What sort of issues are particularly important with boys?

The teen years can be a tough time for both teens and their families. Your son is going through many changes and his emotions may change from one minute to the next. It can be hard to know if what your son is going through is normal or if it is a mental health problem. The resources in this section cover many of the mental health issues that children and teens face, including depression, suicide, aggression, sexualization, and body image issues, but with specific emphasis on boys. Your son, also, might want to use the tools in this section to learn more about the different mental health issues, or to learn how to better express his feelings or deal with stress.

The following topics are covered on this web page:

Boys and mental health in general
Gender identity issues
Suicide and boys
Juvenile offenses
ADHD and criminal behaviors
Conduct Disorder
Drinking and drug use
Divorce and the impact on boys
The draft
Sports and injuries
Wetting the bed
Risky behaviors among teenage boys
Binge drinking
Male body image
Sexuality and puberty
Domestic Violence
Stress and the male
Terrorists attacks and major traumatic events
General considerations for boys

There are a number of issues that matter specifically to boys, which follow below. You'll notice, for the purposes of reference, questions broken down according to how parents might ask them. This list of questions is extensive but not exhaustive; contact Ward Halverson personally, using this web site, to ask more specific questions or request further information on mental health issues with boys.

What are some differences in mental health for boys, compared to boys? What does the research say?

Generally speaking, most disorders are the same for either gender, but there remain significant differences in the patterns and symptoms of certain disorders. These differences vary across age groups. In childhood, for example, most studies report a higher prevalence of conduct disorders, for example with aggressive and antisocial behaviors, among boys than boys. During adolescence, boys have a much higher prevalence of depression and eating disorders, and engage more in suicidal ideation (thinking about hurting themselves) and suicide attempts than boys. Boys experience more problems with anger, engage in high-risk behaviors and commit suicide more frequently than boys.

In general, adolescent boys are more prone to symptoms that are directed inwardly, while adolescent boys are more prone to act out, or direct their symptoms outwardly. This is a major clinical difference between how boys and boys experience mental illness. In adulthood, the prevalence of depression and anxiety is much higher in women, while substance use disorders and antisocial behaviors are higher in men. In the case of severe mental disorders such as schizophrenia and bipolar disorder, there are no consistent sex differences in prevalence, but men typically have an earlier onset of schizophrenia, while women are more likely to exhibit serious forms of bipolar disorder.

With the exception of China and parts of India, the rate of death by suicide is higher for men than women in almost all parts of the world by an aggregate ratio of 3.5 to 1. Again, although men die by suicide more frequently than women, suicide attempts are reported to be consistently more common among women than men, according to a 1999 study covering sites in nine countries.

Interesting, but why is this?

A large number of studies provide strong evidence that gender based differences contribute significantly to the higher prevalence of depression and anxiety disorders in boys and women when compared to boys and men. For example, the lower self esteem of adolescent boys when compared to boys in the same age group, and their anxiety over their body-image is known to result in a higher prevalence of depression and of eating disorders in adolescent boys when compared to adolescent boys. The feeling of a lack of autonomy and control over one's life is known to be associated with depression. Socially determined gender norms, roles and responsibilities place women, far more frequently than men, in situations where they have little control over important decisions concerning their lives.

Studies from industrialized countries have reported that the frequent exposure of low-income women to uncontrollable life events such as illness and death of children or of husbands, imprisonment, job in security, dangerous neighborhoods and hazardous workplaces places them at a significantly higher risk of depression than men. The same problems in men may be associated with abuse of alcohol or other drugs, and violence. A study from China suggests that the distress caused to women by factors such as arranged marriages, unwanted abortions, in-law problems and an enforced nurturing role precipitates psychological disorders. On the other hand, the socialization of men to not express their emotions and to be dependent on women for many aspects of domestic life may contribute to high levels of distress among them when faced with situations such as bereavement. Many studies from the US and UK report that a greater proportion of widowers experienced mental and physical health problems than did widows, although both women and men were vulnerable to illnesses and ailments on losing a spouse

A study from Finland showed that men tended to use alcohol as a remedy for relief from temporary strain caused by external pressure, and considered the use of psychotropic drugs as indicating loss of autonomy. Women, on the other hand, used psychotropics to restore their capacity to carry out emotionally taxing labor related to their caring work in the private sphere. Many studies from industrialized countries report that women are consistently more likely to use outpatient mental health services (such as a therapist, like Ward Halverson) than are men. Men may seek care at a later stage after the onset of symptoms, or delay until symptoms become severe.

What about in America - how are boys handled differently in the world of mental health?

Primary care clinicians were more likely to identify boys using the term "my patient." Researchers suggest this may be the case because boys were more likely to be seen by male clinicians, who are more likely to work in settings that support continuity of care. According to the researchers, clinicians who saw their own patients were substantially more likely to find and treat mental health problems in those patients. The researchers found that, compared with boys, visits by boys with similar parent-reported symptoms were more likely to be perceived by the clinician as mental health related. Clinicians were more likely to find and treat mental health problems during visits perceived as mental health visits.

Why is that?

This may have occurred because parents were more likely to label a boy's behavior as a mental health problem. Alternatively, whereas parents may have labeled boys' and boys' behavior similarly, they may have been more likely to seek medical care for such behavior when exhibited by a boy. Finally, because research relied on the clinician's report, it is possible that the clinician was more likely to label the visit as mental health related when the patient was a boy.

Boys with parent-reported symptoms similar to boys' symptoms were more likely to be identified as having attention-deficit/hyperactivity disorder problems, or other behavior or conduct problems, and were less likely to be identified as having internalizing problems, characterized by shyness, withdrawal, inhibition and inability to successfully form friendships. After adjusting for parent-reported symptoms, medications were more likely to be prescribed for boys. Gender differences were not a significant factor in referral of children and families for mental health professionals - just medical clinicians. According to background information in this example of research, most children are treated in primary care settings for mental health problems. Although it has been shown that boys are more likely than boys to receive a mental health diagnosis in the primary care setting and to receive specialty treatment until adolescence, the nuances of gender differences in similar cases have not been studied. Gender differences are well established in the treatment of adult mental and physical health.

What is gender identity disorder?

A person with a gender identity disorder is a person who strongly identifies with the other sex. The individual may identify with the opposite sex to the point of believing that he/she is, in fact, a member of the other sex who is trapped in the wrong body. This causes that person to experience serious discomfort with his/her own biological sex orientation. The gender identity disorder causes problems for this person in school, work or social settings. This disorder is different from transvestism or transvestic fetishism where cross-dressing occurs for sexual pleasure, but the transvestite does not identify with the other sex.

How would this appear in a male?

Boys with gender identity disorder tend to prefer to dress in boys' clothes. They often avoid competitive sports and have little interest in rough and tumble games. They frequently prefer to play games with boys, and they enjoy boys as playmates. They usually enjoy acting as a female figure, such as a mother or a princess, in the games they play. Boys with gender identity problems pretend not to have a penis; they want it removed, and they wish they had a vagina.

Conversely, boys with gender identity disorder prefer to wear boys' clothes and want to look like a boy. They prefer boys as playmates and often enjoy competitive contact and rough play. Boys with gender identity disorder wish they could grow a penis, and do not look forward to growing breasts or menstruating. They would like to be a man when they grow up.

Adults with gender identity disorder sometimes live their lives as members of the opposite sex. They tend to be uncomfortable living in the world as a member of their own biologic or genetic sex. They often cross-dress and prefer to be seen in public as a member of the other sex. Some people with the disorder request sex-change surgery.

At what age does gender identity disorder appear?

This disorder can be evident in early childhood, and often is. Most people know whether they have a gender identity problem by the time they reach adolescence.

How is gender identity disorder diagnosed?

A mental health professional makes a diagnosis of gender identity disorder by taking a careful personal history from the client/patient. No laboratory tests are required to make a diagnosis of gender identity disorder. However, it is very important not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question that the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.

Frequently, people with gender identity disorder complain that they were "born the wrong sex." They describe their sexual organs as "ugly" and may refrain from touching their genitalia. Although the genitalia of people with gender identity disorder is normal, those with the disorder may show signs of trying to hide their secondary sex characteristics. For instance, males may try to shave off or pluck their body hair, or they may take female hormones in an effort to enlarge their breasts. Females may try to hide their breasts by binding them close to their chest walls.

How is gender identity disorder treated?

Psychological therapy can alter the course of gender identity disorder. Early intervention can lead to less transsexual behavior later in life. The initial focus of the treatment is to help the individual function in his/her biologic sex role as well as possible.

Adults who have severe gender identity disorder which has persisted for many years sometimes request reassignment of their sex, or sex-change surgery. Prior to this kind of surgery they usually go through a long period of hormone therapy which attempts to suppress same sex characteristics and accentuate other sex characteristics. For instance, males that have gender identity disorder will be given the female hormone, estrogen. The estrogen causes the male breasts to enlarge, testes to become smaller, and body hair to diminish. Females with gender identity disorder will be given the male hormone, testosterone, to help them develop a lower voice and possibly a full beard. Following the hormone treatment, the adult will be asked to live in a cross-gender role before surgery to alter their genitalia or breasts is performed.

What happens to someone with gender identity disorder?

If the disorder persists into adolescence, it tends to be chronic in nature. There may, however, be periods of remission. If you, a friend, or a family member would like more information and you have a therapist or a physician, please discuss your concerns with that person. For the most part, however, the question is whether the individual with this disorder is willing to continue living in their gender, or should seek gender reassignment surgery. Although drastic, hundreds of people undergo this surgery yearly and oftentimes are happy with the results. Once complete, by definition the mental illness is now gone.

Is my son at risk of suicide, or hurting himself?

Now that you're a parent, you might not remember how it felt to be a teen, caught in that gray area between childhood and adulthood. Sure, it's a time of great possibility, but it can also be a period of great confusion and anxiety. There's pressure to fit in socially, to perform academically, and to act responsibly. There's the awakening of sexual feelings, a growing self-identity, and a need for autonomy that often conflicts with the rules and expectations set by others.

A teen with an adequate support network of friends, family, religious affiliations, peer groups, or extracurricular activities may have an outlet to deal with everyday frustrations. But many teens don't feel like they have that, and they feel disconnected and isolated from family and friends. These teens are at increased risk for suicide.

Factors that increase the risk of suicide among teens include:

  • The presence of a psychological disorder, especially depression, bipolar disorder, and alcohol and substance use (In fact, approximately 95% of people who die by suicide have a psychological disorder at the time of death.)
  • Feelings of distress, irritability, or agitation
  • Feelings of hopelessness and worthlessness that often accompany depression. A teen, for example, who experiences repeated failures at school, who is overwhelmed by violence at home, or who is isolated from peers is likely to experience such feelings.
  • A previous suicide attempt. This is a major factor to consider.
  • A family history of depression or suicide. Depressive illnesses may have a genetic component, so some teens may be predisposed to suffer major depression.
  • Having suffered physical abuse or sexual abuse
  • Lack of a support network, poor relationships with parents or peers, and feelings of social isolation
  • Dealing with homosexuality in an unsupportive family or community or hostile school environment

OK, what are the warning signs of possible suicidal thinking?

Suicide among teens often occurs following a stressful life event, such as a perceived failure at school, a breakup with a boyfriend or boyfriend, the death of a loved one, a divorce, or a major family conflict. A teen who is thinking about suicide may:

  • Talk about suicide or death in general
  • Talk about "going away"
  • Talk about feeling hopeless or feeling guilty
  • Pull away from friends or family
  • Lose the desire to take part in favorite things or activities
  • Have trouble concentrating or thinking clearly
  • Experience changes in eating or sleeping habits
  • Show self-destructive behavior (drinking alcohol, taking drugs, or driving too fast, for example)
  • Give away items of personal value

What can a parent do?

Most kids who commit or attempt suicide have given some type of warning to loved ones ahead of time. So, as a parent, it's important that you are aware of some of the warning signs that your son may be suicidal, so that you can get your son the help that he or she needs.

Watch and listen. If your son seems depressed and withdrawn, it's a good idea to watch him carefully. Poor grades, for example, may signal that your teen is withdrawing at school. It's important that you keep the lines of communication open and express your concern, support, and love. If your son confides his concerns, it's important to show your son that you take those concerns seriously. Your son's fight with a friend may not seem like a big deal to you in the larger scheme of things, but for a teen, a situation like that can seem immense and consuming. It's important not to minimize or discount what your son is going through. This may increase his sense of hopelessness. Most people who attempt suicide have given some type of warning to loved ones.

If your son will not speak to you about how he is feeling, it's a good idea to suggest that he talk to someone else who he feels comfortable confiding in. If your teen doesn't feel comfortable talking with you, you may want to suggest a more neutral person, such as another relative, a clergy member, a coach, a school counselor, or your son's doctor. It's smart to ask questions. Some parents are reluctant to ask teens if they have been thinking about suicide or hurting themselves. Some parents fear that if they ask, they will plant the idea of suicide in their son's head.

It's always a good idea to ask. Asking a person if he or she is having thoughts about suicide can be difficult. Sometimes it helps to let the person know why you are asking. For instance, you might say: "I've noticed that you've been talking a lot about wanting to be dead. Have you been having thoughts about trying to kill yourself?"

Finally, get help. If you learn that your son is thinking about suicide, get help immediately. Your son's doctor can refer you to a psychologist, psychiatrist, or social worker, or your local hospital's department of psychiatry can provide a list of professionals in your area. Your local mental health association or county medical society can also provide references. In an emergency, you can call (800) SUICIDE or (800) 999-9999. Herkimer County Mental Health can be reached at 867-1465.

If your son is in an emergency situation, your local emergency room can conduct a comprehensive psychiatric evaluation and refer you to the appropriate resources. In this area, Little Falls Hospital is a good resource, although most emergency psychiatric assessments are done at St. Luke's Hospital in Utica. If you are unsure about whether you should bring your son to the emergency room, you can contact your clinician or call MCAT for help. Their number is 732-6228.

If you've scheduled an appointment for your son with a mental health professional, make sure to keep the appointment, even if your son says he or she is feeling better. Suicidal thoughts do tend to come and go; however, it is important that your son get help developing the skills necessary to decrease the likelihood that suicidal thoughts and behaviors will emerge again if a crisis arises in the future. If your son refuses to go to the appointment, discuss this with the mental health professional - you may consider attending the session and working with the clinician to make sure your son has access to the help he may need. The clinician might also be able to help you devise strategies to help your son want to get help.

What about afterward?

Remember that any ongoing conflicts between a parent and son can fuel the fire for a teen who is feeling isolated, misunderstood, devalued, or suicidal. Get help to air family problems and resolve them in a constructive way. Also, let the mental health professional know if there is a history of depression, substance abuse, family violence, or other stresses at home, such as an ongoing environment of criticism.

What if my son knows someone who's committed or attempted suicide?

What should you do if someone your son knows, perhaps a friend or a classmate, has attempted or committed suicide? First, acknowledge your son's many emotions. Some teens say they feel guilty - especially those who felt they could have interpreted their friend's actions and words better. Others say they feel angry with the person who committed or attempted suicide for having done something so selfish. Still others say they feel no strong emotions. All of these emotions are appropriate; stress to your son that there is no right or wrong way to feel.

When someone attempts suicide and survives, people may be afraid of or uncomfortable about talking with him or her about it. Tell your son to resist this urge; this is a time when a person absolutely needs to feel connected to others. Many schools address a student's suicide by calling in special counselors to talk with the students and help them deal with their feelings. If your son is having difficulty dealing with a friend or classmate's suicide, it's best for him or her to make use of these resources or to talk to you or another trusted adult.

Is my son likely to commit suicide?

Statistically, he's less likely to threaten it than a boy, but more likely to be "successful" than a boy. More than 30,000 Americans commit suicide each year, and 5,000 of these Americans are teenagers. Though one of every eight teenagers suffers from depression, the diagnosis is often missed, and depressive symptoms are mistaken for the typical ups and downs of teenage life.

How common is teen suicide?

Suicide is the second most common cause of death among adolescents, and is only surpassed by auto accidents as a cause of death in teenagers.

How common is it for teenagers to think about suicide?

Suicidal thinking, or thinking about death and dying, is not a terribly uncommon thing among adolescents. It's a very different thing, on the other hand, to actually form a plan, or to make a specific attempt. Suicide attempts are relatively common. Completed suicide, of course, is much less common.

Are boys at greater risk of suicide?

Suicidal gestures and attempts can result in disability and death, especially when the attempter underestimates the lethality of their own behavior. Boys with Conduct Disorder and Oppositional Defiant Disorder may be at somewhat higher risk for suicidal thought and behavior. Among white juvenile offenders, suicidal thoughts and behaviors are most often associated with Major Affective Disorders (e.g., Depression; Bipolar Disorder) and Borderline Personality Disorder. No particular diagnostic symptoms have been found to predict suicidal behavior in African-American juvenile offenders. The association between depressive disorders and conduct disorders, two of the most common diagnoses in juvenile offenders, suggests that all people who work with offenders must be educated about the indicators of suicidality and be diligent in assessing suicidal thoughts, seriousness of plans, and access to weapons or other means of suicide.

What sorts of factors may lead up to a suicide attempt? What can parents be on the lookout for?

In terms of teenagers who actually complete suicide, we know that the greatest risk factor is having a mental health disorder. Sometimes concomitant or co-occurring substance use would put a teenager at risk. But depression is probably the single leading cause associated with suicide. There may also be precipitants. A teenager might be depressed, and there may be a stressful event that happens on top of that depression that seems to be a final straw. Sometimes a teenager will form a plan and say, "If this happens, then that's it, I'm going to do it." Romantic breakups are a common catalyst.

There is a preponderance of white older adolescent males who attempt suicide, or complete suicide. Why do you think that is?

There's a very interesting difference between boys and boys. While boys actually make many more suicide attempts than boys, boys are much more likely to succeed because they turn to fatal means. For boys, the most common means of trying to kill themselves is with a gun, actually a long gun (such as a rifle) with boys. These are obviously fatal methods. With boys, overdose attempts and wrist slashings are more common. And these are rarely fatal.

Does that indicate that boys are more likely not to really want to go through with it, but it's more a cry for help?

While there are some things that we think of as a suicide gesture, I think every time that someone is contemplating suicide, and makes an actual attempt, it should be treated very seriously. And it demands a medical evaluation. Sometimes people assume that these attempts are just an effort to manipulate. And while sometimes this may be true, it really demands an evaluation, ideally by a psychiatric professional.

Sometimes teenagers are very dramatic. Should every suicide threat be taken seriously? How does a parent know when to worry?

Whenever a son says, "I'm going to kill myself," I always take that as a warning sign. So when parents tell me this, or tell a primary care provider this, I always urge those professionals to get that son an official expert evaluation. It's not normal to say, "I'm going to kill myself." There may be a manipulation involved and it may not necessarily be a suicide risk, but there's something going on for that son that probably deserves an evaluation.

What are some of the signs that parents should be seriously concerned about?

Parents should be aware of the signs of depression: a change in mood, a loss of interest in normal activities, thoughts or discussion of death, or withdrawal from friends. We know that substance use is a risk factor. If parents have concerns, they probably should act on them, because by the time you recognize that you have concerns, you've probably had them for quite awhile. And when you realize you're worried, it's time to act. Early intervention can mean the difference between life and death.

What about boys who are juvenile offenders?

Mental illness and substance abuse, which often co-occur among juvenile offenders, can contribute substantially to delinquent behavior. Studies have consistently found very high prevalence rates of mental illness among detained and incarcerated juveniles, and juvenile offenders generally. While estimates of the percentage of juvenile offenders who have mental health problems vary widely (e.g., between about 30-90%, depending upon what is included as a mental illness), most estimates are substantially higher than the roughly 20% prevalence rate found in the non-delinquent adolescent population. Indeed, many juvenile offenders have multiple mental health problems, and about 15-20% have a serious mental illness. Lack of appropriate treatment in adolescence may lead to further delinquency, adult criminality, and adult mental illness.

What causes so many boys to break the law?

Psychosocial and environmental risk factors also contribute to juvenile offending. Frequently it is difficult to determine which mental illness or risk factor is the greater source of problems because juvenile offenders often have multiple mental illnesses and/or are exposed to multiple risk factors.

Multiple diagnoses of mental illnesses (known as "comorbidity") are common among juvenile offenders; finding multiple disorders within a single adolescent is not uncommon. The most common diagnoses for juvenile offenders are:

  • Conduct Disorder
  • Oppositional Defiant Disorder
  • Alcohol Dependence
  • Major Depression; Dysthymia (long-term, low-grade depression)
  • Attention Deficit-Hyperactivity Disorder (ADHD)
  • Bipolar Disorder (sometimes known as Manic Depression)
  • Generalized Anxiety Disorder
  • Post-Traumatic Stress Disorder

The most common diagnosis for boys is Oppositional Defiant Disorder or Conduct Disorder, often with an additional diagnosis of ADHD and/or alcohol dependence. Interestingly, the most common diagnosis for boys is depression, often with an additional diagnosis of Oppositional Defiant Disorder and/or Alcohol Dependence.

So that's why boys break the law more?

Yes - behaviors associated with Attention Deficit-Hyperactivity Disorder (ADHD) and Conduct Disorder (CD) are frequently blamed for juvenile offending. The two disorders co-occur so often that it is difficult to determine how much each disorder contributes to delinquent behavior. Thirty to fifty percent of adolescents diagnosed with ADHD also receive a diagnosis of CD, though the two disorders differ substantially. Several studies of incarcerated juveniles found that 87-91% had Conduct Disorder (CD), which is not surprising given that CD is characterized by persistent violation of age-appropriate societal norms or rules or a disregard for the rights of other individuals. Examples of CD symptoms include aggression towards people or animals, destruction of property, theft or running away. Antisocial adolescents are different from other adolescents in the ways they think, perceive relationships, and relate to others. Teens with CD have limited problem-solving strategies because they are inflexible in thinking about problems and possible solutions. Aggressive adolescents tend to see hostile intentions in ambiguous social interactions, and are likely to respond with unanticipated aggression without provocation. Children with a diagnosis of CD demonstrate poor social skills, such as a lack of empathy and a tendency to be impulsive, problems associated with the adult characteristics of psychopathic behavior. Yes, that's frightening.

What about ADHD and criminal behavior?

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by symptoms of inattention (e.g., forgetfulness or disorganization), hyperactivity (e.g., fidgeting or talking excessively), or impulsivity (e.g., interrupting others' conversations). Adolescents with ADHD exhibit poor school performance, reduced participation in extracurricular activities, and poor social relationships. Children and adolescents with ADHD have limited problem-solving skills and difficulty paying attention. ADHD in adults is associated with other mental illness, incarceration, job failures, and marital problems. Earlier research suggested that these two syndromes arose from the same underlying condition, even though they had different symptoms, especially since both diagnoses have been found to predict juvenile and adult criminal offending. But more recent studies suggest that the two diagnoses represent two distinct disorders, with ADHD relating more closely to cognitive and academic problems and CD relating more closely to delinquency in adolescence and antisocial personality disorder in adulthood.

What can I do to help my son, if he has Conduct Disorder?

Several medications have been shown to be effective in treating adolescents with ADHD, including antidepressants, clonidine, neuroleptics, dextroamphetamine, methylphenidate, and pemoline. (These medications have not traditionally been prescribed for behaviors of CD, though methylphenidate has been shown to effectively reduce most CD symptoms.) Other effective treatments for ADHD include psychosocial interventions, such as classroom based behavior modification, social skills training, cognitive skills training, and parent training/home-based interventions. Using more than one of these approaches, along with medication, appears to produce better results than medication alone or a single intervention.

Treatment of CD has generally been limited to non-pharmacological interventions, however. The dysfunction associated with conduct disorder is an integral part of a larger context of living conditions, such as poor housing and education or ineffective parenting skills. Cognitively based interventions appear to reduce antisocial and aggressive behaviors. Parent management training (PMT) teaches parents to respond consistently to children and to interrupt maladaptive interactional habits that maintain aggressive or antisocial behavior. It has demonstrated short-term effectiveness in promoting pro-social behaviors in children and in reducing maladaptive behaviors through effective discipline practices. Functional Family Therapy, which expands parent management training to include family therapy, is also effective. In particular, Multisystemic Treatment (MST), which additionally includes interventions with offenders in school and community settings, has been shown to be a highly effective intervention for the delinquent behaviors associated with CD. Juvenile offending, regardless of diagnostic status, is best thought of as a potentially chronic disorder requiring multiple, persistent interventions across numerous settings, rather than an acute condition that resolves after a brief intervention. This is important to understand.

Should I also focus on treating ADHD with my son?

ADHD may interfere with the acquisition of basic academic skills and general intellectual functioning. CD leads to acting out behaviors that may result in juvenile justice involvement. Early conduct problems associated with CD predict offending as early as age 12-13 and difficulties with social and behavioral requirements in school settings. Juveniles having both ADHD and CD have lower intellectual functioning and poorer academic skills and enter the juvenile justice system earlier. The presence of both disorders results in earlier delinquency and more negative outcomes.

Some juveniles have only ADHD symptoms; some have only CD symptoms; and some have both ADHD and CD symptoms. Therefore, careful examination of each symptom is necessary for a good diagnosis of either of these disorders. Correct diagnosis requires a careful review of the symptoms that may belong to one or the other diagnosis, or to both. Appropriate treatment for the presence of either disorder should include consideration of symptoms indicating the other disorder, and whether treatment for both disorders is indicated.

What about juvenile offenders and problems with drinking and drug use?

Substance abuse is a particular concern with juvenile offenders because it is a major risk factor for delinquency. Substance abuse often co-occurs with Conduct Disorder (particularly in boys) and Depression (particularly in boys), and among juveniles who have been victims of sexual abuse. Juveniles having Conduct Disorder or Depression, who also abuse substances, are at far greater risk for delinquency. Substance abuse increases in severity with symptoms of Conduct Disorder and Depression, and the more diagnoses a juvenile has, the more likely he or she is to become a "polysubstance" (more than one drug) abuser. When substance abuse occurs with Conduct Disorder, it may be a manifestation of the disorder. When it occurs with Depression or Anxiety, it may represent an attempt to self-medicate. This is serious because children may develop serious addiction (dependency) or seriously hurt themselves while using substances or even with the substances themselves.

Substance abuse exacerbates problems associated with other psychological problems and puts adolescents at greater risk for violence and recidivism (reoffending). Adolescents with conduct disorder who also abuse substances often progress to the more serious diagnosis of adult Antisocial Personality Disorder, suggesting that the long-term societal costs are great. Early identification of substance abuse problems, and appropriate interventions, are critical in delinquency prevention and rehabilitation.

Why else to boys become juvenile offenders?

Psychosocial and environmental stressors also contribute to the problems of juvenile offenders. The quality and quantity of parental support and supervision is especially important. Parental psychiatric problems, lack of parental support, and the absence of one or both parents from the home, all predict delinquency. Boys whose parents remarry while the boys are between the ages of 12 and 15 engage in more fighting and theft than their peers, and tend to have less parental supervision and less emotionally warm relationships with their parents.

Exposure to violence is another vulnerability found in juvenile offenders. Exposure to violence may make them more likely to perceive hostility in ambiguous situations, and to accept aggression as a normal part of interpersonal relationships.

  • FACT: Family abuse and exposure to violence are the most significant predictors of juvenile violence when comparing delinquents with non-delinquents.

The same holds true when comparing more violent and less violent youths. As compared with less violent juvenile offenders, more violent juveniles are more likely to have been severely physically abused, sometimes leaving them with injuries to the central nervous system that make it difficult to resist behaviors motivated by strong emotion or impulsivity.

Exposure to violence is also linked to Post-Traumatic Stress Disorder. Half of the youths in a California Youth Survey who met full criteria for Post-Traumatic Stress Disorder (32%) or partial criteria (20%) described witnessing an event of domestic violence as the traumatizing event associated with the disorder.

What else can a parent do to prevent or reduce the risk?

Adequate parental involvement, nurturance, and support serves as an important buffer protecting juveniles from delinquency. Parenting education programs, particularly those teaching effective discipline practices, may be effective in improving the quality and quantity of parental involvement. Prolonged exposure to serious violence (e.g., neighborhood shootings; domestic violence) may put juvenile offenders at risk for Post-Traumatic Stress Disorder. It also can result in learned responses to violence wherein the juvenile learns to accept aggression and aggressive responses as a normal part of interpersonal relationships, thus resulting in delinquent behavior. These juveniles often benefit from interventions aimed at teaching them social problem solving skills.

My son complains of headaches, especially at school. Is this common?

Headaches are an increasing problem, interestingly. It is mostly the school environment which appears to trigger the problem. Teenage boys suffer the worst, a gender difference which extends into the adult years. Headaches are one of the most common health problems reported by teens themselves and by nurses in school health care. In Scandinavian studies, headaches have been shown to occur at least once a month in a large group of children and teenagers. The incidence of recurring headaches in schoolchildren seems to have increased in recent years. Confirmation of such an increase has been reported among Finnish children who started school during a one year period . Recently, figures from the Swedish part of a larger WHO study show an increase of frequent headaches during an -year period, especially among teenage boys in school. In California, fifth, seventh and ninth graders answered health questionnaires over a two-year period. During this time, the amount of students reporting daily or almost daily headaches has increased from 15% to 55%. The number of those who have extreme cases once per week also increased during the same period.

It is not clear whether the prognosis for children with migraine is different in boys and boys before puberty. During the teens, cases of migraine are rare, but they recur in adult life, where the incidences are worse for women than for men. The prognosis for tension headaches in children and teenagers is unclear today, because of our insufficient knowledge about this important health problem. For unspecified recurring headaches in boys and for general headaches in schoolchildren, interestingly, there are increased occurrences among children from lower social/economic groups.

What can be done to reduce the problem with headaches?

Headaches usually appear during school and many students with recurring headaches believe that a chaotic, stressful school environment is a possible factor in bringing them on. In a study of school children, a correlation was found between class size and recurring headaches. It is possible that measures in school to make the environment calmer and less charged with stress, as well as smaller class size, can reduce the incidence of headaches in students. Our knowledge is limited as to which factors in the school's physical environment are related to these concerns. In a Swedish study, a relationship was revealed between carbon dioxide levels in the classroom caused by poor ventilation and an increase in headaches in the students.

Drink more water. Stress and relaxation techniques can help, however. Perhaps the most common causes of recurring headaches in students are different types of mental stress the students experience in daily life, for example, in school, or an event that brings on strong emotions and upset. Some treatment programs have been tested to help solve those problems in children and teenagers which can be linked to recurring headaches. There, the children are taught how to reduce their intake of discomfort and stress, for example with tension-reducing techniques. It is not clear, however, whether such measures, which for example are arranged by the teacher and directed at the entire class, can also reduce recurring headaches in school children, but at least they appear to help. This treatment seems to work best if it is given to children or adolescents who themselves seek help because of the recurring headaches, for example in school health care. Treatment can also be administered by specially educated school nurses. A successful improvement in recurring headaches can usually last several years after the treatment has been completed.

What about divorce? How will my son be affected by this major change?

Nearly one out of every two marriages ends in divorce these days. And though the divorce rate has leveled off recently, one million new children a year are living through the breakups of their families. And their problems are mounting. Over and over, in studies that break down the effects of divorce on children according to gender and age group, their universal reactions are listed as shock, followed by depression, denial, anger, low self-esteem and often, among younger children, a feeling of responsibility for the breakup. These summations are often followed by the words ''especially in boys.''

The benchmark works of three of the most eminent researchers in the field came to the same conclusion: Boys are more handicapped by divorce than boys. One key study compared the preschool children of 72 middle-class, divorced families with 72 intact families over a six year period in the late 1970's and found that, almost without exception, boys are more vulnerable than boys both to conflict in nuclear families and to the effects of divorce. The effects on boys, as well, seem to be more long lasting and more intense.

Tracking 60 families with 131 children between the ages of 3 and 18 over a five-year period, another major study discovered - clearly - the greater stress among boys. ''Eighteen months into the study, three times as many boys were doing well as were their brothers and other boys,'' says the executive director of the Center for the Family in Transition in Corte Madera, Calif. ''There seems to be more vulnerability in boys, and more resilience in boys.''

This is not to say that boys take the breakup of their families lightly. Far from it. The difference lies in their methods of expressing their unhappiness over divorce and their timetables for adjusting to it. Research has found that most boys were greatly improved by the second year after the divorce, many boys were not, and a significant number were showing more problems than boys in unhappy but intact families. The deeper impact on boys continued during the second year to a lesser degree and even into the third year, when most single-parent families had settled down into consistent routines. Some of the effects on boys - increased aggression and a heightened need for attention - were immediate. Others, sometimes called sleeper effects, did not show up in either boys or boys until adolescence. All in all, it took many boys between three and five years to regain their stability after a divorce, more than twice as long as boys.

Why is my son having trouble in school, now, after our divorce?

No area of a boy's life seems immune from divorce fallout. Academically, for example, the National Association of Elementary School Principals found that boys from single-parent families have lower achievement ratings than boys from intact families or boys from either family situation. Socially, further research has found, the sons of divorce have fewer friends and less of a support system than boys living with both parents. Within the family, the relationship between sons and their single mothers often become charged, and even destructive. A pattern sometimes called a ''coercive cycle'' may develop between the two generations and become so unpleasant that, in studies, divorced mothers of sons admitted to more feelings of stress and depression than did divorced mothers of sons.

Does it matter how old my son is during the divorce?

The boy's age at the time of divorce, also, can dictate his reactions to it. Boys as young as 18 months can suffer frequent and particularly terrifying nightmares. An inconsolable sadness has been observed in boys of 7 and 8. ''I don't laugh a lot now,'' an 8-year-old boy has related. ''I just want to go inside.'' Anger is a familiar response among boys of 9 and 10, an anger so intense that one study found visitation with the noncustodial father dropped to its lowest frequency of any age over 3.

For teenagers, research shows the list of divorce-related problems can run from an increase in drug and alcohol use to feelings of shame and condemnation over the actions of their parents. While adolescent boys may become sexually precocious and even promiscuous following divorce, boys can become sexually insecure and threatened. Though the mounting evidence is startling, researchers are still cautious about making too much of the differing responses of boys and boys to divorce. As custody of the children still goes to the mother more than 90 percent of the time, whether by parental agreement or paternal default, almost all of the research has entailed children in the custody of their mothers. This may create a bias of its own, and should serve as a sort of warning signal. There hasn't been enough research on children in father-custody homes.

So, then, why do boys seem to suffer more from divorce?

While few researchers doubt, at this point, that boys show more problems during divorce than boys, the puzzling question is why. Is it indeed the absence of the father? Is it the attitude of the mother? Is it how the divorce is handled? Or, could it be that boys are more susceptible to stress than boys? The answers are not clear-cut, of course. Human behavior never does tidy up into neat packages. But reasonable explanations are being proffered for boys' more intense reactions and behavior, some grounded in their conditioning, others in inherent traits of the sexes.

From the beginning, the characteristics that boys appear to be born with are the ones that most work against them in divorce. Boys are simply more vulnerable to stress of any kind than boys. They are more likely to have 90 percent of all human frailties, including aggression problems, neurotic symptoms, phobias, difficulty with toilet training, even learning. Reading disabilities are seven times more common in boys than in boys. A boy born prematurely is less apt to survive than a boy. No one knows with any real certainty why that is.

Will my son be drafted?

It's doubtful. The U.S. Armed Forces already have the capability to fight a major war with an enemy the size of China or Russia. Also remember, we are not in this War on Terror alone. For the first time in 52 years, NATO has invoked Article V of the NATO self-defense charter that says if one member state is under attack all other member nations would defend it. And many of the Arab nations have pledged their support. Although they have not pledged military support, it's good to know that the world is behind us in our efforts against terrorism.

It is Ward Halverson's opinion that desperate measures would be needed before there is any type of draft. This is a different type of enemy that does not have borders - Ward knows, he fought for a year in Afghanistan earlier in the conflict as an army officer. It is, however, always possible. That's why Ward redirects this question to the ultimate and final source, America's Selective Service process.

So, what does the Selective Service say about a draft?

According to the Selective Service, the fact that a man is required to register does not mean that he will be drafted. No one has been drafted since 1973. No one can be ordered for induction by Selective Service unless Congress and the President determine that inductions are necessary. This would most likely occur only in the event of continuing and escalating war or a major national emergency.

If that happened, who would be selected?

Men who will reach age 20 during the calendar year in which inductions occur would be the first group to be called. If more men are needed that year, after all men turning 20 are considered, the order of call would continue up to those who will reach age 21, then 22, and on up through age 25. The order of inductions within each age group would he determined by a lottery which matches a random sequence number with birth dates. If someone were selected for induction, he would be sent an "Order to Report for Induction" along with detailed instructions explaining where to report and what actions would be required on his part to fulfill this requirement. However, if he filed a claim for postponement or reclassification, the induction will be delayed until a decision is made on whether the claim is accepted or denied. Some examples of the requirements to obtain a postponement or a reclassification are as follows:


  • For full-time college students who desire to finish their current semester.
  • For full-time college students in their last academic year who desire to finish that academic year.
  • For high school students not yet 20 years old who desire to stay in school until they graduate.


  • For men whose induction would create a hardship to their dependents.
  • For students studying for the ministry.
  • For ministers of religion.
  • For Conscientious Objectors. Those who hold deep religious, moral, or ethical beliefs against participation in war. If the objection is to participate in combat military service only, one would be inducted to perform only non-combat military service; if the objection is to participate in all military service, in lieu of induction one would be ordered to perform civilian work contributing to the maintenance of the national health, safety, or interest as determined by the Director of Selective Service.

How would someone file a claim for postponement or reclassification?

Upon being found qualified for military service after an Armed Forces Examination, and prior to your induction into the Armed Forces, the person would be given an opportunity to submit a claim other than 1-A (available for unrestricted military service) to the Area Office, providing administrative support to the Local Board of Assignment. If this person requests a postponement of the induction, the request must be made in writing to the Area Office before the date scheduled to report. The request may be made utilizing the SSS Form 262P (Request for Postponement of Induction), sent with the Induction Order, or by letter. Additional information is available at, call (847) 688-6888, or write to:

Selective Service System Registration Information Office P.O. Box 94638 Palatine, IL 60094-4638

Are sports good for boys?

Close to 6 million high school students play team sports, and another 20 million children take part in recreational or competitive sports out of school. Sports activities help children and adolescents stay fit, learn about teamwork, and develop self-confidence. But playing a sport also brings the risk of injury. Each year, over 775,000 children under age 15 are treated in hospital emergency departments for sports-related injuries. About 80 percent of these injuries are from playing football, basketball, baseball or soccer.

Most sports-related injuries in children - about two-thirds of them - are sprains (involving ligaments, which connect one bone to another) and strains (involving muscles). Only 5 percent of sports injuries involve broken bones. The majority of injuries are mild, but they can cause great inconveniences for both children and their parents during the healing process. And if not allowed to heal properly, a minor injury can become a more serious one that interferes with proper growth and causes life-long problems.

What can I do to help my son avoid injury?

  • Before your son starts a training program or enters a competition, take him to the doctor for a physical exam. The doctor can help assess any special injury risks your son may have.
  • Make sure your son wears all the required safety gear every time he or she plays and practices. Know how the sports equipment should fit your son and how to use it. If you're not sure, ask the coach or a sporting goods expert for help. Set a good example-if you play a sport, wear your safety gear, too.
  • Insist that your son warm up and stretch before playing, paying special attention to the muscles that will get the most use during play (for example, a pitcher should focus on warming up the shoulder and arm).
  • Teach your son not to play through pain. If your son gets injured, see your doctor. Follow all the doctor's orders for recovery, and get the doctor's OK before your son returns to play.
  • Make sure first aid is available at all games and practices.
  • Talk to and watch your son's coach. Coaches should enforce all the rules of the game, encourage safe play, and understand the special injury risks that young players face.
  • If you're not sure if it's safe for your son to perform a certain technique or move (such as heading a soccer ball or diving off the highest platform), ask your pediatrician and the coach about it.
  • Above all, keep sports fun. Putting too much focus on winning can make your son push too hard and risk injury.

My son is still wetting the bed. What can I do?

If your preteen is still wetting his bed at night, don't despair. Plenty of his classmates are doing the same. Bed wetting, or enuresis, is a common problem and about 3% of all 14-year-olds still wet the bed at night. It is much more common in boys, but does happen with boys also.

Bed wetting can be divided into two main types:

  • Primary Nocturnal Enuresis refers to persistent involuntary nighttime urination where the son has never had a dry night
  • Secondary Nocturnal Enuresis refers to an onset of nighttime bed wetting after a dry period of at least six months.

Three of the most common reasons for primary nocturnal enuresis are:

  • Genetic predisposition: 75% of children who wet the bed have parents who had the same problem as a son.
  • Deep sleeping: studies suggest that children who wet the bed are very hard to wake up and have a hard time waking to an alarm clock.
  • Reduced production of vasopressin: an anti-diuretic hormone that directs the kidney to concentrate the body's urine so your bladder doesn't overfill.

Two of the most common reasons for secondary nocturnal enuresis are:

  • Urinary tract infection.
  • Stressful situations at home or school.

Just so you know, with few exceptions, a bed wetting preteen is not lazy. He is not undisciplined. He has a problem and will need the help of a physician, and possible some mental health support as well. Even though most preteens will grow out of this condition in time, it will benefit your son to get this help, as during this time their self-esteem is being affected.

What can be done to help reduce bedwetting?

  • Don't make a big deal out of a wet bed. Show your preteen how to strip the sheets and do a load of wash.
  • Never punish your preteen for wetting the bed.
  • If you were a bed wetter, share your experiences with your preteen.
  • Keep this between your preteen and yourself. Sharing this problem with other family members or friends will only serve to embarrass your preteen.
  • When your preteen is going to stay overnight somewhere, make sure you have a plan in place in case there is an incident.
  • Find positive things to focus your conversations on. Don't let the only communication you have with your preteen be about bed wetting.

What are some risky behaviors to watch for with boys, as opposed to girls?

Since 1991, prevalence of several injury-related behaviors and sexual behaviors have improved among high school students throughout the United States. Fewer students are at risk for motor-vehicle crashes, homicide, unintended pregnancies, and sexually transmitted diseases, including HIV infection. Although current cigarette smoking was more common in 1999 than at the beginning of the decade, current cigarette smoking rates have leveled or might be declining. Nonetheless, too many high school students nationwide continue to practice behaviors that place them at risk for serious health problems. Certain risk behaviors are more likely to be found among particular sub populations of students.

For example, male students were more likely than female students to report:

  • rarely or never wearing seat belts
  • rarely or never wearing motorcycle helmets
  • being injured while exercising, playing sports, or being physically active
  • driving after drinking alcohol
  • weapon carrying
  • gun carrying
  • participating and being injured in a physical fight
  • weapon carrying on school property
  • being threatened or injured with a weapon on school property
  • being in a physical fight on school property
  • current smokeless tobacco use
  • current cigar use
  • episodic heavy drinking
  • lifetime and current marijuana use
  • current cocaine use
  • lifetime heroin, illegal steroid, and injected drug use
  • initiating cigarette, alcohol, and marijuana use before age 13 years
  • smokeless tobacco, alcohol, and marijuana use on school property
  • being offered, sold, or given an illegal drug on school property
  • initiating sexual intercourse before age 13 years
  • having had more than 4 sex partners during their lifetime
  • alcohol or drug use at last sexual intercourse
  • their partner not using birth control pills before last sexual intercourse
  • being at risk for overweight and being overweight.

What can parents do to reduce risky behaviors with boys?

The short answer is consistency and accountability. Children copy their parents, and boys are no exception. Parents who model responsibility - with few exceptions - raise children who are ultimately responsible themselves. Parents who are impulsive, use drugs or alcohol, create fractured relationships and marriages, threaten others or talk about violence, ultimately create children much like themselves. Ward Halverson puts great stock on responsible parenting - the idea of "monkey see, monkey do" as opposed to the dangerous and largely ineffective approach of "do as I say, not as I do".

What about homosexuality - are gay youth at higher risk for suicide?

With regard to completed suicide, there are no national statistics for suicide rates among gay, lesbian or bisexual (GLB) persons. Sexual orientation is not a question on the death certificate, and to determine whether rates are higher for GLB persons, we would need to know the proportion of the U.S. population that considers themselves gay, lesbian or bisexual. Sexual orientation is a personal characteristic that people can, and often do, choose to hide, so that in psychological autopsy studies of suicide victims where risk factors are examined, it is difficult to know for certain the victim's sexual orientation. This is particularly a problem when considering GLB youth who may be less certain of their sexual orientation and less open. In the few studies examining risk factors for suicide where sexual orientation was assessed, the risk for gay or lesbian persons did not appear any greater than among heterosexuals, once mental and substance abuse disorders were taken into account.

With regard to suicide attempts, however, several state and national studies have reported that high school students who report to be homosexually and bisexually active have higher rates of suicide thoughts and attempts in the past year compared to youth with heterosexual experience.

Experts have not been in complete agreement about the best way to measure reports of adolescent suicide attempts, or sexual orientation, so the data are subject to question. But they do agree that efforts should focus on how to help GLB youth grow up to be healthy and successful despite the obstacles that they face. Because school-based suicide awareness programs have not proven effective for youth in general, and in some cases have caused increased distress in vulnerable youth, they are not likely to be helpful for GLB youth either. Because young people should not be exposed to programs that do not work, and certainly not to programs that increase risk, more research is needed to develop safe and effective programs.

What about binge drinking? When does it become a serious problem?

It can be serious immediately, as binge drinking statistics reflect a growing trend that's often - unfortunately - associated with death. A telephone survey conducted by the Centers for Disease Control and Prevention found that binge drinking is on the rise, especially among young adults. Episodes of binge drinking, defined as having five or more drinks in a sitting, increased 17 percent among all adults between 1993 and 2001, and shot up 56 percent among 18- to 20-year-olds. Adults age 21 to 25 went on drinking binges an average of 18 times in 2001, according to the CDC. Those ages 18 to 20 did so an average of 15 times. The legal drinking age in the United States is 21.

What can parents do to reduce the risk of binge drinking?

  • If your son is under the legal drinking age, don't allow drinking in your home.
  • Model responsible drinking behavior. If you binge drink, chances are your son will also.
  • Offer alternatives. People who are active in their community, church or other organizations tend not to have the time to 'pound a few'.
  • Remind them of the consequences.
  • Share stories from your own youth that reflect "learning" and the high costs of making poor choices as a young adult

Do boys have body image issues too?

The media and health agencies are reporting that body image issues have been becoming more and more of a problem for teen boys over the past decade. This is because boys are increasingly interested in their appearance including their hair, clothes and physique. According to a study done in Australia, it was estimated that about 45 percent of Western men are unhappy with their bodies to some degree, compared with only 15 percent some 25 years ago.

As parents, there is no need to wait for the facts and figures to come strolling in if your teenage son is having problems with his body image. Talk to him and seek help - especially if he is showing signs of destructive behaviors like eating disorders.

How do I talk to my son about sexual matters? What do I say?

It's often uncomfortable for parents, but that doesn't mean it isn't unnecessary. The best parents don't have "the talk" just once and consider the issue finalized. Rather, good parents make sexual morality and training part of an ongoing discussion that lasts for several years, cropping up at opportune moments or when a question comes up naturally from the son.

One good place to start is the "normal development" information, such as the following:

Sexual Development Stage 1:
Age: less than 10 years old
Prepubertal, small penis and testes
No pubic hair growth

Sexual Development Stage 2:
Age: 9 - 13 years
Testes grow
Scrotal skin becomes redder and coarser
Sparse, fine hair develops at the base of the penis

Sexual Development Stage 3:
Age: 12 - 14 years
Penis lengthens, with small increase in diameter
Scrotum and testes continue to grow
Pubic hair increases in amount and becomes darker, coarser, and curly

Sexual Development Stage 4:
Age: 12 - 15 years
Penis and testes continue to grow
Pubic hair increases in amount and becomes darker, coarser, and curly

Sexual Development Stage 5:
Age: 14 - 18 years
Penis is at its full adult size
Pubic hair is at its adult color, texture, and distribution

What should boys expect during puberty?

This is a very confusing and awkward time for all teenagers. For boys, expect to feel weird. It's normal. There are many changes that occur:

  • Experience growth spurt between 13 and 14 years old (on the average)
  • Grow larger ears, hands and feet
  • Grow larger penis and scrotum around 12 years old
  • Develop very sensitive testicles (balls)
  • Develop (temporarily) larger and more sensitive breasts (yes, breasts)
  • Experience more frequent erections
  • Experience ejaculations and "wet dreams"
  • Develop larger muscles and broader shoulders
  • For boys, ejaculation is the first sign that they are going through puberty. Ejaculation is the release of semen (cum) through the penis. Ejaculation may occur because of masturbation (or self-stimulation, when someone becomes aroused by touching him) Ejaculation also can occur involuntarily while a boy is sleeping. This is called a "wet dream." It is very normal for this to happen.

What if my son is experiencing a delay in puberty?

Start by easing fears. Everyone has his or her own normal biological timetable for pubertal development. Some boys, for example, show signs of puberty while still in elementary school, while others can get well into high school still looking like little boys. Being different from the average can be especially hard on a boy who's puberty is delayed. If your son is in this situation, there are several things you can do to help. As a clinician, I've given temporary gym excuses to boys who were too embarrassed by lack of pubic hair, or genital growth to use showers after gym. Six months later, development may be sufficient to allow the boy to shower with peers without undue embarrassment. Since late development is often a hereditary characteristic, it may help to share this fact with your son, especially if the father, or another male relative, happened to be a late bloomer. This can help reassure the boy that he is normal -- that he will develop into a man in his own time and help him to feel that someone understands.

What about sex and love?

Love and sex are not the same thing. Love is an emotion or a feeling. There is no one definition of love because the word "love" can mean many different things to many different people. Sex, on the other hand, is a biological event. Even though there are different kinds of sex, most sexual acts have certain things in common. Sex may or may not include penetration.

Differences Between Love and Sex

Love is a feeling (emotional). There is no exact "right" definition of love for everybody. Love involves feelings of romance and/or attraction.

Sex is an event or act (physical). There are different kinds of sex but all kinds of sex have some things in common. Can happen between a male and a female, between two females, between two males, or by one's self (masturbation)

The word for not having sex, of course, is abstinence. Some people, especially people who think it's not cool to wait to have sex, think that abstinence is a completely bad thing. Actually, there are some really good things about abstinence and some of them might apply to teenage boys. Abstinence, or not having oral, vaginal or anal sex, is the best way to protect from making a baby or getting a disease. It is possible to get an STD even without having intercourse (penetrative sex) through skin-to-skin contact (herpes and genital warts can be passed this way). Teenage boys also have to think about their own personal values and feelings. The teenage years bring a lot of changes in how you feel about yourself, family, friends and potential love interests - even if you don't think about sex. No matter what a teenage boy's feelings on sex are, it may be smart to wait until something "feels right."

How can a teenage boy express love without sex?

There are millions of nonsexual ways to show someone you like them. You can show a person you care for them by spending time with them. Go to the movies. Or just hang out and talk. If you are with someone you really like, then anything can be fun. There are other ways to feel physically close without having sex. These ways include everything from kissing and hugging to touching and petting each other. Just remember that if you're not careful these activities can lead to sex. Plan beforehand just how far you want to go, and stick to your limits. It can be difficult to say NO and mean it when things get hot and heavy.

What are some of masturbation myths?

Myth It's more acceptable for boys to masturbate than boys. Fact It's natural for boys and boys to masturbate - both do it.

Myth A son who masturbates has been exposed to sexual information that is not appropriate for his/her age. Fact From birth, children explore their bodies by touching. They learn this feels good. Showing knowledge of sexual acts besides masturbation could mean they've been exposed to inappropriate sexual information.

Myth Masturbation causes acne or loss of eyesight. Fact This oldie but goodie probably ties to the fact that teenagers generally start masturbating around the same time puberty hits, which is also the time of acne and when many teens get glasses.

Myth Masturbation causes sexually transmitted diseases. Fact In order for a disease to be 'transmitted', you need two people. Mutual masturbation is actually taught in some sex education courses as a way to avoid sexually transmitted diseases.

Myth Masturbation causes hair to grow on your palms. Fact About 98% of adults have reported that they've masturbated at some time in their lives. I don't know anyone with hair on their palms. How about you?

Myth Teenagers shouldn't masturbate often, as they will lose the ability to have children. Fact Teenagers will tend to masturbate more often than adults as their hormone levels are at the highest they will be in their lifetime. Remember to knock when their door is closed - and don't worry - they will still be able to give you grandchildren.

I'm concerned about bullying. How serious can it be?

Bullying is not just a normal, if unpleasant, part of growing up, according to federal researchers. Rather, children who bully other children appear to be at risk for engaging in more serious violent behaviors, such as frequent fighting and carrying a weapon. Moreover, victims of bullying also are at risk for engaging in these kinds of violent behaviors. Researchers found that boys across all age groups were more likely to be involved in bullying and violent behaviors than were boys. Both children who bullied and their victims were more likely than youth who had never been involved in bullying to engage in violent behaviors themselves. However, the association between bullying and other forms of violence was greatest for those who bullied others. For example, among boys who said they had bullied others at least once a week in school, 52 percent had carried a weapon in the past month, 43 percent carried a weapon in school, 38 percent were involved in frequent fighting, and 45 percent reported having been injured in a fight. By comparison, of the boys who said they had been bullied in school every week, 36 percent had carried a weapon, 28 percent carried a weapon in school, 22 percent said they were involved in frequent fighting, and about 31 percent said they had been injured in a fight.

Earlier studies have concluded that the effects of bullying behavior carry into adulthood. People who were bullied as children are more likely to suffer from depression and low self esteem as adults, and the people who bullied others when they were children are more likely to engage in criminal behavior later in life. A strong and consistent relationship between bullying and violent behaviors was observed, the authors wrote. This suggests that bullying is likely to occur concurrently with more serious aggressive behavior, and while prevalent, should not be considered a normative aspect of youth development.

What can I do to make sure my son does well and is, overall, happy?

  • Do your best to provide a safe home and community for your son, as well as nutritious meals, regular health check-ups, immunizations, and exercise.
  • Be aware of stages in son development so you don't expect too much or too little from him.
  • Encourage your son to express his feelings; respect those feelings. Let your son know that everyone experiences pain, fear, anger, and anxiety.
  • Try to learn the source of these feelings. Help your son express anger positively, without resorting to violence.
  • Promote mutual respect and trust. Keep your voice level down-even when you don't agree. Keep communication channels open.
  • Listen to your son. Use words and examples your son can understand. Encourage questions.
  • Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.
  • Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your son's feelings or behaviors or if you are unable to control your own frustration or anger.
  • Encourage your son's talents and accept limitations.
  • Set goals based on the son's abilities and interests-not someone else's expectations. Celebrate accomplishments. Don't compare your son's abilities to those of other boys; appreciate the uniqueness of your son. Spend time regularly with him.
  • Foster your son's independence and self-worth.
  • Help your son deal with life's ups and downs. Show confidence in your son's ability to handle problems and tackle new experiences.
  • Discipline constructively, fairly, and consistently. Keep in mind that discipline is a form of teaching, not physical punishment. All boys and families are different; learn what is effective for your son. Show approval for positive behaviors. Help your son learn from his mistakes.
  • Love your son unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job.

What about domestic violence?

In America, police reports indicate that children are present in the home in 40 to 50 percent of cases involving domestic violence calls. Research indicates that between 3.3 and 10 million children are exposed to domestic violence in the United States every year. Children are significantly affected by this exposure to domestic violence in a number of ways. The most common are that they observe violent acts, they incur injury to themselves, and they suffer neglect by their caretakers.

Children who observe domestic violence react in many ways. External behaviors may include aggressive behavior and conduct problems in home and in school, fighting, cursing, and name calling. Internal behaviors that may also occur include anxiety, depression, low self esteem, guilt, crying; decreased intellectual and academic functioning including inability to concentrate; difficulty with school work, school truancy and failure; and developmental delay. Domestic violence can also affect children's social development, causing them to become isolated and withdrawn from friends and family and demonstrate low levels of empathy. Children affected by domestic violence may also exhibit negative physical health, developing somatic - physical - symptoms, poor sleeping and eating habits, headaches, stomachaches, and self-destructive behaviors such as suicide attempts and self-mutilation. A 1998 study shoed that between 45 and 70 per cent of children exposed to domestic violence are also victims of physical abuse. Children in homes with domestic violence are at higher risk of sexual abuse than children in nonviolent homes.

At every stage of a son's life the impact of exposure to violence in the home is evident. Infants or very young children are vulnerable to injury when adults handle them roughly in a moment of violence, but children are also subject to injury when flying objects are thrown or smashed or when weapons are used. They also may be ripped from their caretakers' arms or hurt when the person holding them falls or is knocked down. The victim of domestic violence may neglect the son in an attempt to appease the abuser or in fear that the son might be harmed further if concern is shown. Effects of this neglect can be seen in infants or young children through eating or sleeping disturbances (particularly if the abuse routinely occurs during meal times or after the son has gone to sleep), listlessness, developmental delays (due to lack of stimulation), and failure to thrive (due to lack of nurturing). Exposure to violence interferes with children's ability to develop trust in adults charged with their care. These children commonly exhibit excessive irritability, fear of being left alone, regression in toileting and language skills, and other delays in learning.

School-age children between the ages of five and twelve may exhibit more significant behaviors as a result of observing domestic violence. These children may be aggressive toward other children, exhibit low self-esteem, feel insecure, run away, use drugs, or have problems in school. As the son enters the teen years, he may exhibit more of the behaviors associated with the abuser or the victim. The son who identifies with the victim may come to accept violence as part of an intimate relationship. The son who identifies with the perpetrator learns to use violence to control relationships. Teens may also feel compelled to intervene on behalf of the victim and be injured, or be coerced into participating in the violence. Teens commonly experience shame about what is going on in their home and seek to remove themselves from the situation by running away or attempting suicide. When a victim seeks to remove herself and her children from an abusive situation, the children are frequently separated from their communities, friends, and schools. This puts additional stress on the son.

Given the serious consequence of domestic violence on children, some professionals argue that exposure to domestic violence constitutes a form of child maltreatment. But others argue that not all children are affected in the same way and that, in fact, many children learn to cope with the violence. Thus, witnessing abuse should be viewed as a potential risk factor for son maltreatment rather than conclusive evidence.

What about domestic violence in Herkimer County?

Rural domestic violence victims are in more isolated locations and may have difficulty accessing health care and other services due to lack of transportation or poor weather and road conditions. Emergency response time is often slower in rural areas like ours. In addition, some rural homes do not have telephone service to request emergency assistance. Herkimer is a relatively poor area, and rural poverty is a particular concern regarding domestic violence. Studies have shown that poverty and domestic violence are related. Poverty greatly contributes to family and relationship stress and limits victims' ability to leave abusive partners or family members. Non-metropolitan poverty rates are higher than those in metropolitan regions for many demographic groups. Rural family violence survivors who live in poverty and lack transportation may be unable to travel to family members' or friends' homes for shelter.

Domestic violence survivors may be in need of legal assistance for protection orders, divorces, son custody proceedings and other legal matters that are a consequence of abuse or violence. In rural areas, it can be more difficult to find an affordable lawyer or legal aid. Law enforcement and the courts in rural communities may be less familiar with issues of domestic violence and appropriate responses.

What can we do in our community to address domestic violence?

Herkimer County has worked for years to develop a coordinated community response, or CCR, in which health care providers, community groups, criminal justice, and social service agencies work together. Such a response is considered one of the best approaches to addressing domestic violence. Some of the characteristics of CCR programs include a shared philosophical approach, understanding of the each group's role, and a plan to work together to improve the community's response to violence against women. The CCR approach provides a more unified response to victim needs while holding offenders accountable for their actions.

What are the signs that a teenage boy is in an abusive or unhealthy relationship?

Your friend or the person you are going out with:

  • Gets angry when you talk or hang out with other friends or other dating partners " bosses you around " Often gets in fights with other people or loses her temper " Pressures you to have sex or to do something sexual that you don't want to do " Uses drugs and alcohol, and tries to pressure you into doing the same thing " Swears at you or uses mean language " Blames you for her problems or tells you that it is your fault that he or she hurt you " Insults or tries to embarrass you in front of other people " Has physically hurt you on purpose " Makes you feel scared of their reactions to things " Always wants to know where you are going and who you are with

Some people think that their relationship isn't abusive unless there is physical fighting. There are other types of abuse, though. Below is a list of different types of abuse.

  • Physical abuse is when a person touches your body in an unwanted or violent way. This may include: hitting, kicking, pulling hair, pushing, biting, choking, or using a weapon or other item to hurt you.
  • Verbal or emotional abuse is when a person says something or does something that makes you afraid or feel bad about yourself. This may include yelling, name-calling, saying mean things about your family and friends, embarrassing you on purpose, telling you what to do, or threatening to hurt you or hurt themselves. Pressuring you to use drugs or alcohol is also abuse, as is keeping you from spending time with your friends and family.
  • Sexual abuse is any sexual contact that you do not want. You may have said "no" or may be unable to say no because the abuser has threatened you, stopped you from getting out of the situation, or has physically stopped you from leaving. This may include unwanted touching or kissing or forcing you to have sex. Sexual abuse includes date rape.

What can a boy do to get out of it?

Abusive relationships are very unhealthy for teens, and for everyone. You can have trouble sleeping or have headaches or stomachaches. You might feel depressed, sad, anxious or nervous, and you may even lose or gain weight. You may also blame yourself, feel guilty, and have trouble trusting other people in your life. Staying in an abusive relationship can hurt your self-esteem and make it hard for you to believe in yourself. If you are being physically abused, you can be in pain and may suffer permanent damage. You should definitely leave the relationship if you are getting hurt, or if you are being threatened with physical harm in any way. The most important reason to leave an unhealthy relationship is because you deserve to be in a relationship that is healthy and fun. Here's how to get out:

  • First, if you think that you are in an unhealthy relationship, you should talk to a parent/guardian, friend, counselor, doctor, teacher, coach or other trusted person about your relationship. Tell them why you think the relationship is unhealthy and exactly what the other person has done (hit, pressured you to have sex, tried to control you). If need be, this trusted adult can help you contact your parent/guardian, counselors, school security, or even the police about the violence. With help, you can get out of an unhealthy relationship. Sometimes, leaving an abusive relationship can be dangerous, so it is very important for you to make a safety plan. Leaving the relationship will be a lot easier and safer if you have a plan.
  • Go to your doctor or hospital for treatment if you have been injured.
  • Tell a trusted adult like a parent/guardian, counselor, doctor, teacher, or spiritual or community leader.
  • Tell the person who is abusing you over the phone that you do not want to see him or her so they cannot touch you. Do this when a parent or guardian is home so you know you will be safe in your house.
  • Use a diary to keep track of the date the violence happened, where you were, exactly what the person you are dating did, and exactly what effects it caused (such as bruises). This will be important if you need the police to order the person to stay away from you.
  • Avoid contact with the person.
  • Spend time with your other friends, and avoid walking by yourself.
  • Think of safe places to go in case of an emergency, like a police station or a public place like a restaurant or mall. " Carry a cell phone, phone card, or money for a call in case you need to call for help. Use code words on the phone that you and your family decide on ahead of time. If you are in trouble, say the code word on the phone so that your family member knows you can't talk openly and need help right away. " Call 911 right away if you are ever afraid that the person is following you or is going to hurt you. " Keep domestic violence hotline numbers with you in a safe place or program them into your cell phone. The 24-hour National Domestic Violence Hotline is 1-800-799-SAFE (7233) or 1-800-787-3224 (TDD). Herkimer County's number is 866-0458.

What can I do, as a parent?

The best thing you can do is protect your son. If he's under the age of 18, you have to - follow the safety plan described above. If he's over 18, work with him to understand the risks he may be taking and be as supportive as you can. You may consider providing the police with information, although if he refuses to seek help, there may be little you can do directly. Call Ward Halverson for more information or ideas.

What can a parent do to avoid teen pregnancy?

During an episode of a now-classic 70s television program, a mother is worried about how to broach the subject of sex with her pre-teen son. The mother finally gets up the courage to start the conversation and says, "I want to talk to you about the birds and the bees." With a straight face, the son replies, "OK, what do you want to know?" Ward Halverson finds this hilarious, but the topic is deadly serious. Your children may not be as matter of fact as that young TV character, but you may still be surprised at what they already know, or perhaps don't know, about sex.

Here are some useful tips for parents:

  • Be clear about your own sexual values and attitudes. Talking to your children about love, sex and relationships will be more successful when you're clear about how you feel about them.
  • Talk early and often with your children about sex. Forget about "The Talk." Kids need more than a one-time lecture.
  • Look out for teachable moments: use TV, movies, magazines and real-life situations to discuss sex, love and relationships.
  • Get to know your children.
  • Don't assume that if your son asks questions about sex, he is necessarily thinking about having sex.
  • Set a good example.
  • It's not just the birds and the bees. Don't limit the conversation to just sex. Talk about abstinence, the male and female reproductive systems, pregnancy, birth control, love and the emotional consequences of having sex.
  • Leave age-appropriate articles or books about teenage sexuality around your home.
  • Don't wait for your son to start the conversation.
  • Reassure your son that not everyone is having sex.
  • Don't rely solely on the schools for providing your son's sex education.
  • If the signs are there, take your son - and his girlfriend, if possible - to Planned Parenthood

If you don't believe your children are exposed to sexual concepts, you may want to rethink your perceptions. Here are a few possible clues: Your nine-year-old son gets caught at school with your Victoria Secret catalog. Your three-year-old daughter is walking around singing "Shake Your Laffy Taffy" and she's not referring to the candy. Your 13-year-old wants to spend her allowance on a present for her friend's baby.

Still not ready to use the "s- word"? Consider the alternative: What children don't learn about sex from a parent, they learn mostly from friends. Remember the one about how a boy can't get pregnant the first time? Ultimately, parents must make the decisions about sex education that are right for their own kids, but research shows that uniformed children are at greater risk for early sexual activity, pregnancy, sexually transmitted diseases and abuse.

OK, what are some useful books on the subject of teen pregnancy and sex?

  • The Real Truth about Teens and Sex: From Hooking Up to Friends with Benefits: What Teens Are Thinking, Doing, and Talking About, and How to Help Them Make Smart Choices by Sabrina Weill.
  • Beyond the Big Talk: Every Parents Guide to Raising Sexually Healthy Teens from Middle School to High School and Beyond by Debra Heffner.
  • Flight of the Story: What Children Think (and When) about Sex and Family Building by Anne C. Bernstein.
  • But How'd I Get There in the First Place?: Talking to Your Young Son about Sex by Debra Roffman.
  • Raising a Son Responsibly in a Sexually Permissive World by Sol and Judith Gordon

Although the rate for teen pregnancies have dipped since the early 1990s, the United States still has the dubious distinction of having the highest rate of teen pregnancy among other countries of similar status. So if you are parent of a teenager, be cautious and be prepared to make some hard choices, or you're going to be a grandparent earlier than expected.

How do I know if my son is over-exercising?

If you're concerned that your son may be exercising compulsively, look for these warning signs. There could be a problem if he or she:

  • Won't skip a workout, even if tired, sick, or injured
  • Doesn't enjoy exercise sessions, but feels obligated to do them
  • Seems anxious or guilty when missing even one workout
  • Does miss one workout and exercises twice as long the next time
  • Is constantly preoccupied with his weight and exercise routine
  • Doesn't like to sit still or relax because of worry that not enough calories are being burnt
  • Has lost a significant amount of weight
  • Exercises more after eating more
  • Skips seeing friends, gives up activities, and abandons responsibilities to make more time for exercise
  • Seems to base self-worth on the number of workouts completed and the effort put into training
  • Is never satisfied with his own physical achievements

It's important, also, to recognize the types of athletes who are more prone to compulsive exercise because their sports place a particular emphasis on being thin. Ice skaters, gymnasts, wrestlers, and dancers can feel even more pressure than most athletes to keep their weight down and their body toned. Runners also frequently fall into a cycle of obsessive workouts.

So what can I do to get my son some help?

If you recognize two or more warning signs of compulsive exercise in your son, call your son's doctor to discuss your concerns. After evaluating your son, the doctor may recommend medical treatment and, hopefully, other therapy. Because compulsive exercise is so often linked to an eating disorder, a community agency that focuses on treating these disorders might be able to offer advice or referrals. Extreme cases may require hospitalization to get the son's weight back up to a safe range. Treating a compulsion to exercise is never a quick-fix process - it may take several months or even years. But with time and effort, your son can get back on the road to good health. Psychotherapy can help improve self-esteem and body image, as well as teach your son how to deal with emotions instead of sweating them out. Sessions with a nutritionist can help your son develop healthy eating habits. Once your son knows what to watch out for, she will be better equipped to steer clear of unsafe exercise and eating patterns. At home, you can do a lot to help your son overcome a compulsion to exercise:

  • Involve your son in preparing nutritious meals.
  • Combine activity and fun by going for a hike or a bike ride together as a family.
  • Be a good body-image role model. In other words, don't fixate on your own physical flaws, as that just teaches your son that it's normal to dislike what he or she sees in the mirror.
  • Never criticize another family member's weight or body shape, even if you're just kidding around. Such remarks may seem harmless, but they can leave a lasting impression on kids or teens struggling to define and accept themselves.
  • Examine whether you're putting too much pressure on your son to excel, particularly in a sport (because some teens turn to exercise to cope with pressure). Take a look at where your son may be feeling too much pressure. Help your son put it in perspective and help him or her find other ways to cope.
  • Most importantly, just be there with constant support. Point out all of your son's great qualities that have nothing to do with how much he or she works out - small daily doses of encouragement and praise can help improve your son's self-esteem. If you teach kids to be proud of the challenges they've faced, and not just the first-place ribbons they've won, they will likely be much happier and healthier children now and in the long run.

My son's self-esteem is in the toilet. Is that normal?

Part of being a teen - especially a teenage boy - is having thoughts and feelings about different parts of your life, such as how you feel about:

  • Your friends and other kids your age
  • How you are doing in school and in other activities
  • Your parents
  • The way you look

While having these new feelings, many changes are also taking place in your body. It is normal to feel self-conscious or shy about the changes in your body and emotions but there are also changes to celebrate. Some cultures even have celebrations to recognize these changes. For example, the Western Apaches have the Sunrise Dance or "Na'ii'ees" and the Jewish community has the Bar Mitzvah - both mark a boy's passage to becoming a man. Even though it might seem tough sometimes, remember that you are absolutely great!

Having a healthy or high self-esteem can help you to think positively, deal better with stress, and boost your drive to work hard. Having low self-esteem can cause you to feel uneasy and may get in the way of doing things you might enjoy. For some, low self-esteem can contribute to serious problems such as depression, drug and alcohol use, and eating disorders.

What can a boy do to boost his self-esteem?

For boys: self-confidence is also an important part of feeling good about yourself. Self-confidence is that little voice inside of you that tells you that you are okay, that you are a good person, and that you know how to deal with things in good times and in bad. You are not born confident - confidence is learned. As a baby, you started to learn self-confidence from knowing your family loved you. As you learned to walk, play and talk, you also learned self-confidence. Now as a young woman, you are learning to be more self-confident in school, playing sports and in other social settings, but sometimes it's not easy. Participating in class, talking to new teachers or students, or trying out for an after-school activity may make you feel stressed or anxious...but that is normal. The good news is, as you try these new things, you are gaining confidence in spite of your fears. In fact, that is what real self-confidence is - your belief that you can do things well even when you have doubts.

Try these steps to boost your self-esteem:

  • Tell yourself that it is okay not to be the best at everything.
  • Help out by doing chores around the house and volunteering in your community.
  • Do things that you enjoy, or learn about new things you would like to try.
  • Understand that there will be times when you will feel disappointed in yourself and other people. No one is perfect!
  • If you are angry, try talking it over with an adult you trust, such as parents/guardians, relatives or a school counselor.
  • Think positively about yourself and the things you can do. Think: "I will try!"
  • If you still find that you are not feeling good about yourself, talk to your parents/guardian, a school counselor, a clinician, or your doctor because you may be at risk for depression. You can also ask the school nurse for help through tough times. Most schools in this area offer counseling
  • Learn more about depression and other health issues that can affect your mind.

Try these steps to boost your self-confidence:

  • Think positive thoughts about yourself! Focus on your strengths - not your weaknesses. Realize that you are better at some things than others.
  • Set realistic goals. This means not setting goals too high or too low, but at a level you know you can reach. Then, you can always strive to do better than your goal.
  • Give yourself credit when you reach a goal and praise yourself when you have done well.
  • Do more of anything that you're good at. Activities or sports that make you feel positive about yourself will also make you feel better about other parts of your life.
  • Learn to be assertive - express your thoughts, opinions, needs, and feelings openly - but without abusing others' rights.
  • Don't compare yourself to others - remember, you're just fine the way you are!
  • Practice positive body language. Walk tall, don't slump. When your body says "I can" everyone will believe you can.

Is my son suffering from problems with stress?

Stress is what you feel when you react to pressure from others or from yourself. Pressure can come from anywhere, including school, work, activities, friends, and family members. You can also feel stress from the pressure of wanting to get good grades or wanting to feel like you belong. Stress comes in many forms and everyone feels stress.

Interestingly, the body has a built-in response to handle stress. When something stressful happens, you may experience sweaty palms, dry mouth, or knots in your stomach. This is totally normal and means that your body is working exactly as it should. Other signs of stress include emotional signs, such as feeling sad or worried, behavioral signs such as not feeling up to doing things, and mental signs such as not being able to concentrate or focus.

OK, so what causes stress among boys?

Lots of everyday things, as well as new things in life or unexpected changes:

  • School work
  • Not feeling good about yourself
  • Changes in your body or weight
  • Body shape or size
  • Problems with friends, boyfriends, or other kids at school
  • Living in a dangerous neighborhood
  • Peer pressure from friends to dress or act a certain way, or smoke, drink, or use drugs
  • Not fitting in or being part of a group
  • Moving or friends moving away
  • Separation or divorce of parents
  • A family member who is ill
  • Death of a loved one
  • Changing schools
  • Taking on too many activities at once
  • Not getting along with your parents or having problems at home
  • Feeling lonely
  • Really, just being a teen can be stressful - there is so much going on and so many changes that are happening all at once

Is stress always a bad thing?

No - on the contrary, a little bit of stress can work in a positive way. For instance, during a sports competition, stress might push you to perform better. Also, without the stress of deadlines, you might not be able to finish schoolwork or get to where you need to be on time. Stress is more of a concern when it starts to interfere with a person's daily functioning, like in school, at home, or in the community.

What are some signs that there's too much stress?

  • Feeling down, edgy, guilty or tired
  • Headaches or stomachaches
  • Trouble sleeping
  • Laughing or crying for no reason
  • Blaming others for bad things that happen to you
  • Wanting to be alone all the time (withdrawal).
  • Not being able to see the positive side of a situation
  • Not enjoying activities that you used to enjoy
  • Feeling resentful of people or things you have to do
  • Feeling like you have too many things you have to do

How can I help my son handle this stress?

Different people are stressed by different things. For example:

  • He might get upset or stressed when she doesn't make good grades but his friends might not.
  • He might be able to handle doing homework and being involved in after-school activities but his sister or friend might feel they can't do both.
  • His friend might see moving to a new house as a stress but he might view it as an adventure, or vice-versa.

There are no right or wrong things to stress over - there are just differences in what we consider to be stressful. No matter what stresses your son out, there are many things she can try to help her deal.

Before continuing, recovering from a major event follows the same approach.

Such as the stress following a terrorist attack or major disaster?

Yes. Sometimes we are part of, or have lived through, a very stressful event such as a hurricane, a serious car accident, or an assault, like date rape. These kind of scary events can cause a very strong stress reaction in the victims, but the reactions may be different for each person. Some become cranky or depressed; others can't sleep or have nightmares, some may keep reliving the experience, some might experience nervousness and their hearts might race, and some people put the event out of their minds. Feelings that lead to this type of stress include fear, a sense that your life is in danger, helplessness or horror. People don't have to be hurt to experience this type of stress, but can simply be a witness to the event or be threatened with physical harm to have this type of stressful reaction.

The first step is to recognize that it's normal to feel nervous about your own safety and wonder how you would react in an emergency. Here are some things you can do to handle this special kind of stress:

  • You may think it feels better to pretend the event did not happen, but it is best to be honest about how you are feeling. Ignoring or hiding your feelings can be worse for your health in the long run. It is okay to feel scared and uncertain.
  • Try to remember that, while you might feel like a changed person and everything seems off balance right now, your life will calm down and you will find a new normal groove.
  • Talk to a teacher, your parents, or a counselor about your sadness, anger, and other emotions. It can be tough to get started, but it is important to confide in someone you trust with your thoughts and feelings.
  • It is common to want to strike back at people who have caused you or those you love great pain. This feeling is normal, but it is important to understand that it is useless to respond with more violence. Nothing good can come from using hateful words or actions.
  • While you will always remember and feel changed by the event, the feelings will become less painful over time. In learning to cope with tragedy, you will become stronger and better at handling stressful situations. You may also find yourself appreciating life and the people you love even more.
  • Recognize when it's too much: Struggling with major stress and low self-esteem issues can contribute to more serious problems such as eating disorders, hurting yourself, depression, alcohol and drug abuse, and even suicide. Continued depression and thoughts about hurting or killing yourself are signs that it is time to seek help. Boys should to an adult they trust right away.

Anything else to consider with my son?

It's also important to know that many children experience mental health problems that are real and painful and can be severe. Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 boys may have a serious emotional disturbance that severely disrupts her ability to function. Tragically, an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.

A variety of signs may point to a possible mental health problem in a son or teenager. If you are concerned about a son or have any questions, seek help immediately. Talk to your doctor, a school counselor, or another mental health professional trained to assess whether your son has a mental health problem.

It's a concern when an adolescent boy is troubled by feeling:

  • Sad and hopeless for no reason, and these feelings do not go away.
  • Very angry most of the time and crying a lot or overreacting to things.
  • Worthless or guilty often.
  • Anxious or worried often.
  • Unable to get over a loss or death of someone important.
  • Extremely fearful or having unexplained fears.
  • Constantly concerned about physical problems or physical appearance.
  • Frightened that his mind either is controlled or is out of control.

It can be significant when a boy experiences big changes, such as:

  • Showing declining performance in school.
  • Losing interest in things once enjoyed.
  • Experiencing unexplained changes in sleeping or eating patterns.
  • Avoiding friends or family and wanting to be alone all the time.
  • Daydreaming too much and not completing tasks.
  • Feeling life is too hard to handle.
  • Hearing voices that cannot be explained.
  • Experiencing suicidal thoughts.

Other warning signs of a mental illness with a boy include:

  • Poor concentration and is unable to think straight or make up her mind.
  • An inability to sit still or focus attention.
  • Worry about being harmed, hurting others, or doing something "bad".
  • A need to wash, clean things, or perform certain routines hundreds of times a day, in order to avoid an unsubstantiated danger.
  • Racing thoughts that are almost too fast to follow.
  • Persistent nightmares.

Also, a boy might behave in a way that causes problems, such as:

  • Using alcohol or other drugs.
  • Eating large amounts of food and then purging, or abusing laxatives, to avoid weight gain.
  • Violating the rights of others or constantly breaking the law without regard for other people.
  • Setting fires.
  • Doing things that can be life threatening.
  • Killing animals.

Some children diagnosed with severe mental health disorders may be eligible for comprehensive and community-based services through systems of care, particularly in Herkimer County. Systems of care help children with serious emotional disturbances and their families cope with the challenges of difficult mental, emotional, or behavioral problems. Contact Herkimer County Mental Health at 867-1465 locally. To learn more about systems of care in other areas, call the National Mental Health Information Center at 1-800-789-2647, and request fact sheets on systems of care and serious emotional disturbances, or visit the Center's web site at