What to Know Fact Sheets

Important Facts

• Anxiety often starts in childhood.
• 15 to 20% of children and adolescents have an anxiety disorder.
• Children and adolescents have a hard time talking about anxiety.
• People with anxiety disorders respond well to treatment.
• The median age of the onset of anxiety is 11 years old.^{1, 3}

Types of Anxiety

• Social Phobia — anxiety in social settings or performance situations. ¹
• Generalized Anxiety Disorder — chronic, excessive anxiety about multiple areas of life. ¹
• Specific Phobia — fear of a specific object or situation. ¹
• Panic Disorder — unexpected, brief episodes of intense anxiety without an apparent trigger. ¹
• Separation Anxiety — excessive fear of being separated from home or caretakers. ¹
• Obsessive Compulsive Disorder — repetitive mental acts or behaviors to alleviate anxiety without an apparent trigger. ¹
• Post Traumatic Stress Disorder — anxiety symptoms following exposure to a traumatic event. ¹

Common Symptoms

• Struggling to concentrate. ¹
• Not sleeping, or waking in the night with bad dreams. ¹
• Not eating properly. ¹
• Quickly getting angry or irritable, and being out of control during outbursts.
• Constantly worrying or having negative thoughts. ¹
• Feeling tense and fidgety. ¹
• Complaining of stomach aches and feeling unwell, or using the toilet often. ¹
• Being clingy. ¹
• Always crying. ¹
• Somatic symptoms like stomach aches. ¹

Resources to Help

• namioklahoma.org/resources/oklahoma-resources
• childmind.org/topics/anxiety
• depts.washington.edu/uwhatc/PDF/TF-%20CBT/pages/cognitive_coping.html
• aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Anxious-Child-047.aspx

What to Remember

• Anxiety is a problem when kids feel frequent intense distress, feel unable to cope or feel unable to do what they need or want. 1
• Anxious kids imagine bad outcomes, increasing anxiety and avoidance.
• Avoidance convinces children that they can’t face their fears.
• Anxiety can worsen without treatment, but generally improves with treatment.

Ways to Support

Validating Emotion

• Help the child become more aware of emotions. ¹
• Help the child talk about their own emotions. ¹
• Help the child become calmer and more accepting of negative emotions. ¹
• Help the child transfer emotional validation to others. ¹

Tools

• Deep breathing exercises.
• Progressive muscle relaxation.
• Guided imagery.
• Cognitive behavioral therapy.
• Parent-based therapy.
• Medication (i.e. SSRI’s).

References

1. Chesher, Tessa (2023). OKCAPMAP Provider Education Anxiety in Children and Adolescents Learning Module
2. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.) https://doi.org/10.1176/appi.books.9780890425596
3. Zhang, Y., Zhang, Z., Ge, H., Q., Li, Y. & Li, N. (2019). The application of artificial intelligence in the diagnosis and prognosis of colorectal cancer: A review. Frontiers in Medicine, 6, 224. http://doi.org/10.3389/fmed.2019.00224

Irritability is a core symptom of depression in children.

Important Facts

• 2% of children suffer from depression.
• 4% of adolescents suffer from depression.
• Depression is closely associated with suicidal thoughts and behavior; it is imperative to evaluate for symptoms routinely at pediatric visits.
• Comorbidity diagnoses are also common with depression.

Common Symptoms

• Depressed mood — most of the day for most days. ¹
• Decreased interest — diminished pleasure in all or almost all activities most of the day nearly every day. ¹
• Significant weight changes — significant weight gain (more than 5% of body weight increase in one month) or weight loss without dieting. ¹
• Insomnia or hypersomnia — nearly every day. ¹
• Psychomotor agitation or retardation — observable by others, not just subjective. ¹
• Fatigue or loss of energy nearly every day. ¹
• Feelings of worthlessness or excessive or inappropriate guilt — maybe delusional, nearly every day. ¹
• Concentration problems — diminished ability to think or concentrate, or indecisiveness nearly every day. ¹
• Thoughts of death or suicide — recurrent suicidal ideation without a specific plan; or a suicide attempt or specific plan for committing suicide. ¹

Resources to Help

• 988oklahoma.com
• aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/The-Depressed-Child-004.aspx
• nami.org/your-journey/kids-teens-and-young-adults
• childmind.org/topics/depression-mood-disorders
• nimh.nih.gov/health/publications/teen-depression

Ways to Support

• Active Listening
• Being quiet and listening to the person talking.
• Let the person who spoke confirm that you have understood what they are saying.
• Invite the person to tell their story.
• Use open ended questions to follow up.

Nonverbal Communication

• Match nonverbal language with the intent of your verbal language.
• Facial expressions, gestures, touch and position.
• Vertical and horizontal distance and physical barriers.
• Voice tone, rhythm, volume and emphasis.
• Flushing, blanching, swallowing and tearing up.

Empathy

• Strive to understand where a person is coming from.
• Listen with full attention.
• Check with the person for understanding.
• Summarize what has been told to you reflecting the feelings and the facts.
• Elicit and accept corrections.
• Continue until it is confirmed that the person feels understood.

Tools

• Cognitive behavioral therapy.
• Interpersonal psychotherapy.
• Medication (i.e. SSRI’s).

References

1. Chesher, Tessa (2023) OKCAPMAP Provider Education Depression in Children and Adolescents Learning Module
2. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
3. Son, S. E., & Kirchner, J. T. (2000). Depression in children and adolescents. American Family Physician, 62(10), 2297-2308. Retrieved from https://www.aafp.org/pubs/afp/issues/2000/1115/p2297.html

Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn and behave. ¹

Autism is known as a spectrum disorder because there is wide variation in the type and severity of symptoms people experience. ¹

Important Facts

• Boys are approximately four times more likely to be affected by autism than girls.
• Signs of autism usually appear by ages 2 or 3-years old but can be diagnosed as early as 18 months old.
• Sensory sensitivities and medical issues such as gastrointestinal disorders, seizures, sleep disorders, anxiety, depression and attention issues often accompany autism.
• Some people with autism may require significant support in their daily lives, while others may need less support and live entirely independently in adulthood.
• Research shows that early intervention leads to positive outcomes later in life for people with autism.
• Many people with autism may also struggle with sleep, constipation, eating, self-injurious behavior and aggression.

Common Symptoms

The following symptoms can be seen at any age and may indicate a child is at risk of developing autism:

• Loss of previously acquired speech, babbling or social skills.
• Avoidance of eye contact.
• Persistent preference for solitude.
• Difficulty understanding other people’s feelings.
• Delayed language development.
• Persistent repetition of words or phrases (echolalia).
• Resistance to minor changes in routine or surroundings.
• Restricted interests.
• Repetitive behaviors (flapping, rocking, spinning, etc.).
• Unusual and intense reactions to sounds, smells, tastes, textures, lights and/or colors. ^{2, 6}

Pull Quote

Autism is a SPECTRUM so while there are similarities in individuals there are also a lot of differences and it is crucial to support the individual tailored to their specific needs and preferences. ⁴

Treatment Options

• Applied behavioral analysis (ABA).
• TEACCH/Structured teaching method.
• Developmental and relationship-based therapies.
• Occupational therapy.

Targeted medication for specific symptomatology:

• Irritability
• Aggression
• Repetitive behavior
• Hyperactivity
• Attention problems
• Anxiety and depression ²

Ways to Support

There is no proven single treatment option or medication for ASD; treatment methods will be dependent on the individual.

It is important to understand children with autism see the world differently, and it is OK if they do, and it should be respected. Acceptance of who your child is without trying to change who they are is key. ²

Autism needs early support as soon as possible. When you see signs of autism it’s important to get evaluated and treated sooner rather than later. ³

Steps to Support Children With Autism at Home

1. Learn and educate yourself on autism (reading this guide is the first step). ¹
2. Accept your child for who they are.
3. Learn your child’s triggers and preferences.
4. Be consistent between school, home and any treatments of therapy.
5. Develop and maintain a structured schedule.
6. Use positive reinforcement.
7. Create a safe space at home for your child to feel secure.
8. Find creative ways to connect with your child in their own way — this may end up being nonverbal. ⁵

References

• Chesher, Tessa (2023) OKCAPMAP Provider Education Autism in Children and Adolescents Learning Module
• National Institute of Mental Health (2024). Autism Spectrum Disorder
• U.S. Department of Health and Human Services (2024). Autism Information
• Interagency Autism Coordinating Committee (n.d.) About Autism
• HelpGuide (n.d.) Helping Your Child with Autism Thrive
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

ADHD can make it very hard for children to focus on their school work or other tasks, pay attention and sit still. Children with ADHD have a harder time controlling themselves than other children their age, which can lead to challenges at school and at home. ¹

Important Facts

• 7 to 8% of children and adolescents suffer from ADHD.
• ADHD is commonly associated with other mood and behavioral concerns.
• The symptoms must negatively impact social and academic/occupational activities.
• The symptoms must be present in two or more settings (e.g., home, school, work, with friends or family).
• There is no one size fits all testing method, usually determining ADHD takes a full holistic evaluation that will include asking questions about the child’s parents, legal guardians, teachers, etc. ³
• ADHD is oftentimes more common in males than females. ⁴

Common Symptoms:

• Often has difficulty sustaining attention in tasks or play activities.
• Often does not seem to listen when spoken to directly.
• Often does not follow through on instructions and fails to finish tasks.
• Often has difficulty organizing tasks and activities.
• Often easily distracted by extraneous stimuli.

These are just a few symptoms of ADHD. A professional mental health provider would need to assess a child to determine if they have ADHD.

Sometimes, medication is necessary for treatment if determined by a professional. ¹

ADHD is a condition in which people have difficulty with:

• Inattention
• Hyperactivity
• Impulsivity
• Regulating their mood
• Organization²

ADHD has two main behaviors:

• Inattentiveness
• Impulsivity

Most individuals will have one or both of these behaviors. The behaviors must be more than what’s typical for a child at their age and over a long period of time.

Resources to Help

• childmind.org
• chadd.org
• nami.org

Ways to Support

The parent can provide positive attention through labeled praise when the child is doing a behavior that the parent wants them to continue.

• For example, if a child is sharing a toy with their sibling, the parent might say, “Great job sharing your toy with your sister!”
• This can lead the child to want to increase this behavior.
• Children can often hear what they are doing wrong, and making a conscious effort to focus on praising behaviors can change this belief. ²

This common element can help children and their families find solutions to problems together.

The five steps are:

• Identify the problem.
• Brainstorm as many solutions as possible.
• Evaluate the potential solutions.
• Choose the best overall solution.
• Evaluate whether the solution worked in 1 to 2 weeks.
• Go back to brainstorming if it didn’t work for therapeutic support.

Behavior therapy is the primary therapy of choice for ADHD in children and adolescents. Specifically, parent training in behavior management (PTBM) also known as parent management training (PMT) has the greatest amount of evidence for this patient population. ²

Pull Quote

Implementing and maintaining a consistent routine is crucial for the caregiver and the child. Be clear and consistent with demands and expectations because predictability for the child is key day to day. ⁴

References

• Child Mind Institute. (n.d.). Quick Guide to Attention-Deficit Hyperactivity Disorder (ADHD)
• Chesher, Tessa (2023) OKCAPMAP Provider Education ADHD in Children and Adolescents Learning Module
• Substance Abuse and Mental Health Services Administration (2023) Attention-Deficit HyperactivityDisorder (ADHD)
• National Institute of Mental Health (n.d.) Attention-Deficit/Hyperactivity Disorder

A traumatic event is a frightening, dangerous, or violent event that poses a threat to a child’s life or bodily integrity. Witnessing a traumatic event that threatens the life or physical security of others, especially a loved one, can also be traumatic. This is particularly important for young children as their sense of safety depends on the perceived safety of their attachment figures.¹

Common Symptoms

Children 0-5

• Poor verbal skills.
• Memory problems.
• Scream or cry excessively.
• Poor appetite, low weight or digestive problems.
• Listlessness or lack of crying.

Children 3-6

• Difficulty focusing and learning in school.
• Develop learning disabilities.
• Act out in social situations.
• Imitate the abusive, traumatic event or be verbally abusive.
• Be unable to trust others or make friends.
• Blame self for traumatic event.
• Lack of self confidence.
• Stomach and head aches.

Children 6-12

• Fear of separation from caregiver.
• Sudden negative change to worldview.
• Replaying trauma through artwork and role play.
• Loss of appetite.
• Loss of interest in previously liked activities.
• Physical complaints.
• Unusual mood changes.
• Loss of concentration.

Types of Stress

Positive

• Brief increase of heart rate.
• Mild elevation of stress hormone levels.

Tolerable

• Serious, temporary stress response.
• Buffered by supportive relationships.

Toxic

• Prolonged activation of stress response systems.
• Absence of protective relationships.

Risk and Protective Factors

Severity of the event

• Seriousness. ¹
• Injuries or death. ¹
• Child separated from the caregiver. ¹

Prior history of trauma

• Children continually exposed to traumatic events are more likely to develop traumatic stress reactions. ¹

Family and community factors

• The culture, race and ethnicity of children. ¹
• Family and community support. ¹

Experiences that might be traumatic

• Physical, sexual or psychological abuse and neglect.
• Natural disasters or terrorism.
• Family or community violence.
• Refugee and war experiences.
• Military family — related stressors.
• Sudden or violent loss of a loved one.
• Substance use disorder.
• Serious accident or life threatening illness.
• Other medical events such as a medical procedure.

Resources to Help

• info.childcareaware.org/hubfs/After%20Violence_1. Nov2023.pdf
• nctsn.org/audiences/youth
• Child Trauma Academy

What Adults Can Do to Help

• Your response as an adult greatly influences how children and adolescents react to trauma.
• Prioritize safety and basic needs for children and adolescents.
• Create a safe and supportive environment and remain as calm as possible.
• Allow children to be sad or cry.
• Let them talk, write or draw pictures about the event and their feelings.
• Limit exposure to repetitive news reports about traumatic events.
• Allow temporary changes for comfort, like sleeping in your room or with a light on.
• Stick to routines like bedtime stories, family dinners and games.
• Help them feel in control by letting them make some decisions like choosing meals or picking their clothes.
• Talk to a trusted friend or caring adult for emotional support.
• Engage in mindful practices by paying attention to the body and deep breathing.
• Encourage physical activity like stretching, walking, running and dancing.
• Suggest creative outlets like journaling, drawing, painting and singing.
• Support spiritual practices like meditating, being in nature or going to a place of worship.
• Foster a sense of community through volunteering and group participation.

What Adults Should Avoid

• Do not expect children and adolescents to be brave or tough.
• Do not make them discuss the event before they are ready.
• Do not get angry if they show strong emotions.
• Do not get upset if they begin bed-wetting, acting out or thumb-sucking.
• Do not make promises you can’t keep, like saying “You will be OK tomorrow.”

When to Seek Professional Help

• Many reactions are normal and will lessen with time.
• If symptoms last for more than a month, reach out to a health care provider.
• Contact a health care provider if new problems develop, especially if symptoms like flashbacks, racing heart/sweating, being easily startled, emotional numbness, or severe sadness/depression occur for more than a few weeks.
• It is always a good idea to talk with a trusted adult like a parent, relative, counselor, health provider, teacher, or religious leader if feelings continue to be bad.

Support for Caregivers and Family Members:

• When caregivers and family members support their own ability to cope, they can provide better care for others

Pull Quote

30% of children will develop a clinical syndrome with emotional, behavioral, cognitive and physical symptoms called post traumatic stress disorder.

Treatment

Children 0-5

• Dyadic therapy — requires participation from the caregiver.
• Attachment and biobehavioral catch-up.
• Child-parent psychotherapy.
• Stepped care trauma-focused cognitive behavioral therapy (TFCBT).
• Dyadic play therapy.
• Potentially medication.

Children 6-17

• TFCBT.
• Seeking safety.
• CBT.
• EMDR.
• Medication.
• Mindfulness.
  Breathing exercises.

Empathy vs. Sympathy

• Sympathy is a response to a person’s circumstance.
• Empathy allows someone to recognize and share the emotions of the child or adolescent’s traumatic experience(s).

References

1. Chesher, Tessa (2023) OKCAPMAP Provider Education Trauma in Children and Adolescents Learning Module
2. National Institute of Mental Health. (n.d.). Helping children and adolescents cope with disasters and other traumatic events. U.S. Department of Health and Human Services, National Institutes of Health. Retrieved from nimh.nih.gov/health/publications/helping-children-and-adolescents-copewith-disasters-and-other-traumatic-events
3. Michigan Department of Health and Human Services. (n.d.). Trauma-informed care toolkit: Information for youth. Retrieved from michigan.gov/-/media/Project/Websites/mdhhs/Adult-and-Childrens-Services/Children-and-Families/Trauma_Toxic-Stress/TI_Toolkit_Info_for_Youth.pdf

Navigating the IEP or 504 process can feel overwhelming with all the jargon and requirements. Here are some easy-to-understand tools to help you feel more confident as you advocate for your child’s school services.

Important Facts

What is an IEP?

Individualized Education Program (commonly called an IEP in the school setting)
A written document outlining a child’s levels of educational performance, strengths, needs, goals, objectives, services, and transition plan. It ensures that children with disabilities who qualify receive tailored instruction and services to meet their individualized needs.

What is a 504 Plan?

504 Plan (commonly called a 504 in the school setting)
Guarantees that children with disabilities receive accommodations and modifications in the school setting, providing equal access to participate in activities with their peers. Section 504 defines a person with a disability as having a physical or mental impairment that substantially limits major life activities.

Getting the Process Started

• Request an Evaluation — Parents can request the school evaluate their child for services at no cost.
  Collaborate with the School Team — Work with your child’s teacher, counselor, special education staff, administrator and specialists to determine the educational goals and services your child needs.
• Build Relationships — Communication and building relationships with your child’s school team create a positive school-home environment that fosters educational success.

Need help?

Contact the Oklahoma Parents Center
Connect with the Oklahoma Parents Center (OPC) for assistance in navigating the path to getting your child the services and support for special education. Visit Oklahoma Parents Center: oklahomaparentscenter.org

Helpful Resources

• Special Education Terms Oklahoma Parents Center — oklahomaparentscenter.org/special-educationterms/
• Parents Guide to a 504 Children’s Health — childrens.com/patient-families/resources-for-yourchild/school-and-education-services/school-services-parent-resources/parents-guide-for-section-504
• Starting the IEP Process Understood.org — understood.org/en/articles/how-to-getiep#Getting_the_IEP_process_started

2SLGBTQIA+ youth experience significant health inequities compared to their cisgender heterosexual peers. These inequities highlight the importance of understanding factors that influence their health. Families have a profound impact on the health of 2SLGBTQIA+ youth. Research consistently shows that family reactions play a major role in their risk and well-being.²

The coming out process is often challenging for both youth and parents.
While it can be a significant stressor, parental acceptance is crucial. Parents may initially feel uncertain, stressed, confused or surprised, but their role as an anchor is key.

Important Facts

Family rejection is strongly linked to negative health outcomes. 2SLGBTQIA+ youth who experience high levels of family rejection are at a significantly increased risk for:

• Mental health problems, including depression and suicidality. Highly rejected youth are more than eight times as likely to have attempted suicide and nearly six times as likely to report high levels of depression.
• Substance use. They are more than three times as likely to use illegal drugs.
• Sexual risk behaviors, including increased HIV risk.
• Homelessness and entering the foster care system, as they may be forced to leave home.
• Lower self-esteem and increased isolation.

What to Remember

Parental and family support is associated with better health outcomes. 2SLGBTQIA+ youth who perceive strong family support tend to have:

• Better mental health.
• Lower risk of substance abuse.
• Lower sexual risk behaviors.
• Higher self-esteem, greater life satisfaction and a stronger belief in a positive future as an LGBTQ adult.

Important Facts

• Parenting practices, such as monitoring and communication, are complex for 2SLGBTQIA+ youth. While generally protective for adolescents, their influence on 2SLGBTQIA+ youth’s health outcomes can be mixed and requires parents to be aware of and tolerant of their child’s identity and provide tailored health information. Open, mutual, and low-conflict communication is linked to better health outcomes.
• Many parents lack 2SLGBTQIA+-specific health information and skills to support their children, such as knowledge about safer sex or coping with bullying. They may also be unaware of the negative impact of seemingly well-intentioned rejecting behaviors.
• Misconceptions about sexual orientation and gender identity are common among parents. It is important for parents to understand that it is not “just a phase.”
• There is no cure; it is not something that needs to be fixed.
• No one, including parents, can make someone gay.
• Support and education for parents are crucial. Families are motivated to learn when they understand the powerful impact of their actions on their child’s well-being. Even a small decrease in family rejection and a small increase in support can significantly reduce health risks.
• Schools play a vital role in supporting 2SLGBTQIA+ youth, but bullying is a significant problem. Parents should stay involved with schools, look for signs of bullying, advocate for inclusive policies like Gay-Straight Alliances (GSAs) and push for inclusive sex education.
• More research and innovation are needed to understand family influences on 2SLGBTQIA+ youths’ health and to develop effective interventions. Current research is limited, often focusing only on youth perspectives or accepting parents and there are no existing randomized controlled trials of family-based interventions specifically for 2SLGBTQIA+ youth.
• Parents can take specific actions to support their 2SLGBTQIA+ children, even if they initially feel uncomfortable. These include expressing affection, talking about their child’s identity, advocating for them, connecting them with resources and role models and welcoming their friends and partners. Organizations like Parents, Families and Friends of Lesbians and Gays (PFLAG) provide support to parents. ¹²³

Education and Understanding

• Learn accurate facts about sexual orientation and gender identity to combat common misconceptions. Understand that their identity is not just a phase, there is no cure or fix, and no one can make someone gay.
• Recognize that gender identity develops at early ages (around 2-3). Avoid shaming or embarrassing gender-nonconforming behavior, as parental fear of societal harm can lead to seemingly well-intentioned but rejecting actions.

Fostering Healthy Relationships and Futures

• Ensure they form healthy relationships as they begin dating. Be involved and engaged, and encourage healthy, age-appropriate dating to normalize LGBTQ relationships.
• Stay informed about their social media and phone application use, monitoring content and discussing it with them. Understand that youth may turn to these apps if they feel they lack guidance and support elsewhere, highlighting the importance of being available for your child. ¹²³

Resources to Help

• lgbthotline.org
  lgbtlifecenter.org/wellness/support-groups/
  pflagoklahomacity.org/resources

Emotional Support and Acceptance

• Let your child know they are loved unconditionally. Parental acceptance acts as their anchor, allowing them to handle external challenges. Simple phrases like, “I’m here for you. I love you, and I will support you no matter what” can be profoundly meaningful.
• Express affection when your child shares their 2SLGBTA+ identity with you or when you learn about it.
• Support your child’s 2SLGBTA+ identity even if you initially feel uncomfortable, stressed, confused or surprised. It’s vital not to withdraw when they need you most.
• Welcome your child’s 2SLGBTA+ friends and partners into your home and family activities and events.
• Support your child’s gender expression.
• Believe that your child can have a happy and productive future as an 2SLGBTA+ adult.

Communication and Dialogue

• Encourage open, mutual and low-conflict communication with your child. Build trust by showing curiosity about their life, getting to know their friends and asking about their day.
• When discussing sensitive topics, consider less direct approaches, such as talking about friends or characters in age-appropriate media. Use these moments to initiate conversations, for example, by saying, “The character in this show is attracted to boys and girls. That’s OK with me. What do you think?”

Advocacy and Protection

• Require that other family members respect your 2SLGBTA+ child.
• Advocate for your child if they face mistreatment or discrimination due to their 2SLGBTA+ identity.
• Stay actively involved with their school to help ensure a comfortable and safe environment.
• Be vigilant for signs of bullying, such as changes in behavior, discipline issues, declining grades, unexplained absences, shifts in friendships or engagement in out-of-character risky behaviors.
• Advocate for inclusive policies like Gay-Straight Alliances (GSAs), which have been shown to make schools safer and boost academic performance for 2SLGBTA+ students.
• Maintain frequent contact with teachers and be prepared to escalate concerns to the principal or school board if necessary.
• Push for more inclusive sex education in schools, and be prepared to provide 2SLGBTA+-specific health information yourself if the school’s curriculum is lacking.

Seeking and Providing External Support

• Connect your child with 2SLGBTA+ organizations or events so they can see other 2SLGBTA+ individuals leading fulfilling lives and find peer and community support.
• Connect your child with an 2SLGBTA+ adult role model to demonstrate positive future possibilities.
• Find or help establish a supportive faith community that welcomes your family and 2SLGBTA+ child, especially if religion is important in your lives.
• If you, as a parent, are struggling, seek support from pediatricians, school counselors, close family members or community organizations like Parents, Families and Friends of Lesbians and Gays (PFLAG).

References

1. Fields, E. L. (n.d.). Tips for parents of LGBTQ youth. Johns Hopkins Medicine. Retrieved from hopkinsmedicine.org/health/wellness-and-prevention/tips-for-parents-of-lgbtq-youth
2. Newcomb, M. E., LaSala, M. C., Bouris, A., Mustanski, B., Prado, G., Schrager, S. M., & Huebner, D. M. (2019). The influence of families on LGBTQ youth health: A call to action for innovation in research and intervention development. LGBT Health, 6(4), 139–145. doi.org/10.1089/lgbt.2018.0157[1] (https://psycnet.apa.org/record/2019-30806-001)
3. National Center for Cultural Competence. (n.d.). Providing services and supports for youth who are lesbian, gay, bisexual, transgender, questioning, intersex or two-spirit (LGBTQI2-S). Georgetown University Center for Child and Human Development. Retrieved from nccc.georgetown.edu/documents/LGBT_Brief.pdf

Sleep hygiene refers to both your sleep environment and daily behaviors. It involves creating a bedroom environment and daily routines that promote consistent, uninterrupted sleep. It’s considered one of the most straightforward ways to help yourself and your family set up for better sleep. Sleep hygiene can be tailored to suit individual needs within the family. It has very little cost and virtually no risk, making it an important part of public health strategies for improving sleep.¹

Important Facts

• Good sleep is essential for our health and emotional well-being.
• Getting enough good quality sleep is crucial for healthy sleep.
• It helps to revitalize the mind and body and prepares you to perform at your best.
• Healthy sleep improves physical and mental health, boosts productivity and enhances overall quality of life.
• Regular exercise makes it easier to sleep and offers many other health benefits.

Health Benefits of Enough Sleep

• Getting enough sleep can help your family:
• Get sick less often.
• Stay at a healthy weight.
• Reduce stress and improve mood.
• Improve heart health and metabolism.
• Lower the risk of chronic conditions like type 2 diabetes, heart disease, high blood pressure and stroke.
• Lessen the risk of motor vehicle crashes and related injury or death.
• Improve attention and memory to better perform daily activities.
• Forming good habits makes healthy behaviors feel almost automatic, creating positive reinforcement for sleep.

Key Takeaways

• While sleep hygiene is very beneficial, it will not cure all sleep problems.
• If you or a family member have long-lasting or severe sleeping problems, or significant daytime sleepiness, it’s essential to talk with a doctor or health care provider. Other treatments might be necessary, as sleep hygiene alone isn’t a cure-all.
• A health care provider can run tests, including sleep studies, to determine if a sleep disorder like insomnia, restless legs syndrome, narcolepsy or sleep apnea is present.
• Keeping a sleep diary can help identify patterns between behaviors and sleep duration or quality that may be interfering with sleep. Your diary should include when you go to bed, wake up during the night, wake up in the morning, take naps, exercise, drink alcohol or caffeinated drinks and take medications.
• You should also note length and quality of sleep, awakenings and device use.
• Making changes to daily routines can be challenging, so working with a partner or other family members can help in adopting and sticking to recommendations for healthy sleep. ^1,2,3,4

Set a Consistent Sleep Schedule

• Go to bed and get up at the same time every day, including weekends. A fluctuating schedule prevents getting into a rhythm of consistent sleep. While consistency is healthier, some “catch-up sleep” on weekends might be beneficial after insufficient sleep during the week.
• Prioritize sleep by treating it as a vital part of the day. Calculate a target bedtime based on a fixed wake-up time and aim to be ready for bed around that time nightly.
• If you need to shift sleep times, make gradual adjustments of up to an hour or two at a time to allow bodies to adjust.
• Be mindful of naps. While naps can regain energy, keep them relatively short and limited to the early afternoon to avoid disrupting nighttime sleep. Sleep experts recommend naps of half an hour or less, if needed.

Follow a Nightly Routine

• Keep your routine consistent with the same calming steps each night, like putting on pajamas or brushing teeth, to signal to the brain it’s bedtime.
• Budget 30-60 minutes for winding down before bed. Encourage quiet, calming activities like listening to soft music, gentle stretching, reading for pleasure in soft light, relaxation exercises or a warm bath.
• Dim the lights as bright lights can interfere with melatonin production, a hormone that helps with sleep.
• Unplug from electronic devices. Create a device-free buffer time of 30-60 minutes before bed. Cell phones, tablets and laptops can be mentally stimulating and emit blue light that may reduce melatonin production.
• Don’t toss and turn. If someone hasn’t fallen asleep after about 20 minutes, encourage them to get out of bed and do something calming in low light (like stretching or reading) before trying to sleep again. This helps maintain a strong mental connection between bed and sleep.

Signs Your Family Might Have Poor Sleep Hygiene

• Difficulty falling asleep.
• Repeatedly waking up during the night.
• Feeling sleepy or tired even after getting enough sleep.
• An overall lack of consistency in how much or how well your family members are sleeping can also be a symptom.
• Poor sleep hygiene practices are significantly associated with sleep problems, daytime sleepiness and depression. For example, a study showed a significantly higher percentage of subjects with poor sleep hygiene (76.5%) reported sleeping problems in the past three months compared to those with good sleep hygiene (56.1%).

Recommended Sleep Duration by Age

• Newborns (0–3 months): 14–17 hours.
• Infants (4–12 months): 12–16 hours.
• Toddlers (1–2 years): 11–14 hours.
• Preschool (3–5 years): 10–13 hours.
• School age (6–12 years): 9–12 hours.
• Teens (13–17 years): 8–10 hours.
• Adults (18–60 years): 7 or more hours.

Cultivate Healthy Daily Habits

• Get daylight exposure. Natural light, especially sunlight, helps regulate the body’s natural sleepwake cycle (circadian rhythms).
• Be physically active. Regular exercise can make it easier to sleep at night and offers many other health benefits. For some, exercising within two hours of bedtime can interfere with sleep, while for others, evening exercise is fine; experiment to find what works best.
• Avoid smoking. Nicotine is a stimulant that can disrupt sleep.
• Reduce alcohol consumption. While alcohol might seem to help fall asleep, its effects wear off and can disrupt sleep later in the night. It’s best to moderate consumption and avoid it in the evening. Alcohol can also worsen snoring and reduce REM sleep.
• Limit caffeine. As a stimulant, caffeine can keep you awake, so try to avoid it in the afternoon and evening.
• Don’t dine late. Eating large, heavy or spicy meals close to bedtime can make it hard to sleep because the body is still digesting. Any snacks before bed should be light. Evening meals should be consumed at least three hours before bedtime.

Optimize Your Bedroom Environment

• Restrict in-bed activity: Encourage using the bed primarily for sleep (with the exception of sex) to strengthen the mental link between the bed and sleeping.
• Keep electronic devices and work-related items in another room.
• Ensure a comfortable mattress and pillow: Your sleeping surface is crucial for comfort and pain-free sleep. Replace them if they are worn or uncomfortable.
• Use excellent bedding: Choose sheets and blankets that are comfortable and suit your preferences.
• Set a cool, comfortable temperature: Most people sleep better in a slightly cool room, aiming for around 65-68 degrees Fahrenheit.
• Block out light: Use heavy curtains, shades or an eye mask to prevent light from interrupting sleep.
• Drown out noise: Earplugs, a white noise machine or a fan can help block bothersome sounds.
• Heavy curtains and rugs can also absorb sound.
• Try calming scents: Light, soothing smells like lavender may help create a more relaxed and positive sleep space.

Resources to Help

• thensf.org/sleep-health-topics
• sleepeducation.org
• extension.okstate.edu/fact-sheets/promoting-healthy-sleeping-habits-in-children-andadolescents.html
• Cognitive behavioral therapy for insomnia (CBT-I) is a short, structured, and evidence-based approach to combating the frustrating symptoms of insomnia. sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia

References

1. Sleep Foundation. (2024, March 4). Mastering sleep hygiene: Your path to quality sleep. Retrieved from sleepfoundation.org/sleep-hygiene
2. Centers for Disease Control and Prevention. (2024, May 15). About sleep. Retrieved from cdc.gov/sleep/about/index.html
3. Alanazi, E. M., Alanazi, A., Albuhairy, A., Alanazi, A. A. A., et al. (2023). Sleep hygiene practices and its impact on mental health and functional performance among adults in Tabuk City: A cross-sectional study. Cureus, 15. doi.org/10.7759/cureus.36221[1] (scispace.com/papers/sleep-hygienepractices-and-its-impact-on-mental-health-and-8ftgk7cm)
4. Solodar, J. (2025, January 31). Sleep hygiene: Simple practices for better rest. Harvard Health Publishing.Retrieved from health.harvard.edu/staying-healthy/sleep-hygiene-simple-practices-forbetter-rest

Understanding and Responding to a Mental Health Crisis

Examples of a Mental Health Crisis

• Panic attack.
• Non-suicidal self-injury.
• Suicidal thoughts and behaviors.

Key Takeaways

• In immediate crisis situations, where someone is thinking about harming themselves or others, or is acting erratically, call 911 immediately. Request responders with specific training in mental health or crisis de-escalation.
• Remember, your role as a first aider is not to diagnose someone or solve their problem, but to provide support and information. Staying calm is essential as you offer support. ¹

How to Support

Mental Health First Aid (MHFA) offers a structured approach to support someone experiencing a distressing situation, similar to how you’d administer first aid for a physical injury.

The core of MHFA is the ALGEE Action Plan, a five-step process that can be used in any order, and not all steps must be used in every situation:

• A – Approach, assess for risk of suicide or harm.
  Find a suitable time and place to talk privately. If the person doesn’t want to confide in you, encourage them to talk to someone they trust.
• L – Listen non judgmentally.
  Let the person share their experiences and emotions without interrupting. Try to show empathy and acceptance, even if you don’t agree with what they are saying. You can start by saying, “I noticed that…”.
• G – Give reassurance and information.
  Provide hope and useful facts once the person has shared their feelings.
• E – Encourage appropriate professional help.
  The sooner someone receives help, the better their chances of recovery. Offer to help them learn about available options.
• E – Encourage self-help and other support strategies.
  This includes helping them identify their support network and community programs and to create a personalized self-care plan.

Supporting Someone Having a Panic Attack

What a Panic Attack Is

A sudden, intense surge of fear or discomfort that peaks within minutes, accompanied by symptoms such as a pounding heart, sweating, trembling, shortness of breath, chest pain, dizziness, feelings of unreality and a fear of losing control or dying. They usually last between 5 to 20 minutes and can be triggered or unexpected.

If You Suspect a Panic Attack

• Ask if they know what is happening and if they’ve had one before. Reassure them they are safe, especially if they seem disoriented.
• Be aware that symptoms can resemble a heart attack. If you are concerned it might be a medical issue, or if the person loses consciousness or has severe difficulty breathing, call emergency services.

What Not To Do

• Do not dismiss or ignore their panic attack or minimize their symptoms (e.g., “Don’t panic,” “Just calm down”).
• Do not criticize, express pity or overwhelm them with too much talk.
• Do not grab, hold or restrain them, or touch them without their permission.
• Do not pressure them to explain the cause of their panic.
• After the attack: Encourage them to seek professional help (like a GP or health professional) if they have future attacks or recurring attacks as effective treatments are available.

How to help

• Ensure their safety by moving them away from potential hazards, and if they are driving, ask them to pull over.
• Reassure them that they are safe, that a panic attack is frightening but not life threatening and that it will pass.
• Acknowledge their discomfort and terror, speaking in a reassuring but confident manner.
• Give them space and remove anything that is causing distress.
• Communicate calmly and clearly, using short, positive sentences.
• Encourage them to use any coping strategies that are already working, such as slowing their breathing.

Understanding and Responding to Non-Suicidal Self-Injury ²

Important Facts

• Non-suicidal self-injury refers to intentionally harming oneself without the intent to die.
• All self-injuring behavior should be taken seriously, regardless of severity, as accidental death can occur.
• People self-injure for many reasons, often to manage painful feelings, to punish themselves or to communicate. It is rarely done for attention. People who self-injure are at higher risk of suicide attempts. You should always directly ask if they are suicidal.

Common Signs

• Common methods include cutting, scratching, hitting, punching, biting and burning.
• Frequent, unexplained injuries or attempts to conceal injuries.

If You Suspect Self-injury

• Discuss your concerns privately and be prepared to address your own feelings about self-injury first.
• Ask directly and in an understanding way, such as, “Sometimes, when people are in a lot of emotional pain, they injure themselves on purpose. Is that how your injury happened?”.
• Avoid strong emotional reactions like anger or revulsion.

If You Find Someone Self-injuring

• Intervene supportively and non-judgmentally. Stay calm and express concern. Ask if medical attention is needed.
• Your focus should be on making their life more manageable, not just stopping the self-injury, as it takes time to recover and learn healthy coping mechanisms.
• Do not promise to keep self-injury a secret. If you need to share information for their safety, discuss this with them first.

Emergency Medical Attention

• It’s needed if the injury is severe (e.g., a gaping cut, a burn larger than 2 cm or on hands, feet or face). Call an ambulance immediately if someone has taken an overdose of medication or consumed poison, as the risk of death or permanent harm is high.
• Encourage the person to seek professional help (general practitioner, psychologist, etc.) and explore alternative coping strategies. Remember, you are not responsible for their actions, but you can offer support. 4

Assessing Urgency and Ensuring Safety

Take all thoughts of suicide seriously. Do not dismiss them as attention seeking. Ask specific questions to determine immediate risk:

• Do they have a plan?
• How, where and when do they intend to do it?
• Have they secured the means?
• Are they using drugs or alcohol?
• Have they attempted suicide before?

Addressing Suicidal Thoughts and Behaviors

Important Facts

• Suicide is preventable. Most people contemplating suicide do not wish to die, but rather seek relief from overwhelming pain. Openly discussing suicidal thoughts can save a life.
• Reasons for suicidal thoughts often include a desire to escape unbearable emotional pain or to communicate distress and seek help.
• A person who is suicidal should not be left alone. Work collaboratively to develop a safety plan, which is an agreement outlining actions to keep them safe. This plan should be clear, focus on what the person should do, be for a manageable length of time and include contact numbers for support (e.g., their doctor, a suicide helpline, trusted friends or family).

Warning Signs

• Threatening to harm themselves.
• Seeking means to end their life.
• Talking or writing about death or suicide.
• Expressions of hopelessness, rage and reckless behavior.
• Feeling trapped.
• Increased substance use.
• Withdrawal and drastic mood changes.

Risk Factors

• Mental illness.
• Substance abuse.
• Poor physical health.
• Previous suicide attempts.
• Recent negative life events.
• Childhood abuse.

How to Approach

• Act promptly if you suspect someone is suicidal, even a mild suspicion.
• Directly ask if they are having thoughts of suicide. Asking directly will not put the idea in their head; it shows you care and gives them a chance to talk.
• Never agree to keep a plan for suicide or risk of suicide a secret. Explain that you care too much to keep such a secret and they need help. You may need to breach confidentiality for their safety; if so, be honest about who you will tell.

How to Talk

• Remain calm, confident and empathic, even if you feel panic or shock.
• Listen with undivided attention and without judgment, allowing them to express their feelings, including anger or tears.
• Do not argue or debate their thoughts, minimize their problems or offer false reassurance (e.g., “Don’t worry,” “cheer up”).
• Do not avoid using the word ‘suicide’. Use terms like ‘suicide’ or ‘die by suicide,’ and avoid stigmatizing language.

Seeking Professional Help

• Encourage the person to get appropriate professional help as soon as possible.
• Provide information about available resources, such as hospitals, mental health clinics and helplines.
• If they refuse help, call a mental health center or crisis telephone line for advice.
• If the person is at urgent risk (e.g., has a specific plan or means) or has a weapon, contact police and inform them the person is suicidal. Do not put yourself in danger.
• If the person has already harmed themselves, administer first aid and call emergency services for an ambulance immediately.
• Remember to take care of yourself after helping someone who is suicidal, as it can be an exhausting experience. ³

Resources to Help

• Emergency Contacts: If you or someone you care about feels overwhelmed with emotions like sadness, depression, or anxiety, or expresses a desire to harm themselves or others, you can call 911. Additionally, you can contact the Substance Abuse and Mental Health Services Administration’s (SAMHSA).
• Disaster Distress Helpline at 800-985-5990, the National Suicide Prevention.
• Lifeline at 800-273-8255 (TALK), or text “MHFA” to 741-741 to talk to a Crisis Text Line counselor. or call 988 for a suicide situation.

References

1. Mental Health First Aid USA. (2020). Mental Health First Aid USA for Adults Assisting Adults. Washington, DC: National Council for Mental Wellbeing.
2. Panic Attacks: Mental Health First Aid Guidelines, 2021 Version 2.3, 2022. © Mental Health First Aid International.
3. Suicidal Thoughts and Behaviours: Mental Health First Aid Guidelines, 2014 Version 2.3, 2022 © Mental Health First Aid International.
4. Non-Suicidal Self-Injury MHFA Guidelines, 2014 Version 2.3, 2022 © Mental Health First Aid International.

Intellectual Disability / Developmental Disability (ID/DD) are disorders that are typically present at birth and affect an individual’s physical, intellectual and emotional development.

Important Facts

Individuals with IDDs are more likely to experience mental health problems than the general population. This is due to several factors:

• Communication deficits can lead to difficulties with social connections, potentially resulting in feelings of loneliness, anxiety and emotional dysregulation.
• Difficulties with independent task completion and learning can contribute to low self-esteem, low self-efficacy and increased frustration.
• Individuals with IDDs are more likely to have increased vulnerability and be the victims of abuse, which can lead to trauma and stress related disorders.
• They may also experience more family stress and have an increased risk for adverse childhood experiences.

Chromosomal, Genetic or Metabolic IDDs

• Down Syndrome.
• Fragile X.
• Rett.
• Prader–Willi
• PKU (untreated).

IDD Causes

• Prenatal exposures: Fetal alcohol spectrum disorders, infections like cytomegalovirus or toxins like lead.
• Perinatal: hypoxic-ischemic injury, prematurity complications.
• Postnatal/early childhood: severe traumatic brain injury, meningitis, severe malnutrition and neglect.
• Environmental deprivation and toxicity: lead, mercury and severe neglect.

Pull Quote

While there’s no cure for IDDs, an individual’s potential is not limited. With the appropriate support, children with IDDs can learn, grow and thrive.

Importance of Assessment

A key purpose of describing limitations is to develop a profile of needed supports. Valid assessment considers cultural and linguistic diversity, as well as differences in communication, sensory, motor and behavioral factors.

Types of assessments:

• Cognitive: WISC-V, Stanford-Binet-5 or DAS-II.
• Adaptive: Vineland-3 or ABAS-3.
• Standard: language, hearing and vision screenings.
• Culturally and linguistically responsive assessment and use of interpreters when needed.

Challenges in Diagnosis

• Individuals may have difficulty self-reporting symptoms.
• Many diagnostic tools lack norms for the IDD population.
• It can be difficult to differentiate behaviors due to IDD versus a secondary mental health concern.
• Diagnostic overshadowing can occur, where psychiatric concerns are wrongly attributed solely to the IDD.

Commonly Diagnosed Co-occurring Disorders

• Attention deficit hyperactivity disorder (ADHD) — higher prevalence than the general population.
• Autism.
• Cerebral palsy.
• Anxiety disorders — specific phobia, agoraphobia, generalized anxiety disorder.
• Conduct and externalizing disorders.
• Depressive disorders like major depressive disorder and persistent depressive disorder.
• Other disorders sometimes diagnosed include bipolar disorder and PTSD.

When symptoms of another disorder are present, they should be taken seriously, evaluated and treated as indicated. When unsure, addressing the behavior of concern directly can prevent treatment delays.

Characteristics

Significant limitations in intellectual functioning like:

• Reasoning.
• Problem-solving.
• Abstract thinking.
• Learning.

Significant limitations in adaptive behavior like:

• Skills needed for daily living such as communication.
• Social skills.
• Personal independence.

Onset occurs during the developmental period commonly defined as before age 18 per DSM; American Association on Intellectual and Developmental Disabilities (AAIDD) uses before 22. This age is based on recent scientific research showing that important brain development continues into early adulthood. If these problems began after this developmental period, the correct diagnosis would be a neurocognitive disorder.

For children under age 5, global developmental delay may be used. For older children when assessment is precluded, unspecified intellectual disability may be considered.

Psychological Interventions

• Behavioral therapies, such as applied behavioral analysis (ABA) and positive behavioral support (PBS), have demonstrated effectiveness for mental health treatment and increasing adaptive behaviors like conceptual, social and practical skills.
• Adapted cognitive behavioral therapy (CBT) including visuals, concrete language, in-session practice and caregiver involvement has supportive evidence for mild–moderate IDD; outcomes improve with modifications.
• Contextual therapies (e.g., mindfulness-based therapy, dialectical behavior therapy, acceptance and commitment therapy) may also be effective due to their integration of environmental and contextual factors.
• Interventions should be tailored to the individual’s preferences, understanding, communication style, strengths and needs.
• Additional support between sessions is beneficial.

Medication (Psychopharmacology)

• Diagnosis should not be based on a single symptom.
• Evidence-based treatments for neurotypical patients may not have included individuals with IDD; therefore, the recommendation is to start low and go slow with medication doses.
• Monitor treatment response using behavioral data, rating scales and measures of side effects.
• More is not always better; a rush to polypharmacy can complicate treatment.
• If you or your health care provider feel unsure or that things are not making sense, consult with a specialist.
• In summary, while IDD is a lifelong neurodevelopmental disorder indicating significantly below-average adaptive and intellectual skills, it is not a hopeless condition. Individuals with IDDs can learn and grow with appropriate supports.Co-occurring mental health challenges should be seriously addressed with tailored and effective interventions.

Pull Quote

With appropriate personalized supports over a sustained period, the life functioning of the person with ID generally will improve. Some individuals, especially those with more severe deficits, may need life-long support.

Systems of Support

These are resources and strategies that promote development and well-being. They are designed to be:

• Person-centered, comprehensive, coordinated and outcome-oriented.
• Built on values, facilitating conditions and supporting relationships.
• Incorporate choice and personal autonomy, inclusive environments, generic supports and specialized supports.
• Integrate and align personal goals, support needs and valued outcomes.

Nature of Supports

• Include more opportunities for practice.
• Provide a more structured setting.
• Offer increased opportunities for reinforcement.

Behavior, Safety and Crisis

• Behavior support plans.
• Functional behavior assessment (FBA).
• Crisis and suicide screening adapted for communication level (simple language, caregiver collateral). There is increased suicide risk in autistic youth and the need for adapted screening.

Help for Families

• Early Intervention (Part C).
• IEP/504 (IDEA/Section 504) — transition planning (IEP) beginning by age 16 or earlier in practice.
• Care coordination.
• Medicaid waivers.
• Social Security Income (SSI)/SSA.
• State Developmental Disabilities Services (DDS).

Resources to Help

• childmind.org/guide/quick-guide-to-intellectual-developmentdisorder1
• cdc.gov/child-development/about/developmental-disabilitybasics.html
• parentcenterhub.org/intellectual/
• aaidd.org/home
• ssa.gov/disability
• oklahoma.gov/okdhs/services/dds

References

1. Rich, Sara. Dual Diagnosis: Intellectual Developmental Disabilities and Mental Health Problems. Presentation for OSU-CME session, 2024
2. Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). Intellectual and developmental disabilities (IDDs). U.S. Department of Health and Human Services, National Institutes of Health. Retrieved June 26, 2025, from nichd.nih.gov/health/topics/factsheets/idds
3. Schalock, R. L., Luckasson, R., & Tassé, M. J. (2021). An overview of intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.). American Association on Intellectual and Developmental Disabilities. Retrieved from researchgate.net/publication/355661119

Opioid use and Opioid Use Disorder (OUD) constitute a significant and growing public health crisis impacting youth in the U.S. Nearly 1 in 4 adolescents and young adults report some form of opioid use, with hundreds of thousands meeting OUD diagnostic criteria annually. Misuse often begins with prescription opioids, frequently obtained from family, friends or personal prescriptions. Post-dental visits are a leading source of initial opioid prescriptions for youth, linked to increased risk of persistent use and OUD. ¹ ² ³

Important Facts

• Opioids cause pain reduction, anxiety reduction and feeling of euphoria. ¹
• Highly addictive narcotic drug group.
• Can be legal for prescribed pain use, such as oxycodone, or illegal, such as heroin.
• Large doses can slow the body’s heart and breathing rate to a complete stop in some cases.

Common Signs

• Taking longer than or in larger amounts than initially intended or prescribed.
• Persistent desire or craving and unsuccessful effort to cut down or control use.
• Use that begins and/or continues to interfere with a significant role or obligation at school, work or home.
• Continued use even in the event of recurrent social or interpersonal issues.
• Important social, occupational or recreational activities given up or reduced because of use.
• Recurrent use in situations where they become physically hazardous.
• Continued use even when knowing there is a persistent physical or psychological problem that is caused or worsened by use.

Signs of Intoxication

• Drowsiness
• Mood changes
• Nausea or vomiting
• Loss of appetite
• Slowed heart rate
• Pinpoint pupils
• A state of euphoria
• Odd behavior

Always carry NARCAN/Naloxone in the case of an overdose. ¹

Withdrawal Symptoms

• Sweating
• Anxiety
• Trembling
• Nervousness
• Stomach pain
• Panic attacks
• Mood swings
• Insomnia
• Anger
• Fever
• Chills
• Muscle cramps
• Irritability
• Goose bumps on the skin

Long-term Effects

• Cardiac abnormalities.
• Decreased fertility.
• Infectious diseases from injection.
• Mental health struggles.
• Relational issues.
• Neglect of responsibilities.
• Loss of recreational or hobby activities.

Tolerance

• Need for markedly increased amounts to achieve intoxication or the desired effect.
• Markedly diminished effect with continued use of the same amount of the opioid.

Prevalence and Risk

• Opioid use is common among adolescents and young adults, with nearly 1 in 4 reporting some type of opioid use, including medical prescriptions.
• Over 150,000 adolescents under 18 years of age met diagnostic criteria for an opioid use disorder (OUD).
• The earlier the age of opioid exposure, the greater the vulnerability to developing an OUD.
• Tragically, 1 in 10 adolescents and young adults 15 to 24 years of age died from opioid-related causes.

Parents

• Know your child’s friends.
• Know where your child is.
• Set appropriate boundaries and rules for their age.

Prevention for Families

• Family-based therapy.
• Multidimensional family therapy.
• Cognitive behavioral therapy (CBT).
• Multicomponent psychosocial therapy.
• Third wave cognitive behavioral therapies.
• 12 step programs.
• Exercise, yoga and mindfulness.
• Recovery specific educational settings.
• Goal setting.
• Digital strategies.
• Culturally-based programs. ¹

Essentials of Opioid Use Intervention

Prevention

• Education on risks.

Nonpharmacological Interventions

• CBT therapy.
• Contingency management.

Pharmacological Interventions

• Methadone.
• Buprenorphine.
• Naltrexone.

Motivational Interviewing

• Empowerment of the child’s autonomy in decision making.
• Supporting the child to achieve their goals.
• Validating the child’s feelings and experiences.

Importance of Early Intervention and Family Involvement

• It is crucial to identify opioid use early, prevent escalation and reduce harms.
• Pediatricians are uniquely positioned to manage addiction in youth, given their expertise in longitudinal, preventive, and family- and patient-centered care.
• Engaging families of youth in the treatment plan has been shown to improve rates of treatment adherence and completion; lead to longer durations of abstinence from substance use; and result in fewer relapses for youth.
• Family-based therapies are highly efficacious for youth and can address various issues, including family communication, conflict, co-occurring behavioral and mental health, and learning disorders, school problems, and peer networks.
• Confidentiality and minor consent laws can vary by state when involving
  parents in a youth’s treatment.

Harm Reduction Strategies

• Fatal opioid overdose remains a major cause of opioid-related mortality among youth and young people are often uninformed about this risk.
• Pediatricians should deliver overdose education as part of any visit where a youth endorses opioid use. This education should include strategies for reducing overdose risk, recognizing signs of overdose and responding to an overdose.
• Pediatricians should prescribe naloxone for opioid overdose reversal to youth and their families for all youth using opioids. It is vital to educate and train both the youth and someone close to them on how to administer naloxone in the event of an overdose.
• For youth who are injecting opioids and not yet ready for treatment or cessation, safe injection practices and linkage to needle or syringe exchanges should be considered to reduce complications. Education on safe injection includes choosing safer places and materials, identifying safer injection sites like forearms are better than legs; neck and groin should never be used, and reducing exposure to contaminated products by avoiding sharing equipment. ²‚ ³

Ways to Support

• It is crucial that youth be offered treatment at the time of an OUD diagnosis, which includes medications, behavioral interventions and/or referral to mutual support groups such as traditional 12-step programs or youth-oriented organizations.
• The two medications commonly used for office-based OUD treatment in adolescents are extended-release naltrexone, an opioid antagonist, and buprenorphine, a partial opioid agonist. Evidence from youth-focused studies and adult data supports the use of these medications as the gold standard for OUD treatment in youth.
• Home-based delivery of extended-release naltrexone has been shown to be feasible and acceptable to youth and their families, leading to more doses being received at home compared to office visits. ²‚ ³

Resources to Help

• okimready.org/overdose/
• samhsa.gov/find-help/helplines/national-helpline
• adolescenthealth.org/resources/clinical-care-resources/
• aacap.org/AACAP/Families_and_Youth/Resource_Centers/Substance_Use_Resource_Center/Home.aspx

References

1. Chesher, Tessa (2023) OKCAPMAP Provider Education Opioid Use in Children and Adolescents Learning Module
2. Robinson, C. A., & Wilson, J. D. (2020). Management of Opioid Misuse and Opioid Use Disorders Among Youth. Pediatrics, 145(Suppl 2), S153–S164. https://doi.org/10.1542/peds.2019-2056F
3. Centers for Disease Control and Prevention (U.S.). David J. Sencer CDC Museum. (2022). Teen newsletter: July 2022 – Opioids. Public Health Academy Teen Newsletter. Retrieved from https://www.cdc.gov/museum/education/newsletter/2022/july/index.html

Substance Use Disorder (SUD), also known as addiction, is a complex, chronic disease that affects brain function and behavior. It is characterized by uncontrolled or compulsive use of a substance despite harmful consequences. It’s important to understand that people with SUD do not lack moral principles or willpower. The initial decision to use drugs may be voluntary, but repeated use leads to brain changes that make it difficult to control use and resist intense urges. These brain changes can be persistent, and addiction is considered a relapsing disease. Relapse is common but does not mean treatment doesn’t work; it indicates a need for continued or adjusted treatment. 2345

Important Facts

• Substance misuse is when someone uses any substance at high doses or in inappropriate situations.
• Substances can be legal like alcohol or tobacco, illegal like heroin, cocaine or controlled (prescribed).
• Substance use disorder is a diagnosable illness where repeated and prolonged use of a substance at high doses and/or high frequencies impairs health and functions requiring special treatment. ¹

Signs of Intoxication

• Drowsiness.
• Mood changes.
• Nausea or vomiting.
• Loss of appetite.
• Slowed heart rate.
• Pinpoint pupils.
• A state of euphoria.
• Odd behavior.

*Always carry NARCAN/Naloxone in the case of an overdose. ¹

By the Numbers

• 62% of teens in 12th grade have abused alcohol.
• 11% of all 12 to 17 year olds in Oklahoma reported using marijuana in the last year.
• 15% of high schoolers reported having taken illicit or injection drugs such as cocaine, inhalants, heroin, methamphetamines, hallucinogens or ecstasy.
• 14% of students reported misusing prescription opioids.

The Most Common Misused Substances Are:

• Cannabis.
• Nicotine.
• Alcohol. ¹

Why Youth are Especially Vulnerable

• No single factor predicts addiction, but a combination of factors
  influences risk.
• Developmental stage plays a critical role: Although drug use at any age
  can lead to addiction, the earlier drug use begins, the more likely it is to
  progress to addiction.
• This is particularly problematic for teenagers because the areas of their brains that control decision-making, judgment and self-control are still developing, making them more prone to risky behaviors like trying drugs.
• Other factors include genetics accounting for about half the risk and
  environmental influences like peer pressure, stress, early drug exposure
  or parental guidance.

How Substances Affect the Brain

• Most substances affect the brain’s reward circuit, flooding it with dopamine and causing feelings of pleasure or euphoria. This reinforces the unhealthy behavior of taking drugs.
• With continued use, the brain adapts, leading to tolerance, where larger amounts are needed to achieve the same effect.
• Long-term use causes changes in brain functions related to judgment, decision-making, learning, memory and behavioral control. People may continue to use it despite being aware of harmful outcomes.

Common Symptoms

• Impaired control: Experiencing strong urges or cravings to use the substance and desiring or having failed attempts to cut down or control use.
• Social problems: Substance use causing a failure to complete major tasks at work, school or home, or cutting back on social, work or leisure activities.
• Dangerous use: Using the substance in unsafe settings or continuing to use despite knowing it causes problems.
• Drug effects: Developing tolerance by needing more for the same effect and experiencing withdrawal symptoms when discontinuing use. 2345

How Parents/Guardians Can Help

• Learn all you can about alcohol and drug dependence and addiction.
• Speak up and offer your support. Talk to the person about your concerns and offer to go with them to get help. The earlier addiction is treated, the better.
• Express love and concern. Focus on specific behaviors and avoid name-calling.
• Do not expect the person to change without help. Treatment, support and new coping skills are needed.
• Support recovery as an ongoing process and remain involved once they are in treatment or attending meetings.

Things to Avoid

• Lectures, threats, bribes or emotional appeals, which can worsen shame and lead to isolation.
• Covering up, lying or making excuses for their behavior. Open and honest communication is vital.
• Confrontations with someone who is intoxicated, as they won’t be able to have a meaningful conversation and it could escalate.
• Feeling guilty for their behavior. SUD is an illness not caused by any one person.
• Joining them in drinking or using, as it harms both them and you. 2345

Ways to Support

• Drug use and addiction are preventable. Education and outreach are key in helping young people understand the risks. Parents, teachers, and health care providers have crucial roles in prevention.
• Treatment is available and effective. Addiction is treatable and can be successfully managed, although it is generally not a cure.
• The first step is recognition of the problem. While self-referrals are encouraged, interventions by concerned friends and family often prompt treatment. A medical professional should conduct a formal assessment.
• Effective treatment often involves a combination of medication and individual or group therapy, tailored to the individual’s specific needs and any co-occurring issues. Remaining in treatment for an adequate period is critical.

Resources to Help

• okimready.org/overdose/
• samhsa.gov/find-help/helplines/national-helpline
• adolescenthealth.org/resources/clinical-care-resources/
• aacap.org/AACAP/Families_and_Youth/Resource_Centers/Substance_Use_Resource_Center/Home.aspx

References

1. Chesher, Tessa (2023) OKCAPMAP Provider Education Substance Use in Children and Adolescents Learning Module
2. National Institute on Drug Abuse. (n.d.). Understanding Drug Use and Addiction. National Institutes of Health. Retrieved from https://nida.nih.gov/publications/drugfacts/understanding-drug-use-addiction
3. American Addiction Centers. (2025, March 26). Alcohol and Drug Abuse Statistics (Facts About Addiction). Retrieved from https://americanaddictioncenters.org/rehab-guide/addiction-statistics-demographics
4. American Psychiatric Association. (n.d.). What is a Substance Use Disorder? Retrieved from https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder