CTE – A Brain Injury That Can Impact Teenagers

CTE – A Brain Injury That Can Impact Teenagers

Many parents of high school athletes are aware of the dangers of concussions. Even one concussion can cause permanent damage according to recent research studies. However, there is another condition that parents need to be aware of when their child plays sports. This disorder is CTE. CTE is Chronic Traumatic Encephalopathy (CTE) it is a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma, including symptomatic concussions as well as asymptomatic subconcussive hits to the head.

Our brain sits in our skull surrounded by fluid. Therefore, any time anyone hits their head or their head is jarred around, the brain moves in this fluid hitting the front and back of your skull or the sides of the skull depending on what direction the force came from. When the brain hits the skull it can cause bruising and microscopic tears of very fine nerve fibers. Nerve fibers that are too small to be seen on an MRI or a CT scan.

Physicians have known that CTE effects boxers for many years, however, it was just recently that evidence showed that football players are at risk too. This was the main focus of the movie, Concussion, starring Will Smith. The NFL did everything they could to stop the filming of this movie. The movie shows how CTE results in the patient becoming severely depressed and psychotic. Many of the patients with CTE commit suicide. Also many CTE patients were football players.

Why is this important for parents to know? It is important because CTE is caused by chronic head injuries. Head injuries that date back to when a teenager was playing high school sports. Therefore, it is important for parents to ensure that their teenager’s school is using the latest safety gear, especially for the head, and to take any head injuries seriously. There is no way to tell what will happen when these teenagers become adults.

For many years, football and schools have reported that they are developing helmets that protect the head better. However, these safer helmets are not being used in high schools or professional football. Schools and professional football are monitoring players closer after a head injury, but still little to nothing is being done to protect the brain prior to an injury.

As an adolescent psychotherapist who has been practicing for 20 years, I am seeing more evidence of this every year. Every year I am seeing more teens with Post Concussion Syndrome. This may occur after a concussion and can be associated with headaches, mood swings and memory difficulties. The teenagers who experiences this Syndrome become very frustrated because they are aware of the changes and because no one can say how long the symptoms will continue. In fact, no one can guarantee that the symptoms will disappear.

This becomes very frustrating to the teenager and their parents. Some teenagers are so overwhelmed that they start self-medicating with drugs and alcohol. Anything that they think might help. Others become so depressed because they fear that the symptoms are permanent that they become suicidal and may attempt suicide.

For many years these head injuries in teenagers were down played because there was not enough evidence to indicate that teenagers could be impacted by head injuries. Well the research clearly indicates that teenagers can suffer long term results from a single concussion. Additionally, this can create symptoms that are overwhelming for the teenager and their family. Imagine being a parent and you see your child suffering with Post Concussion Syndrome and there is nothing you can do to stop it. Parents also become depressed and nervous that their child may never recover.

Another issue to consider, in CTE, patients have mood swings and feel like they are going crazy. They do not understand what is happening inside their head. Many teenagers who act out often report the same feelings and the fear that they are going crazy. Many of these teenagers have had head injuries. It is possible that teenagers may also suffer from CTE?

Everyone’s brain is different and so is the recovery process. This means we have no way of knowing how many Concussions or head traumas it takes before CTE is started in someone. It also means we have no way to determine how long it will take for someone to recover from a concussion or if they will have permanent impairments. We only can tell after it occurs not before.

We do know that patients recovering from Post Concussion Syndrome or dealing with CTE can benefit from psychotherapy. Often this option is not given to teenagers because again many people believe teenagers are very unlikely to suffer with these issues. However, if you look at the research it indicates that teenagers can and do suffer from Post Concussion Syndrome and teenage head injuries can cause CTE.

As a psychotherapist who treats teenagers with head injuries, I strongly encourage every parent to watch the movie, Concussion. Also before your child starts playing any competitive sports, such as football or soccer, go online and research head injuries and signs and symptoms of concussions. Also if you teenager does sustain a head injury while playing sports or just playing have them evaluated. You never know how severe a head injury is by just looking at someone. A few years ago an actress fell in the snow and her friends said to go to the doctor she said she was fine. Two hours later she was dead. When she fell she caused her brain to bleed and she died.

Above all, use your best judgement as a parent. Do not be afraid to ask for a CT scan or an MRI if your child suffers any type of head injury. If your teenager does sustain a concussion and you notice a personality change or memory issues do not hesitate to seek psychotherapy for your child and for yourselves. Also don’t hesitate to talk to your teenagers high school. If the teenager is having problems concentrating after a head injury, the school may need to provide them with accommodations until the child recovers.

This can be an overwhelming and frightening topic to consider but the more you educate yourself, the easier it will be to manage. If you have additional questions regarding the personality changes or neuropsychological changes with head injuries, please feel free to contact me.

Dr. Michael Rubino has been treating children and teenagers for over 20 years. He also has training in neuropsychology. For more information about Dr. Rubino’s work or private practice visit his website at www.RubinoCounseling.com or his website that deals with accommodations at school www.LucasCenter.org.

Teenagers and Concussions

Teenagers and Concussions

Schools are back in session and many high school students are either trying out or getting ready for try outs for their sport. Parents are learning that “basic” Concussions in teenagers are more common than people think and can create more problems that people think. A concussion can cause physical impairment such as not being able to walk or emotional issues such as a teenager suddenly having anger problems or depression.

Many teenagers develop Post Concussion Syndrome after a concussion. Teenagers can have violent mood swings, difficulties concentrating and with memory. This can cause problems at school and with family and friends. I have seen teenagers who get so depressed by these changes that they become suicidal. Post Concussion Syndrome can last a year and often physicians do not warn parents or teenagers about this syndrome. This makes matters worse because they feel like they are crazy because they don’t understand why they have the symptoms. Also these symptoms can create problems at school that the student may need accommodations for in order for the student to understand the classes.

We have been hearing more and more about concussion in professional sports in recent years. We have also seen professional athletes walk away from their careers because they are not willing to risk the after effects of multiple concussions. A fact that some in professional sports do not want to be publicized. Will Smith stared in a movie regarding a professional football player and how his life significantly changed after several concussions. The National Football League tried to stop this movie from being made and shown, but they lost.

However, we do have examples. Mohammad Ali is the most notable example of how multiple concussions can change a person and leave them disabled. Also a news anchor for ABC News documented how his life changed after receiving a traumatic brain injury while covering the war in Afghanistan.

Concussions and Traumatic Brain Injuries also occur in teenagers. Teen athletes such as football players routinely suffer concussions. Many of these athletes suffer permanent brain damage such as difficulty remembering things or emotional issues such as mood swings. Also a number of high school athletes do die from concussions every year.

High school athletes are not the only teenagers at risk for concussions. Teens in general are at risk because teens are willing to engage in risky behavior such as jumping off something or racing cars. Many teens feel they are safe. They hear about these issues but think it would never happen to them. However we never know who it will happen to. Therefore, parents you need to educate and monitor your teenager’s behavior. If you have a teen athlete, you may need to make the decision to stop them from playing a sport if they have suffered a couple concussions. This is not easy but you must think of their lives after high school.

Also boys are not the only ones at risk for concussions. Girls are at risk for concussions too. In fact, some studies show that cheerleaders are at a higher risk of getting a concussion than foot players. Cheerleaders do not use helmets and have no head protection. Also many people assume a child needs to be knocked out in order to sustain a concussion. This is not true. You can sustain a concussion without losing consciousness. So football players are not the only one at risks. Any high school athlete is at risk – boy or girl. Anything that causes a jarring of the head can cause a concussion. Our brain sits in fluid in our skull. Therefore any jarring force can cause the brain to hit the side of the skull and cause a concussion. This is why all high school athletes are at risk for concussions.

I have included a link to a YouTube video where a physician describes the basic information about what happens to a brain during a concussion and the process of recovery from a concussion. This is a must see for any parent https://youtu.be/zCCD52Pty4A.

In addition to this video I have included a fact sheet from the CDC regarding information about concussions for you to review http://www.cdc.gov/headsup/pdfs/schools/tbi_factsheets_parents-508-a.pdf.

I have also included this link from the CDC which helps parents, coaches and schools https://www.cdc.gov/headsup/

Dr. Michael Rubino has over 20 years experience working with teenagers and their families. For more information on Dr. Rubino or his work please visit his website at www.rcs-ca.com or follow him on Twitter @RubinoTherapy.

Facts about Teenagers and Heroin

Facts about Teenagers and Heroin

Many teens die from suicide and drug abuse. Suicide is the third leading cause of deaths for children 10 to 24 years old. One thing that contributes to teenage suicide is drug use. Specifically, the use of pain killers and heroin. In this article I attempt to describe both issues for parents. It is important for parents to be aware of these issues if we are going to stop them.

ABC 20/20 did a very good show the other night about the epidemic of heroin use in the United States. If you did not see it, you can probably find it on their website. Parents this is a show you need to see because many teenagers I work with are not afraid or concerned about how dangerous heroin can be.

According to ABC 20/20, 129 people die every year from a heroin overdose. A majority of these deaths are teens and people in their twenties. Heroin is used by people in the lower income level and by people who are the wealthiest in the country. It is used by whites, blacks, Hispanics basically every ethnic group. It is also used by males and females. Therefore, for the families in Lafayette, Walnut Creek and Danville who say we don't have that problem here, yes you do. Also for parents and educators who think that if their child is in a private school they are less likely to use, you are wrong too. Heroin crosses all ethnic and economic boundaries. The epidemic is so severe some schools are teaching children in the 6th grade how to use Narcan. This drug can reverse an overdose of heroin if administered in time.

Therefore, parents in the Bay Area, you need to pay attention to this issue and these facts. You might be saving the life of your child or someone else you love.

As stated Heroin use to to be a drug of the past but it is now very popular with teens. Heroin is a cheaper alternative to many other drugs. For $10 a teenager can buy a capsule of heroin. This is much cheaper than other drugs.

Heroin is still mainly snorted or injected. Because it is injected teens are exposing themselves to HIV and Hepatitis C. Both are life threatening conditions with no cure. Also many girls who use heroin get pregnant but don't realize they are pregnant until the 4th or 5th month. The girls stop but it is too late. The babies will be born drug addicted and if they live through withdrawals, these children will have on going health issues and learning disabilities. In addition to exposing themselves to diseases most teens use Heroin with other drugs such as alcohol. This makes the probability of overdosing on Heroin even higher. Heroin lowers a persons breathing rate and the drugs they are combining it with lower the breathing rate even more making an accidental over dose more likely. The rate of overdosing from Heroin has quadrupled over the years.

Why is Heroin coming back and very popular with teens? Heroin is very similar to the Opioid based pain killers that teens have been using for years. However, with the cost of pain killers rising on the streets and becoming harder to get due to new prescription laws, heroin is easier to get and cheaper. Also teens tend to like the high better. It is not uncommon for someone to get addicted after using heroin one time. Also with the Opioid epidemic in our country, teens are now more likely to try heroin because it is easier to get and cheaper.

In the last few years heroin use has doubled in teenagers. What teens are at the highest risk? Those who have been using Opioid pain killers, those abusing marijuana and males. Remember it is very common for teens to combine heroin with other drugs and they are unaware of the impact it has on their breathing. They may collapse and not know why and by the time their friends get them to an emergency room it's too late. Also teens may go to sleep after using and their breathing rate is so shallow they never wake up.

This is a very dangerous drug. If it doesn't kill when the teen uses it the drug can kill when the teen contracts HIV or Hepatitis C. The rate of teens using this drug has doubled and the amount of people dying from an overdose has quadrupled over the last few years. Again, parents you cannot ignore this issue. Heroin is being used by upper class children and poor children, athletes, and all races. So it is impacting all teens.

The other major issue with this drug is stopping. Someone cannot just go off heroin. People can die from withdraw. However, finding a treatment center that is affordable or with an open space is very difficult. They may have to wait four months to get into a rehab center. This is very dangerous. When someone decides to stop heroin, they need to enter rehab immediately. If they have to wait even 2 days, they may not make it because they cannot stand the withdrawal symptoms.

If we get involved we can hopefully stop teens from using this highly addictive killer. I have attached a link to a handout by the CDC with facts, warning signs and suggestions to help your son if you think he is using heroin. http://www.cdc.gov/vitalsigns/heroin/
http://www.cdc.gov/vitalsigns/heroin/

In addition to these issues, Heroin and drug abuse is linked to teenage suicide. These drugs besides creating a high, create depression. At times a depression so severe that a teenager decides they would be better off dead and they commit suicide. For the age group 10 to 24 years old, suicide is the third leading cause of death. Therefore, we need to pay attention to the pain killers and other drugs kids are using. And yes 10 year old kids are using these drugs too.

Many times the teen has decided they want to get clean and stop using the drug. However, as I mentioned above, finding an affordable treatment program with an open bed can be very difficult. Some teenagers may need to wait 2 months. This can be two months two long. The teenager may be so depressed and tired of living the drug life that they decide to kill themselves rather than endure the emotional and physical pain of waiting two months.

Another point is for some teenagers they have to try four or five times in rehab before they are successful. Again most teenagers are usually dealing with severe depression at this point. For them the thought of trying again and not succeeding is to much to tolerate. Therefore, they chose the option of suicide to eliminate their pain.

Finally, I mentioned a number of teenagers can overdose by accident, however it may not be an accident. These teens know these drugs very well so they know how to stage what will look like an accidental overdose. Therefore, we really don't know how many teenagers are committing suicide due to being sick and tired of using drugs and living a drug life. Many of the accidental overdosages could really be suicides. There is no way to tell.

What we know is drug use and suicide are at an epidemic rate for teenagers. It is at a point where we need to get aggressive and provide better access to rehabilitation programs and better access to psychotherapy so the depression can be treated. We need a multi-disciplinary approach to this issue and we need to make it easy for teenagers and parents to use it.

Dr. Michael Rubino is a psychotherapist who has been working with teens for over 20 years and he is considered an expert in this field. For more information about Dr. Michael Rubino and his private practice visit his website at www.rubinocounseling.com or his Facebook page at http://www.Facebook.com/DrRubino3.

Important New Information about IEPs and 504 plans

Important New Information about IEPs and 504 plans

School is starting and I am receiving many emails about IEP's versus a 504 plan. Many parents do not know what an IEP is or what a 504 Plan is in regards to a child's education. Also many parents are not aware of their rights or their child's educational rights. Anytime I write about IEPs, i receive numerous emails from parents. Therefore, here is an article describing IEPs and 504 plans for parents.

Parents here is important information about Individualized Education Plans (IEP) and 504 agreements. Besides ensuring that your child receives a good education, you do not need to pay for items such as special computer programs that the school district should be paying for not you. If your child has an IEP the school district is responsible for most educational expenses even a private school if necessary. Please read this article so you understand your rights and your child's rights.

The beginning of the school year is fast approaching. Besides the mad dash to get ready for school and schools are going to start assessing students to determine if they qualify for an Individualized Educational Program (IEP). I am already hearing from parents how school districts are misleading them and pressuring them to sign an agreement for a 504 before the parents clearly understand the difference between an IEP and 504 plan. The definition for both is further down in this article. An IEP and 504 are not the same. An IEP is legally enforceable and has legal guidelines and time frames. An IEP follows a student from school to school or state to state. A 504 is not legally enforceable and doesn’t follow a child nor are there legal guidelines.

An IEP will not stop your child from getting a job or from getting into college. In fact and college because they still would be entitled to assistance and the State of California may pay for their books. Also educational records are confidential therefore, no one would know your child had an IEP in school.

Many schools say your child must be two grades below in order to qualify for an IEP. If you said your child had a math or reading disability this is true. However, if they have ADHD, Bipolar, school anxiety etc. they can qualify under OTHER HEALTH IMPAIRMENTS. All your child needs is a diagnosis such as ADHD which would interfere with their ability to fully benefit from their learning experience in the classroom. The 2 grade below level qualification doesn’t apply to this category.

Also if you have a child in private school and they would benefit from additional assistance, contact your child’s public school district. Even though they attend private school the public school district is legally obligated to provide your child with services.

One more issue, never pay for outside testing before the school district tests your child. They have the right not to accept any outside testing until they test the child. If you disagree with the district’s testing then you can request an objective testing from an outside professional and you can request that the school district pays for the testing and you can select the evaluator.

An IEP or an Individualized Education Plan is a document that outlines the specialized education services that a student will receive due to their disability. It ensures the student will receive the assistance necessary so they will receive an education.

When most parents hear disability, they usually think of a person in a wheelchair or a student wIth a learning disability. There are various condItions that can qualify as a disability. Depression, Bipolar Disorder or even diabetes. The disability is any condition that will interfere in the student receiving the same education as other students. The students who qualify for an IEP need accommodations which meet the criteria of needing specialized education. As I stated above their are numerous conditions which may qualify a student for an IEP.

if a student does qualify for an IEP, they also qualify for Special Education. Many parents hear this and are afraid or embassies. There is nothing to be afraid of or embossed about. If a student qualifies for Special Education, if the student needs speech therapy or special computer programs, the school district is obligated to provide the services to the student at no expense to the student’s family.

There is also an option called a 504 Plan. This was established in the Rehabilitation Act of 1973. The 504 plan ensures that a student with a disability will receive accommodations so they will receive the same education as other students. However, the 504 plan does not qualify a student for Special Education services and It is not overseen as closely as an IEP plan.
Currently, many districts are telling parents that their child does not need or qualify for an IEP and a 504 plan is just a good. This is not true. Many school districts are telling parents that their child does not qualify for an IEP because the IEP is more expensive for the district and most districts are trying to save money.The districts take advantage of the fact that as parents, you do not know all the differences between an IEP and a 504 so they can talk a family into a 504 plan easily.

If you find that your child is having difficulties at school due to a learning disability, health issue or emotional issue, consult an outside professional before you automatically assume that the school is giving you the appropriate recommendation.

I see many parents who have been told that their child is better with a 504 plan and that is not the truth. You can consult an educational consultant or a therapist who works with children. You can contact me at via my website http://www.rcs-ca.com. I help many families at their child’s IEP meeting. The main thing is, do not be afraid to ask if your child should have a 504 or an IEP. Also don’t let the district make you feel guilty because you want time to think and investigate the options. This is your child and you should never sign anything until you are sure it is in your child’s best interest.

I have added a link to a chart that will help you compare the two and understand the differences.

504 Plan vs. IEP – Education Centerwww.ed-center.com/504This pages lists the differences between an IEP and a 504 plan.

I have also added a link to a video which helps to explain the differences between an IEP and 504 plan.

Furthermore, in March 2017, the Supreme Court of the United States, issued an unanimous verdict that School Districts must provide more opportunities to children with disabilities. They found too many children with physical and learning disabilities do not finish high school and 1 out of 3 will be living below the poverty level. This is a huge victory. I have included a link so you can read about this landmark case. https://themighty.com/2017/03/supreme-court-rules-schools-must-support-students-with-disabilities/

Dr. Michael Rubino has over 20 years experience working with children and teens. He also has over 20 years experience working with children in Special Education and was an Intern for the AB3632 program which works with children in Special Ed and IEPs. Dr. Rubino also serves as an advocate for families who have a child who needs an IEP. For more information about Dr. Rubino’s practice visit his website at http://www.RubinoCounseling.com, http://www.rcs-ca.com or his new website that deals specifically with IEPs, http://www.lucascenter.org.

How The North Korea Crises Makes Teenagers Anxious

How The North Korea Crises Makes Teenagers Anxious

In light of how Trump is reacting to North Korea and the news is covering the story 24 hours a day, it makes sense to remind parents how children and teenagers are being impacted. I have been seeing more and more teenagers who are complaining of anxiety and depression. Many of these teenagers are also afraid to go to school too. I have also been seeing more teenagers being placed on home/hospital for school. This means a teacher comes to the house once a week instead of the teenager going to school. This is an alarming trend.

I have also been hearing more teenagers talking about needing to carry a knife with them for their own safety. They tell me you never know when someone might try to attack you. These are not juvenile delinquents or gang members, these are average teenagers. They come from healthy families and are doing well in school and not involved in drugs. This need they feel to protect themselves is an alarming trend.

However, if you take a step back and look at what these children have seen over their lives it makes sense. Most of these teenagers were very young on 9/11, or were not even born yet, when the United States was attacked. Since 9/11 they have also seen two wars and heard on the nightly news about numerous terrorist alerts or attacks around the world and here in the United States. They also hear how the TSA are putting tighter security on travelers and places such as Disneyland are increasing security due to concerns about terrorism.

And now, children are hearing all day long how we are on the verge of having a nuclear war. Our President is making threats that are terrifying everyone, including children. Furthermore, we then have the attach in North Carolina. As a result, children are afraid that the end of the world is around the corner.

In addition to terrorism, this is the first generation growing up with mass shootings. According to ABC News from 2000 to 2015 there have been 140 mass shootings and since January 1, 2016, there have been more mass shootings than the previous 15 years. According to the statistics on mass shootings every day 36 people are killed in the United States by a gun. This does not include suicides. For the group we are discussing, suicide is the third leading cause of death for children between 10 and 18 years old and using a gun is one of the most popular methods of suicide. Also because of school shootings, students have seen increased security on their school campuses. Many campuses have metal detectors that students have to pass through as the enter the campus and there are police officers assigned to school sites due to the fear of violence.

Now, in addition to these facts stated above, think about what these children see on the news nightly and the video games they play daily. Anytime there is a shootings incident in the United States, or any where in the world, there is pretty much 24 hour news coverage of the event for days. Also when there are bombing or shootings in Europe there is 24 hour news coverage for days too. And now we have moved on to covering funerals. When the officers were killed in Dallas the memorial was televised nationally. If we look at the video games these kids are playing most have to do with killing and death. And since computer graphics have significantly improved, many of these games look real.

Additionally, children in the fourth and fifth grades are telling me they are worried about our election results. They have heard what the President has said and they are afraid other countries attacking us or that the President may start a war. Also Hispanic children who are legal citizens are afraid that they will be deported. This is a great deal for a nine or ten year old child to worry about.

Looking at all of this it begins to make sense why I am seeing more depressed and anxious teenagers who fear for their lives. These teenagers are being traumatized. They may not be experiencing the trauma personally but they are experiencing vicarious trauma. With all of the pictures on television and news reports and realistic video games these teenagers are playing, they are being traumatized vicariously. We have never had a generation of children grow up with the amount of trauma that these children are growing up with in the world. Even children growing up during World War II didn't experience this amount of trauma. We didn't have instant access to news nor did we have the graphic videos being shown by the news media.

The question now becomes, what do we do? Well we can not change the world unfortunately. However, we can monitor how much exposure our children are receiving to mass shootings when they occur. We can monitor the video games they are playing and limit access to games that focus on violence and killing. We can demand that the Congress pass gun control laws that make sense. No one needs an assault weapon to hunt a deer. We can also listen to what our children are saying and talk to them about their concerns. When a mass shooting occurs we can ask them how they are feeling, ask if they have any concerns and reassure them that you are there as their parents to protect them. Also try to become active. Look for sites by the Red Cross or the benefit concert for victims of the Manchester incident. Making a donation helps children to feel there is something they can do instead of just being a victim.

Finally, if you start to notice a change of attitude in your child that you are concerned about have talk to your child or have them assessed by a psychotherapist. I have included a link to an article by the American Association of Child and Adolescent Psychiatry which describes what parents can do http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Talking-To-Children-About-Terrorism-And-War-087.aspx. There is nothing to be ashamed of if a child needs therapy. We are exposing children to situations that most adults have problems dealing with themselves. You may find it very upsetting to talk to your child about these incidents. For these reasons and many more, if you feel your teenager has been traumatized vicariously make an appointment with a psychotherapist who specializes in treating teenagers and victims of trauma. Our kids have had to deal with a lot. We can help make it easier for them growing up in this time by providing the help they need.

Dr. Michael Rubino has over 20 years experience treating children and teenagers and is an expert treating victims of trauma and also performs Critical Incident Debriefing. For more information about his work or private practice visit his website at www.RubinoCounseling.com or on Twitter @RubinoTherapy.

How to Handle Your Teenager & Their Cellphone

How to Handle Your Teenager & Their Cellphone

In today's society many people including teenagers view cell phones as a necessity of life. However, cellphones are a privilege not a necessity. We need to remember that fact.

In a couple of weeks many students will be starting Middle School and moving on to High School. Many of those students, who do not have cellphones, will be asking for Smartphones. For those students who have Smartphones many will be asking for better Smartphones. Many teens feel they are entitled smartphones and cannot live without one.

Many people have forgotten that cellphones are privileges especially teens and children in Middle School. This is a common argument I encounter between children and parents. The other argument that is common between parent and children is how much and where the cell phone is being used. Teens basically accuse parents of child abuse if they say no to a phone or if the parent set limits. You are not being abusive, you are being a responsible parent. Remember being a parent is not a popularity contest. You need to do what you feel is best for your child.

Parents if you stop and think about it, why does an 11 year old child need an IPhone 7? They do not need to track mileage or expense accounts nor do they remember their own appointments. There is really no reason they need a Smartphone.

Smartphones are an area where technology has moved faster than our ethics. If you think about it, IPhones and Smartphones were not around in the year 2000. Now everyone including a majority of teens have an IPhone or Smartphone. In my opinion an adolescent does not need a cellphone until they enter Middle School and at that point all they need is a basic cellphone. They need a basic phone so they can check-in with you if their plans change or if they feel they are in need of help.

As I stated above, there is no reason that a teenager really needs a Smartphone. They are not taking care of a family nor are they running a business. Therefore, a basic cellphone should be adequate for what they need it for. I understand that given the way our society has changed some parents may find that it is helpful to their family if a child in middle school has a cellphone. This is a decision that every parent needs to make based on their family's situation.

The parent needs to make this decision, not let the child guilt them into buying them a cell phone. If you are divorced and have children, this may be extremely difficult, but the decision about if your child gets a cellphone or not, should be a joint decision by both parents and a decision you both agree on. One parent should not buy a cellphone without consulting the other parent and they should not use it as a weapon in the divorce.

If you decide that your middle school child is mature enough for a cellphone, you should discuss the rules and guidelines about using the phone prior to getting a phone. Some things to discuss are who they give their cell number to, not texting during class and not taking it into the bedroom at night so they can text most of the night. Many kids will text with their friends until 2 or 3 am and then be too tired for school the next day.

Also there should be a discussion about sharing photos. You never know what someone will do with a photo if they get mad with you. Also there needs to be a discussion about the law. It is not uncommon for teens to send their boyfriend/girlfriend nude photos of themselves. What they don't understand is they are under the age of 18 years old. Therefore, if they have a nude picture of their 15 year old girlfriend, they can be charged with possession of child pornography. Many may say this won't happen to me, but I have had a number of teens in psychotherapy because they were charged with having child pornography. Also you need to remember, once those pictures are out on the internet, they are out there forever. There also needs to be a discussion about on-line perpetrators too. There are many pedophiles on line trying to lure unsuspecting teens into their plans. Your children need to understand this is a real risk and what to watch for.

Finally, it should be made clear that the phone does not belong to the child — the phone belongs to you the parent. Yes you are giving them the phone to use, but it still belongs to you. If you ask for it back, then the child hands it over no questions asked. Also if you feel they are using their phone in an inappropriate manner, all you need to do is call your cellphone carrier and request that their phone line be suspended. It cost you nothing and it is an easy way to control the phone. When you feel that your child has earned the right to have the cellphone back all you do is call your carrier to reinstate that phone line.

It is very important that you and your teen have an agreement about conditions regarding their cellphone use. All of these conditions and agreements should be written down in an agreement that you sign and the child signs. You each get a copy of the agreement and one copy is posted on the refrigerator. If there are any disputes about a rule, you simply go back to the agreement and you follow what is written. A written agreement is very important because I have seen parents have conversations, make agreements and then 6 months later there is a disagreement and everyone's memory is slightly different so you have a big fight.

Also given how many adults have gotten into trouble with their Smartphones, if you are going to allow your child to use any kind of cellphone you must discuss the pros and cons so the child does not get into major trouble with the phone.

Below I have included a sample contract that you can use with your child and modify as you need.

Cellphone Contract

I, child’s name, will not bring my cellphone to the family dinner table.

I will not go over our plan's monthly minutes or text message limits. If I do, I understand that I may be responsible for paying any additional charges or that I may lose my cellphone privileges.

I understand that I am responsible for knowing where my phone is, and for keeping it in good condition.

I understand that my cellphone may be taken away if I talk back to my parents, I fail to do my chores, or I fail to keep my grades up.

I will obey rules of etiquette regarding cellphones in public places. I will make sure my phone is turned off when I am in church, in restaurants, or quiet settings.

I will obey any rules my school has regarding cellphones, such as turning them off during class, or keeping them on vibrate while riding the school bus.
I promise I will alert my parents when I receive suspicious or alarming phone calls or text messages from people I don't know. I will also alert my parents if I am being harassed by someone via my cellphone.

I will not use my cellphone to bully another person.

I will send no more than _____ texts per day I understand that having a cellphone can be helpful in a emergency, but I know that I must still practice good judgment and make good choices that will keep me out of trouble or out of danger.

I will not send embarrassing photos of my family or friends to others. In addition, I will not use my phone's camera to take embarrassing photos of others. I understand that having a cell phone is a privilege, and that if I fail to adhere to this contract, my cell phone privilege may be revoked.

Parent Responsibilities I understand that I will make myself available to answer any questions my tween might have about owning a cellphone and using it responsibly.

I will support my child when he or she alerts me to an alarming message or text message that he or she has received. I will alert my child if our cellphone plan changes and impacts the plan's minutes.

I will give my child _______ warning(s) before I take his or her cellphone away

Signed ______________________________ (Tween) Signed ______________________________ (Parents). Date ______________________________

Dr. Michael Rubino has been working with middle school and high school students for over 20 years. He is considered an expert in this field. Dr. Rubino is one of the founding members of the National Alive & Free Program, a program designed to work with teens. For more information about Dr. Michael Rubino's work and private practice visit his website at www.rcs-ca.com or www.rubinocounseling.com or follow him on Twitter @RubinoTherapy.