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Adolescent Violence Prevention Page

(by Peter Stringham MD, Boston University Medical Campus)  


What to Do After an Injury Due to a Fight

  If a child has been injured by violence, it is a time for many cool heads. Parents should seek medical attention if there is any question about the extent of the injuries. Once things are stable medically, someone needs to find out exactly how the injury happened. He needs to get all the details, filling in any gaps that don’t seem to make sense. He needs to see if this incident is safely settled for the short term and needs to find out what part the injured child may have had in the incident.

QUESTIONS TO ASK

· At this point is the teenager safe? (Is anyone coming after him for revenge because of an unsettled disagreement?)  
· Does he know what to do if he does not feel safe? (Can he get  help if he finds the dispute continues?)  
· Is there anyone else who is not safe? (Will the other person be attacked? Are either party’s friends or relatives trying to get revenge?)  
. Who can settle this non violently before it gets bigger? (Is there a mutual friend or trusted adult who can talk to all parties and calm this down and settle it? Do you need to call the school? the police?)

After the acute conflict is settled parents and other responsible adults need to do a longer term intervention depending on the individual incident and individual child.
 

 If the attack was serious and the child was an innocent bystander and had nothing to do with the attack he may need help with post traumatic stress. Trained counselors or therapists can help with this.  

 If the teenager seemed upset before the injury and seemed to put himself in a dangerous situation, a trained therapist or counselor can help the underlying problem-- maybe depression . 

 If the teenager was experimenting with violence and wouldn’t walk away from the fight, he may need some help learning how to handle street conflicts non violently and he might need to join one or more healthy groups.  

 In any of these cases the community might need more adult supervision of the place where the injury occurred. Parents can talk to other parents to get support for themselves and set up safer environments for their adolescents.

 
Many people in the medical community are trying to establish these guidelines in all emergency rooms and medical practices. If the community requests these responses, it will make the change in the practice of medicine go faster.

What Parents Can Do at Home

  THIS SECTION IS DESIGNED FOR PARENTS BUT OTHER PEOPLE LIKE COACHES, TEACHERS AND COUNSELORS CAN READ IT TOO.

 Try to be a good role model for handling conflict. A child learns how to approach the world by seeing what goes on in the home and how you approach the world. The culture of the media tells all of us to be aggressive and a bully when dealing with adversity. Our culture has long been one of "might makes right" and "rich is better."  Many of us grew up in homes where men made most of the decisions and the women went along with that. You have to be sure to expose the myths in our culture--to show your children that all in your family are of equally high value and that you know even your adversaries are high value human beings like yourself who deserve to be treated with respect.

 Be sure you handle stress well without being self destructive, defeatist or violent. Show them how you handle your anger by keeping yourself cool in a crisis and always treating people with respect. Tell your children how you acted at work to calm down and truly resolve conflicts. Your teaching of self restraint when under verbal attack can allow a child to calm down an upset opponent and may save his life.

 Most adults agree that truly successful human beings live with high ethics and good morals. When you have choices you usually choose decently and morally. Adolescents need help identifying what are good morals and good ethics.

The tabloids and television love to tell stories of cowardice, greed, deceit, self indulgence, blaming others for problems, disrespect for others and violence. In the media everyone is a victim and few are responsible for their own good or poor actions. While interesting to look at in others, those poor decisions seem shallow, sad and not really decent. People who define themselves as "victims" justify their striking out and excuse all kinds of terrible behavior.

You can try to identify your own morals. You can value courage, helping others (altruism), trying for fairness (justice), self denial, trying for goodness, trying to do what is right, kindness, self control, respect for all human beings, and trying for non violence.

Set examples for people you have contact with and you may well counteract much of the media’s nonsense. "Do as I do," teaches the most powerful lessons. Adolescents cannot easily see the value of honest work for lower pay as superior to sleazy or unethical work for high pay. Live this in your own life and children will see it. Remember that many moral and ethical people sometimes are selfish and unethical sometimes. When prominent figures have their lapses exposed, help your children think about the totality of their lives.
 

Many adults and teenagers have learned non violent problem solving at work. When confronted with an angry aggressive customer  we try to communicate and connect with the decent side of the aggressor. We try to keep ourselves alert, but not anxious, cautious but not afraid. Sometimes we decide to just get away from a dangerous situation. This safe assertive problem solving works on the streets for your teenagers.

Just like younger teenagers however you may be upset after the situation is safe, After an experience with a particularly aggressive customer we may wish we had handled the conflict with rudeness or violence, because we ourselves have been exposed to all the cowboy and spy ‘heroes’ who we may secretly admire. Similarly we might feel upset because the aggressive customer reminded us of a time when we experienced violence when we were younger. And although noble to take some abuse from someone who is upset, most of us do not like it. Potential and real violence are emotional issues for us all.

Despite our emotions and fantasies, we must remember that non violent, assertive problem solving works better than violence. It is safer for us at work, and it allows us to end up with a customer who is somewhat satisfied and safety for ourselves and at least of no further threat.

· Try to keep yourself and young people from defining themselves as ‘victims.’ Everyone has advantages and disadvantages. Life can be seen as making the most of what you have already been given. Too much blaming ‘others’ for your problems, while possibly true, gives the message that all of life is either "good luck" or "bad luck" and that human beings cannot work out ways to live a happy and decent life despite disadvantages.

· All of us are sometimes overwhelmed. We work hard at stressful jobs. When parents come home they would like peace and quiet, but their second job has begun. They need to feed their families, be sure the homework is done and think about the next day. Just like at work, parents can take a break before rushing to start dinner and ask "what is going on? What do we as a family need to do?" Some parents have their children report on the "most interesting thing and the oddest thing that happened that day" as a way to start the conversation. After 15 minutes you can feel everyone knows where everyone else is at, and you can start the dinner. Write down family things to do and figure out how to do the tasks and who can do them. Even if communication is sometimes one way you can communicate your love and respect.
 

· Older children need communication. They need parents’ opinions about alcohol and other drugs, smoking, tattoos, violence, dating relationships and sex. Trust that your values are better than someone who is hanging on the corner and happy to teach your child how to fight, drink, drug, get his nipples pierced and have sex.

· Parents can practice kind nonviolent behavior when they are in a conflict with their children.

 "Your aunt is coming to visit and I want your room clean. I’ve asked you four times and it is still a mess. I love you, but this messy room is driving me crazy. I expect you to work out this problem for us. By what time can it get done?"

Respect

  The safest people are those who consider themselves and all other human beings of high value and as a result do not fight with anyone. Bullies and other violent people feel powerful and good about themselves and sometimes feel good about their violence. A teenager’s ability to get out of a dangerous situation may depend on his ability to connect with the decent side of the aggressor and recognize that the aggressor is a person of high value even though he is being obnoxious at the moment. Another person can have ideas, values or abilities that are of higher or lower value, but in the ultimate scheme of things all people are of high value.

You can also model respect. If someone begins to tell ethnic jokes at a family gathering you might want to ask the person to stop. If they don’t you might say,

 "When people start referring to other people by using disrespectful names they sometimes take away that person’s value as a human being. Once a person is dehumanized some other people think it is all right to hurt that person. I don’t want to ever encourage that. I don’t allow disrespectful talk around me."

In the school and community groups be sure that the adults are teaching adolescents respect for themselves and everyone else.

"What would you do if someone was calling a kid you kind of like a ‘homo’ or ‘fag’? The kid isn’t there so he might never hear about it. And you have no idea if the kid is homosexual.  Using any kind of slur takes away people’s humanity;. It is hard to speak up sometimes, but I’ve always felt better when I defended someone who wasn’t there to defend himself. You could say, "Hey! That’s my friend you’re talking about, so watch it. You can be mad at him without calling him names." What do you think?"

Handling Frustration and Anger

  The only people who never experience frustration are leading completely empty lives. Feeling frustration and disappointment are a normal part of trying to accomplish anything. Sometimes frustration feels like disappointment, sometimes like feeling depressed, and sometimes like anger.

Healthy ways of handling frustration are talking about the problem with parents, friends or other trusted adults. A person needs temporary healthy ways to get rid of the anger until he can find time to discuss the problem.

 "All teenagers feel frustrated sometimes. If you set high goals, you will sometimes miss those goals, and you can feel disappointed, depressed, frustrated and even angry. There are lots of unhealthy ways to handle frustration , and there are healthy ways.

"Healthy ways are talking to people about feeling frustrated and explaining how you feel. You can talk to me or any other sensible adult. Sometimes you can’t talk to someone you trust right away. In that case you can try to distract yourself with physical exercise, music or doing something else you like. It is easy to think of all the unhealthy ways to handle frustration--drinking, drugging, smoking, overeating, spending too much money, gambling, unsafe or inappropriate sex, kicking the cat, fighting with a friend, picking on someone or hurting yourself. Stick with the healthy ways. "

As part of the daily check in with their child parents can ask, "What was the most interesting thing that happened today? What was the oddest thing? The worst thing?" Teenagers can ask the same things of their parents.

Enjoyment in Life

Many children who are violent do not feel enjoyment in life. Others have no sense of connectedness or meaning in the universe. Many non violent problem solving teenagers feel a connection to all other people, nature and the universe, and they can feel good when they relax. They are able to keep themselves calm when under stress.

The ability to keep calm and feel the decency of a person who is trying to fight with them is an advantage to the child who is trying to keep himself and his friends safe in an argument. A calm adolescent can see if he is sensing real fear that means he should get away, or if he thinks he can talk to the decent side of the kid.

Identify the ability to enjoy oneself, calm down quickly and feel the decency of all other people as a high priority. Organized religion does not always teach these skills, but it can. The family can model ways to enjoy creativity, hobbies and other healthy pursuits. The community can expose children to a variety of ways to feel enjoyment and calmness. Sometimes a child needs to join more than one group,-- for example a sports team and an environmental group--or a church group and a camping group.

 "Do you sometimes you get that feeling-- ‘I really love this right now!’? That feeling of enjoyment is one of the most important parts of life. I get that feeling when I am walking in a woods and just hear the wind and birds. It is not the same as feeling a thrill like when you are skiing really fast. It is a quiet, calm feeling. Handling stress, succeeding in school and being a good person are important, but feeling really glad to be alive is important to feel many times a day. It may be the most important part of life.

"When I am feeling really glad to be alive and someone starts to insult me. I find I can usually keep myself calm and remember that the other person is upset and may be insulting me , but that he is a decent human being. Then I can usually talk to him.

"You are still young, and no one expect you to be able to feel really great all the time or feel the decency of everyone you meet all the time, or always keep cool under stress, but these are good goals."

Get Others to Help

  Teenagers are not finished growing and they will make mistakes. It the job of parents and the community to correct their mistakes and teach them the right way to go. Teenagers need to hear the same messages of respect, enjoyment of life, handling frustration well, communicating well and loving themselves and the world from a variety of different sources.

A healthy community has a variety of programs for teenagers of all interests. These programs need to be led by caring adults who are kind, set good limits, create atmospheres where there is no fear and where there is mutual respect for everyone. At home, at school and in the community, children need to be praised when they do the right thing and gently and firmly corrected when they are wrong. They need guidance.

It should be obvious that this guidance should not include any physical punishment, which allows a child to waste time on resentment and anger and keeps them from hearing the major lessons you want to teach.  There is no place for corporal punishment, screaming at teenagers aggressively or pushing them around.

This ‘community’ of caring parents, relatives, school, youth groups and community groups should help teenagers believe in themselves, feel hope and grow to become healthy adults.

Parents do the best they can realizing that they cannot raise adolescents alone. Parents may feel frightened because they know that sometimes people can mess up. Use the resources around you. Children need help with all kinds of issues and parents may not be the best person to talk to about a particular problem. Try assembling a list of all the  resources and friends a teenager has. Even a troubled teenager will see that there are adults and older teenagers who can help him. At the end of adolescence most people become pretty normal adults who can deal with life quite well.

 

 

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Symptoms of Severe Stress Disorders:
 
 The most severely distressed children are at risk for develping conditions known as acute stress disorder (ASD) or Post Traumatic Stress Disorder (PTSD). Only a trained mental health professional can diagnose ASD or PTSD, but there are symptoms for parents, teachers and caregivers can look out for in high risk children. Symptoms for ASD and PTSD are similar and include the following:
 
  • Re-experiencing of the trauma during play or dreams. For example, children may repeatedly act out what happened when playing with toys; have many distressing dreams about the trauma; be distressed when exposed to events that resemble the trauma event or at the anniversary of the event; act or feel as if the event is happening again.
  • Avoidance of reminders of the trauma and general numbness to all emotional. For example, children may avoid all activities that remind them of the trauma; withdraw from other people; have difficulty feeling positive emotions.
  • Increased "arousal" symptoms. For example, children may have difficulty falling or staying asleep; be irritable or quick to anger; have difficulty concentrating; startle more easily.  
ASD is distinguished from PTSD primarily in terms of duration. Symtoms of ASD occur within four weeks of the traumatic event, but then go away.  If a  youngster is diagnosed with ASD, and the symptoms continue beyond a month, your child's mental health professional may consider changing the diagnosis to PTSD. 
 
Know the Signs and Get Help if Necessary:
 
Parents and other significant adults can help reduce potentially severe psychological effects of a traumatic event by being observant of children who might be at greater risk and getting them help immediately.

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