Father’s Day is not always a happy day

Father’s Day is not always a happy day

Today and Mother’s Day tend to be a happy day for people where they can honor their father and mother. However, it is not a happy day for everyone. Some people their father or mother may have died when they were children. For some people their father or mother may have left them when they were children. Therefore, today may not be a happy day. Also for children who were raised in foster care all their lives, today also may not be a happy day.

While this may not be a happy day for adults, it also can be a very difficult day for children too. Many children have fathers and mothers who have passed away or left the family and are not involved with them any longer. Seeing the television commercials or having other family members tell them that it still can be a good day can be difficult for them.

I work with many of these children in psychotherapy. Many don’t express their feeling, but they tend to deal with the emotional pain by acting out. They may be very oppositional during the week and today as away to express their feelings. Other children may isolate and not want to be involved with anything having to do with Father’s Day or Mother’s Day.

I have had parents ask me how they should handle Father’s Day or Mother’s Day when a parent has passed away or left the family. They understand that it is a difficult day, but they do not know what to do in order to help their children.

My recommendation is let the child cope with the day in the way they need. Try not to make an issue about the day. The other thing I recommend to a parent is to talk to their child. Acknowledge that Father’s Day or Mother’s Day may be difficult but it is just one day. They may have a rough day today but tomorrow is another day. I also recommend to parents is to ask the child if there is anything they may want to do. A child may want to release a ballon with a note, they may want to visit the cemetery or they may want to do something for an uncle or aunt or another male or female role model in their life. If they do have an idea, go with what they want to do. If they don’t have an idea, let them know that is okay. If they come up with an idea then you can do it. If they do not have an idea, then remind them it’s just one day that you all need to get through and tomorrow will be better.

Hopefully this will help parents understand the issues their children may be dealing with on Father’s Day and make it easier for everyone.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating children and teenagers. For more information about Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or on Twitter @RubinoTherapy.

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Coping with An Angry Teenager

Coping with An Angry Teenager

The teenager years can be very difficult for teenagers and parents. Many teens suffer with mood swings, depression and difficulties with anger. Unfortunately, the teenager’s neurological system is not fully developed. This means the prefrontal cortex of the teenage brain is not fully developed. The prefrontal cortex is responsible for our executive functioning. In other words, this part of the brain analyzes issues, make decisions about what is right and wrong and makes decisions about what actions someone will take. Since this part of the brain is not fully developed in teenagers, when they are angry sometimes they do not know what to do. I often have parents ask me what they should or should not do when their teenager is very angry. I read an article by Kim Abraham, LMSW and Marney Studaker-Cordner, LMSW, which lists things not to do when a teenager is angry. I know many parents worry about what to do, but you also do not want to do the wrong thing. Making a wrong move may only exacerbate the teenager and increase their anger. Therefore, knowing what not to do is very important too. The article I read uses the same recommendations that I use with teenagers. I have included the list below so parents can use it.

Stop and think for a moment: when your child or teen is in the throes of a tantrum or an all-out rage, what is your initial reaction? Do you get angry yourself and start yelling, do you freeze and say nothing, or do you become frightened and give in? Maybe your answer is even, “All of the above, depending on the day!” You are not alone. Dealing with childhood anger and explosive rage is one of the toughest things we are faced with as parents. Not only is it hard to do effectively, it’s exhausting and can easily make you feel defeated, even if you don’t lose your cool.

We all know the above reactions (yelling, freezing and giving in) aren’t helpful, but why exactly is that so? Simply put, if you freeze and do nothing, lose control and yell or give in to your child’s demands, he will know that he can push your buttons—and that it works. Even if your kid can’t put it into words, on some level he understands that if he can scare you or wear you down by throwing a tantrum, he’ll get his way.  As soon as your child realizes you have certain weak spots, he will continue to use them, because now he has a handy tool he can use to solve his problems. Instead of facing consequences or being held accountable, he’s figured out a way to get off scot-free. Here’s the good news: Learning to overcome your knee-jerk reactions of either freezing or becoming angry and “losing it” will be the start of turning around your relationship with your child—and the first step in teaching him appropriate ways to manage his temper.

Don’t get us wrong, as therapists and parents, we know firsthand how difficult this task can be—but fortunately we also know what really works to manage angry kids. Before we tell you some techniques you can use in the moment (and afterward) to turn this pattern around in your family, understand this: anger is always a “secondary emotion.” What this means is that another unpleasant feeling is always underneath an angry or enraged response; anger just leaves us feeling less vulnerable than hurt or fear do. If you can stop and remember that something else affected your child first, whether it was disappointment, sadness or frustration, you will be one step ahead. Another key point to understand is that anger serves a purpose. It lets us know something’s wrong in the same way burning your finger lets you know the stove is hot. It hits quickly and the reaction is immediate:  Your child is disappointed he can’t go to his friend’s house and kaboom, you have a fight on your hands. (We’ll explain how to get to the bottom of these emotions later.)

Keeping all of this in mind, here are 7 things for you to avoid doing when your child is angry.

1. Don’t get in your kid’s face

When your child is having an explosive anger attack or enraged response to something, do not get in his face. This is the worst thing you can do with a kid who’s in the middle of a meltdown. As long as your child is old enough, we would recommend that you not get anywhere close to him. You have to remember that kids with explosive anger are out of control. The adrenaline is pumping and all rationale has left the body. They are in fight or flight mode, about to blow up. How close do you really want to get to that? By getting in there with your child, you will likely only further ignite their anger. And if you try to say something to them in the middle of it, you’re just going to fan the flames. We often feel like we have to stand right there and handle the meltdown with our kids. But if nobody’s getting hurt and it’s not a life-threatening situation or safety issue, it’s better to back off and give them some distance. After all, if you saw an angry stranger in a store, you wouldn’t go up to him and start yelling or rationalizing, would you? You’d probably leave the area as soon as possible!

2. Don’t react out of emotion

When your child is angry, rather than reacting out of emotion, which will escalate things, do whatever you need to do to step out of the situation. Walk away, take some deep breaths, and try your best to stay objective and in control. Take a time-out if you need one (and if your child is old enough for you to leave the area). Use some phrases to remind yourself, “I’m going to respond to this logically instead of emotionally. I’m going to stay on topic. I’m not going to get off track.” You might also remind yourself, “One step at a time. None of this is going to happen overnight.” Part of our job as parents is to model how to handle emotions appropriately. (Easier said than done, we know!) When you’re upset, your job is to show him good ways to deal with the emotions at hand.

3. Don’t jump to conclusions about your child’s anger

Your child may not be wrong for feeling upset. There may be some justification for his anger, even if the behavior is not justified. When parents tell us they’re upset with their child for being angry, we say, “Is it not okay for him to ever just be disappointed and unhappy and mad? Because everyone feels that way sometimes.” Remember that people can be justifiably disappointed and may present that in an angry way. If your child can’t be respectful in explaining his viewpoint, then you’ll need to leave him alone until he calms down. You can say, “I understand you feel angry; I’m sorry you feel that way.” Then leave it alone until he’s cooled off. If it turns into a temper tantrum where he’s saying foul things, breaking objects or hurting others, then that’s when you want to address the behavior. You can’t in any way control the way your child feels about things—all you can do is give him consequences and hold him accountable for his behavior. Getting mad at your child for being mad will only escalate the situation.

Understand that it’s normal for kids to get angry. We all get angry. In actuality, it’s not anger that’s the problem, it’s the resulting behavior. Kids have notoriously low frustration tolerances. Just because your child is angry doesn’t mean it has to turn into an unrecoverable situation. Don’t expect your child to always be happy with you or like you or your decisions. Accept that it goes along with the territory that sometimes they’re going to be angry with you—and that’s okay.

4. Don’t try to reason with an angry child

Avoid trying to hold a rational conversation with your angry child; it’s not going to work. If she’s disappointed about something and you try to reason her out of it, it’s probably only going to make things more heated. Don’t try in the moment to get your child to see it your way because you don’t want her to be mad at you. When you jump in and try to make her see it your way, it really isn’t helpful. And you’re going to come away from that more frustrated yourself, especially with ODD kids. They’re not going to have any of it and will turn the tables and try to rationalize with you in order to get their way. Instead, just give everyone a cooling off period. You can say, “I can see that you’re really upset; we can each take a timeout and get back to this later.”

5. Don’t give consequences or making threats in the heat of the moment

Along these same lines, wait until everything has calmed down before you give consequences to your child. If you try to punish her when emotions are running high, chances are you will cause further eruptions. You might come back later and say, “You were really angry. I’m wondering if there was one part of how that went that you wish was different. What could you do differently next time?”

You might also think about whether or not consequences are really necessary after a tantrum. Sometimes, parents will give consequences to kids just for blowing up. We’ve had kids come in to a therapy session and tell us that they’ve lost all of their privileges because they’ve had a tantrum. Let’s say a teen girl slams the door and mutters something under her breath on the way out before going for a walk. When you look at it objectively, a child who’s working on her anger has actually handled it fairly well—going for a walk to cool down. In this situation, you might decide to forego consequences. While every family has different rules about what is allowed and what isn’t, there should be some latitude to allow your child to express anger appropriately. Again, don’t give consequences for feelings, give them for inappropriate behavior.

6. (For older kids) Don’t miss a chance to talk with your child later

If it’s appropriate and if your child is old enough—and seems willing to talk about what made them so angry—try sitting down and discussing it. You can say, “You were really mad earlier, but I’m just wondering if that came from you feeling so hurt about what happened at school.” Wait to hear what your child says, and really listen. Don’t interrupt or preach. If they do open up, try asking open-ended questions like, “What do you think you could do to handle it better next time?” Or, “Is there anything I could do that would be helpful to you?”

Most of the time when older kids or teens throw tantrums or lose control, it’s because they have very poor problem-solving skills. They haven’t yet learned to solve their underlying problems in healthy ways, so they scream, break things, and call people names. Problem-solving skills don’t come naturally—they come with practice. Sometimes by talking to your child and finding out what’s going on, you can guide them to those problem-solving tools.

7. Don’t lose sight of your goal

Always ask yourself what you’re aiming for as a parent. What is your end goal? One of our most important jobs is to show them appropriate, healthy ways to behave as we give them some problem-solving tools. It’s not only important to discipline our kids, but also to teach and to guide them. Sometimes lessons don’t require a consequence, but are rather an opportunity to talk and help your child come up with a better way to handle the situation next time.

Hopefully this list will help. Remember there is no such thing as a perfect parent. It is even more difficult to parent when you are dealing with an angry teenager. So if things do not go perfectly do not blame yourself. You did the best you could do.

Dr. Michael Rubino is a psychotherapist who specializes in treating children and teenagers. He has over 20 years experience working with teenagers. For more information about his work or private practice visit his website www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

Helping Children Cope with Stress

Helping Children Cope with Stress

Many times parents can see that their child is dealing with stress or worry that a situation may cause a child to be stressed. Many parents will ask me what they can do to help their child cope with stress or if they can prevent a stressful situation before it occurs. These are valid concerns and questions for parents to ask. Given the state of the world with mass shootings occurring at schools on a regular basis and many children are now homeless in the United States, children are experiencing many stressful situations that never existed before. Since children’s brains are not fully developed, they process information differently and coping with stress can be difficult for children. Also parents are having less control to the stress their child is exposed to due to technology we now have instant coverage of events and 24 hour media coverage which makes it difficult for parents to help their children. I recently read an article by Lori Lite with some good tips for parents to help children cope with stress. I have included these tips and information below.

Children do not think, act, or manage stress like adults; the younger the child the smaller the stressors. Help children cope with stress by realizing you can empower your children.  Arriving at school to find a  rearranged classroom or a substitute teacher can be big stressors to kids.

Young children do not yet have the ability to identify or express their own feelings of stress. They struggle with their own emotions and they pick up on their parents tension. The American Psychology Association noted that 39% of children feel sad and worried when their parents are stressed. Often a stressed out child can be detected when a teacher or parent  observes changes in a child’s  behavior.

Frequent melt-downs, sleeping problems or nightmares, clingy behavior, refusal to go to school, acting younger than their age, bed-wetting, stomachaches and headaches are  signals that your child may be experiencing too much stress. The main thing to look for is a change in behavior. Trust your instinct.

Tips to Help Stress:

1. Help children put words to their feelings. Ask them if they feel nervous, scared, or worried. Ask them what is making them feel that way.

2. Acknowledge your child’s feelings and encourage the use of positive statements. Often children do not understand the outcome of an action or change. Instead of realizing their favorite teacher will be back tomorrow..they might think she is gone forever. Create positive statements for the situation.

“I am safe. My substitute teacher is fun. My teacher will be back soon.”

3. Introduce stress management techniques to  children. Parents and teachers can easily teach and use techniques like breathing, positive statements, and visualizing on a regular basis. Lesson Plans are available.

4. Establish a bedtime routine that helps kids relax. Soothing music or relaxing stories.  Indigo Dreams: Kids Relaxation Music promotes sleep and relaxation.

5. Spend reassuring quality time with children. Parents and teachers can  laugh and play together. Singing songs like This Is The Way We Laugh And Play and If You’re Happy And You Know It can be a liberating and fun stress reliever that you and your children can enjoy together.

I hope these tips are helpful. Parents it is important to remember all you can do is your best to try to help your child. However, as I stated above, with the advancement of technology and events such as mass school shootings happening on a regular basis, you cannot protect your child from every stressful event.

Dr. Michael Rubino is a psychotherapist with over 20 years experience and he specializes in treating children, teenagers and trauma victims. For more information about his work or private practice visit one of his websites www.rcs-ca.com or www.RubinoCounseling.com or his Facebook page www.Facebook.com/drrubino3.

What to do When Teens are Violent at Home

What to do When Teens are Violent at Home

As a psychotherapist who treats teenagers, I often have parents ask me about what they should do if their teenager threatens or breaks something in the house. Sometimes teenagers will break their own stuff, such as their IPad, or something that belongs to a sibling or a parent. These does need to be taken seriously and addressed with the teenager. The most common incident is punching a hole in the wall. When these incidents occur many parents are not sure about what is the appropriate way to handle the situation and why it is occurring. I recently read an article by Kim Abraham, MSW and Marney Studaker-Cordner, MSW, which deals with these complex and upsetting issue. They lay out an excellent plan that will help keep your child responsible for their choices and use the incident as a life lesson too. I have included their plan below. I recommend the same approach to the parents I work with in psychotherapy.

Punching holes in the wall. Breaking and throwing things. Smashing in the windshield on your car. Most of us never expect to face these behaviors from our children, and certainly not when our child is “old enough to know better.” If you have a child who purposely destroys family property out of anger or spiteful, vengeful reasons, you naturally feel a variety of hurtful and negative emotions. It feels like a punch in the stomach. First comes shock—how can my child be doing this to me? Anger, resentment and guilt follow: What did I do wrong for my child to end up like this? If you’re like other parents in this situation, you probably also take an aching heart to bed with you every night.

The fact is, your child is having a problem coping with strong emotions. This is their “cope of choice” right now, which is self-destructive in the long run. So why do they cope by damaging things when they’re angry or upset, and what can we do to teach our child healthy boundaries and limits? How can we motivate a child in this situation to develop healthier, more mature coping skills? Kim Abraham, MSW and Marney Studaker-Cordner, MSW, creators of The ODD Lifeline®, explain how

Why Some Kids Resort to Destructive Behaviors

We know that kids use destruction as a coping mechanism, but why? What led them to this extreme place?

Low frustration tolerance. Children are generally known for having a low tolerance for frustration. They want things to go their way. When something happens that’s unexpected, disappointing or requires the use of coping skills, many children have a difficult time handling such situations effectively. Some older children and teens still engage in “tantrum behaviors” long past the age we might expect. Why? They may not have the skills to handle the stress they’re experiencing. Physically releasing that energy helps them relieve their distress for the moment—even though it’s unpleasant for everyone around them. This is particularly true for children with an underlying condition such as ADHD, Oppositional Defiant Disorder (ODD), Asperger’s Syndrome or a mood disorder. The father of a 10-year-old diagnosed with ADHD shares, “My child has a very hard time when plans change. If we were going to the movies and we have to cancel because the road conditions are bad, she’ll start throwing her things around the room. She knows that’s not going to change the situation, but she just gets so angry when she’s disappointed that she explodes.”

Intimidation. Sometimes destructive behavior serves a different purpose: intimidation. A child may learn that by breaking things, punching holes in the wall and behaving in a violent manner he will effectively frighten a parent into doing what he wants, such as giving in or allowing him to have his way. One adolescent shared in therapy, “I know how to get ungrounded. I just start throwing things around the living room and my mom tells me to get out of the house.” Intimidating parents and family members may also give a child who’s feeling powerless a sense of control. It’s important to note that teens and older children who destroy property as part of an overall pattern of violating the rights of others (stealing, destruction, violence, breaking the law) have moved beyond Oppositional Defiant Disorder and into what we term Conduct Disorder.

Misery enjoys company. Ever have a bad day, come home and picked an argument with a “safe person?” Sometimes misery enjoys company and you just want to spew out those horrible feelings and let them land where they will. Our kids feel this way sometimes, too. When your child is feeling miserable, he probably won’t pick the neighbor to share his misery with—he’s going to pick you. Things can escalate and before you know it, your child starts releasing his feelings physically, not just verbally.

Payback. Often the most frustrating situation is when a child behaves in a passive-aggressive manner, breaking things out of revenge for anger they’re feeling toward a parent. You may find something of yours broken—perhaps particularly sentimental or valuable—you know your child did it, but you can’t prove it. Your child will deny until there’s no breath left in her body that she’s responsible, yet your gut tells you she’s getting even for something she isn’t willing or able to share with you.

What Can I Do about My Child’s Destructive Behavior?

It’s a good idea to wait until your child has calmed down before telling him what the consequence will be for his actions. Don’t say to your child, “Well, I hope you liked that vase you just broke, because that just became your Christmas present!” That will likely escalate the situation and my lead to more destruction. Instead, wait it out and when the storm is over, you can let him know how he will make restitution for the damages. Below are some ideas for consequences and how to approach the conversation.

Be proactive. Make sure your child knows right off the bat that while you understand he gets frustrated sometimes, destroying property is not acceptable, not in your home and not in the rest of the world either. Be clear in your expectations and what the consequences will be if your child does destroy your property.

Offer alternatives. Talk with your child during a calm moment about things she can do instead of breaking things when she gets upset. Give her the opportunity and space to calm down when she’s upset. If she needs to release some physical energy, what are some non-destructive activities she can engage in? How can she learn some more effective ways to cope with her emotions? One mom told us her 12-year-old daughter has a trampoline she jumps on to release pent-up energy. Another parent bought his child stress balls to use so he can squeeze when he’s feeling as if he’s going to lose control. The child was able to use these at school as well. You can also let your child know she can count in her head until the negative feeling goes away. This will help her realize that eventually the feeling does start to alleviate on its own, even if she doesn’t act on it. Your child can also use journaling, music, drawing, clay, Play-Doh or any other non-destructive activity they might be interested in to release feelings.

Determine if natural consequences are enough. Some children break their own things when they’re upset or angry. If your child gets angry, throws his phone and it breaks, the natural consequence is that he no longer has a phone. Don’t buy him a new one!

Hold your child accountable. No matter what the reason is for your child’s behavior, she needs to be held accountable. Just like when you’re in a store: you break it, you buy it. If your teenager puts a hole in your wall and it will cost $100 to fix it, how will you get that money back? You may offer opportunities for him to “work it off” around the house through chores. If your child is truly remorseful for his behavior, he’ll be willing to do so. If not, you’ll need to use more creative ways of recouping that money. How much do you normally spend on school clothes at the mall? $200? Well, if your child isn’t willing to work off her debt, you may choose to give her $100 for her clothes instead. She’ll still get clothes, but maybe from a less expensive store. Wearing no-name jeans might make her uncomfortable enough to stop and think before she breaks things again in the future. Take a minute to identify in what ways—even small ways—you spend money on your child. Think of things that aren’t necessities. Remember, there’s a difference between needs and wants. Your child needs to be fed; but he wants McDonald’s. You’re obligated, as his parent, to provide the first, but not the latter. Instead of a Big Mac, he may get peanut butter and jelly at home. (In The ODD Lifeline, we explain specific ways you can regain money spent to repair damages or replace broken items that have proven very helpful for parents.)

Determine if Parental Consequences are Enough

You will likely respond to your child’s destructive behavior based on several factors: your child’s age, the extent of damage that was done and the frequency of your child’s destructive behavior. You may choose to make a police report if the destruction of your property is severe enough or is happening frequently in your home. In the “real world,” consequences depend upon the degree of destruction. If your 12-year-old breaks one of your knick-knacks, you may decide it’s sufficient to have him “brown bag it” to school rather than pay for hot lunches until his debt is clear. On the other hand, if your 15-year-old smashes your car windshield causing thousands of dollars in damage, you may decide it warrants a police report. It may be something that actually requires such a report for insurance purposes, but that’s a decision only you can make as a parent. The benefit to making a report is that, even if your child isn’t charged, you’re starting a paper trail. This is particularly important if your older child or teen has moved into Conduct Disorder, where he or she is violating the rights of others and believes there will be no consequences. If your child is at a point where he’s enraged, breaking things left and right, and appears to be escalating to the point of being a danger to himself or others, that’s a time when calling the police is appropriate as a safety precaution. When in doubt, ask yourself, “What would I do if this was a neighbor kid?” If your neighbor’s 11-year-old-son causes minor damage to your property, you might work something out where he makes restitution to you. If that boy breaks a $10 vase, you’re probably not likely to call the police. At what point would you consider the damage serious enough to make a police report? And how do you think a neighbor would respond to your child, if he exhibited the same level of property damage while at their home?

A Learning Opportunity

Think of this situation as a learning opportunity. Your job as a parent is to prepare your child for Adult Life with a capital “A” and “L.” In society, if you destroy property, there are consequences—financial and sometimes legal. You want to respond to your child’s destructive behavior in a way that leaves no doubt about what he will experience should he engage in this behavior outside your home. One parent shared his reluctance to give consequences for his child’s destructive behavior: “She was just really upset when she kicked a hole in the wall. She felt terrible afterwards.” Maybe so, and it’s good if your child appears to have remorse for her actions, but she still must be held accountable. In her adult life, if that same young lady is in front of the judge after smashing in her ex-boyfriend’s taillights, and says, “I’m really sorry, Your Honor. I was just so upset,” it’s not going to save her from consequences.

Keep your Own Emotions in Check

Parents often feel angry—even furious—when their child damages their property. That’s completely understandable. Property destruction is a personal violation and it hurts to have a child treat something that we’ve worked hard for with such little respect. One mom states, “I think I got so angry because while I watched my son kick a hole in the front door, I was thinking I’m going to have to pay for that. Once I made up my mind that I would hold him accountable for anything he purposely destroyed, making sure he paid for things by controlling the money I usually chose to spend on him, I didn’t feel as angry. I was able to respond more calmly because I knew he would be held accountable. Once I adjusted my thinking to, Well, I guess he won’t be getting any money for allowance or any extras this month, I was able to respond more calmly and follow through with consequences. And, once he learned that he would pay for the damages, it only took a few times for him to choose to handle things differently.”

On the flip side, remember, if you don’t hold your child responsible for his behavior, you’re not doing him any favors as he prepares for the real world. Just because this is your child, whom you love, you still have the right to assert that your property will not be destroyed as a result of your child’s negative behavior. Holding your child responsible for damages to your property is done out of love and respect. The bottom line is that you are teaching healthy limits and boundaries when you hold him accountable.

Dr. Michael Rubino is a psychotherapist with over 20 years experience specializing in working with children and teenagers. For more information regarding Dr. Rubino’s work or private practice visit his website www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy

School is out and New Drugs are out too

School is out and New Drugs are out too

As a psychotherapist who treats teenagers, I hear about what is going on with teenagers and what they are doing. I have been hearing from many teens about new designer drugs they are taking. Many people assume teenagers are primarily using marijuana. However, teenagers are looking for new drugs and ways to modify how they use marijuana. These new drugs can be very dangerous, even deadly. However, many teenagers are not aware of the dangers and risks they are taking.

It is now summer and school is out so for many teenagers this means partying and using drugs. One major problem facing teens is the fact that many Emergency Room physicians cannot keep up with all the new drugs teenagers are using. Therefore, if a teenager ends up in the Emergency Room due to overdosing or having a bad reaction to one of these new drugs, a teenager may die before an Emergency Room physician determines what the teenager took and how to treat it. The show The Good Doctor recently had an episode which addressed this issue. The teen had used, Molly, not a new drug but because there were so many options, the teenager almost died before they could determine how to treat him.

Recently I read an article by Angela Chen. The article discusses these new dangerous drugs and how deadly these drugs can be. I have included her article below so parents can be aware of the dangers facing their teenagers. Hopefully, parents will also take this opportunity to discuss this issue with their teenagers.

On a July day a little over a year ago, over 30 people collapsed on a street in Brooklyn. They lay on the ground, vomiting down their shirts, twitching and blank-faced. Some, half-naked, made jerking movements with their arms, eyes rolled back. Others groaned and clutched onto fire hydrants to try to stay upright. Witnesses said the scene was like The Walking Dead. Headlines claimed that people had turned into “zombies,” while police said that the 33 affected were lucky to be alive.

All had smoked an “herbal incense” product called AK-47 24 Karat Gold. Eighteen people were sent to the hospital by ambulance. The situation had all the signs of a drug overdose, and so doctors ordered the usual tests: blood count, urine analysis, heart rate monitoring.

The first patient tested was a 28-year-old man who was slow to respond, but otherwise showed few clear signs of trauma. Heart sounds: normal. Blood count: normal. His lungs were clear and there were no major neurological problems, no excessive sweating or skin lesions. He tested negative for opiates, cocaine, amphetamines. Nothing came up.

The case went to the Department of Homeland Security and the Drug Enforcement Agency. They knew who to call to get a second opinion. They packed blood and urine samples on dry ice and shipped them to a small lab 3,000 miles away in San Francisco, run by toxicologist Roy Gerona. If anyone in the country could figure out what was in 24 Karat Gold, it would be him.

Forty years ago, drugs had easy names: cocaine, meth, heroin. Today, the names can read like an ingredients list for a chemistry class: 5F-AMB, PX-2, MDMB-CHMINACA. Today’s designer drugs are made by synthesizing chemicals and hoping they give you a high that’s strong enough to be worth it, but not strong enough to send you to the hospital.

Designer drugs are volatile. If you tweak just one molecule, you can get an entirely differently substance, one you hadn’t bargained for. They’re also easy to get. There’s no shortage of “research chemicals” vendors on the dark web are willing to sell. And they’re growing more popular. These so-called “novel psychoactive substances” entered the mainstream in 2009. That year, according to the United Nations Office on Drug and Crime, there were about 100 of these substances reported; six years later, there were nearly 500. Because designer drugs don’t show up on traditional drug tests, they’re hard to track and identify. It’s a public health problem that requires a special set of skills to handle.

One of the most prominent categories of designer drugs are those intended to mimic marijuana, called synthetic cannabinoids. Marijuana, or cannabis, is widely considered one of the safest drugs, but synthetic cannabinoids are some of the most dangerous synthetic drugs. The Global Drug Survey (GDS) found that last year, for the fourth year running, the risk of seeking emergency medical treatment was higher after using synthetic weed than for any other drug.

When you smoke a regular joint, a chemical called tetrahydrocannabinol (THC) travels through your blood. It binds with receptors called CB1 and CB2. Because of the structure, there’s “kind of a limit on how stoned you can get,” says Adam Winstock, a London-based psychiatrist who administers the GDS. If you’re smoking a popular cannabinoid like K2 Spice, a chemical travels through your blood, but this time, it’s not THC. It’s something else that also binds with CB1 and CB2 — but unlike with regular weed, we don’t know exactly how these chemicals bind, especially when they’re illicit drugs from the black market. This mystery makes synthetic marijuana likely to lead to “much more extreme responses,” like seizures and psychosis, according to Winstock.

Synthetic cannabinoids originated in a quest to create a better pain medication. A Clemson University chemist named John W. Huffman synthesized hundreds of compounds in an attempt to find a better painkiller, but often created incredibly psychoactive substances with no medicinal properties at all. When he published the results of these compounds — called JWH compounds, after his initials — he made the information available to be copied.

There are more than 300 JWH compounds alone, and around 2004, labs in China began studying old research papers, synthesizing the compounds and distributing them as “herbal incense” products. K2 Spice itself — often partly based off the JWH-018 compound — started in China, became popular in Germany around 2008, and entered the US around 2009.

Labs can also turn to the expired patents — patents that are rich fodder, even if (or perhaps because) there was a good reason said drugs never made it to market. It’s nearly impossible to figure out how to shut down the overseas labs producing these drugs. As soon as you ban one substance, the labs move on to another.

Gerona, a toxicologist with gray hair styled in an undercut, was the one who received the biological samples from the DEA. From a small lab in the Medical Sciences Building at the University of California, San Francisco, Gerona says he and his team are playing a “cat and mouse game” with illicit international drug manufacturers. When an overdose happens, Gerona’s team tries to identify the drug in question — often synthetic substances no one has seen before. But the lab goes one further: Gerona’s lab attempts to identify and classify these substances before the mass overdoses even happen.

Inside, the lab is meticulously neat: rows of spotless tables are covered in bottles with orange rubber caps, all labeled with orange duct tape, and small gray centrifuges. A window overlooking a courtyard has molecular structures scribbled over it in pink and green marker. Near the door sits an enormous freezer, filled with thousands of brightly colored, frost-covered boxes of drug samples kept at -112 degrees Fahrenheit.

Gerona launched his toxicology lab in 2010, in partnership with the San Francisco Poison Control Center. The date wasn’t a coincidence; he says that 2010 was the year that a designer drug called “bath salts” began flooding the market. “Bath salts” is a blanket term for a group of designer drugs made from stimulants; they create a euphoric high like MDMA, sometimes with hallucinations thrown in. The drugs usually come in powdered and capsule form, and can cause freak-outs that were well-documented on YouTube at the time. The most famous of these was a viral story of a 31-year-old Miami resident attacking and then eating a homeless man. (Scientists dispute the drugs’ role.)

For users and the DEA, the spike in bath salts use was a nightmare. For Gerona, the increased interest in designer drugs led to more work and more samples from around the country. Eventually, the lab caught the notice of both Michael Schwartz, a toxicologist at the Centers for Disease Control and Prevention, and DEA pharmacologist Jordan Trecki. A collaboration between Gerona’s lab and the DEA was formed. (Neither the DEA nor the CDC responded to repeated requests for comment.)

The first step in doing an analysis at Gerona’s lab is getting the sample — urine, blood or, rarely, a tiny bit of drug itself — shipped over on dry ice. In traditional drug testing, you check to see if the sample matches any of the known substances: marijuana, heroin, cocaine, and so on. They match, or they don’t. Designer drugs, almost by definition, are made of chemical combinations we haven’t seen before. They almost never match traditional databases, and the chemists often don’t know what they’re looking for. So Gerona’s lab gathers as much information about the substance as possible.

A tiny vial of the biological sample — usually plasma, the colorless part of blood — goes into a bulky, printer-like machine. That machine is called a liquid chromatography mass spectrometer, and very crudely put, it separates out all the different parts of the plasma by mass. (Think of it like an extremely sensitive centrifuge.) That process makes it easier to identify chemicals, and the mass spectrometer then spits out the different measurements in a computer chart with peaks and valleys called a chromatogram.

Then, says Axel Adams, a graduate student in Gerona’s lab, you turn to the so-called “prophetic library.”

“ RESEARCHES LOOK FOR POSTS ABOUT DRUGS ON SUBREDDITS LIKE R/RESEARCHCHEMICALS

Gerona’s “prophetic library,” about three years in the making, is a detailed catalog of already synthesized variants that his team believes is going to be the next big street drug. The library was made possible with the help of Samuel Banister, a synthetic chemist at Stanford University. Banister synthesizes variants of popular street drugs and takes down their chemical information to create “reference standards.” Synthesizing can take anywhere from a few days to a couple of weeks; the lab now has almost 150 variants on file. It’s a side job for Banister, but at one point, he says, “I was pumping out five to 10 a week.” The final products look like white crystalline solids and are kept in drawers in the lab, ready for when a case like AK-47 24 Karat Gold comes along.

In addition, lab members spend hours each week on drug forums, researching trends. It’s more of an art than a science. Researches look for posts about drugs on subreddits like r/researchchemicals. They reference surveys like the Global Drug Survey and survey “trip reports” from experiential documentation sites like Erowid and PsychonautWiki.

They look for terms like synthetic pot, K2, Spice, and sometimes, scientific terms like “cannabinoids,” or a specific popular class of cannabinoids, like “FUBINACA” or “JWH compounds.” Often, the posts themselves will include the name of the chemical. Gerona has ordered drugs off the dark web. In one case, the invoice billed him for “cosmetics,” and the package included lipstick, fake eyelashes, and tabs labeled “powder.” The “powder,” unsurprisingly, turned out to be drugs. But most of the time, the drugs in the powder were not the drug that was ordered.

“ THE INVOICE BILLED HIM FOR “COSMETICS,” AND THE PACKAGE INCLUDED LIPSTICK, FAKE EYELASHES, AND TABS LABELED “POWDER”

If there is a match because the compound is already in the library, finding the right variant is “only going to take 15 minutes,” says Gerona. “Otherwise, it could take a week, or it could not be solved.”

Adams checked the results of a blood sample tied to AK-47 24 Karat Gold against the prophetic library. The computer pulled up a chart that indicated a line — jagged, up and down — that shows the mass of the components of AK-47 24 Karat Gold, versus the same information for AMB-FUBINACA.

Drugs don’t pass through the body untouched. Once they’re ingested, the body processes the compounds. So by the time they’re in the blood or urine, it’s not exactly the same compound as the drug that was ingested. It’s hard enough to find a reference standard for the original compound; it’s even more difficult to find a reference standard for the possible variants. In the case of AMB-FUBINACA, the chemical in the biological sample from Brooklyn wasn’t the parent compound. It was a derivative. Luckily, Banister had already synthesized that variant, too.

The peaks and valleys of the two lines of AK-47 24 Karat Gold and AMB-FUBINACA matched up precisely. It took the team only seven days to identify the substance in the Brooklyn case — and most of that time was spent waiting for the sample to get there.

Gerona’s lab has worked on cases across the country, from New York City to Sacramento to Colorado. The number of cases varies. Sometimes, they’ll get 15 to 25 samples a month. One Mississippi case involving synthetic cannabinoids resulted in over 400 samples. The average turnaround on results is about six months, says Adams. That’s not good enough for Gerona.

And it’s not likely that the problem will go away. Marijuana legalization advocates claim that people will stop with the synthetic stuff once the real thing is okay. But that’s not true in the experience of Andrew Monte, a clinical toxicologist at the University of Colorado School of Medicine who collaborates with Gerona’s lab. Recreational marijuana is legal in Colorado, but he sees patients who are on these synthetic compounds anyway. Monte’s team has surveyed people who come into the ER and even set up at music festivals to ask attendees questions. Synthetic drug users are “taking it for a different reason, to get a different high,” Monte says. “They’re really looking for something different than what pot gives, the same way you might choose cocaine over pot or meth over pot.”

“ ONE MISSISSIPPI CASE INVOLVING SYNTHETIC CANNABINOIDS RESULTED IN OVER 400 SAMPLES

To help address this problem, in 2016 Gerona started a new research consortium called P SCAN, or the Psychoactive Surveillance Consortium and Analysis Network. (Yes, the double entendre is intended.) They’re working with about 10 poison control centers in places like Kansas and Colorado. They’ve had more than 100 cases referred to them and are writing up case reports and manuscripts. (The 24 Karat Gold case was published by the New England Journal of Medicine.)

P SCAN will continue to do the surveillance work Gerona has been doing for years, but also create a database of clinical data connected to the specific synthetic drugs they track and discover. Think of it like a medical version of Erowid. This way, the next time there’s an outbreak like the one in Brooklyn, investigators and researchers can look at specific physical indicators (heart rate, respiratory information, neurological information, and more) and say, “Ah, this matches the symptoms of AMB-FUBINACA” — all without shipping samples across the country.

But even with P SCAN and the prophetic library, the task is huge. “The identity of a lab needs to constantly expand and rework in order for it to stay relevant,” says Gerona.

Gerona is a biochemist by training. Before launching his lab, he didn’t know anything about Spice, or AK-47 Gold, or the dark net. But now, Gerona says, “I have no other choice but to really learn about it, so that I am relevant and retain my relevance in the field.” He’s hoping to work with people in technology to automate this “market research” to glean new insights and make the prediction process even faster. “It would be so great if we could predict the drugs coming in with more accuracy, instead of after people are hurt,” he says.

Weeding out designer drugs is a Sisyphean task, Gerona admits. It may be impossible to shut down the overseas labs, but he wants to have even better methods for predicting what’s going to get big and then, instantly identifying the substances. He compares the endless drug variations to nature: the cold virus is still around because it changes all the time. HIV has never been cured because it continues mutating. “In a sense, they’re reinventing themselves all the time, so reinvention is key to persistence. As long as you’re reinventing yourself, you can persist.

Dr. Michael Rubino is a psychotherapist with over 20 years experience treating teenagers. He treats teenagers with drug issues and has seen many end up in the Emergency Room because teenagers think they are the experts. For more information about Dr. Rubino’s work or his private practice visit his website www.RubinoCounseling.com or his Facebook page http://www.Facebook.com/Drrubino3.

Coping with The Recent School Shooting Threat in Our Area

Coping with The Recent School Shooting Threat in Our Area

Many children already experience anxiety about going to school or their safety in general due to the number of mass shootings. Until now most of these threats or shootings have not occurred in our area. However, this fact changed this past week. A student threatened to shoot students at Valhalla Middle School on the last day of school. The police were alerted to the threat and the student was arrested. The police searched his home and he had guns so he could have carried out his threat.

The school district and police did a good job of not publicizing the threat. The students who needed to be aware of the issue were warned and many schools added extra security measures for the last day of school. The good news is the police took action and prevented another mass school shooting. However, this incident brings this issue home. Before these incidents were occurring thousands of miles away. Now we had a real threat in our area.

Many children that I see for psychotherapy are already anxious and afraid that they will be shot at school or in a public place. I have children as young as 10 years old who carry knives with them where ever they go. When I ask them about why they need to carry weapons, they tell me for their protection. This current incident can exacerbate the anxiety and fears that children are feeling.

What can parents do? You can be there to reassure your child. If they mention the recent incident explain yes there was a threat, but the police were aware of it and took care of it and no one was hurt. You do not want to lie to them because that will increase their anxiety. It will also cause them to lose trust in you. They will hear about it from other children so being honest is the best solution. Also children’s imaginations are much more creative than reality. This is why it is important to tell them the truth.

Parents also need to watch their children for any significant personality changes. If your child is having difficulties sleeping or if they are reluctant to go play with friends or if you notice any significant mood changes. These are all indicators that your child may be having difficulties with anxiety or depression. If you notice any of these changes, schedule an appointment with a mental health clinician who specializes in treating children. You want someone who treats children because children often express anxiety and depression differently than adults. Therefore, if the therapist is use to treating mainly adults, the therapist may miss the warning signs in your child because they do not treat children on a regular basis. Also there is nothing to be ashamed of if you feel your child needs to be evaluated. Mental health issues are real and are not a sign of weakness or that someone is crazy. Mental health is part of a person’s over all health just like physical health. Also the sooner you address an issue, the easier it is to address the issue.

I have provided a couple things parents want to watch for in their children. I am also including a link to an article that discusses signs and symptoms that are more common in children and teens and not in adults https://www.psycom.net/hidden-signs-teen-anxiety/. This is a good list to help you determine if your child needs to be evaluated for anxiety or depression.

I understand that this is scary for parents too. Many parents may prefer to ignore the issue. However, this will not help our children and teenagers. This is the world they are going up in and as adults we need to do our best to prepare and protect them.

Dr. Michael Rubino is a psychotherapist who specializes in treating children and teenagers. He has over 20 years experience working with teenagers and also specializes in trauma and critical incident debriefings. For more information regarding Dr. Rubino’s work or private practice visit his web sites www.rcs-ca.com or www.RubinoCounseling.com or follow him on Twitter @RubinoTherapy.

The Teenage Suicide Epidemic

The Teenage Suicide Epidemic

As a psychotherapist who treats teenagers, I work with many parents who are worried that their teenager is depressed and may be suicidal. Many parents worry because suicide is a mental health issue for children and teenagers that often is ignored. In fact, suicide is the third leading cause of death for children 10 to 18 years old. Also it is becoming very common in our society. This past week Kate Spade, a designer, and Anthony Bourdain, the chef from CNN, both committed suicide this week. Suicide is also common in soldiers who have been deployed over seas. Therefore, it is becoming common in our society, however, there are few resources available to people. Also the negative stigma associated with suicide prevents people and families from taking about the issue. I hope the information in this article helps you understand the issue of suicide. To start off with, I have included an article where six people describe their suicidal feelings and the help they need http://linkis.com/huffingtonpost.co.uk/AlJc2

http://linkis.com/huffingtonpost.co.uk/AlJc2.

In today’s society there has been a significant increase in depression, anxiety and suicide among teenagers and children. As I stated above, suicide is the third leading cause of death in children 10 to 18 years old. Yes 10 year old children are committing suicide daily. The increase is significant enough that Netflix is running a series about teenagers feeling suicidal. The show is called 13 reasons why. The suicide rate for teenagers has been increasing yearly. It is increasing faster in teenage girls and is considered an epidemic. It is estimated 800,000 people a year commit suicide and approximately 25 times that attempt suicide (CDC). Again, suicide remains the third leading cause of death for kids 10 to 18 years old and it rises every year and we are not providing resources (CDC).

In my practice I am seeing more and more children and teens reporting they feel depressed, anxious and overwhelmed. One of the main reasons I hear for these feelings is that children feel a great deal of pressure to succeed in school. I have kids in 5th grade and 6th grade worrying about grades. Not because their parents will get mad because if they don’t get As they wont get into a good college and won’t get a good job and won’t be able to afford a house. They only feel like a success if they can make a lot of money. They don’t even consider how compassionate and caring many of them are and the good they offer our world. In their eyes, compassion is nothing if you are not driving a Mercedes.

This is a great deal for a 5th grader or 6th grader to worry about at their age. It is also a terrible way for them to value theirselves. This is how we create Bullies because compassion is looked at as a weakness.

I also see middle school students and high school students involved in several sports and other activities such as Boy Scouts. The kids are feeling pressured to do extracurricular activities not for fun but for their resume. They are again concerned about getting into a good college and being a success. This pressure is not coming from parents either. It is pressure kids are now placing on themselves.

Recent studies are showing a correlation between lack of fun and time to relax with the increase in depression in children and teenagers. A study in Psychology Today discusses this issue. I have included the link so parents can read this study and think about it. Also so you can look at your children and talk with them. See if they are enjoying life or feeling overwhelmed because they need to succeed. Money pays the bills but doesn’t guarantee happiness https://www.psychologytoday.co.

Many parents are not sure what to look for and do not want to over react. If you notice these signs they are indicators that your teen may be feeling suicidal and needs to be assessed by a mental health clinician. The major warning signs are:

• Aggressive behavior

• Verbal outbursts

• Withdrawal from friends

• Writing or talking about suicide

• Dramatic mood swings

• Reckless behavior

• Refusal to engage in daily responsibilities

• Giving way personal items of worth such as jewelry or furniture

If you notice any of these signs don’t be afraid to ask your

teenager if they are feeling suicidal or thinking about suicide.

Many people have the misconception that if you ask someone

about suicide that you will cause them to think about suicide.

This is not true. By asking someone if they are feeling suicidal,

you are letting them that it is safe for to talk about their feelings,

including suicidal feeling. If someone is feeling suicidal it

is essential that they feel safe to talk about their feelings and

thoughts. Therefore, asking if your teen if they are feeling

suicidal will not hurt them, it can help them to talk and possibly

save their life.

I understand that the topic of suicide is scary and something our

society denies and views it as there is something wrong with

anyone feeling suicidal. But the truth is, it is a mental health

issue and it is nothing to be ashamed of. It is also an epidemic for

teenagers. If we want to prevent the number of suicides from

rising and help teenagers who are currently feeling suicidal,

we must talk openly about suicide and seek mental health care for

teenagers who are feeling suicidal.

Another factor related to this issue is family and friends. If someone commits suicide, family

and friends tend to feel guilty and ashamed. They blame themselves for the suicide and feel they

should have prevented it. However, if the person doesn’t express their feeling and there are few

resources, how do you prevent it? Also because of the huge negative stigma associated with

suicide, family and friends are embarrassed to talk about the death. As a result, many families

friends fail to get help after a suicide and their lives may be ruined for the rest of their lives. We

seldom consider the impact that suicide has on the family and friends. I have included a link to

an article which discusses the impact suicide has on family and friends

https://nypost.com/2018/06/06/after-kate-spades-death-think-of-the-survivors/. We need to

consider these issues and start to provide more resources for people feeling suicidal and family

and friends who survive a suicide.

Dr. Michael Rubino is an expert psychotherapist who works with children and teenagers for over 20 years. For more information about Dr. Rubino and his work visit his website www.RubinoCounseling.com, www.rcs-ca.com or follow him on Twitter @RubinoTherapy.