance of hospital staff to patients, HIV testing without consent, lack of confidentiality and denial of hospital facilities and medicines. Also fueling such responses are ignorance and lack of knowledge about HIV transmission.

"There is an almost hysterical kind of fear-at all levels, starting from the humblest, the sweeper or the ward boy, up to the heads of departments, which makes them pathologically scared of having to deal with an HIV-positive patient. Wherever they have an HIV patient, the responses are shameful."

- A retired senior doctor from a public hospital

A survey conducted in 2002 among some 1,000 physicians, nurses and midwives in four Nigerian states, returned disturbing findings. One in 10 doctors and nurses admitted having refused to care for an HIV/AIDS patient or had denied HIV/AIDS patients admission to a hospital. Almost 40% thought a person's appearance betrayed his or her HIV-positive status, and 20% felt that people living with HIV/AIDS had behaved immorally and deserved their fate. One factor fueling stigma among doctors and nurses is the fear of exposure to HIV as a result of lack of protective equipment. Also at play, it appears was the frustration at not having medicines for treating HIV/AIDS patients, who therefore were seen as 'doomed' to die.

Lack of confidentiality has been repeatedly mentioned as a particular problem in healthcare settings. Many people living with HIV/AIDS do not get to choose how, when and to whom to disclose their HIV status. When surveyed recently, 29% of persons living with HIV/AIDS in India, 38% in Indonesia, and over 40% in Thailand said their HIV-positive status had been revealed to someone else without their consent. Huge differences in practice exist between countries and between health care facilities within countries. In some hospitals, signs have been placed near people living with HIV/AIDS with words such as 'HIV-positive' and 'AIDS' written on them.

The way forward

HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic. Fear of discrimination often prevents people from seeking treatment for AIDS or from admitting their HIV status publicly. People with or suspected of having HIV may be turned away from healthcare services, employment, refused entry to a foreign country. In some cases, they may be evicted from home by their families and rejected by their friends and colleagues. The stigma attached to HIV/AIDS can extend into the next generation, placing an emotional burden on those left behind.

Denial goes hand-in-hand with discrimination, with many people continuing to deny that HIV exists in their communities. Today, HIV/AIDS threatens the welfare and well-being of people throughout the world. At the end of the year 2004, 39.4 million people were living with HIV or AIDS and during the year 3.1 million died from AIDS-related illness. Combating the stigma and discrimination against people who are affected by HIV/AIDS is as important as developing the medical cures in the process of preventing and controlling the global epidemic.

So how can progress be made in overcoming this stigma and discrimination? How can we change people attitudes to AIDS? A certain amount can be achieved through the legal process. In some countries people who are living with HIV or AIDS lack knowledge of their rights in society. They need to be educated, so they are able to challenge the discrimination, stigma and denial that they meet in society. Institutional and other monitoring mechanisms can enforce the rights of people living with HIV or AIDS and provide powerful means of mitigating the worst effects of discrimination and stigma.

However, no policy or law can alone combat HIV/AIDS related discrimination. The fear and prejudice that lies at the core of the HIV/AIDS discrimination needs to be tackled at the community and national levels. A more enabling environment needs to be created to increase the visibility of people with HIV/AIDS as a 'normal' part of any society. In the future, the task is to confront the fear based messages and biased social attitudes, in order to reduce the discrimination and stigma of people who are living with HIV or AIDS.

Sources:

• UNAIDS, AIDS epidemic update, December 2004
• UNAIDS, AIDS epidemic update, December 2003
• UNAIDS, HIV and AIDS - related stigmatization, discrimination and denial: forms, contexts and determinants, June 2000
• UNAIDS, India : HIV and AIDS - related stigmatization, discrimination and denial, August 2001

Ten years after Bill Clinton and Monica Lewinsky's relationship made oral sex a mainstream topic, there's still plenty of debate over whether oral sex is really sex.

"There's not only confusion; there's fighting over it," says J. Dennis Fortenberry, a physician who specializes in adolescent medicine at the Indiana University School of Medicine. "People disagree fairly vehemently."

The latest fuss is spurred by new federal data that found that more than half of 15- to 19-year-olds have received or given oral sex. Although the study by the Centers for Disease Control and Prevention did not ask the particulars of these encounters, research conducted in pre-Clinton times, along with more recent studies, suggests that teens largely fall on the "it's not sex" side. (Related story: Teens define sex in new ways)

"If you were to ask someone if they were a virgin, they wouldn't include that they had given or gotten oral sex," he says.

A study published in 1999 in the Journal of the American Medical Association examines the definition of sex based on a 1991 random sample of 599 college students from 29 states. Sixty percent said oral-genital contact did not constitute having sex. "That's the 'technical virginity' thing that's going on," says Stephanie Sanders, associate director of the Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University and co-author of the study, which the researchers titled "Would You Say You 'Had Sex' If...?"

"There is not nearly as much conversation between two people and as much thought put into engaging in oral sex. That, in my mind, makes it a lot different," says Michael Levy, 17, a senior from Owings Mills, Md.

What constitutes sex tends to be defined in a culture and varies with the times, Fortenberry says.

"In certain times in the history of the world, certain kinds of kissing would be considered sex," he says. "Not too many years ago, a woman would have been considered a 'loose woman' if she kissed a person before marriage."

But a new book from the Medical Institute for Sexual Health, an Austin-based non-profit that has worked for abstinence education with the Bush administration, doesn't waffle. In Questions Kids Ask About Sex, oral sex is clearly sex.

"Sex occurs when one person touches another person's genitals and causes that person to get sexually excited," the book states. "A girl or boy who's had oral sex doesn't feel or think like a virgin anymore because he or she has had a form of sex."

Melissa Cox, who edited and contributed to the book, is a Denver-based medical writer who also edited a publication for Focus on the Family, an organization devoted to Christian family values.

She says a medical panel for the institute determined that oral sex is sex because it places young people at risk for sexually transmitted diseases and infections, puts them at risk for long-term emotional harm and opens the door for other sexual activity.

Not everyone agrees.

"If you look at the information that they have, you might find it difficult to cite a basis for that, other than someone's opinion," says adolescent-medicine specialist Fortenberry.

Teenagers say messages from the media make them feel that casual oral sex is normal and suggest that all teens are preoccupied with sex.

"I feel like I see more commercials about casual sex than I do about how important it is to have a family and how important it is to be in a marriage instead of having sex with people from a bar," says Shanae Sheppard, a 17-year-old senior from Owings Mills, Md.

Last week, the federal government announced $37 million in awards to 63 programs across the country aimed at encouraging young people to abstain from intercourse until marriage.

But abstinence-only education may inadvertently reinforce the belief that oral sex isn't real sex, says John DeLamater, a sociology professor at the University of Wisconsin and editor of the Journal of Sex Research, a scholarly journal published by the Society for the Scientific Study of Sexuality.

"We should be sending a message that sexual activity is much broader," he says.

Because teens are focused on that narrow definition of sexual intercourse and the message is to postpone it until they are older, they tend to equate intercourse with adulthood, Tarver says.

"Oral sex is not on a pedestal the way that regular sexual intercourse is," he says.

What students say sex means to them

Opinions varied widely in a Kinsey Institute study of 599 college students from 29 states were asked: "Would you say you've had sex with someone if the first intimate behavior you engaged in was ..." Percentages who said yes for selected behaviors:

• Deep kissing
  • Women - 2.9%
  • Men - 1.4%
• You touch person's genitals
  • Women - 11.6%
  • Men - 17.1%
• Person touches your genitals
  • Women - 12.2%
  • Men - 19.2%
• Oral contact with a person's genitals
  • Women - 37.3%
  • Men - 43.7%
• Oral contact with your genitals
  • Women - 37.7%
  • Men - 43.9%
• Intercourse
  • Women - 99.7%
  • Men - 99.2%

Source: Sanders, S.A. and Reinisch, J.M. (1999) "WOULD YOU SAY YOU HAD SEX IF?"; Journal of American Medical Association

Source: USA Today. Written: 10/19/05.

Intentionally pursuing emotional wellness activities can change your life in ways that last.

Emotional wellness is about more than managing your emotions and feelings. That's part of it, of course, but true emotional health encompasses all of who you are. It's a lifelong process of becoming fully you. Emotional wellness is an attitude, and it's a lifestyle.

Here are five emotional wellness activities that can become an integral part of your emotionally healthy journey.

5 Life-Changing Emotional Wellness Activities

To have a positive relationship with your emotions requires a strong yet flexible foundation to provide support for the myriad feelings that come and go in varying intensities as you navigate life. When you engage in these emotional wellness activities, you'll develop a rich mindset that will nourish your emotional health.

1. Make meaning. Whether it's in your job; your role as a partner, parent, caregiver, or friend; or in the little things you do every day as part of being alive, discover a sense of purpose. Having a sense of greater meaning helps you put even horrible things, like loss or extreme adversity, into perspective and make sense out of chaos.
   
   Takeaway activity: List three of the things that are the most important to you in your life, and describe how they inspire you.
    
2. Cultivate your sense of awe. We tend to ruminate, brooding over things like the past, current problems, and even things that haven't yet happened. This can lead to anxiety and depression, and it can make us feel estranged from others and even from life itself. Engaging in activities that inspire a sense of awe (stargazing, visiting the ocean, walking through a beautiful garden, going to a museum with incredible works of art) pulls you out of yourself and your emotions and puts you in the midst of something bigger. Letting yourself fill with awe and wonder decreases stress, anxiety, and depression and replaces them with emotional health.
   
   Takeaway activity: Create a collage of things and places that inspire feelings of awe within you. Keep it on hand as inspiration, and plan outings to experience them in person.
    
3. Seek connection. Emotionally healthy people connect with others in meaningful ways. Introverts and extroverts alike connect with others to share experiences. Connecting in some way with another human being is a powerful experience that enhances emotional health. If you're a bit apprehensive about this, take heart; you don't have to be the life of a party or even go to a party at all. Talk to people you encounter during your daily routine. Such interactions are short and sweet and have a profound effect on emotional health.  Meet someone for coffee or a walk and just share your life experiences. As with awe, it pulls you out of yourself and connects you with something bigger.
   
   Takeaway activity: Describe what a meaningful connection would be like to you. Create—and follow through with—a plan to connect with someone accordingly.
    
4. Grow your sense of gratitude. Whether you're grateful to a higher power or have a general sense of appreciation for the good in life, feeling and expressing (privately or outwardly) gratitude increases emotional health. When you seek out and appreciate all of the positives in your life, your negative emotions and reactions diminish in intensity. When you do have bad days or encounters or situations, you can put them in a balanced perspective by noticing and being grateful for the things that are right in your life.
   
   Takeaway activity: Keep a gratitude journal by your bed, and every night before turning in, write down one, two, or three things for which you feel grateful that day.
    
5. Hone your humor. Humor is restorative. Humor is healthy. Being able to laugh keeps you from feeling heavy, and it can keep stress at bay. While, of course, you won't burst out laughing or start telling jokes when something horrible happens, having a sense of humor and allowing yourself to appreciate the lighter side of life provides relief as well as healthy emotional balance.
   
   Takeaway activity: Laugh. Watch comedies (movies or TV shows), see a comedian, watch videos online, listen to audiobooks, check out corny joke books from your library and spend time with your partner or a friend telling dumb jokes.

The common theme in these emotional wellness activities is the sense of being part of something bigger than just ourselves. When we pull away from our emotions, we see them from a new perspective. Meaning, awe, connection, gratitude, and humor help all of us create a healthy perspective in which we know we aren't our emotions. We aren't even trapped by emotions. We are free, and we are emotionally healthy.

article references

Schizophrenia patients make up about 1% of the general population (see Schizophrenia Statistics) but can be very difficult to treat, with schizophrenia patients taking up about 8% of the hospital beds. Moreover, people with severe mental illness, like schizophrenia patients, make up about 20%-25% of the homeless population.¹ There are a variety of reasons why schizophrenia patients are a challenge to successfully treat.

Medication and Schizophrenia Patients

Schizophrenia medication is extremely effective for treating many of the symptoms of schizophrenia, like hallucinations and delusions. In fact, when treated, about 80% of people who experience their first psychotic episode will never have another.

The problem, though, is that many schizophrenia patients stop taking their medication; this is known as medication noncompliance. A schizophrenia patient may stop taking their medication for a variety of reasons, medication side effects being one. Just some of the medication side effects include:²

• Muscle movement disorders
• Weight gain
• Dry mouth
• Sedation
• Blurred vision
• Sexual dysfunction
• Blood sugar problems
• Blood pressure problems

It’s unfortunate that patients with schizophrenia stop taking their medication because this often sends them into psychosis, making it impossible for them to work with a doctor or therapist to find a better treatment for them.

Other reasons a schizophrenia patient may not take their medication include:

• Cost
• Medication availability
• Not "feeling like themselves"
• Reemergence of symptoms

Insight of Schizophrenia Patients

One symptom that 97% of schizophrenia patients suffer from is lack of insight. This means that the schizophrenia patient doesn’t fully understand their illness and the need for treatment. This symptom, in and of itself, can make patients stop taking medication simply because they do not believe they need it and do not believe they are sick.

Schizophrenia Patients and Co-Occurring Disorders

Schizophrenia patients also have high rates of co-occurring disorders, like substance abuse and depression. These additional disorders can make the underlying schizophrenia more difficult to treat and it is possible schizophrenia may even be misdiagnosed due to the existence of the other disorders.

Additionally, schizophrenia patients with substance use disorders are known to be less likely to follow a treatment plan.

Schizophrenia Patients and Social Environment

Unfortunately, patients with schizophrenia also suffer from social and environmental factors that can make the illness more difficult to treat. For example, many schizophrenia patients have lost touch with their friends and family, removing the social supports needed to facilitate recovery. This might be because of the strain the illness has placed on those relationships before treatment is attempted.

Schizophrenia patients are also often homeless. This may be because many schizophrenia patients initially develop the mental illness around age 20 – the age when they are to be entering the workforce. Because the symptoms can be so severe, many people with schizophrenia lose, and then later cannot regain a job. This joblessness can easily lead to homelessness.

Up to 6% of schizophrenia patients also live in jails or prisons, creating an environment that makes the treatment of schizophrenia more difficult.

article references