• Abuse occurs when people mistreat or misuse other people, showing no concern for their integrity or innate worth as individuals, and in a manner that degrades their well-being.
• Abusers frequently are interested in controlling their victims and use abusive behaviors to manipulate their victims into submission or compliance with their will.
• Abuse takes on many different forms, including physical, sexual, emotional, and verbal abuse and occurs in many different contexts, including the home (domestic violence, spouse rape, incest), the workplace (sexual harassment), in institutional (elder abuse, bullying) and religious and community (hate crime) settings.
•  Abuse touches victims across the lifespan from children through elders.

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• Verbal Abuse occurs when one person uses words and body language to inappropriately criticize another person. This often involves 'putdowns' and name-calling intended to make the victim feel they are not worthy of love or respect, and that they do not have ability or talent. This type is dangerous because it is often not easily recognized as abuse, and therefore it can go on for extended periods, causing severe damage to victim's self-esteem and self-worth.
•  Psychological Abuse (also known as mental abuse or emotional abuse) occurs when one person controls information available to another person so as to manipulate that person's sense of reality; what is acceptable and what is not acceptable. This often involves strong emotionally manipulative content designed to force the victim to comply with the abuser's wishes.
• Physical Abuse occurs when one person uses physical pain or threat of physical force to intimidate another person. Actual physical abuse may involve simple slaps or pushes, or it may involve a full on physical beating complete with punching, kicking, hair pulling, scratching, and damage in some cases that requires hospitalization.
• Sexual Abuse of children or adults includes any sort of unwanted sexual contact perpetrated on a victim by an abuser. Molestation, incest, inappropriate touching (with or without intercourse), and partner or date rape are all examples of this. Sexual abuse is often coupled with physical abuse (or threat of physical abuse) and emotional abuse.
• Neglect occurs when a person fails to provide for the basic needs of one or more dependent victims he or she is responsible for. Basic needs include adequate and appropriate food, shelter, clothing, hygiene, and love or care.
• Hate Crimes are a type of abuse that involve verbal, physical, emotional, or sexual abuse toward an individual or a group of individuals based solely on some characteristic they may share in common, such as their religious or sexual affiliations or the color of their skin.

 
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• A great deal of verbal, physical, emotional, and sexual abuse and neglect takes place in the home within the context of the intimate relationships between family members.
• Abuse between relationship partners is sometimes referred to as "partner abuse", "domestic violence", "relationship violence", or "family violence".
• Partner abuse may take many forms including destruction of property, psychological and emotional abuse, and physical and sexual assault.
• On the milder, but still quite serious side, domestic abusers threaten victims, use verbal put-downs and derogatory names, attempt to publicly humiliate them, and play manipulative mind games.
• Abusers may attempt to limit their victim's access to family, friends or employment so as to keep them under better control and away from people that could see what is going on.
• Child and elder abuse also occur in the home and include verbal, physical, and sexual abuse. Another form of abuse that children and elders may be subject to is neglect, which occurs when they are not provided with adequate amounts of food, shelter, and clothing, or are not given proper attention and supervision.

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• Abuse is not the easiest thing in the world to recognize, even if it is happening to you directly.
• Not everyone who is being abused understands that what they are experiencing is abuse.
• You may recognize that something isn't right about how you are being treated, but may be afraid to speak up and name it as abuse for fear of retribution from your abuser.
• The following list describes various interactions that people might have that are examples of abuse. If one or more of these things is happening to you, there is very good chance that you are being abused.
• Being physically, sexually, or emotionally hurt and/or violated by your partner on a regular basis.
• Being called hurtful names and/or being put down by partner on a regular basis.
• Being controlled by your partner. For instance, if your partner tells you that you are not allowed to have friends, leave the house without permission, or tells you that you are not allowed to pursue your own goals, such as attending school or finding work.
• Becoming more withdrawn so that you do not spend much time with others who may clue in to the fact that abuse is happening to you.
• Finding yourself making excuses for partner?s bad and harmful behavior (perhaps so that you won't have to accept the fact that abuse is happening).
• Recognizing that your relationship has a pattern or cycle in which something abusive occurs, you tell partner that you will not tolerate the abuse anymore, but then forgiving your partner when he or she apologizes.
• Blaming yourself for bad things your partner has done to you. For example, telling yourself that you are really difficult to live with so you deserve to be hit.
• Feeling trapped in your own home and being fearful when you know partner is coming home.

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• If you are a third party to a potentially abusive situation (suspected child abuse, domestic abuse or elder abuse), it may be difficult to know if abuse is happening in any direct manner.
• You might need to rely on circumstantial evidence to identify the abuse.
• The following list suggests things to look for that could be indicative of abuse.
• There are physical signs of injury, such as bruises, sores, burns, cuts, or black eyes and such injuries may be hidden, for example, behind sunglasses or with clothing.
• The victim makes unrealistic excuses for injuries or absences ("I fell down the stairs.").
• The victim displays personality changes, such as becoming angry, depressed, moody, or defensive, or becomes withdrawn, or suddenly fearful.
• The victim has difficulty sleeping at night, or may display excessive tiredness, which can be a symptom of depression.
• The victim's self-esteem lowers.
• The victim is distracted and has difficulty concentrating.
• The victim neglects hygiene (becomes smelly, goes unwashed; may be an attempt to ward off a sexual predator if a child, or as a consequence of depression).
• The victim complains of pain in the genital region (more common in children).
• For older children and adults, the victim 'acts out', becoming sexually promiscuous, and/or using drugs.
• Elders may display confusion.

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• Some abusers learned to abuse from their parents. Their early history consisted of receiving abuse themselves and/or seeing others abused (one parent abusing the other or their sibling, etc.). As a consequence, abuse is the normal condition of life.
• The opposite of being a victim is not simply opting out of abuse; it is instead, to be abusive. Given the choice between being the out-of-control victim, or the in-control abuser, some people grow up to prefer the role of the abuser.
• Abusive behavior can also result from mental health issues. For example, someone with anger management issues, a diagnosis of intermittent explosive disorder, or a drinking or drug problem may easily get out of control during arguments and verbally or physically strike out at their partners and dependents.
• Some abusers cannot or will not relate to other people as people, choosing instead to treat them as objects and as though they were there solely for their convenience and do not otherwise have an independent, important life.
• Some people may abuse because of the benefits they receive from doing so, for instance, sexual or financial gratification, or the simple allure of power over other people's lives.

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• Some abused people feel they cannot leave their relationships because they are economically dependent on them, such as the case of a stay-at-home mother who may feel that she cannot leave because if she did, she would have no way of providing for her children.
• Other abused people stay because they believe that is the proper thing to do given their religious or cultural background. They may be motivated to put up with a lot of spousal abuse because the alternative is to go against the teachings of their faith.
• Still other abused people may rationalize staying because they think it is the right thing to do for their children.
• In a typical instance of domestic abuse, abuse tends to occur periodically or cyclically, rather than all the time. Shortly after the abusive event occurs, the abuser frequently expresses remorse or guilt and wants to apologize. The abuser will swear, "It will never happen again" and may shower the victim with gifts and demands that the victim forgive him or her.  Following the guilt and making up stage comes a "honeymoon" period during which things are good for a while between the partners. In this context, victims often rationalize that they aren't really being abused, that their partner really loves them despite being abusive and that makes it okay, that the abuse really isn't all that bad, and other similar statements.
• Victims may also have any number of low-self-esteem type beliefs that also keep them paralyzed and willing to accept something that is merely "good enough."
• Finally, victims that do try to break away from abusive partners may find that abuse escalates to dangerous proportions with the partner stalking them, beating them severely, or otherwise attempting to control their ability to exit the relationship, even with threats of killing themselves if the victim leaves.

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• Knowing that abuse is taking place is an important first step in dealing with abuse, because it focuses attention on the problem.
• Get clear on what abuse is and isn't.
• Stop rationalizing that abusive treatment of others is acceptable. Abuse is NEVER healthy or acceptable regardless of the messages you may have been taught or witnessed in the past.
• If a substance abuse disorder is present, get sober through the help of rehabilitation programs, twelve step programs, counseling or similar resources.
• Get professional help immediately to deal with your anger issues, poor parenting skills, poor boundaries and personal relationship strategies.

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• The first thing to do is to determine whether your situation is life threatening or if you have the luxury of time to plan a careful exit. If your situation is life threatening, just pack a bag and leave immediately. Do whatever you have to do to remove yourself from the situation.
• If you have the luxury of time, spend some time developing a careful and realistic plan that details how you will get away from your abusive situation and into a better one.
• Learn what abuse is and isn't, and what your legal rights are with regard to abuse. Contacting a lawyer is a good idea if you can afford that. If you can't, contacting a domestic violence shelter worker or social worker familiar with domestic violence and abuse is also helpful.
• Locate and contact domestic violence shelters in your area.
• If children are involved, consider getting your state's Child Protective Services involved by making an abuse report.
• Call the police whenever abuse is threatened or seems likely.  There are several reasons for doing this including that the police can help keep you safe, they will document that abuse is happening, and they can help you get a restraining order.
• Get yourself or your children a medical exam to document any injuries resulting from abuse and to receive treatment for those injuries.
• Seek out counseling services with a therapist who specializes in areas of abuse to help you deal with your conflicted feelings about leaving and to help you find community resources and to help you generate your plan to leave.
• Make a step-by-step plan that details how you will care for yourself when you leave the abusive situation.
• When your plan is defined and you've worked out the details of how you will manage, put that plan into action and separate yourself from your abusive partner.

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• Call the police first thing and report your assault. Get them to document what has happened to you. You can also report the assault later on, if you aren't comfortable doing so first thing, but it is best to do it sooner rather than later, if you can manage.
• Go to the hospital as soon as you possibly can and tell them you have been assaulted. If you have been raped, ask them to do a rape examination. If you think you may have been drugged, for example with Rohypnol, ask them to test your urine. Don't bathe, brush your teeth or do anything to change your condition no matter how bad you look.
• As soon as possible, document what has happened to you in your own words.
• Get to a safe place and stay there. If you can't get to a safe place, try to make where you are safer by asking someone safe to come and stay with you for a while.
• Know that it wasn't your fault that you were assaulted.
• Understand that you can expect to be shaken up for weeks or months after the assault. It takes time to heal from rape and assault.
• Rape and assault can be psychologically traumatizing, and post-traumatic stress disorder (PTSD) is a possibility. If you find that you are not recovering from the rape or assault, seek professional mental health assistance.

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• You can report the abuse to the police or the relevant government agency.
• Encourage the victim to seek help from the police, a lawyer, the courts, or an abuse shelter.
• You can listen to the victim and be a shoulder for them to vent upon. Talk with them and help them understand the nature of what abuse is and that it is happening to them. They may be in denial and not realize that what they're experiencing is not safe or normal or necessary.
• You can offer support and assistance in helping the victim to make a plan for exiting the abuse. Give them numbers for local resources like domestic violence shelters, and help them to learn how to file a restraining order with the local court.
• Resist the urge to pass angry judgment, as this may turn the victim away from confiding in you. However, do feel free to label abuse as abuse and to encourage the victim to seek out help.

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• Take the time to learn what abuse is and isn't, so that you immediately recognize abuse if it occurs to you or someone close to you.
• If you have a tendency to be passive in relationships with others, you can learn to be more assertive, particularly in communicating your boundaries and what is acceptable and not acceptable to you.
• If you have a tendency to be very assertive with others, you may want to consult with others you trust to make sure you are not regularly and unconsciously crossing over the line from assertiveness into abuse.
• If you are a parent, you should teach your child in age-appropriate ways to identify what abuse is and isn't, how to avoid circumstances that might lead to abuse, the difference between appropriate and inappropriate touching, and that they should always talk to you even if someone threatens them or says they shouldn't.
• If you are dating, use the buddy system, be wary and do not take unnecessary risks, such as going home with strangers or meeting them in a non-public place, and tell someone at home where you are going and when you will be back.

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• Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition associated with several characteristic symptoms including distractibility, poor impulse control, forgetfulness, inattention, hyperactivity, and impulsivity that is beyond what is normal or average for a given age.
• Usually, ADHD is first identified during childhood; but, it often persists into adulthood.
• Although adult-ADHD is more common than once believed, not all children with ADHD will become adults with ADHD.
• Symptoms of ADHD change across the lifespan.
• Although ADHD is referred to as a single disorder, there are different types.

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Common symptoms of ADHD in children include:

• Failure to pay attention or a failure to retain learned information
• Fidgeting or restless behavior
• Excessive activity or talking
• The appearance of being physically driven or compelled to constantly move
• Inability to sit quietly, even when motivated to do so
• Engaging in activity without thinking before hand
• Constantly interrupting or changing the subject
• Poor peer relationships
• Difficulty sustaining focused attention
• Distractibility
• Forgetfulness or absentmindedness
• Continual impatience
• Low frustration tolerance
• When focused attention is required, it is experienced as unpleasant
• Frequent shifts from one activity to another
• Careless or messy approach to assignments or tasks
• Failure to complete activities
• Difficulty organizing or prioritizing activities or possessions

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Common symptoms of ADHD in adults include:

• A history of poor school performance - lower grades, criticism from teachers, as well as parents, and sometimes, the need to repeat a grade.
• Career difficulties - problems with concentration and task completion that affect school performance continue to be problems in a job setting.
• Adults with ADHD will likely benefit from predictable, consistent work routines, flexible deadlines, and projects that allow for creative involvement. One surprising research finding regarding this group is that they appear to be more likely to own their own small business.
• As a result of various ongoing problems, adults with untreated ADHD tend to have a lower socioeconomic status, and money is often a serious concern. Frequent job changes and poor job performance may leave the finances of many ADHD adults in disarray.
• Individuals with adult ADHD may appear as one of two extremes: withdrawn and antisocial, preferring to spend their time alone; or overly social and unable to easily endure even brief periods of solitude.
• Relationships of all kinds are difficult for the adult with ADHD. Impulsive comments and behaviors in combination with a notoriously short temper can cause extreme problems.

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• Despite this large body of research, the specific cause of this disorder remains uncertain.
• The vast majority of researchers conclude that ADHD is primarily a neurological or brain-based disorder. It is either present at birth, or it develops early on in childhood.
• Research has established that genetics play a powerful role in many behavioral symptoms.
• The estimated heritability of ADHD (i.e., the proportion of a trait that can be attributed to genetics) ranges from 75 to 91%.
• Research has determined that ADHD is actually a result of reduced brain functioning (particularly frontal lobe) and decreased levels dopamine.
• At present, there is no scientific evidence that demonstrates media exposure causes ADHD.
• Research has clearly demonstrated that nutrition and eating habits do not cause ADHD. However, that said, there are some indications that children with this disorder are metabolically different from others.

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Diagnosing ADHD in Children:

• To meet the diagnostic requirements, the symptoms must affect someone's functioning in a variety of settings (home, school, playground, extra-curricular activities, etc.).
• Clinical guidelines suggest a multistage assessment with a team of multidisciplinary professionals. This team may include teachers, healthcare providers, psychologists, and school counselors.
• The evaluation includes three main steps: 1. An assessment of academic, social, and emotional functioning; 2. Clinical interviews; and 3. A complete medical evaluation and history.
• Self-report instruments are questionnaires and checklists that identify ADHD symptoms in both children and adults.
• The initial evaluation usually begins with interviews about personal, family, and educational history. Caregivers, teachers, and child all participate.
• A psychiatric and/or medical exam is necessary to rule out other conditions that could cause similar symptoms.

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Diagnosing ADHD in Adults:

• Adults are diagnosed with ADHD using the same criteria as for children and ADHD. However, the symptoms look different in adults and children.
• ADHD is a diagnosis that requires symptoms be present before age 12. This diagnostic requirement means there must be evidence that symptoms were present before age 12.
• ADHD has symptoms shared by other disorders called, differential diagnosis; and, other disorders commonly occur in addition to ADHD called, co-occurring disorders. Teasing ADHD apart from these other disorders can be complex.
• Teasing ADHD behaviors apart from normal variations in adult behavior often requires specialized
skills.
• Cultural expectations, stereotypes, and life-long coping skills can conceal the disorder.

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Common treatments for ADHD in Childhood:

• The goal is to arrive at the best mix of treatment 'ingredients' for each individual person.
• Medication is the single most effective treatment for ADHD.
• Psychoeducation provides patients and their families essential information about a mental health condition affecting them. Its goal is to empower them to cope with their condition in an optimal manner.
• The family therapist helps the family to build and strengthen positive relationships.
• The goal of individual therapy varies according to each child. One rather universal goal is for the child to recognize, and accept ADHD-related symptoms and behaviors.
• Cognitive behavioral therapy (CBT) is a particular type of psychotherapy where therapists pay special attention to thoughts and behaviors that interfere with school, family, and social functioning.
• Skills training focuses on techniques that change the surroundings of a child to improve behavior.
• Social skills training classes are designed to improve peer relationships.
• Coaching is aimed at helping people set and achieve realistic goals.

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Common Treatments for ADHD in Adulthood:

• Research has demonstrated the most effective treatment for ADHD is a combination that includes medication, education, and skills training.
• Nearly 70% of adults with ADHD benefit from stimulant medication.
• One of the first therapeutic tasks of a clinician is to help newly diagnosed individuals understand and accept their disorder.
• ADHD coaches work with individuals to improve work and study habits, organizational abilities, relationship skills, and self-management techniques.
• Social skills training is a well-researched and effective therapeutic intervention. It is usually taught in small groups by clinicians who specialize in social skills training.
• Psychoeducation offers people the information and other resources they need to understand the causes, symptoms and, possible treatments options of a disorder.

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• Learn and utilize effective disciplinary techniques.
• Find out as much as you can about ADHD and available resources.
• Evaluate your own potential for ADHD.
• Be proactive to prevent ADHD-related accidents and injuries.
• Manage stress.
• Learn and teach the skill of self-regulation.
• Provide order and structure in the home.
• Develop routines.
• Demonstrate and teach organizational skills.
• Identify expectations, establish consistent rules, and provide clear instructions.
• Communicate and collaborate with schools.
• Express confidence in your child's abilities.
• Help children improve social skills and peer relationships.
• Avoid homework battles.
• Participate in the administration and monitoring of medications.

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• In our definition, addiction:
• Includes both substances (drugs and alcohol) and activities (such as sex and gambling).
• Leads to substantial harm.
• Is repeated involvement despite substantial harm.
• Continues because it was, or is, pleasurable and/or valuable.
• Substance addiction includes any substances that are taken into the body, which may include street drugs, nicotine, and some prescription medications when used improperly.
• An activity or process addiction includes activities such as gambling, sex, the internet, pornography, and shopping.
• As someone's addiction gets worse, that person feels "out-of-control" or "powerless" over their own behavior and despite their best intentions to remain in control, there are repeated episodes with more negative consequences.

Using data reported for 2010 by the U.S. Substance Abuse and Mental Health Services Administration shows that:

• 51.8% of the U.S. population aged 12 or older, or 131.3 million people, are current drinkers of alcohol.
• Nearly one quarter (23.1%) of the U.S. population, or 58.6 million people, aged 12 or older participated in binge drinking during past 30 days, which includes having five or more drinks at least 1 day in the 30 days prior to the survey.
• 6.7% of the U.S. population aged 12 or older, or 16.9 million people reported heavy drinking, which is binge drinking on at least 5 days in the past 30 days.
• 40.6% of young adults in the U.S. (age18 to 25) participated in binge drinking and the rate of heavy drinking was 13.6%.
• 12.0% of persons aged 12 or older drove under the influence of alcohol at least once in the past year. 8.9% of the U.S. population, or 22.1 million people, aged 12 or older would meet the diagnostic criteria for a drug or alcohol use disorder (substance use disorder).
• 23.1 million people aged 12 or older needed treatment for an alcohol or substance use disorder and of these, only 2.6 million people received treatment at a specialized addiction facility.

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• There are many costs to addictive behavior and identifying those that you are currently experiencing can help you recognize whether the costs are beginning to cause substantial harm and may signal an addiction being present. In addition to your own evaluation, try to imagine how others might rate your behavior on this list.
• Emotional costs of addiction: living with daily feelings of fear, anger, sadness, shame, guilt, paranoia, loss of pleasure, boredom, emotional instability, self-loathing (disgust with oneself), loneliness, isolation, and feelings worthlessness.
• Social costs of addiction: disruption or damage to important relationships; decreased ability or interest in forming meaningful connections with others; and limiting one's social sphere to other unhealthy, addicted persons.
• Physical and health costs of addiction: poor general health; poor personal hygiene; lowered energy and endurance; diminished enjoyment of sex or sexual dysfunction; poor sleep; and damaging the health of an unborn child (with certain types of substance use).
• Intellectual costs of addiction: loss of creative pursuits; decreased ability to solve problems; and poor memory.
• Work and productivity costs of addiction: decreased productivity in all aspects of life; missing important deadlines and failing to meet obligations; impaired ability to safely operate tools and equipment (including driving); and lost time due to accidents arising from being impaired (e.g., falling and breaking a leg).
• Financial costs of addiction: money spent on the addiction itself; money spent dealing with the consequences of addiction (healthcare costs, legal costs, etc.).
• Legal costs of addiction: direct legal costs due to involvement with an illegal drug or activity (e.g. selling drugs, child pornography); indirect legal costs because of what someone did while engaging in their addiction (DUI, bar fights, domestic violence, divorce); or did not do (failing to care for children properly).
• Lost time due to addiction: sacrificing time spent in meaningful, life enriching activities in order to engage in addictive behaviors.
• Diminished personal integrity due to addiction: as addicted people gradually lose their moral compass, they begin to disrespect the rights and needs other people. They even mistreat the people that matter to them most. This begins by failing to meet certain responsibilities, commitments, or obligations and evolves into more obvious forms of disrespect and mistreatment as addiction progresses, such as flat-out lying and deception; stealing from loved ones; and threatening these same people if their demands are not met.

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• While we do not yet know how various influences combine to form an addiction, we do know there are two basic types.
• One type of influence is biological forces, such a person's genetics.
• The second type is environmental influences, which includes people's life experiences, interpersonal relationships, and culture.
• There are many different explanations, or models, of addiction. One of these, the Bio-Psych-Social-Spiritual (BPSS) Model of addiction recognizes these different aspects of addiction are inter-related.
• Addiction is unlike many medical diseases where we can point to a certain germ or defect that caused the disease.
• Models of addiction have very practical applications and understanding the causes of addiction, can lead to effective treatments.
• The BPPS model of addiction accepts there are multiple causes and multiple solutions to addiction. In practice, it is possible to combine models or elements of models and these mergers regularly occur.

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• The Bio-Psycho-Social-Spiritual (BPSS) model of addiction says that there are 4 inter-related issues that lead to an addiction.
• The biological portion of the BPSS Model considers addiction a brain disease with biological, chemical, and genetic roots.
• We now know that certain activities, in addition to drugs or alcohol, can also be addictive (eating, sex, gambling). Addiction is a problem of brain functioning and our genetics greatly determine this. We become addicted to the chemicals our brain releases, not the substance or activity that causes this release.
• The psychological portion of the model views addiction as a learned behavior, a problem of faulty thinking, or of developmental delay. Other psychological disorders can also contribute directly or indirectly to the development of an addiction.
• The social portion of the model looks at multiple factors including the sociological forces that cause entire groups of people to be more vulnerable to addiction, the type and severity of sanctions that the society places on those that engage in addictive behavior, and the family and support system that a person has around them.
• Adding "Spirituality" to the Bio-Psycho-Social model assists some people to move beyond the physical aspects of their addiction. It is clear that the violation of deeply held beliefs and values is a significant consequence of addiction and restoring these beliefs and values becomes an important component of recovery.

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• The DSM-5 has established a group of Substance-Related Disorders including Alcohol, Cannabis or marijuana, Hallucinogens, Inhalants, Opioid such as heroin, Vicodin, and oxycontin, Sedatives/Hypnotics or Anxiolytics, Stimulants including cocaine and methamphetamine, and Tobacco.
• Regardless of the particular substance, the diagnosis of a substance use disorder is based upon a pathological set of behaviors related to the use of that substance that fall into four main categories including impaired control, social impairment, risky use, and tolerance and withdrawal.
• Impaired control includes 1) Using for longer periods of time than intended, or using larger amounts than intended; 2) Wanting to reduce use, yet being unable to do so; 3) Spending excessive time getting/using/recovering from the drug use; or 4) Cravings that are so intense it is difficult to think about anything else.
• Social impairment may occur when people continue to use despite problems with work, school or family/social obligations, despite having interpersonal problems because of the substance use and important and meaningful social and recreational activities may be given up or reduced because of substance use.
• Addiction may be indicated when someone repeatedly uses substances in physically dangerous situations and other risky situation. For instance, using alcohol or other drugs while operating machinery or driving a car, or continuing to use even though they are aware it is causing or worsening physical and psychological problems, such as the person who continues to smoke cigarettes despite having a respiratory disorder such as asthma.
• Tolerance occurs when people need to increase the amount of a substance to achieve the same desired effect.
• Withdrawal is the body's response to the abrupt stopping of a drug, once the body has developed a tolerance to it. These very unpleasant and sometimes fatal symptoms are specific to each drug.

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• Alcohol Use Disorder - Alcohol is the most widely used (and overused) drug in the United States. For more information
• Cannabis-Related Disorder - the more commonly used word for cannabis is marijuana. Other names are pot, hash, weed, Buddha grass, dope, ganga, herb, and reefer. Marijuana is the most commonly used illegal substance. For more information
• Hallucinogen-Related Disorder - Hallucinogens include a wide variety of substances, including LSD (also called acid), morning glory seeds, mescaline, mushrooms, and ecstasy. These substances create a high and have effects that cause visual and auditory perceptual distortions. For more information
• Inhalant Use Disorder - Inhalants refer to a wide variety of household products, such as glue, gasoline, paint thinners, cleaners, and various aerosols, which contain hydrocarbons that produce vapors. Intoxication occurs by inhaling these vapors, through a process known commonly as huffing. For more information
• Opioid-Related Disorder - The most common opioids are opium, morphine, heroin, codeine, methadone, oxycodone, and Vicodin. For more information
• Sedative, Hypnotic, or Anxiolytic Use Disorder - This class of drugs include sedatives, such as Valium, Librium, Ativan, Klonopin, Rohypnol, Barbiturates, such as Amytal, Nembutal, Seconal, Phenobarbital, and other antianxiety and sleeping medications. For more information
• Stimulant/Amphetamine Use Disorder - The most commonly known drug in this class is methamphetamine or "crystal meth" (also known as crank). For more information
• Tobacco-Related Disorder - Cigarettes are by far the most commonly used tobacco product. For more information
• Gambling Addiction - Gambling addiction occurs when an individual continues to gamble despite negative consequences. For more information
• Sexual Addiction and Pornography Addiction - Sexual activity, like alcohol, drugs, and gambling, increases levels of dopamine in the brain, which is the primary neurotransmitter in the brain's reward system. For more information
• Internet Gaming Addiction - The DSM-5 does not currently recognize Internet gaming disorder as an official diagnosis, but has proposed it for future consideration and further study. For more information

• Natural recovery is recovery that occurs without treatment or support groups. For more information
• Biological approaches to addiction treatment attempt to correct or modify the presumed underlying faulty brain chemistry. Medications can make recovery efforts more comfortable, and make addiction less rewarding. For more information
• Psychological approaches to addiction recovery aim to increase a person's motivation for change by helping them to accurately determine the costs and benefits of their addiction. For more information
• There is the social support approach to addictions recovery, which capitalizes upon the benefits of social support through groups that meet to discuss their hopes, disappointments, successes, and failures. For more information

• Prepare for a personal marathon (not a sprint) - You don't need to be perfect, or re-set the clock every time you slip.
• Determine whether you just need to work on an addiction problem, or whether you also need to address other life problems.
• Make a beginning plan with a few small and easily accomplished steps, not a huge master plan.
• Keep records - Find something truly meaningful that supports recovery and count it or measure it.
• Expect that the transition period is usually the most difficult and that it will end.
• Remain focused on the reasons you are making this change.
• Remember the three fundamental facts about craving - they are time-limited, will not harm you and cannot force you to use.
• Get private (anonymous) input if you need it.
• Devote your time and attention to the two great pleasures of life: love and meaningful work (in that order).
• Involve some other trustworthy people in your project.
• Check out a few therapists, and/or check out a few support groups.
• Keep at it and Re-cycle through these actions.
• Be creative and approach your addiction problems from a fresh perspective.
• More treatment is the backup plan.

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• Anxiety is a human emotion that everyone experiences.
• Anxiety is a complex, individual experience that is produced by multiple causes and is expressed by a diverse set of symptoms, including physical, emotional, behavioral, and cognitive ones.
• People differ in how often, and how intensely, they experience anxiety.
• A normal degree of anxiety is part of the everyday human experience, but sometimes people may experience anxiety to such a heightened degree that it causes them great distress.
• Abnormal anxiety is a chronic condition that impairs a person's functioning and interferes with his/her well-being.

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• Anxiety can produce physical, behavioral, emotional, cognitive and psychological symptoms. Common physical symptoms include a feeling of restlessness, feeling "keyed up," or "on-edge;", shortness of breath, or a feeling of choking, sweaty palms, a racing heart, muscle tension, nausea, feeling faint or shaky and sleep disturbances.
• Behavioral symptoms of anxiety refer to what people do (or don't do) when they are anxious. Typical behavioral responses to anxiety may include avoidance, such as avoiding social situations or taking the stairs instead of an elevator, escaping behaviors, such as excessive drinking or drug use; or limiting the amount and scope of daily behaviors and activities to feel safe.
• Emotional symptoms of anxiety include distress, apprehension, dread, nervousness, feeling overwhelmed, panic, worry, jumpiness or edginess.
• The thoughts people experience when anxious are commonly referred to as worry. Although the content of the thoughts may vary depending on the person and situation, common themes include "What if _ happens?" or "I can't possibly tolerate not knowing_" or "I am going crazy" or "What's happening to me?"
• Psychological symptoms of anxiety may include problems with concentration, or difficulty with staying on task; memory difficulties; and, depressive symptoms such as hopelessness, a lack of energy, and a poor appetite.

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• The biopsychosocial model suggests that the causes of anxiety can be roughly categorized into three main groups: 1. biological causes, 2. psychological causes, and 3. environmental or social causes.
• The biological category refers to the body's physiological, adaptive responses to fear. It also refers to genetic traits, and the brain functioning that we inherit.
• The biological model involves 6 systems in the body including the nervous system (including the brain), the cardiovascular, respiratory, digestive, excretory, and endocrine system.
• Biological causes also include the "fight or flight" response where when we are in the presence of an immediate danger, our bodies will automatically begin to prepare us to either attack the threat (fight) or to escape from the danger (flight). A person's heart begins to beat very fast and this increased blood flow ensures extra oxygen is delivered to the muscles to prepare for that fighting or flight.
• The psychological factors refer to our thoughts, beliefs, and perceptions about our experiences, our environment, and ourselves.
• Research has identified four important variables that predict a psychological vulnerability to anxiety. These are perceived control (our ability to control a potentially stressful event), cognitive appraisals (the way we evaluate and assess a particular environmental event or situation), cognitive beliefs (our core beliefs about ourselves, and the world around us), and cognitive distortions (errors we make in our thinking).
• Environment refers to our life experiences, particularly social interactions with other people, especially caregivers, family members, etc.

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• According to the National Institute of Mental Health (NIMH, 2008), approximately 40 million American adults (about 18%) have an anxiety disorder in a given year.
• On average, the first episode occurs before a person is 21.5 years old.
• Both adults and children can be diagnosed with Anxiety Disorders, although some disorders are more common in one group than the other.
• Many of these disorders develop during childhood, and persist into adulthood when left untreated.
• While both adults and children may experience anxiety, children may display different symptoms and may also describe their symptoms differently.
• In order to be diagnosed with an anxiety disorder, the criteria require that symptoms must cause a person significant distress or problems in their functioning.

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• Panic attacks are a specific, common symptom of many anxiety disorders.
• Panic attacks are sudden, extreme feelings of fear and/or discomfort lasting for a distinct period of time. This sudden surge peaks in intensity within a few minutes, at which point it begins subside.
• There is often a sense of doom and gloom and a powerful desire to escape.
• Common symptoms include palpitations and/or pounding heart; sweating; trembling or shaking; chest pain or discomfort; feeling dizzy; numbness or tingling sensations; hot flashes or chills; fear of losing control or "going crazy" or a fear of dying.
• Panic attacks are a false alarm that triggers the "fight or flight" response system.
• There are 2 types of panic attacks - uncued and cued.
• Unexpected, or uncued, panic attacks seem to come from "out of the blue." They do not have an identifiable source that sets them off. It is believed these occur in response to some kind of life stress. They are found in Panic Disorder.
• Expected, or cued, panic attacks are attacks with an obvious trigger. They occur when a person is exposed to certain situations or objects where panic attacks have happened before. The onset is sudden and occurs immediately upon exposure to the situation or object.
• Cued panic attacks are found in Social Anxiety Disorder, specific Phobias, and agoraphobia.
• Panic disorder is characterized by uncued (unexpected) panic attacks.
• In order to be diagnosed with Panic Disorder, a person must experience repeated, unexpected (uncued) panic attacks and be followed by constant concerns about having more attacks; worrying about the consequences of the attacks; or significantly changing behavior to avoid the attacks. These worries and concerns about experiencing another attack must continue for a month or longer for a diagnosis of Panic Disorder.

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• Separation Anxiety Disorder is characterized by a developmentally inappropriate and excessive fear of becoming separated from a primary attachment figure. For more information about Symptoms and Treatments  
• Selective Mutism occurs when a child or adult persistently refuses to speak in specific situations where speaking is expected. For more information about Symptoms and Treatments  
• Agoraphobia is characterized by an intense fear or anxiety that occurs when someone is faced with a situation that is difficult or embarrassing to leave, or where help would be unavailable if they were to experience panic-like symptoms, such as becoming dizzy or disoriented. For more information about  Symptoms and Treatments
• Specific phobia is the intense fear, anxiety, and avoidance of a specific object or situation, such as flying, heights, getting a shot, or being near animals. For more information about Symptoms and Treatments  
• Social phobia, or Social Anxiety Disorder, is the intense fear, anxiety, and avoidance of social situations where there is the potential of being negatively judged by others. For more information about Symptoms and Treatments  
• People with Generalized Anxiety Disorder (GAD) have uncontrollable, excessive anxiety and excessive worry. For more information about Symptoms and Treatments  

• Anxiety disorders are one of the most treatable psychiatric conditions.
• Research consistently finds that cognitive behavioral therapy (CBT) is the most effective treatment strategy for treating a variety of conditions including anxiety disorders.
• Supportive psychotherapy (often thought of as "talk therapy") and psychodynamic or psychoanalytic therapy tends to be ineffective for anxiety disorders.
• A common type of behavioral therapy used in the treatment of Anxiety Disorders is called exposure and response prevention therapy (ERP). Exposure means facing or confronting one's fears repeatedly until the fear subsides. Response prevention means not engaging in avoidance or escape behaviors when faced with a feared situation.
• Acceptance and Commitment Therapy (ACT) recognizes that words (and the thoughts formed with words) have individual and unique meanings. Because language allows us to attribute meaning to thoughts, it is possible for us to allow thoughts to enter our minds without giving them importance. ACT teaches people how to accept their emotional distress.
• Dialectical behavior therapy (DBT) teaches participants skills that enable them to: 1) better regulate their intense emotions; 2) become more effective in their interpersonal relationships; 3) improve their ability to cope with emotional crises; and, 4) decrease their reliance on unhealthy coping behaviors such as substance abuse, self-injury, and suicidal behaviors. Dialectical behavior therapy may be beneficial for persons who are reluctant to engage in exposure and response prevention therapy (ERP).

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• Historically and still today, conventional married couples are considered the best candidates for becoming adoptive parents.
• Partners who are not formally married have a harder time adopting and when this is allowed at all in the United States, the states consider the adoption to be valid for only one of the partners, who is essentially adopting as a single parent.
• It is now possible for single people to adopt a child in the United States, although it is still much more difficult to be approved than it is for a married couple.
• Gay and lesbian singles or couples will generally face many challenges in the adoption process.
• For all adoptive parents, agencies set minimum age requirements for adoption, (25 years of age or older), and many have maximum age requirements (45 or 50 years of age or younger).
• When considering a married couple, the agency may also look at the age of each partner and the age difference between the two.
• International adoptions may also have age restrictions or requirements as well.
• Adoption application procedures include a thorough background check and any past legal or financial issues that show up may restrict an adoption from taking place.
• Certain medical or psychological conditions can also negatively affect the status of an adoption application.

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• The process begins when a couple or single person decides to adopt a child.
• They contact an adoption agency and fill out an application, which requires a great deal of information regarding details of the couple's life, including legal and financial details.
• The couple will then have some time to consider what they are looking for in a child and how they will pay for the adoption process, which can be quite expensive.
• The agency may provide a gallery of images of available children, or they may require the application process be completed before any matching of adoption candidates with children can take place.
• As part of the application, the agency will also require a home study, which involves a social worker coming out to the couple's home and reporting to the agency on what is found.
• After some time passes, the couple's application materials are processed and approved (or denied).
• At that time, the couple will have the opportunity either to select a child or to be matched with a child.
• If a child meeting the applicant couple's criteria is not available, which is likely in a domestic adoption situation, the couple will have to wait until a child becomes available.
• Even if a child is available, there will likely be additional administrative hoops to jump through before an adoption is finalized.
• A significant amount of time will likely go by before it is possible for the adoptive couple to take their child home.
• If the adoption is taking place internationally, one or more extended visits to the international country may be required.
• If the adoption is domestic and open in nature, the adoptive parents will be introduced to the birth parent (or parents).
• Eventually, all the necessary papers are signed and more fees are paid.
• The adoption goes to court and a judge signs off on the adoption, making it permanent.
• The entire process may take as little as six to nine months, or as long as two years or more.

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• A private-agency domestic adoption will generally cost anywhere from $7,500 to $15,000.
• Up-front costs generally include application and other fees (background checks, etc.) with the bulk of the money being due when placement occurs.
• In addition to the agency costs, lawyer fees can range anywhere from $500 up to $10,000 or more, depending on how involved the lawyer is in the adoption process.
• Finally, the birth mother's medical costs or other expenses may need to be negotiated.
• State-arranged adoptions are much cheaper than agency adoptions and will usually only require court fees, out-of-state adoption fees (if relevant) and possible home study costs, which are sometimes by the state. An adoption of this type may cost anywhere between a few hundred to several thousand dollars to complete.
• Fees vary widely for international adoptions depending on the country and agency chosen, but typically range from $7,000-$30,000.
• Extra costs associated with international adoption vs. domestic adoption include the cost of multiple non-optional extended trips to the adoption country, and/or the hiring of a native-speaking proxy (a lawyer or agent) to act on the adoptive parents' behalf within the adoption country.
• The standard costs of an adoption (administrative fees, home study costs, etc.) also apply to an international adoption.

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• Closed adoptions occur when adoptive parents and birth parents have no contact with one another, never meeting or gaining information about each other.
• The birth parents surrender the child to an adoption agency and never learn who adopts the child.
• All records identifying the birth parents are then sealed by the court and not disclosed to the adoptive parents or to the adopted child.
• Semi-open adoptions occur when birth parents are given some say in determining which parents will have the opportunity to raise their child.
• They are presented with profiles of potential adoptive families and have the opportunity to read them and choose the family they believe has the most to offer the child.
• Open adoption occurs when birth and adoptive parents' contact information is shared with one another and there are no barriers preventing contact between the parties, either before the adoption is finalized or afterwards.
• If the birth mother has not yet given birth, the adoptive parents may be invited to participate in preparations for labor and delivery.
• Following the adoption, some form of regular contact is established between the birth parent and the adoptive family.

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• Domestic adoptions occur when both sets of parents live in the same country, while international adoptions occur when the birth parents live in one country and the adoptive parents live in another.
• Domestic adoption agencies generally are able to provide more detailed and accurate information about birth parents' medical information and are also better able to provide the option of an open or semi-open adoption than are international agencies.
• People may choose to adopt domestically because it is the best way to adopt a newborn or young infant.
• If a family pursues an international adoption of an infant, the child will most likely be several months old at best, and possibly over a year old or more, before the child is permitted to travel to the new home.
• Many adoptive parents do not desire any contact with birth parents and like the fact that most international adoptions are closed in nature.
• Others like the humanitarian payoff of knowing that by choosing to adopt a child internationally, a child can be removed from harmful or poverty level situations - although the same could be said for many domestic adoptions.
• The way that most international adoptions are conducted also minimizes the risk that a child could be offered to prospective parents and then withdrawn because the birth parents have already transferred their parental rights to a third-party adoption agency or orphanage before the adoptive parents get involved.

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• Very young children should be told about their adoption in simple terms that convey how much they were loved by their birth parents and by their adoptive parents.
• As the child matures, the story will need to have details added to answer additional questions that the child may have concerning the circumstances of the adoption as his or her understanding grows.
• Older children may wonder why their birth parents couldn't take care of them, and may believe that they were rejected because they were bad.
• Adoptive parents can help their child work thorough feelings of rejection by their birth parents by helping the child to see that there are many reasons why some people are not able to be good parents when a child is born and that these reasons don't have anything to do with the child, but rather with the birth parents.
• The most important thing a parent can do to help their child work through such hurt feelings is to remain calm and be a good listener.
• If the adoption is a completely open one, then the child will obviously need to be told that the person who is visiting or sending cards and letters is his or her birth parent.
• When the adoption is completely closed, the birth parents will not be in the child's life at all, which may lead to additional issues that need to be addressed.
• It is important to realize that some children may feel unsafe at the prospect of discussing birth parent issues for fear of upsetting their adoptive parents.

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• It is often hard for birthmothers to tell friends and family about their decision to adopt out their child.
• This is particularly hard when your extended family is against the idea of adoption and makes suggestions about how the family can accommodate a new child or makes pleas to not give a part of the family away.
• While family opinions and ideas should be seriously considered, it is ultimately you, as the mother, who must make the final decision about what is best for yourself and your child, even if that means going against the wishes of your family.
• Once you give the family time and opportunity to adjust to your decision, you can then use them as support while you go through the adoption process.
• You should also recognize that just as you will need to deal with grief and loss issues surrounding the adoption, your extended family may also need time and space to go through their own grieving process.
• You may choose to keep a pregnancy journal to be given to the adoptive parents to someday share with the child and can allow your family to participate in the journaling as well.

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• "Cognition" is a word that mental health professionals use to describe the wide range of mental actions that we rely on every day. Cognition involves many different skills, including:
• perception (taking in information from our senses)
• memory
• learning
• judgment
• abstract reasoning (thinking about things that aren't directly in front of us)
• problem solving
• using language
• planning.
• Damage to any part of the brain can result in cognitive problems.
• Most mental health professionals now believe that the majority of mental disorders (if not all of them) are caused or influenced by brain chemistry or another medical issue that affects how the brain functions.

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• There are many other possible causes and types of cognitive disorders.
• It would take an entire book to list all the possible causes of cognitive disorders and the causes of what is often referred to as cognitive dysfunction.
• Cognitive dysfunction is a change in thinking like the changes that happen in cognitive disorders but is not a diagnosable disorder like dementia.
• Some of the major causes of cognitive disorders/dysfunction include:
• Genes: Genetic influences appear to play a role in many different cognitive disorders.
• Head Injury: Head injuries can produce significant cognitive dysfunction. They can be a source of disorders like dementia or amnesia.
• Diseases and Infections: There are many bacteria, viruses, and disease conditions that can affect the brain and lead to cognitive dysfunction or a cognitive disorder.
• Brain Tumors: Tumors that happen in the brain or in the coverings of the brain can affect the area of the brain where they are located.
• Exposure to Toxic Substances: There are many substances that can affect the functioning of the brain and lead to cognitive disorders or cognitive dysfunction.
• Malnutrition or other Lifestyle Factors: Not eating properly, getting sufficient exercise, or other factors associated with the person's lifestyle can lead to the development of a cognitive disorder.

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• There are many conditions that can result in a person developing a neurocognitive disorder. Some of these conditions can be reversed and others cannot be reversed currently.
• Dementia is a term that refers to a gradual or sudden loss of a person's cognitive abilities. Some of these conditions can be reversed fully or partially.
• Some examples of forms of dementia that are not reversible currently include:
• Alzheimer's disease.
• Lewy body dementia.
• Dementia associated with Huntington's disease.
• Frontotemporal dementia.
• The dementia associated with an HIV infection
• Some conditions that can produce neurocognitive disorders that may be reversed are:
• Depression
• Other neurocognitive disorders that are the result of emotional factors
• Certain forms of delirium
• Neurocognitive disorders associated with a vascular problem
• Neurocognitive disorders associated with a head injury
• Neurocognitive disorders associated with the use of drugs or medications

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• Dementia is not a specific disease itself.
• It is an overall term used to describe the symptoms and the effects of symptoms that happen because of certain types of diseases or medical conditions.
• Dementia happens when areas of the brain that are involved in functions such as learning, memory, language, and making decisions are affected by a disease, an infection, or some type of medical condition.
• The results of these conditions significantly interfere with the person's ability to function.
• Alzheimer's disease is a form or type of dementia.
• People that develop dementia may have difficulty with:
• Learning new information or recalling (remembering) information.
• Problems with attention and concentration.
• Expressing themselves verbally.
• Understanding spoken or written language.
• Making decisions.
• Understanding how objects in the environment are related to one another.
• Orientation such as not being able to remember the month, year, or where they are.
• Emotional functioning such as having issues with severe depression or anxiety.
• The most common type of dementia is Alzheimer's disease, but there are many other known causes of dementia. Other relatively common forms of dementia are Vascular dementia, Dementia with Lewy Bodies, Mixed dementias, reversible types of dementia.
• Other types of dementia account for a very small proportion of all types of dementia. These conditions include the dementia associated with HIV/AIDS, Parkinson's disease, frontotemporal dementia, and many other conditions.

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• Alzheimer's Disease is the most frequent cause of dementia and is not a normal part of aging or "just what happens when we get old."
• There are several differences between normal aging and Alzheimer's Disease:
• Memory Changes - Changes in memory are the main features that happen in people with Alzheimer's disease.
• Language Abilities - In the early stages of Alzheimer's disease, people may develop problems with language comprehension. This means that they have trouble understanding spoken words and sentences. This often first appears as difficulty following instructions from others.
• Problem Solving - Another area that is severely affected in the early stages of Alzheimer's disease is the person's ability to solve problems and make decisions. At first, the person may have trouble solving problems such as calculating how much they owe at the grocery store or paying their bills. Later, even simple decisions such as how to open a can of soup can become an issue.
• Self-care and Other Areas: As the disease continues to get worse the mental changes that happen in the person may cause them to have issues caring for themselves. This might include remembering to bathe, how to dress themselves, and take care of their basic needs. Other mental abilities can also be affected.
• The organization, Alzheimer's Disease International, suggests that overall Alzheimer's disease accounts for 70%-75% of all dementia cases.
• In industrialized nations the diagnosis of dementia ranges from between 5% - 10% in individuals in their 70s. This risk increases significantly as people age with most sources reporting a sharp increase for every decade after the age of 65.
• Researchers report that the development of any form of dementia is due to the interaction of many factors. Thus, as a person gets older there must be other factors that interact with the aging process that result in an increase in the chance to develop Alzheimer's disease or other forms of dementia.

For more information on Alzheimer's Diease
For more information on causes
For more information on diagnostic criteria
For more information on warning signs
For more information on how it is diagnosed
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• Research does suggest that there may be several activities that most people can engage in that will either significantly decrease the risk that they will develop Alzheimer's disease or will delay the onset of the disorder.
• These options are often referred to as protective factors or behaviors.
• Staying Active: Research has consistently reported that remaining active is an important protective factor for many different diseases and conditions that may happen as one gets older. The research has also shown that staying physically active is a very powerful protective factor against age-related diseases and conditions.
• Getting Good Nutrition: Research has also indicated that good nutritional practices are important preventive factors that can help protect someone against age-related diseases and disorders like Alzheimer's disease.
• Staying connected with others: Continuing to participate in activities with other people is an important protective factor against all sorts of physical and mental age-related problems. People can significantly decrease the risk of developing disorders like Alzheimer's disease and other dementias by doing things like attending talks or lectures, going to church, playing cards, or just being with other people and interacting with them.
• Continuing to get regular medical checkups: It is extremely important for older people to make sure that they are up-to-date on all their medical checkups. They also need to continue to follow the instructions of their doctor regarding any medications or the treatment for any conditions. This includes regular dental checkups.

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• Do not be afraid to ask for advice from your doctor regarding how to handle this new situation.
• Confide in family and friends and explain the situation to them as soon as possible.
• If possible, have family and close friends meet with a doctor and the treatment providers to discuss the situation and potential approaches/coping methods that everyone can work together on.
• Consider joining a support group.
• Get treatment for emotional responses such as the start of depression or anxiety.
• Start a journal to record your reactions, thoughts, feelings, etc.
• Make use of strategies that can aid you.
• Change your diet, so that you are eating less junk food, less salt, less carbs, fewer fatty foods, etc. Try to eliminate any use of alcohol except for an occasional alcoholic beverage. Eating healthy can make you feel better.
• Discuss your use of caffeine with your doctor.
• Stay as active as possible.
• For people who are still working, it may be a good idea to discuss the situation with your supervisors to prepare for the future.
• Stay updated on your treatment.
• Organize your life to make it as simple and routine as possible.
• Make sure to plan for the future. If you have not already assigned a legal guardian or power of attorney, this is the time to do that while you can still make these decisions without significant difficulty.
• Make sure that you always carry identification on you. Getting an identification bracelet with an emergency contact number is a good idea for anyone.
• Don't give in no matter how difficult it seems.

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• Do your best to understand dementia. Ask questions of treatment providers, read material, and make sure that you understand the basics about dementia.
• Do your best to understand caregiving. Read books and materials on effective caregiving..
• Attend to your personal needs in the same way and with the same manner of care that you attend to the needs of the person that you are caring for.
• Understand and learn about caregiver burnout. This way you can recognize the signs and symptoms of potential burnout and address them.
• Part of being an effective caregiver is understanding when to take control of the situation, and went to give control to someone else.
• Ensure that your expectations of the person that you are caring for are realistic.
• Work with the doctors and other healthcare workers to ensure the best care and setting for your loved one. Do not be afraid to ask questions or ask for help.
• Always immediately attend to the medical needs of the person you are caring for.
• Do not put off legal matters such as guardianship issues, power of attorney issues, etc.
• Plan to do things with the person you are caring for. Do not simply become a waitperson.
• Remember to adjust your expectations accordingly. Work with treatment providers to understand the person's level of functioning and capabilities. Be ready to change your expectations according to the level of decline that the person experiences.
• Again, when in doubt, ask for assistance. Do not be afraid to bother physicians, nurses, or other healthcare workers if you have a question about anything.

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• This category of medicine goes by many names including alternative medicine, complementary medicine, natural medicine, and integrative medicine.
• The terms describe an approach that (at times) can stand on its own as an alternative to standard medicine, and at other times is used as an add-on to standard medicine.
• It includes many different practices including acupuncture, biofeedback training, chiropractic, exercise, energy healing, herbal remedies, homeopathic treatment, hypnosis, imagery or relaxation techniques, massage therapy, nutritional/dietary advice, spiritual healing or prayer, traditional medicine (for example, Chinese or Indian medicine), meditation, vitamin therapy, and yoga.

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• While defining CAM medicine is hard, determining whether someone is a CAM practitioner is also difficult.
• Not all CAM practitioners are created equal and choosing one requires some investigative work.
• There is potential for harm from those who don't know what they are doing, who aren't aware of the harmful side effects of what they are prescribing, and who do not know about the dangers associated with the course of different illnesses.
• Most good CAM practitioners have associations with standard medical practitioners and you should make sure to ask about this when interviewing them.
• When visiting a practitioner, checking their background is essential.
• Many good CAM practitioners attend certified schools and are licensed by the state in which they live; however, other practitioners do not have such education and oversight.
• While attending a qualified school and being licensed does not necessarily guarantee that the person is honest and knowledgeable, it does amount to some measure of safety.
• If practitioners you are thinking of working with are licensed, ask to see their license and check with the state licensing board if you have any questions about the provider or their practices.
• If they are not licensed, then you should be more diligent about asking for references and training descriptions.

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• Many people associate the word "natural" with safe and think that alternative medicines must be ok, but this is often not the case.
• While most CAM therapies are safe, natural substances can have side effects and/or interfere with conventional drugs (either by strengthening or weakening their effects).
• CAM medicines have the advantage of being easily available over-the-counter without a prescription, which may lead to a false sense of security about their safety.
• Supplement quality is also a concern because there is very little oversight of supplement manufacturing companies and these companies may at times skimp on ingredients or fail to follow good manufacturing practices.
• Understanding that "natural" does not necessarily mean harmless is a good place to start.
• Checking with your health care practitioner whenever you decide to start taking a new supplement is an essential part of taking care of yourself.

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• Alternative medicines for mental disorders occupy a supportive care role, for the most part.
• However, for a few select mental disorders, there are well-researched supplements that may stand on their own and substitute for standard medicines.
• St. John's Wort for depression and Kava for anxiety are two examples, but for the bulk of CAM therapies, though, this is not this case.
• Research investigating the effectiveness of these treatments is either minimal, poorly done, or inconclusive.
• The selection of a CAM therapy is best determined by the severity of your disease, how well it helps or hinders conventional therapy, and your willingness to try a therapy that is largely untested.
• Using a good health care practitioner who can help you to integrate different therapies, along with avoiding drug interactions and other pitfalls, tends to be the most effective strategy for any health condition.

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For more information on the role of CAM treatment for Anxiety
For more information on the role of CAM treatment for Depression
For more information on the role of CAM treatment for Bipolar Disorder
For more information on the role of CAM treatment for Schizophrenia
For more information on the role of CAM treatment for ADHD (Attention-Deficit/Hyperactivity Disorder)

• Anger is a basic human emotion that is experienced by all people.
• Typically triggered by an emotional hurt, anger is usually experienced as an unpleasant feeling that occurs when we think we have been injured, mistreated, opposed in our long-held views, or when we are faced with obstacles that keep us from reaching personal goals.
• The experience of anger varies widely; how often anger occurs, how intensely it is felt, and how long it lasts are different for each person.
• At its roots, anger is a signal to you that something in your environment isn't right and it captures your attention and motivates you to take action to correct that wrong thing.
• Out of control anger alienates friends, co-workers and family members and also has a clear relationship with health problems and early death.

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• Like other emotions, anger is experienced in our bodies as well as in our minds.
• There is a complex series of physiological, or body, events that occurs as we become angry.
• Emotions more or less begin inside two almond-shaped structures in our brains which are called the amygdala, which is the part of the brain responsible for identifying threats to our well-being, and for sending out an alarm when threats are identified that results in us taking steps to protect ourselves.
• Our brains are wired in such a way as to influence us to act before we can properly consider the consequences of our actions.
• As you become angry your body's muscles tense up.
• Your heart rate accelerates, your blood pressure rises, and your rate of breathing increases.
• Your face may flush as increased blood flow enters your limbs and extremities in preparation for physical action.
• Your attention narrows and becomes locked onto the target of your anger.
• The prefrontal cortex of your brain, which is located just behind your forehead, serves in a role to keep things under control, handles judgment, and can switch off your emotions.

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• Research has found a direct connection between being constantly angry, competitive, and aggressive, and early heart disease.
• High blood pressure (Hypertension), and blood pressure reactivity are also related to the expression of anger and hostility.
• Chronically angry, hostile and irritable people have been described as having "Type A" personalities.
• Repeated increasing of heart rate and blood pressure and many other factors involved in the Type A arousal response cause cumulative and non-repairable damage to the body's organs and tissues, including the heart, nervous and immune system.
• In addition to physical health costs, there are significant social and emotional costs to being angry all the time.
• Hostile, angry people are less likely to have healthy supportive relationships.
• Chronic anger reduces intimacy within personal relationships and partners and other family members tend to be more guarded and less able to relax in their interactions with hostile people.
• Angry people frequently have cynical attitudes toward others and are unable to recognize or accept support when it is available.
• Angry people also tend to drink, smoke, and eat more than others.

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• Some physical signs of anger include:
  • clenching your jaws or grinding your teeth
  • headache
  • stomach ache
  • increased and rapid heart rate
  • sweating, especially your palms
  • feeling hot in the neck/face
  • shaking or trembling
  • dizziness
• Emotionally you may feel:
  • like you want to get away from the situation
  • irritated
  • sad or depressed
  • guilty
  • resentful
  • anxious
  • like striking out verbally or physically
• Also, you may notice that you are:
  • rubbing your head
  • cupping your fist with your other hand
  • pacing
  • getting sarcastic
  • losing your sense of humor
  • acting in an abusive or abrasive manner
  • craving a drink, a smoke or other substances that relaxes you
  • raising your voice
  • beginning to yell, scream, or cry

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• Immediately stop how you are thinking and acting at the first sign you are getting angry. If imagery helps you, imagine a big red stop sign.
• Your breathing rate and heart rate both increase when you become emotionally aroused, so you can learn to reverse these increases through the use of controlled deep breathing and muscle relaxation.
• Reflect and try to identify the emotional trigger that has set you off.
• In order to better manage anger, it is important to slow down and not simply act on your aggressive first impulses. Instead do some reality testing so as to know whether your anger is truly justified or not.
• A quick alternative reality testing method is to use the "Count to 10 before you act" rule, otherwise known as giving the target of your anger the benefit of the doubt.
• It is a good idea for you to develop a list of personal reasons why you want to stay calm and cool in certain situations, and to read over these reasons frequently so that they stay fixed and clear in your mind.
• When angry people do make requests, they often them in the form of demands, which provoke angry feelings in others, so learning to make effect requests can be a helpful step to take.
• Choose how you want to respond. Work to come up with an assertive response rather than an aggressive one.
• Then (and only then) ... Respond to the situation.

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• For some people, the easiest way to change the way they handle anger is to work with a psychologist or other licensed mental health professional in an individual or group therapy setting.
• A typical course of therapy for anger management is more like a class than a traditional therapy session, and participants are helped to become conscious of their emotional, cognitive and physical responses to anger and the different ways they respond to conflict.
• Anger management classes may be available through your employer, or through a variety of organizations serving your community, and will often assign you homework projects to complete, and will use quizzes to track your progress through the course.
• You can also learn to deal with your anger issues on your own in a number of different ways, including video and audio recordings and online classes that allow you to complete programs in your spare time and work at your own speed. Some of these programs offer email or phone support, and online message boards or chat groups.

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• It is a very good idea to draw up a written contract detailing the things you agree to practice in the course of your anger management program. This is a way of providing yourself structure and support, both of which are important for your success.
• Agree that you will take a temporary time-out when confronted with angering situations, whenever this is possible to do.
• Agree that you will practice relaxation exercises on a regular basis (preferably on a daily basis).
• Learn to recognize the types of situations that trigger you, and the types of characteristic angry thoughts that tend to occur to you when you are faced with those triggers.
• Agree that you will spend some time each day practicing assertive communication skills.
• Any contract you draw up should only cover a short span of time - one to several days at a time are a good sized duration. Then continue to make new commitments as you reach the end of the previous ones.
• Agree on a signal that family or friends can give you when they see you start sliding into old aggressive patterns.
• Write rewards for yourself into your anger contract. You should have a reward each time you successfully do the things you said you'd do during the contract period.
• Don't let a lapse turn into an excuse for quitting your anger program, or forgetting all you have learned. Instead, treat a relapse as a learning experience.

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• Autism spectrum disorder (ASD) is a neurological disorder (a "brain" disease) characterized by the presence of persistent (ongoing) communication and social issues.
• From a very early age, children with autism spectrum disorder demonstrate difficulties in interacting with other people. They also have trouble with processing social and non-verbal forms of communication, such as eye contact and facial expression.
• People on the autism spectrum also tend to demonstrate odd or socially inappropriate behaviors.
• The communication symptoms of autism spectrum disorder usually become apparent between eighteen and twenty-four months of age. They can become noticeable during the first twelve months if developmental symptoms are severe. The behavioral symptoms usually first appear in early childhood.
• Once established, autism spectrum disorder symptoms continue into adulthood. The symptoms range in severity (across people) from relatively mild to severe and crippling.
• Though intervention cannot reverse the course of autism, it can result in symptom improvement and a greater ability for independence.

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• Autistic symptoms cluster into two groups: social communication/social interaction and restricted, repetitive patterns of behaviors, interests, or activities.
• Communication issues include difficulty in social and emotional interactions with others, trouble using nonverbal communication skills, and difficulty developing, maintaining and understanding relationships with others.
• People with autism spectrum disorder have a tendency towards isolation, difficulty making eye contact, and an inability to develop appropriate peer relationships.
• Patterns of behavioral symptoms in autism spectrum disorder typically include stereotyped or repetitive body movements, insistence on a set routine that cannot be changed, highly restrictive interests that are strongly focused on, and either a lot of interest or no interest in sensory aspects of their surrounding environment.
• Those with Autism Spectrum Disorder often have other mental health conditions or challenges that they face.

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• In the past, there were several pervasive development disorders that could be diagnosed including Autism, Asperger's Disorder and Pervasive Development Disorder Not Otherwise Specified (PDD NOS).
• With the release of the Diagnostic and Statistical Manual of Mental Disorders (the DSM; currently in its 5th edition), there were extensive changes made to the diagnosis criteria and categories. Rather than multiple disorders, there is now a single condition called Autism Spectrum Disorder.
• To be diagnosed with this condition, there must be:
• A. Persistent/ongoing problems in social communication and social interaction across multiple settings as shown by the following: 1) Deficits in Social/Emotional Connections 2) Deficits in nonverbal communication behaviors used for social interaction 3) Deficits in developing, maintaining and understanding relationships.
• B. Restricted, repetitive patterns of behavior, interests, or activities as shown by at least two of the following: 1) Stereotyped or Repetitive Motor Movements, Use of Objects, or Speech 2) Insistence on sameness, inflexible adherence to routines, or ritualized pattern of verbal and nonverbal behavior; 3) Highly restricted, fixed interests that are abnormal in intensity or focus; 4) Hyper- or hypo- reactivity to sensory input or unusual interest in sensory aspects of the environment.
• C. Symptoms of autism spectrum disorder must be present in the early developmental period. However, they may not become fully displayed until social demands exceed the person's limited capabilities, or they may be masked by learned strategies later in life.
• D. These symptoms cause a great deal of stress in the person's life and problems handling school, work, relationships, and other commitments.
• E. These disturbances are not better explained by intellectual disabilities or global developmental delay.

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• There is no cure for autism spectrum disorder.
• It is a lifelong condition that can only be treated and managed with appropriate intervention.
• It is crucial to intervene as early as possible because the condition can interfere with normal language development. Without therapeutic assistance, children with autism spectrum disorder may not learn language properly or at all.
• A wide variety of interventions have been developed for children with autism or PDD diagnoses. A few of these include:
• Behavioral and communication approaches, such as speech and occupational therapy
• Picture Exchange Communication System (PECS), which is a visually presented method for teaching children with autism to comprehend language
• Applied Behavioral Analysis, which involves rewarding children if they behave in ways that are desirable
• Sensory Integration, which address sensory needs by either lessening or amplifying the intensity of various forms of sensory stimulation that children receive.
• Medications to manage behavioral and mood symptoms
• Selected approaches address each child's specific needs as determined by educators and clinicians whose findings are formalized as an individualized treatment plan.
• Each child's treatment plan outlines that child's strengths and needs and also lists long-term and short-term goals for the child to reach.
• The treatment plan also outlines specific interventions that are to be used to help the child meet these goals.

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• Raising a child who has been diagnosed with autism or a related pervasive developmental disorder is a daunting and exhausting task.
• There are many appointments to keep with some families coordinating between 20 and 40 hours of therapy each week.
• They are visited by therapists, behavior specialists, case managers and support staff.
• They deal with their children's isolation, anxiety and tantrums, as well as their own often troubling emotional reactions.
• In short, families need support to help them cope.
• Respite services help families caring for children with autism to have a break from caregiving, usually for just long enough so that caregivers can catch their breath.
• Support groups are mutual self-help groups, run either by peers (other parents of autistic children), or by professionals working in the autism or PDD field.
• Wraparound is a temporary, physician prescribed service that brings therapy directly to needy families and is used to help children with autism work towards independence.

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• Autism spectrum disorder is a life-long, chronic disorder that can significantly impact affected people's social and cognitive development.  As a result, adult functioning is frequently compromised.
• Some adults with ASD learn to function well in society. They can earn degrees and maintain gainful employment.
• Others never develop the communication and self-help skills necessary to live independently.
• When children with ASD reach the age of fourteen, their caregivers and teachers create a transition planning review in collaboration with the school district. The transition planning review covers issues like education and training as well as career planning
• Living arrangements and income are some of the major issues facing adults with autism spectrum disorder. While some can manage independently, others must be supervised around the clock to insure their safety.
• Even if an adult with ASD can maintain a job and can groom himself independently, he may not be able to deal with everyday situations requiring good social skills like meeting new people, asking appropriate questions or maintaining interpersonal relationships.
• The ideal jobs for adults with autism spectrum disorder are usually quite structured in nature and make a virtue of their strengths and interests. Many high-functioning adults with ASD find gainful employment in computer-related fields, some like the repetition of assembly line work, and others prefer working with animals.
• Many adults with autism are able to function quite well in group homes that provided assisted living support, while others live with family members throughout their lives.

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• Bipolar Disorder (often called Manic-Depression, or sometimes Bipolar Affective Disorder), is a category of serious disorders.
• Bipolar Disorder involves a swing between high and low energy states. When in a high-energy state, people appear happy because they are motivated and excitable. In a low energy state, people feel sad, and lack motivation and enthusiasm.
• Because high-energy manic states exist on a scale, it is possible for someone to be a little manic or very manic.
• People who are very manic are said to be experiencing a manic episode.
• People who are only a little manic are said to be experiencing a hypomanic episode.
• Mania is characterized by a joyful, energetic mood; hyper-activity; a positive, expansive outlook on life; an inflated sense of self-esteem; and a sense that just about anything is possible.
• Depression is, more or less, the opposite mood state from mania. Depressive symptoms can vary a great deal from one person to the next.

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• "Bipolar I Disorder" is used with patients who demonstrate full-strength manic and depressive episodes.
• "Bipolar II Disorder" is used with patients who demonstrate full-strength depression, but only hypomanic episodes rather than full-strength manias.
• "Cyclothymic Disorder" is used to describe patients who demonstrate repeated mood swings which are never quite severe enough to qualify as major depressive or manic episodes.
• "Substance/Medication-Induced Bipolar and Related Disorder" is used when the symptoms happen during or soon after taking a substance or stopping use of a substance that is capable of producing the bipolar symptoms.
• "Bipolar and Related Disorder Due to Another Medical Condition" is used when symptoms are produced by a medical condition (not another mental health condition).
• "Other Specified Bipolar and Related Disorder" applies when symptoms cause significant distress or impairment, but do not meet the full criteria for any of the other disorders in this category. This is used when the clinician specifies the reasons that criteria are not meet (for example, not quite enough days or symptoms displayed to trigger the full diagnosis).
• "Unspecified Bipolar and Related Disorder" is used to describe situations where the clinician chooses not to specify the reason that the criteria for one of the other types are met or when there is not enough information available to make a more specific diagnosis.

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• Often two types of medication are used in bipolar disorder treatment. These are antidepressants and mood stabilizers.
• Antidepressants help the patient to come back "up" and out of depressive states.
• Mood stabilizers help to keep patients' moods even and centered as much as possible.
• Patients with bipolar disorder who are treated with antidepressants alone have a heightened risk of swinging into mania.
• Patients treated with mood stabilizers alone often end up spending more time in dangerous depressive states than is necessary.
• Lithium Carbonate, known informally as "Lithium," is the oldest treatment for bipolar disorder currently prescribed. The American Psychiatric Association recommends lithium as first line therapy for bipolar disorders.
• Valproic Acid, also known as Sodium Valproate, Depakote, or Depakene, is often prescribed as a stabilizing medication for patients who do not tolerate lithium therapy well.
• Antipsychotic medications are now sometimes used to stabilize mood and as preventative medications against bipolar disorder relapses.

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• Hospitalization, electroconvulsive therapy, and psychotherapy are often used in addition to medication treatments.
• Hospitalization is among the more expensive bipolar treatment options available. Because of this, it is generally used only when no other treatment options will prove sufficient to ensure patient safety.
• Electroconvulsive Therapy (ECT) involves passing an electric current through the brain to create an artificial seizure. ECT is typically used for people with severe depression that has not responded to other treatments and/or for people requiring non-medication treatment of depression.
• Psychotherapy is a non-medical "talking" therapy that can be very effective and helpful for some bipolar patients. However, it is generally helpful as an additional bipolar treatment to be provided along with medication treatment.
• The dominate type of psychotherapy for bipolar disorders is Cognitive Behavioral Therapy (CBT). CBT is founded on the basic idea that what people think about an event that has happened determines how they will feel about that event.
• Family focused therapists educate all family members about the nature of bipolar disorder, bipolar treatment, and ways that family members can best support their affected member.
• Interpersonal and Social Rhythm Therapy (IPSRT) is based on the observations that bipolar disorders are essentially body rhythm disturbances, and that altered body rhythms (e.g., circadian rhythms, seasonal rhythms, and social/occupational rhythms) can lead to mood disturbances.

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• People with Bipolar Disorder in the grip of severe mood episodes are often unable to help themselves or often even to stop themselves from acting out in ways that may damage their health.
• However, they actually can do a lot to help ensure their health and safety as their bipolar symptoms stabilize.
• Self-help methods include any activities that will help people keep their moods stable.
This could include:
• Regular physical exercise.
• Setting and maintaining a standard bedtime and wake-time.
• Practicing relaxation or meditation exercises regularly.
• Taking bipolar medication at the same time every day.
• Reducing work and family stress as much as possible
• Eating a healthy diet at regular times each day.
• Regular participation in group activities, such as peer-support groups, religious communities or other interest-based activities
• Regular attendance in psychotherapy and/or regular self-monitoring exercises designed to help promote awareness of moods (talking about problems and problem solving help to prevent depression) can also be helpful.
• Avoidance of mood-altering drugs, including alcohol.

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• The family and friends of those with bipolar disorder may become frightened at and angry about the impulsive and self-destructive behaviors associated with bipolar disorder that they see played out again and again.
• Family and friends provide social support and encouragement, which tends to provide a moderating influence on mood (e.g., helping mood to keep from sinking too low or too high). This influence takes on several different forms.
• First, support takes the form of monitoring. Family and friends are in a perfect position to help those with bipolar disorder to monitor their moods.
• Second, family and friends can persistently encourage patients to comply with bipolar treatment and professional recommendations.
• Third, family and friends can help support bipolar patients by helping them to "reality-test".
• Fourth, family and friends can initiate an intervention when necessary.

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• Bipolar Disorder is a condition that affects the entire family - mothers, fathers, sisters, brothers, grandparents, aunts and uncles, husbands and wives, and children.
• Family members can do only so much to prevent those with bipolar disorder from entering into dangerous mood episodes. Beyond doing all they can to support the person, family members may also need to insulate themselves as best they can from the extremes of behavior that they may have to endure.
• Family members can educate themselves as to the nature of bipolar symptoms so that the various behaviors that may occur will not surprise them.
• Family members may participate in bipolar support groups or family therapy situations where they can talk about and process their experiences.
• The family may find it useful to develop an ongoing relationship with a family therapist who can provide advice and crisis management services.

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• One of the major changes in the newest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5, 2013) was the inclusion of a new group of disorders called Trauma and Stressor-Related Disorders.
• This involved the re-classification and modification of several existing disorders that were previously classified elsewhere in the manual.
• This change in classification reflected a change in our understanding about the impact of unhealed trauma and unmanaged stress on human behavior.
• Disorders included in this category are
• Reactive Attachment Disorder
• Disinhibited Social Engagement Disorder
• Acute Stress Disorder
• Posttraumatic Stress Disorder
• Adjustment Disorders
• Unclassified and Unspecified Trauma Disorders

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Different configurations of these symptoms form specific diagnoses within the classification of Trauma and Stressor-Related Disorders, but generally include:

• Intrusive Symptoms - People experiencing these intrusive symptoms describe it as though they are right back there, reliving and re-experiencing the trauma all over again. These are called intrusive symptoms because they are unwanted, unbidden, and therefore, involuntary.
• Distressing Images, Thoughts, Memories - A distressing memory, image or thought is something that you can't get out of your head related to trauma or stress. These may occur spontaneously, or they may be cued/triggered.
• Flashbacks, Dissociative Reactions - A flashback, while certainly intrusive, is also dissociative, which means there is a brief or extended period where time and reality are suspended.
• Distressing Dreams and Nightmares - For some survivors of trauma, nightmares occurred nightly, while for others, the nightmares are less frequent and unpredictable.
• Intense or Prolonged Psychological Distress - Exposure to reminders or cues associated with a traumatizing experience can trigger symptoms of severe psychological distress such as depression, panic attacks, and even hallucinations.
• Physiological Distress or Body Memory - The physiological, or body, response to trauma can include gastrointestinal pain, chest pain, light-headedness, tingling sensations, shortness of breath, and unspecified muscle pain.
• Avoidance Symptoms - Avoidance symptoms represent an effort to withdraw from certain situations that bring about body-level distress of trauma-related symptoms.
• Negative Thoughts and Feelings - Since unhealed wounds can affect our mood states, it make sense to pay attention to unhelpful thinking patterns, and to explore our feelings about ourselves and the world around us.
• Arousal and Reactivity Symptoms - This category of symptoms has also been called heightened arousal and includes behaviors like jumpiness, sleep disturbances, irritability and/or aggressive behavior, problems with concentration, and reckless or self-destructive behaviors.

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In trying to understand the impact of unhealed trauma on the human brain, it\'s helpful to have a basic understanding of the brain.

A simple model of the human brain is to envision it as three separate brains (the triune brain); each with its own separate functions and sense of time. These parts are:

• R-complex brain or brainstem - The base of the brain contains the cerebellum, and it directly connects to the spinal cord. This part is responsible for functions like reflexive behaviors, muscle control, balance, breathing, heartbeat, feeding/digestion, and reproduction.
• The limbic brain - This area is the center of emotion and learning. This part also includes the amygdala, which scans for any threat or danger, and sends out a signal to other parts of the brain when a threat is perceived.
• The cerebral brain or neocortex - this part is responsible for things that make us distinctly human: logic; reasoning skills; analysis and problem-solving; speech and verbal understanding; meaning-making; willpower; and, wisdom.

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• The simplest framework for healing trauma dates back to the late 1800s and includes 3 stages - Stabilization, Identification and Relapse prevention.
• One great misconception about trauma counseling is that once trauma is processed or cleared, then it's gone. A healthier and more accurate approach is to view trauma as something that can be healed, but not cured. A cure implies you either have a disease or disorder, or you do not. Healing implies various degrees of adaptation and adjustment that occur over time.
• If trauma seems like it might be a factor in your healing journey, finding a trauma-informed therapist is key.
• Trauma recovery looks different for each survivor. It is largely dependent upon each person's recovery goals.
• Cognitive therapies focus on modifying those dysfunctional thoughts so that feelings and behaviors improve.
• Mindfulness teaches people to live in a state of acceptance with a keen awareness of the present moment, and recognizes that thoughts are just that - merely thoughts. They don't represent any truth or reality.
• Many approaches for healing trauma incorporate an element of exposure therapy.
• Eye Movement Desensitization and Reprocessing (EMDR) is currently one of the most researched therapies for PTSD, and it now appears on the SAMHSA registry of evidence-based practices.
• Body, Movement & Expressive Arts Therapies - Because unhealed trauma wreaks havoc on the body, it makes perfect sense to include the body in the healing process.
• Medications - Before you agree to take a medication, be sure you have specifically mentioned to the provider your trauma background. Many symptoms of trauma and stressor-related disorders look like symptoms of other disorders. Without properly considering your trauma background, your provider may prescribe medications that are not helpful, and may even make things worse.

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• Normal cells in the body grow and divide for a period of time and then stop growing and dividing, and only reproduce themselves as necessary to replace defective or dying cells.
• Cancer occurs when this reproduction of cells goes out of control.
• Cancer is a disease characterized by uncontrolled, uncoordinated and undesirable cell division.
• Unlike normal cells, cancer cells continue to grow and divide for their whole lives, replicating into more and more harmful cells.
• As cancer cells divide and replicate themselves, they often form into a clump of cancer cells known as a tumor.
• Tumors cause many of the symptoms of cancer by pressuring, crushing and destroying surrounding non-cancerous cells and tissues.
• Tumors come in two forms.
• Benign tumors are not cancerous and do not grow and spread to the extent of cancerous tumors. They are usually not life threatening.
• Malignant tumors grow and spread to other areas of the body in a process known as metastasis.

• Though cancer is often thought of as a single disease, there are, in fact, many different types of cancer.
• Each type has a different set of risk factors, rates of progression, treatment options, and prognosis.
• The subtypes of cancer get classified and named based on the area of the body where they are originally found.
• Five of the most common types of cancer are breast cancer, colorectal cancer, lung cancer, prostate cancer, and skin cancer.

• The causes of cancer are not fully understood, but years of research have brought to light risk factors that increase people's chances of getting particular types of cancer.
• Some of these risk factors are unable to be avoided, while others can be avoided by choosing to live a healthy lifestyle.
• For example, smoking cigarettes is an avoidable risk factor. Changing your lifestyle to get rid of unhealthy choices such as smoking can be difficult to accomplish (tobacco is an addictive drug and stopping smoking means beating that addiction), but the rewards are real.
• Stopping smoking and similar healthy lifestyle changes will not insure that you never get cancer, but they will reduce your cancer risk.
• This is true whether you have never had cancer before, or if you have previously beaten cancer and are wondering what you can do to reduce your chances of relapse.
• Each specific type of cancer is different and consequently has a different set of associated risk factors.

• Following a positive identification of cancer, doctors will try to establish the stage of the cancer.
• Cancers are ranked into stages depending on the specific characteristics that they possess; stages correspond with severity.
• Determining the stage of a given cancer helps doctors to make treatment recommendations, to form a likely outcome scenario for what will happen to the patient (prognosis), and to communicate effectively with other doctors.
• There are multiple staging scales in use.
• One of the most common ranks cancers into five progressively more severe stages: 0, I, II, III, and IV. Stage 0 cancer is cancer that is just beginning, involving just a few cells. Stages I, II, III, and IV represent progressively more advanced cancers, characterized by larger tumor sizes, more tumors, the aggressiveness with which the cancer grows and spreads, and the extent to which the cancer has spread to infect adjacent tissues and body organs.
• Another popular staging system is known as the TNM system, a three dimensional rating of cancer extensiveness. Using the TNM system, doctors rate the cancers they find on each of three scales, where T stands for tumor size, N stands for lymph node involvement, and M stands for metastasis (the degree to which cancer has spread beyond its original locations). Larger scores on each of the three scales indicate more advanced cancer.
• Still another staging system, called summary staging, is in use by the National Cancer Institute for its SEER program. Summary stages include: "In situ" or early cancer (stage 0 cancer), "localized" cancer which has not yet begun to spread, "regional" cancer which has spread to local lymph nodes but not yet to distant organs, "distant" cancer which has spread to distant organs, and finally, "unknown" cancer to describe anything not fitting elsewhere.

• Every type of cancer is different, and has a unique set of symptoms associated with it.
• Some cancer symptoms are manifest outwardly, and are relatively easy to notice and identify (such as a lump in the breast for breast cancer, or blood in the stool corresponding to colorectal cancer).
• Other symptoms are observable, but harder to decipher.
• Still other forms of cancer produce no observable symptoms until they are at a very advanced (and therefore hard to treat) stage.
• Specific symptom detail for cancer subtypes is provided in our cancer subtype documents.

• Treatments vary based on the type, location, and size of the cancer being treated, as well as patient's age, medical history, and overall health.
• Each form of cancer is different and calls for a different set of treatment approaches.
• Chemotherapy and radiation therapy are two common approaches used to treat almost all types of cancer.
• Chemotherapy is commonly used for patients whose cancer has possibly spread to various locations in the body. It can be used to reduce cancer symptoms and pain, and to slow the growth of cancerous tumors.
• Chemotherapy uses a powerful combination of drugs that are either taken by mouth or injected directly into the bloodstream to target cells in the body that divide and grow quickly and are usually able to destroy these cells.
• Chemotherapy drugs also kill some regular healthy cells causing side effects such as fatigue, nausea, and hair loss.
• Radiation therapy is most commonly used to treat cancer that has not spread from its original location.
• The goal of radiation therapy is to kill cancer cells or at least limit their ability to grow and divide by damaging their genetic material.
• Like chemotherapy, some normal, healthy cells can also become damaged through radiation therapy.

• Being diagnosed with cancer of any type is a frightening and discouraging prospect which can shatter the illusion control that allows most people to live relatively carefree lives.
• In the aftermath of cancer, it is normal to experience a sort of hyper-vigilance for health symptoms, and associated fears that even benign aches and pains may indicate a recurrence of cancer.
• Cognitive psychotherapy can be helpful in learning to manage anxiety symptoms.
• Careful and systematic cancer monitoring with your physician and avoidance of cancer causing risk factors will insure you are doing all you can to avoid relapse.

• The cost of childcare is often one of the biggest issues in the decision regarding childcare and families must first decide if they can afford it.
• Rates vary depending on the area of the country, whether the setting is a city or rural area, the type of care chosen, and the number of care hours needed.
• How attached parents are to their career or job will also influence the decision to choose one form of childcare over another.
• Parents who continue working and place the child in full-time or part-time childcare may feel sad when their work leave has ended and they must leave the child at day care or they may question whether they have made the right decision or feel like they are spending too much time away from the child.
• A parent who telecommutes (works from home) part or all of the time will experience a loss of socialization opportunities and connections with coworkers and will likely have to deal with coworkers who believe that they are not really working when at home.
• Parents choosing to leave the workplace and devote themselves to full-time caregiving must cope with a change in identity and different relationships with others, as well as the fear that they may have a hard time returning to the workplace in the future.
• In a day care setting, a child is exposed daily to many other children and learns the important skills of sharing and playing together.
• Children who remain at home with a parent can end up having less interaction with others and it will be important to look for opportunities for children to be exposed to other children, whether through play groups, children in the neighborhood or extended family, or through short day care situations.

• There are 4 primary types of childcare settings available to parents in the United States including:
• a group day care center
• family child care
• a nanny or au pair
• relative, friend, or neighbor care
• Group Day Care Centers can be part of a national or regional chain or an independent for profit or nonprofit center. They may be a free-standing and independent organization or part of a larger organization, such as an on-site care facility sponsored by an employer.
• Family childcare, also known as an "in-home" day care, takes place in a provider's personal home and is usually a single provider who is caring for multiple children and families.
• A nanny is a professional caregiver of any age and level of experience who will work in the parent's home to care for the child, and may or may not live with the family.
• An au pair is generally a younger person, often a college student, who will live with the family for a few months to a few years to provide care for the children.
• A relative, friend, or neighbor providing care is similar in some ways to a family care setting, but the person is usually only providing care for the child and perhaps his/her own, as well.

• Licensure rules are governed by each state and may differ, but some themes are common to all states.
• Day care centers are always required to maintain a license with the state.
• Family childcare homes will require licensure based on the number of children and families that are cared for.
• While conditions for obtaining and maintaining licensure will be slightly different in each care setting and in each state, generally the licensure process includes an onsite evaluation of the facility, and specific ongoing requirements that providers must meet in order to remain licensed.
• The areas that are generally looked at during the licensure process and that are most often governed by state rules are:
• Guidelines for teacher, assistant teacher, aide, volunteer, and substitute positions
• Staff Ratios and Group Sizes
• Equipment, Materials, and Physical Space
• Food Guidelines
• Nap time Guidelines
• Exclusion of Sick Children
• Reporting Guidelines
• Safety
• Provider Professional Development/ongoing education requirements
• Pets/Animals.

• Start by first making a list of the things that are important with regard to the type of care environment desired for the child.
• For a center or family care home, this list can include items like location, how flexible hours of care are, and the cost of care.
• For a nanny this may include duties that the parents hope the nanny will agree to take on in addition to care, language or cultural preferences, and the salary and benefits the family can offer.
• Once the list has been created, parents can begin to locate possible choices that most closely fit their list.
• For those wanting a day care center or family care setting, it is often good to start by asking for referrals from other parents, local doctors and child social workers, religious communities, family, or friends.
• The next step is to create a short list of care facilities, and to contact the licensing board in the state to verify that each facility's license is current and that there have been no disciplinary actions filed.
• After verifying licensure, it is a good idea to call each center or provider on the list and do a telephone interview.
• For parents wanting to hire a nanny, it may make sense to contract with an agency which can provide a prescreened short list of candidates that match parents' needs.

• Day care centers will usually have a set process for visits that include a tour, and a question and answer session during which materials such as the center handbook and major policies, fee schedule, and enrollment forms are made available.
• In-home providers may have a more relaxed process.
• If possible, a visit to an in-home provider should take place in the evening after the children have left for the day so that the provider can give the parents his or her full attention while discussing care practices.
• If the parents continue to be interested in the in-home provider, they can return for a second visit during the day to see the home with children present.
• In either care setting, areas that parents should look at and ask questions about include:
• Staffing and Ratios
• Caregiver Training
• Safety and Emergency Guidelines
• Sick Exclusion Policies
• Immunization and Child Record Policies
• Pick-up and Drop-off Policies
• Financial Policies and Operating Hours
• Food and Nutrition Policies
• Diapering and Toilet Use
• Sleeping Practices
• Discipline Practices
• Play and Development
• Daily Reports and the Caregiver/Parent Relationship
• Relationship Between the Caregiver and Child

• For new parents leaving their infant, the majority of the adjustment will take place on the parent's end, as the infant will most likely remain content so long as someone is there to hold, feed and change him or her as needed.
• The parents of an infant can have guilt feelings around "leaving" or even "abandoning" their child to return to work.
• Establishing a good relationship with the caregiver can help to reduce these difficult feelings and communication at drop-off and pick-up times is vital.
• For a child old enough to understand separation, it is important to talk about the upcoming change to day care in positive terms.
• Describe the way the child's day will happen to the child and walk through what the new day will look like: where the child will be, what activities he or she will get to do, what people he or she will be with, etc.
• If possible, begin the transition gradually with a few hours per day during the first week and then moving into a full-time situation.
• Establishing a consistent drop-off and pickup routine is critical for the child's sense of security during care.
• Parents should also develop a backup plan for making sure that the child has a safe place to go when the primary day care environment is not available.

• Chronic Obstructive Pulmonary Disease is called COPD for short.
• This condition occurs when permanent blockages form within the pulmonary system (the lungs and respiratory system) that interfere with the transfer of vital gasses, such as oxygen and carbon dioxide, from the air and the blood.
• To be diagnosed with COPD means that some portion of the lungs or airways have become permanently obstructed, reducing the volume of air that can be handled by the lungs.
• As this process progresses, the overall efficiency of the gas exchange process is reduced and it becomes more difficult to breathe.

• There are two diseases that can cause COPD: Emphysema and Chronic Bronchitis.
• Bronchitis is an inflammation of the bronchi, which are the airways or passages within the lungs.
• The walls of the bronchi become inflamed, allowing less air to flow through.
• This inflammation also creates excessive mucous that is thicker and more difficult to cough up than normal, which then clogs the airways and lowers lung capacity.
• Emphysema also reduces the efficiency of the gas exchange process, but in a different way.
• Emphysema affects the alveoli, which are tiny air sacs composed of special membranes found at the end of the bronchi where the transfer of gases between the blood and the air occurs.
• Emphysema causes the membranes to become brittle, rip and tear, and these cannot be regenerated by the body.
• Each time the membranes burst, more surface area within the lung necessary for gas transfer is permanently lost.
• As this process progresses, it becomes very difficult for patients to exhale because their weakened airways threaten to collapse the harder they try to breathe out.
• The heart tries to compensate for the loss of oxygen available in the bloodstream by pumping harder and faster, which can lead to other serious complications including heart failure.

• COPD occurs when either emphysema or chronic bronchitis are present.
• While emphysema and chronic bronchitis are two separate diseases, they share many symptoms in common including:
• Excessive coughing or bronchitis-like symptoms for more than 2 months for 2 consecutive years or for 6 months during 1 year
• Excessive phlegm (mucous) that is difficult to cough up
• Shortness of breath (particularly noticeable after exercise)
• Recurrent infections
• Expanded, barrel-shaped chest
• Wheezing
• Blue appearance of the skin
• Fluid backup, which often causes swelling in the legs

• Inhaled pollutants (in the air, and also from smoking) are usually the most direct cause of COPD.
• COPD can also be caused by bacterial and viral infections.
• Smoking is the most prevalent known cause of COPD because the toxins in tobacco smoke contribute to both emphysema and chronic bronchitis (the two major components of COPD).
• People who live in areas known for higher incidences of air pollution or who are exposed to air pollutants and dusts at work (for instance, factory workers and coal miners) are known to show a higher instance of COPD.
• Individuals who inhabit polluted areas or who work in polluted or toxic environments are at high risk and should take precaution to protect themselves.

• There are multiple ways doctors can look at how well a patient's lungs are functioning.
• At this point, none of these techniques can detect the onset of COPD before some permanent lung damage has occurred.
• However, it is still important to see your doctor as soon as you observe any of the symptoms for COPD because the sooner it is diagnosed the better your outcome is likely to be.
• The first important lung output measurement is lung volume, which is basically the amount of air your lungs can hold when they are full. This is usually tested using a device called a spirometer.
• Forced Expiratory Volume is the rate at which you can exhale air from your lungs. It is measured by having the patient take a deep breath and then exhale as rapidly as possible. The doctor will then determine the volume of air that was expelled in one second. As COPD worsens, forced expiratory volume will decrease.
• The doctor can also look at the levels of carbon dioxide versus oxygen dissolved in the blood. As COPD progresses, oxygen levels decrease and carbon dioxide levels increase.

• At this point in time there are no cures for COPD.
• There are also a range of medications and procedures that can be used to help manage the symptoms and complications.
• The mucous that gets trapped inside the airways during COPD can become a home to infection-causing bacteria, so antibiotics are prescribed to help to ward off these respiratory infections.
• Bronchodilator medications help relax narrowed airways so that more oxygen can get into the bloodstream and more carbon dioxide can be removed.
• Corticosteroids relax and open constricted airways. These are often used when bronchodilators have stopped working.
• Digitalis is a medication that works to strengthen the force that the heartbeat contracts with, and it is often prescribed to boost the heart's pumping capacity, and help reduce the extra stress placed on the heart by COPD.
• Diuretics are substances which cause the body to retain less water than it normally would with the difference leaving the body as urine. They can help combat fluid retention caused by pooling of blood inside the heart's chambers.
• Oxygen therapy increases patients' blood oxygen levels and can improve brain function, decrease strain on the heart, and lessen some of the symptoms of COPD such as headache and restlessness while trying to sleep.

• Regardless of the cause, emphysema cannot be cured once it has been diagnosed.
• It can be prevented in the first place or slowed in progression through healthy lifestyle choices.
• Smoking is the single greatest cause of emphysema and the longer someone smokes, the more likely they are to get emphysema. If you currently smoke you should take steps to quit smoking now.
• You should try to reduce your exposure to airborne pollutants as much as possible, including industrial exposures, and secondhand smoke.
• Individuals who work in settings with high levels of air pollution (miners for example) or who live or work around people who smoke should do as much as possible to protect their respiratory system.
• Eating a nutritious diet can help your immune system to stay strong and fight off infection.
• Starting an aerobic (briskly walking, jogging, swimming, etc.) exercise routine is a great way to strengthen both your cardiovascular and respiratory systems.
• Ask your doctor about breathing exercises you can do to further target and strengthen the muscles used in the breathing process.
• Moderate regular exercise is a great way to boost your energy levels as well as your immune system.

• Chronic bronchitis is best prevented by avoiding exposure to tobacco smoke or other forms of 'recreational' smoking (including marijuana), and other air pollutants.
• If you are a smoker, you should stop smoking immediately so as to best preserve your health.
• If you live or work with smokers, take steps to avoid their second hand smoke.
• Your risk of permanent respiratory damage rises with each additional year of smoking.
• Stopping smoking drastically reduces the amount of irritants your lungs are exposed to, allowing your lungs to heal.
• You should try to avoid airborne pollutants such as dust, chemical and paint fumes as these substances have also been shown to increase your chances of chronic bronchitis.
• Chest infections are often observed in the early stages of chronic bronchitis, but fortunately these infections can often be avoided by adopting healthy lifestyle habits.
• Regular aerobic activities (swimming, jogging, playing soccer) can help prevent the onset of chronic bronchitis.
• Making sure you eat a nutritious, properly balanced diet, while avoiding junk foods is also important for strengthening your immune system.

• A will is a legal document that allows you specify how your property and assets should be divided and how custody of your children (if applicable) should be handled upon your death.
• A health care directive (also known as a living will or advanced health care directive) is a document that enables you to legally record your wishes concerning whether 'heroic' or extended medical care measures should be taken to prolong your life should you become incapacitated and unable to speak on your own behalf.
• Within the health care directive, or as an attachment document, you can name a trusted family member or friend as a "health care proxy", which gives them the power to make health care decisions on your behalf if you become incapacitated.
• A conservatorship (or guardianship) is a complicated court arrangement that gives an individual legal power over the financial affairs of another person. This is pursued only when an individual is judged (by a court) to be no longer capable of managing his or her own affairs (for example, someone in a coma or in the advanced stage of Alzheimer's disease).
• A durable power of attorney for finance gives another person the legal authority to act on your behalf with specific regard to managing finances. A person does not have to be declared incompetent in the court system to use a durable power of attorney document.
• Beneficiary Information - It is important to make sure that beneficiaries are appropriately and currently named on all important financial assets you may have, including retirement accounts (such as pensions and 401k accounts), life insurance plans and other assets.
• Medicare and Social Security - Adults approaching retirement age (generally 65-68 years of age depending on the year of birth) should file for Medicare and social security benefits.
• Supplemental Insurance - Unfortunately, Medicare does not cover numerous medical services and expenses, so you may consider purchasing a long-term care insurance policy, and/or a supplemental medical insurance policy.
• Trusts - A trust is a legal device into which a person's assets can be contributed. In this case, those assets are then no longer the property of the individual (called the grantor, donor, or settlor), but instead now belong to the trust.

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• While this might seem like a morbid task to some, such planning can spare your family from having to make difficult choices at a point in the future when they are also dealing with the pain and grief of your death.
• Advance planning is also a way to spread out the cost and therefore reduce the financial burden that a funeral and burial can place on surviving family members.
• Advance planning tasks can include buying burial plots or space in a mausoleum, making plans about the type of service that is to be held, and discussions with family about your desires.
• While you can choose to prepay all expenses to a specific funeral home, financial advisors and other experts do not generally recommend this practice, as there is considerable risk in doing so.
• Another option is to set up a fund for funeral and burial expenses, which is accessible by a beneficiary at the time of death. This can take the form of a trust fund, a life insurance policy that is equal to the amount that will be needed, or a savings/certificate of deposit account.
• Discussing your wishes can be difficult or uncomfortable, as family members will often not want to think about and discuss your death, but it is particularly important to have this discussion if you have strong beliefs about the type of funeral or burial that you prefer.

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• Research suggests that when considering our own death, we are most concerned about potential pain, helplessness, dependency, and the well-being of our loved ones.
• Other common concerns include fear of a painful or unpleasant afterlife, fear of the unknown, and fear of a loss of dignity or individuality.
• Probably the most famous model of the stages of grieving our own impending death was presented by Dr. Elizabeth Kubler-Ross in her book "On Death and Dying."
• Not everyone will experience all of these stages, or, if all are experienced, they won't necessarily occur in this particular order.
• Denial - In this stage, you may feel unable or unwilling to accept that the loss of your life will shortly take place and it can feel as though you are experiencing a bad dream and you are waiting to "wake up," expecting that things will be normal and that your diagnosis is a mistake.
• Anger - you may begin to feel Anger at the unfairness of it and may become angry at yourself for the disease and at your higher power for allowing it to happen. Feelings of abandonment may also occur and religious beliefs may be severely tested during this stage.
• Bargaining - this stage usually involves promises of better behavior or significant life change, which will be made in exchange for the reversal of the diagnosis.
• Depression - During this period, you may cry, experience sleep or eating changes, or withdraw from other relationships and activities while you process the impending death. You may also blame yourself for having caused or in some way contributed to the diagnosis, whether or not this is justified.
• Acceptance - you have processed your initial grief emotions, are able to accept that the death will occur and cannot be stopped. At this point, you are able to plan for your impending death and re-engage in daily life.

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• Journaling/Life Review - you may want to begin a life review or journaling process in order to get your thoughts out on paper or to share your history with family for future generations.
• Making Amends - you may also wish to repair broken relationships or resolve previous conflicts. This process may include contacting people that you may have hurt in some way, whether by words or actions.
• Saying Goodbyes - it is also a time to say goodbye to family members and friends, which can be done verbally or by writing special letters to be opened after your death has occurred.
• Keeping Active - dying is also a time to continue daily activities (as much as possible) and live each day to the fullest, rather than becoming withdrawn and isolated. You may have a list of things that you wish to do before death occurs, including traveling to special places, spending time with family and friends, reading, etc.
• It is also important for you to remember that during this time it's okay (and quite normal) for you to want to:
• Be assertive in communicating with health care providers and family/friends
• Ask for more pain medication (or other medicines that keep you comfortable)
• Watch television (even if it's "trashy" tv)
• Ask for a particular food or drink (even if it's unhealthy or unusual)
• Take a nap
• Laugh or be silly
• Cry
• Be afraid
• Scream/Shout
• Do nothing for a while
• Do what feels right to you, even if it doesn't make sense to others

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• Providing care for a dying person can be a very difficult and emotional, and yet also rewarding experience.
• You need to take care of yourself in addition to caring for the dying person. This will be a stressful and trying time and if you aren't able to take care of yourself (getting yourself enough rest, food, etc.), you won't be able to provide quality care to your patient either.
• You need to monitor your own emotions and seek outside or professional help if necessary, should you find yourself overcome by anxiety, fear, guilt, anger, depression, or other powerful feelings that may threaten to temporarily overwhelm you.
• You need to ask for help from other family members when needed and/or allow others to help you when they offer.
• It is important to communicate with the dying person about their condition and allow the person to have a say in how they are cared for whenever possible.
• You'll need to work closely with the other health care professionals and caregivers involved in the process in order to help coordinate the flow of information.
• You can also help the dying person to finish any incomplete business he or she may have, including legal or financial matters, making amends, coordinating specific visitors, or even facilitating travel to special places.

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• There are two types of care available to those that are dying - palliative and hospice.
• Palliative care is a form of medical treatment focused on reducing the severity or progression of disease symptoms and is typically provided by a team of medical professionals at a medical facility, such as a hospital or nursing home.
• The goals involve making the person as comfortable as possible and addressing quality of life needs (in physical, psychological, and spiritual realms) in the time remaining.
• Palliative care can be delivered at any point during an illness and for an extended period of time as necessary.
• Hospice care in the United States is a specific form of palliative care limited to the last 6 months of life as determined by a doctor's diagnosis.
• This care is typically provided by medical doctors, nurses, social workers, psychologists, nursing assistants, trained volunteers, and spiritual advisors.
• Hospice care is offered 24 hours a day, and can be provided at an individual's home, a hospice care facility, or a hospital/nursing home.
• The focus of hospice care is to provide pain management and medical care, emotional support, and spiritual counseling for the dying patient, and similar emotional and spiritual help and support for family members.

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• Even though you cannot stop the dying process, you can help the person be as comfortable as possible.
• As the body systems slow down, the dying person will experience a decrease in appetite, thirst, and ability to swallow.
• You may notice irregular breathing patterns where the pattern is shallow breaths followed by a long and deep breath, or periods of panting followed by no breaths at all.
• Circulation of blood flowing out to extremities decreases and the dying person may complain of numbness in his or her legs and feet or may appear blue, purple, or mottled, and feel cooler to the touch.
• A dying person may become restless, agitated (jerking, twitching, pulling at bed linens or clothing), disoriented, or confused (unsure about the time and place, or identity of people).
• Any new pain or changes in pain levels should be reported to the health care team immediately.
• Incontinence (losing control of bowel or bladder function) is not uncommon as death nears.
• The dying person will typically start to withdraw and decrease his or her interactions with friends and family, and at the same time, the person will usually spend more time sleeping.
• Towards the very end, the dying person will show a decrease in consciousness and responsiveness and you will have great difficulty rousing the person and they will stop speaking and responding to questions.
• Research suggests that hearing is the last sense to go; so continue to talk to the person even if they are not speaking.
• Comforting loving words, reminiscing, and giving the person permission to die are all appropriate.
• Continuing to touch the person can also communicate love and comfort throughout the final stage.
• Eventually, a coma state (in which you are unable to arouse the person at all) occurs minutes or hours before death and the final breath.

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• In case of a sudden death where a cause is not immediately known, or if there is suspicion that the cause might have been unnatural, the medical examiner has the ability to require an autopsy.
• When a person has died from natural and known causes, an autopsy is generally not required in the United States.
• Elective autopsies are performed when the deceased has given permission to donate organs or serve as a volunteer for medical research.
• Once a death has occurred, there are numerous people that must be notified including:
• A Minister/spiritual advisor in order to begin planning a funeral and burial.
• If the deceased was still working, the employer must be notified and will usually help handle benefit issues, such as health and life insurance.
• Health and Life Insurance agents will help begin the process of terminating the policies and arrange for payouts to beneficiaries.
• If the person used legal counsel to set up a will, the attorney will begin the legal steps necessary to process the person's will and estate.
• The Executor of the Estate (the person designated to carry out the wishes of the deceased) will assist the attorney in following the will and getting assets to beneficiaries.
• The Social Security Office and Internal Revenue Service will terminate benefits, such as Medicare and Social Security, and process taxes on the person's estate for the year in which the person died.
• The executor will make arrangements to pay back any loans and/or close out accounts with all relevant banks and mortgage companies. Remaining assets will be distributed per the person's will.

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• Major Depressive Disorder is a common yet serious medical condition that affects both the mind and body.
• It creates physical (body), psychological (mind), and social symptoms.
• Informally, we often use the term "depression" to describe general sadness. The term Major Depressive Disorder is defined by a formal set of medical criteria which describe symptoms that must be present before the label may be appropriately used.
• According to the World Health Organization, depression is a common illness worldwide, with an estimated 15% of people affected.
• Depressive disorders are a leading cause of absenteeism and lost productivity.
• We also know that people who are depressed cannot simply will themselves to snap out of it. Getting better often requires appropriate treatment.

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• Symptoms can vary a great deal from one person to the next. Typical symptoms include:
• Trouble sleeping or sleeping too much
• Being tired and have no energy
• A dramatic change in appetite resulting in weight loss or gain
• Feelings of worthlessness, self-hate, and guilt
• Inability to concentrate, think clearly, or make decisions
• Agitation, restlessness, and irritability
• Inactivity and withdrawal from typical pleasurable activities
• Feelings of hopelessness and helplessness
• Thoughts of suicide or death
• Symptoms can also change over time, such as with someone who is initially withdrawn and sad becoming very frustrated and irritable as a result of decreased sleep and the inability to accomplish simple tasks or make decisions.
• When depression is severe, people may even experience symptoms, such as hallucinations and delusions.

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• The biopsychosocial model says that biological, psychological and social factors are all interlinked causes of depression.
• Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters serotonin, norepinephrine, and dopamine.
• A person who has a parent or sibling with depression is almost three times more likely to develop Major Depression than someone with no history of depression in their parents or siblings, which suggests that genetics play a role in the causes of depression.
• Long-term stress that lasts for a year or more can affect the body's immune system and lead to an increased risk of developing physical illnesses and an increased likelihood of becoming depressed.
• Psychological factors influencing depression include negative patterns of thinking, low coping skills, judgment problems, and difficulty in understanding and expressing emotions.
• Personality factors, history and early experiences; and relationships with others are seen as important factors in causing depression.
• People can also become depressed as a result of social factors such as: experiencing traumatic situations (a family death, divorce, job loss, abusive relationship, etc.), lack of social support/relationships, or harassment (bullying).

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• If your depressed mood lasts for more than two weeks, or is seriously interfering with your ability to function at work, with your family, and in your social life, you should consult with a mental health professional as soon as possible.
• If you find yourself thinking seriously about suicide, you should make an appointment with a mental health doctor (a psychiatrist, or psychologist) as soon as you can.
• If you are feeling like you will commit suicide within hours or days unless you receive some relief, then skip making an appointment with a doctor and go immediately to your local hospital emergency room and tell them there that you are feeling suicidal.

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• The diagnosis process often starts with a visit to a primary care doctor who may ask simple questions about your feelings and experiences.
• A physical examination, medical history and lab tests will be done to determine if your depression is related to a physical condition.
• If a physical condition is ruled out, then you should see a mental health professional, such as a psychologist or psychiatrist, who will talk with you to learn more about your current problems and symptoms, as well as to obtain a complete history of previous symptoms, a family history, a history of significant stressful life events, and information concerning your lifestyle, social support, alcohol or drug use, and any suicidal thoughts or tendencies you may be experiencing.
• In order to compare your symptoms to those of other people in order to determine the severity of your symptoms, you may be asked to complete one or more standardized questionnaire forms.

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• It is important to know that depression is a HIGHLY treatable condition.
• There is no single therapy that works equally well for every depressed person.
• Depression is most often treated with a combination of medication and psychotherapy.
• Antidepressants help with some of the brain chemistry causes of depression. Typically this will include either a SSRI (selective serotonin reuptake inhibitor), such as Prozac, Zoloft, or Paxil, or a SNRI (serotonin norepinephrine reuptake inhibitor), such as Wellbutrin or Effexor.
• Psychotherapy helps people understand and then change the behavioral, cognitive and social patterns that cause or contribute to the depressed mood.
• More severe cases of depression may require different and more frequent therapy than milder cases.
• People with severe depression who may be engaging in self-destructive behavior, such as attempting suicide, refusing to eat, refusing to get out of bed, or may be showing signs of psychotic behavior, such as hallucinations and delusions, may require inpatient hospitalization.
• People sometimes turn to Complementary and Alternative Medicine (CAM) techniques such as traditional Chinese Medicine, Acupuncture, Homeopathy, and Herbal Therapy for relief from their symptoms. Very few of these approaches have been tested in clinical trials for depression, so there is often little scientific evidence to support these practices.
• One of the best studied and most famous CAM remedies for depression is St. John's Wort, which is an herbal preparation of a plant extract. Research does support this as a stand-alone alternative treatment for depression and in parts of Europe this herb is often the preferred remedy for treating depression.
• If you are interested in CAM approaches, the best plan is to consult with a qualified CAM practitioner who can help determine which combination of treatments, and in what dosages, would be most beneficial for you.

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• Self-help approaches to treating depression are best thought of as additions to professional treatments.
• People should not delay treating depression professionally, or attempt to treat it solely on their own.
• The more that you take an active role in helping yourself recover, the better your chances of recovery are likely to be.
• It is important to accept your diagnosis and to take the medications and other therapies that have been prescribed for you regularly.
• Accept invitations to social events and maintain your typical social schedule as best you can even if you are not enjoying it as much as you used to.
• One way to reduce the amount of stress you experience is to prioritize the demands you are facing and then to do only the most pressing tasks.
• Talk about what is bothering you with a therapist or with friends or family members. If you don't feel comfortable talking, then keep a journal and vent through writing.
• Regular physical exercise is thought to have an antidepressant effect.
• One way to regain a sense of control is to educate yourself about your illness.
• Choosing to make positive improvements in your sleep, eating, drug and alcohol use, exercise, social and spiritual habits can end up helping you improve your mood.

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• There are three primary eating disorders: Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder. Each disorder is characterized by a distinctive pattern of disordered and harmful eating behavior.
• Anorexia generally involves the severe and extreme restriction of eating to lose weight.
• Bulimia is characterized by the presence of binges, which are when someone eats an abnormally large amount of food in a short period of time. These binges are often followed by purge behaviors that are an attempt to get rid of the consumed calories.
• Binge-Eating Disorder is similar to Bulimia because both conditions share binge-eating behavior. However, individuals with Binge-Eating Disorder do not purge or get rid of what they have consumed, unlike those with Bulimia.
• All three eating disorders are serious mental and physical conditions with potentially life-threatening consequences.
• These disorders can affect daily functioning and destroy general health.
• Individuals typically experience painful emotions before, during and after the eating behaviors.
• They often fear gaining any weight, and their self-esteem is highly affected by their weight. This focus can develop into a distorted body image.

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• The World Health Organization (WHO) estimates that worldwide 70 million people have an eating disorder. Lifetime prevalence statistics suggest that about 0.4% of women and 0.04% of men will meet criteria for anorexia during their lifetimes.
• Between 1% and 5% of women will meet the criteria for bulimia during their lifetimes (as will between .01% and .05% of men).
• The prevalence rate for binge eating disorder is 1.6% in females and 0.8% in males.
• Binge-eating disorder shows much less of a difference between females and males, compared to the other two conditions.
• Eating disorders typically begin in adolescence or early adulthood.
• It does not seem to be associated with what race someone is or their socioeconomic status (whether one is rich or poor). Instead, these disorders are problems affecting people from all different backgrounds.
• Between 6% and 20% of people with an eating disorder will die as a result of their disease.

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• There are many factors that can cause an eating disorder including biological ones, personality traits, family issues, and cultural standards.
• Eating disorders are often biologically inherited and tend to run in families. Research suggests that inherited these genetic factors contribute approximately 56% of the risk for developing an eating disorder.
• Research suggests that several different neurotransmitters in the brain are involved in eating disorders.
• Personality traits. such as emotional stability, obsessiveness, and perfectionism. play a large role in the progression of some eating disorders.
• Individuals with anorexia and bulimia tend to be very competitive. They are quite driven to succeed.
• Psychologists and other professionals have identified that individuals with eating disorders often are missing important coping skills to deal with life's situations.
• Much of the research on eating disorders has focused on the development of healthy emotional boundaries in families.
• Some people turn to an eating disorder after they've experienced a family trauma such as sexual or physical abuse, or neglect.
• Particularly in modern Westernized countries, models, the media and dieting fads influence women and girls to be as thin as possible.

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• Dysfunctional thinking and negative thoughts can keep eating disorders going.
• Some professionals have suggested that people with eating disorders have difficulty coping with and managing strong emotions, such as anger.
• Those with anorexia punish themselves for what they see as failures and for their self-hatred by restricting their food intake. They correct for the ever-increasing pile of mistakes they think they have made by punishing themselves through not feeding their own bodies.
• For those with bulimia, however, their strategy for correction is through purging. Their attempt to make up for binging and the resulting sense of shame is displayed through vomiting, exercising, and laxatives as an abusive response to the body.
• Binge-eating disorder does not focus on restricting food for not being perfect, and instead uses food as a source of comfort during times of stress or when upset.
• Behaviors associated with eating disorders that involve food restriction or purging often develop out of a sense of shame.
• Psychologists know that dysfunctional thinking can affect a person's vulnerability toward development and continuing an eating disorder, as well as depression.
• Teens and young women experience a lot of pressure from their peers to be thin and to stay thin.
• Biological factors that cause eating disorders often keep them going as well.

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• Each disorder has different symptoms and behaviors that appear.
• There are three major criteria for diagnosis of Anorexia Nervosa. These are: 1) Restriction of food eaten - eating less than the body needs, which leads to significantly low body weight for the person's age, sex, and physical health 2) Intense fear of gaining weight or becoming fat or having ongoing behaviors that stop weight gain, even when already underweight 3) Issues with the way the person thinks about their body weight or shape. These thoughts affect how they view themselves. They also do not see the seriousness of their current low weight.
• To be diagnosed with Bulimia Nervosa, a person needs to display the following behaviors, on average at least once a week, for 3 months: 1) ongoing episodes of binge eating 2) ongoing behaviors to prevent weight gain, such as causing one's self to vomit, misusing laxatives, diuretics, or other medications, fasting, or excessive exercise.
• To be diagnosed with Binge-Eating Disorder, a person must have ongoing episodes of binge eating that happen, on average, at least once a week for 3 month. Binge eating is characterized by the amount of food eaten in a 2-hour period that is larger than what most people would eat in similar circumstances. It also involves a lack of control over eating during that episode. The person may feel like they can't stop eating or control what they are eating.

For more information on symptoms and characteristics of Anorexia Nervosa
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• One of the first steps to getting well is being evaluated by mental health and medical professionals.
• This evaluation will generally include an interview with you (the "patient" who is displaying the eating disorder symptoms) and your family.
• The interviewer will ask for a detailed medical and mental health history.
You will be asked verbal questions, as well as given paper and pencil (or computerized) tests to fill out.
• It is important to be as honest as possible when answering questions, even though they may be difficult or painful to answer.
• Hiding information will affect the ability of your therapist and doctor to get you the best help possible for your condition.
• The doctor will complete a routine physical. He/she will also ask you about your eating habits, diet, and physical symptoms of the disease.
• You will have laboratory and other tests done. These will check for any medical complications that your disordered eating may have caused and evaluate how well your body systems are working.
• Test results will also serve as a baseline for future comparisons to check whether treatment is helping.
• During treatment, a medical doctor will continue to monitor physical health, including ongoing checks on vital signs, hydration level and electrolytes.

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• The first priority of treatment is to regain physical health and decrease the medical dangers of the condition.
• Nutritional rehabilitation is often one of the primary goals in the beginning and the ongoing stages of treatment.
• Because many individuals with eating disorders are very knowledgeable about nutrition, they often believe that they don't need to work with a nutritionist. However, nutritional knowledge may be distorted by the faulty thinking that results from an eating disorders.
• Individual therapy is designed to provide you with education and support. It will be important to talk about how and why the eating disorder developed and what keeps the behavior going.
• The most common type of therapy used for eating disorders is Cognitive Behavior Therapy (CBT).
• Inpatient treatment involves around the clock care in a medical or hospital setting. It is designed to treat medical complications and restore weight, as well as provide limited therapy.
• Residential facilities offer 24-hour care to people who may not be in serious medical danger but who continue to do eating disordered behaviors.
• Group therapy is an excellent source of treatment and support for those with bulimia or binge-eating disorder.
• Family therapy can be used to provide loved ones with education, support, communication skills, and conflict resolution.

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• By teaching adults to be aware of the most vulnerable individuals and the symptoms, eating disorders can be caught early and treated.
• Educating both male and female children about healthy eating and body image is also an important prevention task.
• Children need to be taught about critical thinking. This includes learning how to recognize when media images are unrealistically perfect and how to not use those images as comparisons for themselves.
• Parents can be big supporters in building healthy body images, self-esteem and lifestyles for their children.
• It's important to encourage children to be involved in sports and other activities that build self-esteem and promote healthy physical activity.
• Actively teach children how to make healthy food choices.
• Plan and eat meals together.
• Compliment kids - a lot. Praise them for their strengths, their talents, and their efforts.
• Provide kids with lots of physical affection and let them know that you love them for who they are.
• Allow lots of opportunities for children to talk about their insecurities, their body image, and their efforts to fit in.
• Educate them about the unrealistic messages in the media, and help them understand that thinness does not equal happiness.
• Limit the number of hours in front of the television or on the computer.
• Limit access to junk food and fast food.
• Avoid giving food for rewards.
• Striking a balance based on family lifestyle and the personality of the children seems to be key to actively teaching children how to make healthy choices, eat junk food in moderation, recognize when they are full, and include exercise into their life.

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• There are many warning signs an elder may display that indicate they require assistance with activities of daily living.
• The following short list highlights some of the more common signs to watch for.
• Physical Problems:
• Sensory problems, such as lost hearing, sight, or smell
• Walking problems, such as difficulty walking or recent falls
• Chronic health problems, such as Diabetes, Heart Disease, etc.
• Trouble performing activities of daily living (ADLs) such as cooking, cleaning, shopping, dressing, bathing, and driving or using public transportation
• Cognitive or Brain Problems:
• Confusion
• Memory or Attention problems including forgetting to take or mixing up medications
• Financial problems including not paying bills on time, or not being able to account for spending when this was not previously an issue
• Language problems
• Dementia (brain damage from a condition such as Alzheimer's Disease)
• Mood or Emotional Problems
• Depression
• Loss of interest in activities and relationships that used to be important
• Social withdrawal
• Personality changes, such as becoming moody, depressed, irritable, or angry

• In the United States eldercare can be broken down into two major categories: family-provided care and professionally-provided care.
• There are six types of professionally-provided care including:
• in-home licensed or unlicensed care
• adult day programs
• independent living facilities
• assisted living facilities
• continuum of care facilities
• dementia facilities
• There are two types of family-provided care, but many variations are possible.
• Each care arrangement offers advantages and disadvantages and may be appropriate depending on elders' needs and desires and the needs and limits of the family.

• It can be unsafe to leave elders at home alone if they:
• Can no longer manage vital tasks of daily living, such as going to the bathroom, preparing meals, getting themselves from place to place, etc., in an independent manner for whatever reason.
• Require medical care that they cannot self-administer (such as Dialysis care), or if memory or physical impairments make it impossible for them to reliably manage care, such as administering daily shots or medications.
• Have physical impairments that stop them from managing tasks of daily living. For example, they are wheelchair bound and cannot get groceries or visit the doctor without assistance.
• Have moderate memory impairments or other cognitive impairments which make it difficult for them to remember whether they have left the stove on or have locked their doors properly or had taken medications.
• Have severe memory or other cognitive impairments that result in their being unable to maintain personal safety. For example, the elder wanders into other people's homes or down the street, the elder becomes confused or paranoid, etc.
• The nature of an elder's impairments are not always clear or obvious and it is a good idea that elders be evaluated by a medical doctor and by a social worker experienced with coordinating elder care needs.

• A good elder care plan should address elders' legal and financial situations as well as their care needs.
• A will is a legal document that allows a person to specify how their property should be divided and how custody of their children should be handled upon their death.
• A healthcare directive (also known as a living will or advanced healthcare directive) is a document that enables a person to legally record their wishes concerning whether 'heroic' or extended medical care measures should be taken to prolong their lives in the event they are incapacitated and unable to speak on their own behalf.
• In a Durable Power of Attorney for Healthcare a trusted family member or friend can be named as a "healthcare proxy" and then has the power to make healthcare decisions on behalf of the person creating the document when the person is unable to do so on their own.
• A conservatorship is a court arrangement allowing an individual power over the financial affairs of an elder that is only allowed to exist when an elder is judged no longer capable of managing their own affairs.
• The Durable Power of Attorney for Finance is a legal document that authorizes a person to have the legal authority to act on behalf of another person with specific regard to managing their finances.
• It is important to make sure that beneficiaries are appropriately named and up to date on financial assets, including retirement accounts (pensions, 401k accounts, etc.), life insurance plans and other assets.
• Elders approaching retirement age (generally 65-68 years of age depending on year of birth) should file for Medicare and social security benefits.
• It may be wise to explore the purchase of a long term care insurance policy, and/or supplemental medical insurance policy that may help pay for needed care facilities and treatments that Medicare will not.
• A trust is a legal device into which elders' assets can be contributed and can be set up in various ways so as to pay out a small income to the elder during his or her lifetime, and then disburse the remainder of the assets to beneficiaries upon the elder's death.

• Elders and their families should begin by making a list of the things that are most important to them with regard to the type of eldercare environment they want and need.
• This list might include the types of assistance the elder requires and the importance of different aspects of care facilities (such as newness, appearance, activities, transportation, availability of care, social and recreational activities, etc.).
• For each aspect of care, it will be helpful to note whether a skilled healthcare worker is required to administer that care, or if instead the care could be provided by an unskilled family member or hired aide.
• Also important to note are preferences (if any exist) regarding care facility characteristics, such as visiting hours, security services, and overall cost of care.
• Once the elder and family have identified important care items, they are then able to search for facilities or in-home providers who offer those options.
• Families seeking a care facility can ask for references and referrals from other elders, local doctors and social workers, the religious community, neighbors, associations, and friends.
• After identifying potential care facilities, the next step is to screen them to see that they fit the desired requirements, conduct interviews and site visits, and check references.

• Elders often perceive a loss of valued independence when this transition occurs because their daily routines must change to accommodate the needs of their care providers, rather than themselves.
• The elder may have to adjust to having someone share their personal space and structure their daily activities, which can be very frustrating for elders used to living alone and setting their own schedules and routines.
• Elders may also feel shame at the thought that they now require help to get by.
• Elders that are moving into a care facility can experience a loss of personal space, identity and possessions, as well as the disruption of long time relationships with neighbors and friends, in addition to the loss of control over scheduling meals, activities and health services.
• These elders too are likely to experience shame feelings and significant grief and may also build up feelings of resentment towards their family members for not working harder to keep them independent.
• Because the transition into care is stressful, it is helpful if it occur in stages, over a period of several years, rather than all at once. For example, it may initially include a home health worker in the elder's home, followed by transition into an independent living or assisted living facility before finally moving into a nursing home if a health condition worsens and 24-hour care is required.
• Family members can commit to visiting the elder on a regular basis, which gives both parties something to look forward to and reduces the likelihood that the relationship between elders and family members will suffer.
• It is important that families make sure their elders know that they can always contact them to let them know that care is not adequate or should be adjusted or changed.
• The family needs to keep in mind that an elder's feelings of loss, frustration and anger are fairly normal occurrences that do not need to be taken too personally.

• Eldercare is inherently stressful, and not all people involved in elder care are able to maintain a patient and compassionate attitude towards their work at all times while providing care.
• Families should be alerted to the possibility that elder abuse can occur, and should remain watchful for actual signs of elder abuse.
• It is surprisingly easy to overlook signs that elder abuse is occurring as elders may feel too ashamed, defeated, or intimidated to report abuse to family members.
• Elders may also be too out of it to know that they are being abused.
• Signs to watch for that may indicate elder abuse include:
• personality changes (angry, depressed, moody, defensive, etc.)
• confusion
• excessive tiredness
• changes in personal appearance of the home and living environment
• Family members who notice any of these signs should talk to their elders, as well as to a social worker or care plan provider and the court or law enforcement officers who can put a stop to the abuse.

• Diabetes Mellitus (usually called "diabetes" for short) is a serious disease that occurs when your body has difficulty properly regulating the amount of dissolved sugar (glucose) in your blood stream.
• The tissues and cells that make up the human body are living things that require food to stay alive, and this food is a type of sugar called glucose.
• The body's cells are dependent on the blood stream to bring glucose to them and without adequate supply, the body's cells will soon die.
• Human foods get converted into glucose as a part of the normal digestion process.
• Nearby cells are not able to access glucose without the aid of a chemical hormone called insulin, which acts as a key to open the cells, allowing them to receive and use available glucose.
• Insulin can be thought of as a bridge for glucose between the blood stream and cells.
• The concentration of glucose available in the blood stream at any given moment is dependent on the amount and type of foods that people eat.
• Problems with insulin production or with how insulin is recognized by the cells can cause the body's carefully balanced glucose metabolism system to get out of control.
• When either of these problems occur, Diabetes develops and the body risks becoming damaged.

• Diabetes is common, affecting 23.6 million Americans according to a 2007 survey by the American Diabetes Association (CDC, 2008) with roughly 1.6 million more Americans being diagnosed with diabetes every year (CDC, 2008).
• Diabetes comes in two major forms and a third less common form.
• Type 1 diabetes is an autoimmune disease where the body's own immune system attacks and destroys the cells within the pancreas that produce insulin, leaving the person unable to produce insulin naturally.
• Type 1 is also known as juvenile diabetes because it often begins in childhood.
• It is fairly rare, accounting for only 5% or so of all diabetes cases.
• Type 2 diabetes begins with a gradual decrease in the body's ability to respond to insulin (a condition known as "Insulin Resistance"), rather than an abrupt stoppage of actual insulin production.
• Type 2 diabetes, which is linked to obesity and poor lifestyle choices and which often begins in adulthood, is far more common than Type 1 diabetes, and accounts for some 90 to 95% of diabetes cases.
• Gestational diabetes occurs in women in the latter stages of pregnancy, is relatively rare, and generally subsides with the end of pregnancy.
• Women who have experienced Gestational diabetes go on to have an increased risk of developing Type 2 diabetes in later life.

• At this time there appears to be little or nothing that people can do to avoid risk of getting Type 1 diabetes, but there are clear risk factors for Type 2 Diabetes.
• While Type 2 diabetes can occur in people of any age, it is much more common in people aged 40 or older. Recent evidence suggests that more and more children are being diagnosed with type 2 diabetes also.
• African Americans, Native Americans, Hispanic Americans, Pacific Islanders, and Asian Americans are at greater risk for developing the illness than are Caucasians.
• People who have close blood relatives (siblings or parents) who have diabetes are at increased risk of getting diabetes themselves.
• Mothers who experienced temporary Gestational diabetes during pregnancy, or who gave birth to a baby that weighed 9 pounds or more, are at increased risk for developing Type 2 diabetes.
• Pre-diabetes, otherwise known as "impaired glucose tolerance", is a pre-cursor to Type 2 diabetes, and without intervention, many pre-diabetic people go on to develop Type 2 diabetes within a decade.
• People who lead sedentary, inactive lives (for example, those who work at a desk job and then watch a lot of TV) have a greater risk of developing diabetes than more active people (those who have built regular exercise into their daily routines).
• Research has demonstrated that modest sustained weight loss (of even 10 lbs), portion control, and lower-fat and refined sugar dietary choices reduce Type 2 diabetes risk.
• High blood cholesterol and hypertension (high blood pressure) are also risk factors for Type 2 diabetes.

• Your doctor will rely on tests of your blood to diagnose diabetes.
• A Fasting Plasma Glucose test measures baseline blood sugar concentration by testing blood samples taken after prolonged fasting (not eating for eight or more hours), often first thing in the morning. This is the first and most common screening test a physician will use to diagnose diabetes.
• An Oral Glucose Tolerance test involves the collection of a fasting blood sample (as in the Fasting Plasma Glucose test), and then having the patient eat a known amount of sugar (75 grams), and collecting a blood sample from them after two hours have passed to provide information about how blood sugar might swing in the short term after food has been eaten.
• The Hemoglobin A1C measures the relative amount of a particular hemoglobin molecule in a person\'s blood that is related to the amount of glucose their blood contains. This test does not require the patient to fast the night before and gives a good representation of a person's blood glucose control over the past two to three months.
• A Random Plasma Glucose test involves blood samples being taken without regard for meals and fasting, and the results are compared against charts that indicate when glucose levels are simply too high to be normal.

• The purpose of this set of tests is to check for complications of diabetes and to learn whether the diabetes is improving or getting worse.
• A Urinalysis involves the patient giving a sample of their urine in the physician's office. This test is important because it can determine the effect of diabetes on the kidneys.
• The Hemoglobin A1C measures the relative amount of a particular hemoglobin molecule in a person's blood that is related to the amount of glucose their blood contains. This test does not require the patient to fast the night before and gives a good representation of a person's blood glucose control over the past two to three months.
• A Blood pressure check should be done at least once a year and many people with diabetes are also encouraged to purchase a home blood pressure unit so that they may check their pressure regularly.
• An Eye Exam should be done at least once a year as it can help catch diabetic retinopathy early when it may still be treatable.
• Cholesterol testing should be done at least once a year because diabetes and high cholesterol often go hand in hand and can combine to cause serious heart and vascular problems.

• Blood sugar concentration is monitored with the aid of a personal Glucose Meter, a device that can measure glucose concentration within a small sample of blood.
• It is a good idea for diabetic patients to carry some form of sugar with them at all times, so that if self-monitoring of blood glucose indicates hypoglycemia (low blood sugar), they can introduce a safe amount of sugar into their bodies as a counter-measure.
• Insulin therapy is the primary means of treating Type 1 diabetes and is also often used in type 2 diabetes as injecting insulin will have the effect of lowering the patient's blood sugar.
• Those with Type 1 diabetes will most likely need to take insulin every day, often even multiple times a day and the insulin must be injected directly into the body as any attempt to take it orally would result in the destruction of the insulin by the digestive tract.
• While some Type 2 diabetics find that diet and exercise alone are sufficient to help them manage their blood sugar, others require one or more medications to help with blood sugar control.
• Despite best efforts, there are times when diabetic patients are unable to keep their blood sugar under control, and severe hyperglycemia or hypoglycemia states or even unconsciousness (coma) occur and immediate emergency medical treatment is required. At the hospital, doctors can re-balance body systems back towards a normal and healthy state.
• Some people with diabetes may also require hospitalization when consequences of diabetes (cardiovascular disease, infection, limb and vision problems, etc.) become health crises in their own right.

• With Type 1 diabetes the single most important factor for preserving health is proper glucose and insulin management.
• People with Type 2 diabetes also need to pay attention to blood sugar management issues, but often can accomplish that management through careful attention to diet and exercise.
• The best way to combat obesity, and some of the other risk factors for Type 2 Diabetes as well, is to eat a healthy and balanced diet and to commit to a program of regular physical exercise.
• A healthy and balanced diet involves meals that are balanced combinations of different food groups with cereals, grains, fruits and vegetables representing the bulk of meals, meats, fish, and dairy as a smaller component and fats/sweets consumed in very limited quantities. A healthy diet is also one that contains fresh and relatively unprocessed foods.
• Regular exercise (a raised heart rate for at minimum 30 minutes a day, three days each week) is a critical part of effective weight loss. Examples of useful exercises include running, jogging, fast walking, swimming, cycling, stair-climbing, Pilates, tennis, soccer and basketball.
• Sustained weight loss is a difficult thing to achieve, as there are many food and recreational temptations that can undercut your resolve. It is highly useful to seek out social support for your weight loss project.

• The divorce process is started when one spouse files a legal document with the court called the 'complaint' or 'petition' requesting a divorce.
• The court schedules a time for an initial hearing after receiving the complaint and both spouses must receive a copy of the complaint and the summons to appear at the hearing.
• At the initial hearing a judge reviews the complaint and answer documents, interviews the divorcing couple, and makes temporary but binding decisions about how the couple may behave towards each other until a more permanent settlement is agreed upon.
• After the initial hearing, a waiting period must occur before the divorce can be finalized. This waiting period varies by state.
• The couple will need to decide on how they will divide joint property and debt, and if minor children are involved, they will also have to decide how custody will be arranged, and what sort of financial support will be put into place.
• If the couple cannot successfully decide on how to divide their assets, debts and child responsibilities on their own, the state will decide for them.
• The divorce becomes final after the waiting period is over, and a final hearing has occurred during which the judge approves any negotiated settlements or imposes a settlement if one has not been reached.

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• Before property and debt can be divided, it must be first inventoried and appraised.
• Each spouse's income should be accurately reported.
• If either person has assets like a business, or intellectual property, this should be reported and appraised.
• All bank, investment and retirement account balances should be reported and include who has access to what money in these accounts and each partner should verify that no monies have been removed from joint accounts without their knowledge and consent.
• All debts should be reported.
• If a house or other real estate properties are owned, the current value of those properties needs to be assessed, and the amount left on the mortgage for that property (if any) needs to be figured out.
• Other owned property such as automobiles/trucks, boats, jewelry, collectibles, household goods, furniture, and art, should be listed, and the value of each item should be determined or otherwise agreed upon by the couple.
• Couples should then decide how all of these assets will be divided.
• If they can't decide on their own, the court will decide for them.
• In equitable distribution states, the court examines the information available to it concerning the divorcing couple, including each partner's income and employment prospects, custody arrangements if children are involved, and what property was owned by each partner prior to the marriage, and then attempts to divide property in a way that it finds to be fair and just in light of this information. The decision might be for a 50/50 split, but it might just as likely be for a 60/40 division, or a 75/25 division.
• Community Property states (including Arizona, Louisiana, New Mexico, California, Idaho, Washington, Wisconsin, Texas and Nevada) start with the assumption that property and debt should be equally divided between the partners without regard to their different needs, responsibilities or earning powers.

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• Legal custody involves being able to make binding decisions on behalf of your child, such as whether a medical procedure should be attempted, or what school the child should attend.
• Legal custody doesn't have anything to do with whether the child lives with you.
• Physical custody involves being allowed to have the child live with you and being responsible for taking care of the child.
• Parents who have no physical custody arrangements do not have a legal right to have their children live with them.
• Physical custody can be divided to reflect the percentage of time each parent will be responsible for actually taking care of their children.
• Physical custody may be shared equally, or one parent may take on 100% of the physical custody with the other parent being guaranteed visitation rights.
• Joint physical custody tends to work best when both parents continue to live in the same town so that shuttling children between households isn't difficult, and school arrangements can remain undisturbed.
• If parents cannot come to agreement over custody issues, the courts will impose a binding plan for custody on the parents.

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• Child Support involves taking wages from a parent to insure that minor children can receive adequate care.
• Spousal Support (also known as alimony), involves taking wages to insure that an economically disadvantaged spouse can continue to live comfortably after marriage has terminated.
• Child support payments are routinely granted as part of modern divorce and are determined according to rules under state law.
• States vary as to when child support payments end, with varying states terminating support at ages 18, 19 and 21 or tying child support termination to a child's high school graduation.
• Spousal support used to be routinely granted, but has recently become somewhat harder to obtain.
• When granted, it is more likely to be time-limited in nature and designed to provide a transition period during which employable skills can be obtained, rather than the open-ended guarantee of income it used to be.
• Child and spousal support agreements are hard to change once they have been agreed upon and endorsed by the courts.

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• The first thing to know about divorce is that it is common and nothing to be ashamed of.
• Divorce involves a very real end, but it is also a very real new beginning for those involved.
• Divorce can trigger all sorts of unsettling, uncomfortable and frightening feelings, thoughts and emotions, including grief, loneliness, depression, despair, guilt, frustration, anxiety, anger, and devastation.
• It is important to let grieving over the ending of the relationship happen.
• People often move back and forth between a shocked, numb state of denial, depression, and/or minimization of the importance of the loss, and outraged anger, fear, and vulnerability.
• Most grieving people find that, little by little, they are ready to move on with their lives.
• Prioritizing and checking off list items helps make sure that all necessary chores get accomplished, and helps to generate a feeling of control over what might otherwise be experienced as unmanageable demands.
• Put old photographs and mementos away where you don't have to look at them all the time.
• Start paying your own bills and handling those aspects of life that your ex-spouse used to do for you.
• Limit your contact with your ex-spouse.
• Tell trusted family and friends that you are getting divorced, and request assistance from these trusted people as they are able to offer it.
• Divorce support groups provide a face-to-face place where people can come together to educate and support one another.
• Psychotherapy and counseling can also be excellent options for obtaining divorce support.
• Maintaining (or starting) healthy routines is a great means of self-support.
• Keeping a journal of your thoughts and feelings as you go through your adjustment to being divorced can provide many benefits.
• Explore one or more new causes, clubs, fields, hobbies or projects to focus on the future.
• Avoid dangerous and self-defeating coping behaviors, such as drugs, alcohol, gambling, jumping into a new relationship, etc.

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• In preparing for a successful divorce, the first step is to educate yourself about the rules, previous court decisions, and laws governing divorce in your state.
• Divorce is a formal legal process and it is generally wise to hire a state-licensed lawyer specialized in divorce to represent you.
• The lawyer can advise you about how to best navigate the divorce process, advocate for your rights and share what typical settlements look like and how they are best arrived at.
• Get a jump-start on the process by beginning to assemble important documents like your marriage certificate, deeds, titles, bank, investment and retirement account statements, credit card documents, and loan papers as soon as divorce is imminent.
• Real estate and other valuable property (jewelry, automobiles, boats, art, etc.) should be professionally appraised and you should store copies of this documentation in a safe and secure place where your soon-to-be-ex-spouse cannot get to it. It may prove critical if your spouse denies that property exists, or attempts to say it is worth less.
• Work with your spouse to arrive at a specific and detailed plan to divide assets and determine child custody arrangements, keeping in mind that whatever plan is decided upon will have to be approved by the court.
• It is important to be civil, polite, honest and well-groomed during all divorce communications, especially when in court or interacting with a judge, mediator or arbitrator involved in the case.

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• Divorce is very hard on children because it changes their entire lives by changing their families, living conditions and their ability to trust in the stability and reliability of support from their parents.
• Children can become upset, angry, ashamed, embarrassed and outraged, or might also become fearful and withdrawn or anxious and clingy.
• They may express these emotions by going back to old behaviors, such as bed wetting or thumb-sucking, or by having temper tantrums, talking back to authority, cursing, impulsiveness, drug use, or running away.
• They may also feel an inappropriate responsibility to 'hate' one parent and 'protect' the other.
• Many children initially act out, but eventually end up adjusting to their changed circumstances. In the future, they may approach relationships with some caution, but generally are ok.
• Other children react profoundly to divorce and end up coping in dysfunctional and self-destructive ways and go on to have continuing life problems.
• Others may appear to adjust to divorce at first but go on to show emotional and relationship problems later in life that are likely tied to the divorce experience.
• A young child's reaction is often to think that he or she must have caused divorce to happen. Because of this, it is important for both divorcing parents to make it clear to their children that the decision to divorce was not caused by anything that the children did, and that both parents will continue to love and protect their children despite the changed circumstances.
• Keeping children's living circumstances and routines consistent is another important way parents can help shield them from the disruptive effects of divorce.
• Regardless of how they are feeling, parents should do what they can to remain calm, to avoid arguing, and to avoid criticizing the other parent while around their children.
• "Triangulation" is a therapy term used to describe a situation where divorced parents come to pass messages through their children rather than speaking directly with one another or ask their children to spy on the other parent and report back, or use the children in ways to manipulate their ex-spouse. This behavior should be avoided.
• Parents should also invite children to talk, listen to what they have to say, and provide love and emotional support during this difficult time.

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• Divorce offers people the opportunity to reflect on and learn from the mistakes they have made in order to reduce the chances that they will make those same mistakes again.
• Either alone (via journaling), or with the assistance of a trusted friend, family member or therapist, talk or write out the history of the marriage, from beginning to end.
• Work to identify and describe the big points of conflict where compromise proved difficult or impossible and try to figure out where your personality and values clashed with those of your spouse and where they were in harmony.
• Knowing this information will help you to figure out what qualities you will want in a future relationship and what qualities you will want to avoid.
• The next challenge is to place the divorce in the past and decide to move forward with life.
• The new chapter in life can only start when divorcees reach a point where they are ready to 'turn the page' and explore what their new life can become.
• Being able to move on with life is easiest to accomplish when one is hopeful, positive, and looking toward the future, rather than being stuck focusing on and thinking about the past.
• Some people, places and things will cause one to remember the past marriage and keep things focused on the past. It can be a good idea to put such things away so that they don't automatically trigger old memories. When that isn't possible or they can't be avoided, work to create new memories around those people, places and things.
• Exploring interests, old and new, pulls your attention into the present, creates opportunities for creativity, meaningful social interaction and new relationships, and promotes personal growth.

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• To be emotionally resilient means to be able to spring back emotionally after suffering through difficult and stressful times in one's life.
• Emotionally resilient people have a specific set of attitudes concerning themselves and their role within the world that motivates and enables them to cope more efficiently and effectively than non-resilient people.
• Specifically, emotionally resilient people tend to:
• Have realistic and attainable expectations and goals.
• Show good judgment and problem-solving skills.
• Be persistent and determined.
• Be responsible and thoughtful rather than impulsive.
• Be effective communicators with good people skills.
• Learn from past experience so as to not repeat mistakes.
• Care about how others around them are feeling.
• Care about the welfare of others.
• Feel good about themselves as a person.
• Feel like they are in control of their lives.
• Be optimistic rather than pessimistic.
• These special beliefs and characteristics of resilient people help them to keep proper perspective, and to persist with coping efforts long after less resilient people give up.

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• Emotionally resilient people don't know more or better coping skills than non-resilient people. Instead, they are better able to apply the coping skills that they do know compared to non-resilient people.
• Resilient people believe that they have the potential for control over their lives and they believe that they can influence their situation.
• People are able to make judgments and decisions regarding their emotional state, and to act on those decisions even when those decisions run counter to their emotional state. For example, frightened people can evaluate whether or not their fears are justified, and act against their fears.
• Resilient people believe they can change their moods, and so they work to change their moods.

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• Positive emotions (happiness, contentment, joy, etc.) are associated with healthy immune system functioning.
• Negative emotions are associated with weaker immune function, greater production of stress hormones, and greater incidence of illnesses.
• Sharing of positive emotions with others helps to bond people together, creating and maintaining strong, healthy, and caring relationships.
• Caring relationships, in turn, provide social support which nourishes further emotional resilience, and positive feeling states.
• The better you feel, and the more you share that positive feeling with others, the more you are able to draw upon the relationships you create through that sharing to create further positive feelings.

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• Emotionally intelligent people intentionally use their thinking and behavior to guide their emotions rather than letting their emotions drive their thinking and behavior.
• People who are highly emotionally intelligent tend to also be highly emotionally resilient.
• In order to become more emotionally intelligent, it is necessary to develop the following five skill areas:
• Self-awareness involves your ability to recognize feelings while they are happening.
• Emotional management involves your ability to control the feelings you express so that they stay appropriate to a given situation. This means using skills including maintaining perspective, being able to calm yourself down, and being able to shake off out-of-control grumpiness, anxiety, or sadness.
• Self-motivation involves your ability to keep your actions focused on your goals even when you are distracted by emotions and to avoid acting impulsively.
• Empathy involves your ability to notice and correctly figure out the needs and wants of other people.
• Relationship management involves your ability to anticipate, understand, and appropriately respond to the emotions of others.

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• You can begin the process of identifying emotions by asking yourself questions that will help you understand the ways that emotion has affected you. Good questions to ask include:
• What am I feeling now?
• What are my senses telling me?
• What is it that I want?
• What judgments or conclusions have I made (and are they accurate)?
• What is this emotion trying to tell me?
• The answers to these questions are key to using your emotions to move toward your life goals, rather than allowing your emotions to use you.
• Often, your body reactions suggest important clues to what you are feeling. For example, if your face begins to get warm while you are talking with someone, you may be embarrassed; if you have "butterflies" in your stomach, you may be nervous; and if your head pounds, your heart races, and you feel increasingly tense and hot, you are probably angry.
• You can also learn to identify emotions based on the way they make you feel, think and act. For example, maybe certain memories come to the surface of your mind when you are feeling sad that aren't there at other times.
• Consciously knowing what you are feeling and why may suggest steps you can take to help you change your feelings.
• Understanding your emotions makes it possible for you to manage them so that they work for rather than against you.
• If your sadness (or anger, or anxiety, etc.) would normally influence you to act in a way that might hurt yourself or someone else, becoming aware of that emotion can enable you to take steps to not act in that destructive way.

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• Researchers have found four inner traits that help people to have positive attitudes and to be content or happy more often than not.
• Self-esteem - Happy people respect their value as human beings and have confidence in themselves. When times get tough, people with a solid sense of self-worth and a firm belief in their own competence are the very people who persist until the tough times have passed.
• Personal Control - Happy people believe that they have control over what happens to them and they tend to believe that they are actively in charge of their own destiny rather than being a passive victim of fate.
• Optimism - Happy people are hopeful people and they expect they have a decent chance to succeed when they try something new.
• Extroversion - Happy people tend to be outgoing and sociable and they often find it a pleasure to be around others, rather than a chore.
• You can strengthen your own habit of being happy by practicing it again and again.
• As you become more and more comfortable acting happy, the phoniness will be reduced and the happy behaviors and attitudes you have been practicing will begin to feel more natural.

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• Optimism is the name given to the personality trait shown by people who tend to expect that good things will happen in the future.
• The opposite of optimism is pessimism, which is the belief that bad things will happen.
• Optimism helps to motivate people to take healthy actions that they otherwise would not bother with.
• Optimism motivates people to change bad situations and to address problems early on before they spiral out of control.
• Optimism improves a person's ability to develop friendships and supportive relationships because it motivates people to think that other people will like them.
• Optimism affects the body at a physical level by influencing the immune system as research has found that optimists catch fewer contagious disease than pessimists.
• Though the optimistic tendency to look on the bright side of things and to expect good things to happen is a good overall personality trait to have, it is not appropriate to be blindly optimistic in all circumstances.

• The first step usually begins with the awareness that stress can do damage in your life.
• The awareness stage of change begins when you decide to learn more about becoming stronger and more emotionally resilient.
• Seek out more information on stress management, and on various aspects of emotional intelligence and emotional resilience. The more you know going into the process, the easier it will be for you to achieve lasting and positive changes.
• The preparation stage begins when you decide whether you actually want to make the effort to change yourself. It is also the stage in which you start making specific plans for what changes you want to make, and how you will accomplish those changes.
• The specific goals you set should be based on your best assessment of your particular strengths and weaknesses and the goals should help you strengthen weaker aspects.
• The action stage starts when you start working on accomplishing your specific resilience goals.
• As you make your commitment to improving your coping and resilience skills, share that commitment and your plan with at least one other person as public commitments are easier to keep than private ones.
• Don't try to do everything at once. Select one area that is the most important to you to work on first and plan several achievable, time-limited goals.
• Breaking your larger goals into small achievable bits is the best way to successfully complete the change process.

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• Grief is the process and emotions that we experience when our important relationships are significantly interrupted or (more frequently) ended, either through death, divorce, relocation, or some similar process.
• Grief starts when someone or something we care about is lost to us.
• These can be relationships with people that we have strong connections to, such as family members and friends; places we feel attached to, such as the house we grew up in or our hometown; or things that are important to us, such as love letters, a watch that a grandparent gave us, etc.
• There are two types of losses that we may grieve - the actual loss of the person or thing in our lives and then the symbolic loss of the events that can no longer occur in the future because of that actual loss.
• Grief ends when we have gotten past the intense need for the lost person or thing in our lives and are able to function normally without them.
• This doesn't mean that we stop feeling sad when we think about older losses, but instead that we are no longer significantly crippled by the loss.

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• Grief is a normal and natural process that takes work to get through.
• It is not easy to let go of close relationships that have existed in our lives.
• Dealing with the emotions that occur in the grieving process takes much time and energy, and is usually both physically and emotionally demanding.
• It is normal for people to grieve in very different ways - some grieve openly, while others hide their feelings of distress; Some grieve quickly, while others take a long time to "finish."
• There is no "right way" to grieve and each individual comes up with a method of grieving that fits them and their particular loss.
• Some conditions can make it harder for a person to successfully make it through the grief process. For example, sudden losses are harder to deal with than ones that have been anticipated, and the loss of a spouse, lover, child, parent, or best friend is usually more deeply felt than the loss of more distant relations and friends.
• There are different models of grief that have been described to help people understand the stages that many people go through during the grieving process. These include Horowitz?s Model of Loss/Adaptation, Kubler-Ross's Stages of Grief, and Rando's Six R's Model of Grief.

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• Though each person grieves in unique ways, there are common behavioral, emotional, and physical signs and symptoms that people who are grieving typically experience.
• Physically, persons affected by grief may experience:
• Fatigue and exhaustion alternating with periods of high alertness and energy
• Temporary hearing loss or vision impairment
• Difficulty sleeping
• Disturbed appetite (either increased or decreased)
• Muscle tremors
• Chills and/or sweating
• Difficulty breathing or rapid breathing
• Increased heart rate or blood pressure
• Stomach and/or intestinal problems
• Nausea and/or dizziness
• Mentally, persons affected by grief may experience:
• Confusion (memory, concentration, judgment and comprehension difficulties)
• Unwanted thoughts, arousal, and nightmares
• Intense feelings of detachment and denial
• Emotionally, persons affected by grief may experience:
• Shock
• Fear, anxiety or apprehension
• Anger, irritability or agitation
• Guilt
• Numbness, remoteness, depression

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• There are both constructive and destructive ways that people can choose to cope with grief and loss.
• Among the more destructive coping methods are turning to alcohol or other drugs to dull the pain.
• There are many healthy ways to deal with grief including:
• Journaling - Many people find comfort in writing out their thoughts and feelings during the grieving period and this can be a very good way to express feelings that they may not feel comfortable sharing with others.
• Talking - Others find that talking with a close family member or friend is helpful and allows them to share memories about the lost relationship or emotions that they are feeling.
• Getting Professional Help - Some people choose to speak with a professional grief therapist who can help them understand the grief process and deal with the emotions or reactions that are being felt.
• Medication - Grief therapists and other doctors may suggest that a prescription for anti-depressant or anti-anxiety medications would be helpful to take the edge off the worst grief symptoms, especially the physical ones.
• Support Groups - many people find it comforting to speak with others who are experiencing similar types of loss and who are at different stages of the grieving process.
• Good Physical Self-Care - it is important to practice good physical care, which includes getting enough sleep, eating well, and exercising.
• Keep Active and Social - it can actually be helpful for grieving people to stay engaged in other relationships and activities as they provide important opportunities for distraction; allowing grieving people to focus on something other than their grief.
• Putting Off Major Decisions - While grieving a loss, it is generally best to put off any major life decisions, as people's ability to think straight and use good judgment can become clouded by their loss.
• Read - People may find comfort in reading books about grieving, self-help, the meaning of life, and inspirational or religious/spiritual matters.
• Pray - People who find comfort in prayer and religious participation should pray and take part in prescribed rituals as a means of helping themselves cope with their loss.

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• It can be difficult for someone who is grieving to know when grieving will be completed.
• Grief can be an extended process and it has no set timeframe for finishing.
• Important signs that grief is winding down include the slow return of the ability to feel pleasure and joy again, the ability to look forward to things in the future, and the return of desire for reaching out to others and re-engaging in life.
• The transition from a sad focus on the past to a re-engaged hopeful focus on the present and future does not happen all at once.
• Grieving people may start to feel guilty when they realize that they are not wanting to remain grieving.
• They may see their recovery from grief as an abandonment of their past relationship and resist this perceived abandonment.
• In time the guilt feelings tend to subside too as life continues.
• A final sign that grief is ending occurs when grieving people are able to think about their lost person, place or thing more as a happy past memory and less as a painful present absence.
• They may still feel pain at the loss, but it is not as intense as it once was.

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• Many people are unsure what to say or do to be helpful or they worry that they will accidentally cause additional problems for grieving people by saying or doing the wrong thing.
• Reach Out - Many people hesitate to reach out, and instead choose to wait for the grieving person to ask for assistance. Help should be offered in the form of specific tasks that the griever may need assistance with, rather than a general "call if you need anything."
• Don't Minimize the Loss - Often while wanting to make the mourner feel better, we may actually accomplish the opposite by minimizing the loss, or insinuating that the mourner is not behaving as others expect.
• Listen - Instead of trying to offer "helpful" comments, you can help by simply being present and listening to what the grieving person has to say.
• Don't be Afraid to Mention the Lost Person - Often people fear that if they use the deceased person's name or refer to the loss, they will make the mourner upset, but most people feel worse when those around them act as though the deceased person or the relationship never existed and that nothing has changed.
• Suggest Professional Help if you are worried that a griever is "stuck" in their grieving process, experiencing difficulty acknowledging the reality of the loss, or displaying signs of physical or mental illness.

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• Coping with a death can be difficult for the strongest of adults and it can be even more difficult and confusing for children.
• Tell the Child What Has Happened - It is important to communicate this openly and honestly. Many people try to soften the blow by using phrases such as "He's gone to sleep" or "She's gone away." Dodging the issue in this manner suggests that the person had a choice in the matter, and can communicate that other people may abandon the child too.
• It is okay for children to see that adults are upset, and that loss is difficult for anyone to get through, regardless of age and experience. It is important not to feel as though you must have all the answers, or present yourself as invulnerable.
• However, children should not be expected to do or say something to make things better for the adults.
• It is important to take into account a child's developmental level when deciding how much and what to say because it is not until about ages 9 to 12 that a child fully comprehends the meaning and reality of death.
• Very young children may experience death as a loss, but they will not understand the irreversible nature of the loss and will not be able to verbalize that loss.
• Parents may want to step in and provide answers to some common childhood questions about death, even if the child has not asked the questions because the child may be afraid to ask them. But whether or not to offer such information is a judgment call that each parent has to make independently based on their knowledge of their child.

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• The term "Pathological Grief" is sometimes applied to people who are unable to work through their grief despite the passage of time.
• It can take most people up to several years to get past a serious loss.
• A pathological grief reaction may be diagnosed after a long time (one or more years) have passed and the grieving person is not improving.
• By labeling someone's grief as pathological, a doctor is indicating that the grieving process resolution is delayed for some reason and that professional help is needed.
• No disrespect is intended toward the patient in using this term.
• There is no absolute time frame within which grief is considered pathological, although there are cultural norms that serve as guidelines.
• In North America a person might be judged as being "stuck" if they are still actively grieving 18 to 24 months after their loss.
• An 'overly intense' grief process of shorter duration might also be labeled as pathological.
• Keeping these guidelines in mind, know that it is very much appropriate to encourage people who appear to be stuck in their grief process to seek professional grief counseling.

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• The general term used to cover malfunctions of the heart is Heart Disease, or sometimes Cardiac Disease as "Cardiac" is a Latin word that means heart.
• The two most common types of Heart Disease are Heart Attack and Heart Failure.
• Some risk factors are out of your control, but many of them can be avoided by choosing to live a healthy lifestyle.
• Some of the risk factors you cannot control are:
• Gender: Men have a greater risk than women for developing heart disease. Men also are at greater risk of having a heart attack at a younger age. However, heart disease is the number one killer of women (just like men).
• Age: Simply put, the older you get, the greater risk you run for developing heart disease. It is estimated that four out of five individuals who die of coronary heart disease are 65 years of age or older.
• Family History: A family history of heart disease, high blood pressure (hypertension), and diabetes increases the chance you will develop heart disease.
• Some of the more controllable risk factors include:
  • High Cholesterol: Too much cholesterol, a type of fat molecule, in your blood, puts you at increased risk of heart disease.
  • High Blood Pressure: Uncontrolled blood pressure increases your risk of heart disease.
  • Obesity: People who are overweight are more likely to have high blood pressure and high cholesterol levels.
  • Smoking: Smoking is a major risk factor for heart attacks.
  • Diabetes: A diabetic person's risk of developing heart disease is equal to the risk of a person who has had a previous heart attack.
  • Stress, drinking too much alcohol, and depression have also been linked to cardiovascular disease.

• The heart cannot take oxygen and nutrients directly from the blood it moves through the body.
• Instead, the blood that feeds the heart has to pass through the coronary arteries which run along the outside surface of the heart muscle.
• A Heart Attack (also known as a myocardial infarction or "MI"), occurs when the supply of oxygen and nutrients to the heart through these coronary arteries becomes interrupted.
• In a heart attack, the blood supply to the heart muscle becomes blocked in a section of the coronary artery system, in many cases causing a section of the heart muscle to die or sustain permanent damage.
• In the event the victim survives the attack, the newly dead area of heart muscle eventually scars over, causing the heart to pump with reduced efficiency afterwards.
• There is no single set of symptoms that signals an impending heart attack.
• Symptoms can include (but may not be limited to) the following:
• Chest Pain: Angina is a term for chest pains and a feeling of intense pressure (as though a heavy weight has been set on the chest) caused by a lack of blood supply to the heart muscle.
• Radiating Pain and Numbness: Intense pain and chest pressure may spread outward to the shoulders, neck and arms (especially the left arm). The pain can occur with varying degrees of intensity.
• Dizziness or Lightheadedness
• Nausea and Vomiting
• Sweating
• Shortness of Breath
• Anxiety and/or a Sense of Nervousness (sometimes combined with an impending sense of doom).
• Pale Coloration of the skin
• Heart Rate Increase or Irregularity
• Indigestion or a choking feeling similar to heartburn
• It is also possible to have a heart attack without experiencing any symptoms at all, which is known as a "silent" myocardial infarction. Older adults or people who have diabetes are most at risk for this uncommon type of heart attack.

• It is important that you call 911 if you find yourself (or someone that you are with) experiencing symptoms or the warning signs of a heart attack.
• The longer treatment is delayed, the more likely it is that irreversible damage will occur to the heart muscle.
• At the hospital, the doctor will ask questions and perform tests to determine whether or not the symptoms are truly being caused by a heart attack.
• The doctor will ask questions about the medical history and risk factors for heart disease such as whether you smoke, your family history, and cholesterol history.
• One or more of the following tests to determine whether or not you have actually had a heart attack, may be performed:
• ECG. An ECG (also referred to as an EKG or electrocardiogram) measures the electrical activity of the heart. Changes in the heart's activity levels can signal a heart attack. The EKG also monitors your heart rate for irregular heart rates that can occur during a heart attack.
• Blood Tests. Heart muscle cells contain unique enzymes that help them to function and when heart muscle cells are broken during a heart attack, the contents of the cells, including these enzymes, get spilled into the bloodstream. Doctors can measure the levels of these heart muscle enzymes in your blood to determine if you have had a heart attack.
• Echocardiography(ECHO). An ECHO is an ultrasound of the heart and is particularly useful at identifying which heart structures have been damaged during a heart attack and the amount of function lost.
• Stress Test. If your doctor is uncertain whether your chest pain is caused by your heart, he or she may perform a stress test. There are several types of stress tests, but their purpose is to observe your heart while it is under stress. During a stress test the doctor is looking for changes that show your heart is not getting enough blood flow to some of its muscles.
• The treatment of a heart attack generally begins immediately after diagnosis.
• The sooner the blockage constricting the coronary arteries is alleviated, the less permanent damage your heart muscle will incur.
• Heart attacks are often treated with a combination of medicines and other medical procedures designed to restore blood flow to affected areas of the heart muscle.
• Medications used to treat heart attacks include those designed to slow your heart down so it doesn't work as hard (known as beta-blockers), medications to break-up existing clots (called thrombolytics) and aspirin or antiplatelet medicines to help stop more blood clots from forming.
• Medical procedures used to treat heart attacks include angioplasty with stent placement and bypass surgery.

• The term "Heart Failure" is used to describe a condition where someone's heart is unable to pump enough blood to support all of his or her body's organs, muscles and other tissues.
• The heart continues to work during heart failure, but not efficiently enough to adequately support the body's needs.
• Over 5 million people in the United States have heart failure and it is a major cause of hospitalization for people older than 65 years.
• Heart failure can affect one or both sides of the heart.
• Heart ventricles, responsible for pumping blood out into the body, can become defective in two different ways.
• They can lose their ability to contract and can no longer generate enough force to push the blood through the body effectively.
• They can lose their ability to relax and cannot open enough to fill completely, and the volume of blood available for pumping is drastically reduced.
• Either condition results in a decreasing rate of blood flow throughout the body's circulatory system which often leads to fluids backing up in various tissues, which is called an edema.
• There are multiple symptoms that can indicate heart failure.
• Most of these symptoms are related to the fluid back-up that occurs as a result of heart failure.
• Edema/Fluid Retention - If you gain three to five pounds in the span of a day, this weight gain can most likely be attributed to fluid retention. Your kidneys may retain fluids when they perceive less than normal blood flow. This extra fluid will build up in various tissues, often causing visible swelling of the limbs, most often in the legs, ankles, and feet.
• Congested Lungs - In addition to your legs and ankles, fluid can buildup in your lungs during heart failure. This causes symptoms including shortness of breath, a cough that is often worse at night, and suddenly awakening in the middle of the night short of breath.
• Dizziness and Fatigue - All of your muscles and body organs require regular blood flow to supply them with the oxygen and nutrients they need to function. When your organs and muscle cells become deprived of these nutrients, you may feel weak, dizzy or tired for no apparent reason.

• Some individuals who develop heart failure may have simply been born with a structural defect in a portion of their heart while others develop the disease as a result of medical conditions that have not been controlled.
• The major causes of heart failure include:
• Coronary Artery Disease, which disrupts blood flow in the coronary arteries that supply blood to the heart itself.
• Diabetes, which involves high blood sugar levels, can cause damage to many organs such as the heart and kidneys.
• Hypertension, which is also known as high blood pressure, causes the heart muscle to become thicker and stiff, decreasing the heart's ability to relax and adequately collect blood for pumping.
• Heart Valve Dysfunction causes the heart to need to pump harder so as to keep up with the body's demand for oxygen and the elevated strain this process places on the heart can lead to heart failure.
• Cardiomyopathy: Damage and weakening of the heart muscle can lead to reduced efficiency and heart failure. Cardiomyopathy has many causes including viral infections, alcoholism, autoimmune diseases (e.g., rheumatoid arthritis, lupus), high blood pressure, and heart attacks.
• Lung Disease: When the lungs are damaged and they do not provide adequate oxygen for exhausted blood to pick up, the heart pumps faster so as to compensate, placing strain on the heart which can lead to heart failure.
• Thyroid disease: both too much and too little thyroid medicine can result in heart failure that usually is reversible with treatment.
• Arrhythmia is a condition in which the heart beats irregularly rather than rhythmically and it interferes with normal blood flow.

• The earlier heart failure is diagnosed and properly treated, the faster you can start down the path to recovery and with less long-term damage.
• When discussing your symptoms with your doctors, be prepared to honestly answer questions concerning your medical history, your drug and alcohol use, and smoking habits.
• Your doctor may also order one or more of the following medical tests to further diagnose your condition:
• Blood Tests - The doctor will most likely request a blood sample so that he or she can check levels of various hormones and enzymes in your blood.
• An X-ray - Your doctor may order an x-ray photograph of your chest area to give the doctor an indication of the size of your heart and whether there is any fluid buildup in or around the lungs.
• An Echocardiogram, which is used to show the structures of the heart, and can show how well the heart is pumping and which areas are not functioning properly.
• The doctor may also make a referral to a cardiologist for other heart testing including an angiogram (to look for blood vessel blockage), a holter monitor (to look for irregular heartbeats), and a stress test (to look for signs of coronary artery disease).
• Treatments for heart failure vary based on the severity of the disease process.
• Surgical and medical procedures as well as the following lifestyle changes may be recommended:
• Quit Smoking - smoking raises your blood pressure, increases your body's need for oxygen and increases your chance of heart disease.
• Lose Weight - Losing weight eases strain on the heart, while also improving diabetes, blood pressure and cholesterol control.
• Limit Sodium - in heart failure your body has too much fluid and by limiting sodium you can help limit the fluid retained.
• Limit Fluids and Alcohol
• Exercise has been shown to improve quality of life and decrease death from heart failure.
• Check your weight regularly as a sudden increase in your weight may suggest that you are retaining more fluid and that you are experiencing a worsening of your heart failure that may require medication adjustment.
• In addition to lifestyle changes, your physician may place you on medications specifically for your heart failure. This may include diuretics to help remove the excess fluid, beta-blockers to slow your heart rate and improve the relaxation of the heart, and ACE inhibitors which have been shown to decrease symptoms of heart failure.
• If your heart failure is not controlled through medications, your doctor may recommend surgery. This could include a Coronary Artery Bypass, Heart Valve Replacement or Repair, a Left Ventricle Assist Device (called a LVAD) and a Heart Transplant, which is generally used as a last resort after all other treatment options have been exhausted.

• A diagnosis of heart disease should be a wake-up call alerting you to examine your own habits to see if any of them might be harmful to you or if they are likely worsening your heart disease.
• There are several important things you can do which will help reduce the symptoms and progression of your heart disease.
• Quit Smoking - the first change you should make is to quit smoking if you are a smoker. While this is often one of the hardest lifestyle changes to make, it is also one of the most important.
• Eat A Healthy Diet - the dietary choices you make can contribute to or lessen your heart disease risk.
• Keep in mind that healthy food doesn't have to taste bad and you don't need to view your diet changes as an end to your enjoyment of eating.
• While sodium (salt) is necessary for the body to function properly, too much sodium can cause problems, especially for those individuals who have heart failure.
• In extreme cases of heart disease your doctor may want to regulate how much fluid (liquids) you take in.
• Foods high in saturated fats and trans fats such as red meat, whole milk, cheeses, prepared baked goods and many processed/prepackaged foods can increase your cholesterol levels, and should be eaten in limited quantities.
• You should limit the amount of dietary fat you take in each day.
• Make healthier protein choices by focusing on fish, chicken, lentils and beans, and soy products.
• Eat Smaller Portions More Frequently, rather than skipping meals.
• Get regular exercise - aerobic activities (e.g, biking, jogging, walking, and swimming) raise your heart rate and strengthen your cardiovascular system.

• High blood pressure, also called hypertension, affects nearly one out of every three Americans.
• The body's tissues depend on nourishment from the blood in order to survive and blood circulates to all body tissues through a network of blood vessels and organs known as the circulatory system.
• Blood is forced through the circulatory system by the heart.
• The force of the heart's muscular contractions put pressure onto the blood, forcing it to flow through the blood vessels in a forward movement in a continual loop.
• Blood pressure is the result of the force of the heart and the resistance of the vessel walls - coming together to push the blood through the body's circulatory system.
• Blood pressure is not constant or flat; rather it is cyclical or wavy.
• As the heart beats, it puts force on the blood, increasing the overall blood pressure and as the heart relaxes between beats, there is less force put onto the vessels and the blood pressure lowers.
• The body's blood vessels are strong, elastic and designed to handle a variety of blood pressures, but it is important that the blood pressure never get too strong because the vessels themselves can be damaged with long term issues for the health of the tissues and organs that depend on those vessels.
• When damage does occur, it generally happens slowly over time and not as any single 'blowout' event.

• Measurements of blood pressure have two components: one to capture the peak pressure during a heartbeat (systolic), and the other to capture the resting pressure during the space between heart beats (diastolic).
• Blood pressure is measured in a unit called "millimeters of mercury".
• The systolic blood pressure measurement is the higher of the two numbers and is written on top of the diastolic.
• Blood pressure measurements can be classified into four categories depending on how they vary from what is most healthy. The categories are hypotensive, optimal, prehypertensive, and hypertensive.
• Hypotensive, or lower than normal blood pressure, is mostly only of concern when patients are hospitalized or feeling faint upon standing up or passing out for unknown reasons.
• For most purposes, blood pressure readings can be considered optimal, prehypertensive, or varying degrees of hypertensive.
• Optimal blood pressure is 120 over 80 - meaning the systolic pressure is below 120 and the diastolic is below 80.
• Prehypertension is diagnosed when the systolic is between 120 and 139 and the diastolic is between 80 and 89.
• Mild Hypertension is when the systolic is between 140 and 159 and the diastolic is between 90 and 99.
• Moderate to Severe Hypertension is when the systolic is above 160 and the diastolic is above 100.

• Hypertension is sometimes called the "silent killer" because for all the disease and destruction it can cause, it is surprisingly quiet and difficult for a person to identify.
• You can have raging high blood pressure and not know it, as there are often no obvious symptoms that you would experience.
• When hypertension does produce symptoms they tend to be subtle and non-specific symptoms such as headache, dizziness, or blurred vision.
• Because of the absence of obvious symptoms associated with hypertension, regular visits to the doctor's office are essential.

• Diagnosis of hypertension is made by a doctor with the aid of a blood pressure measurement device such as a blood pressure cuff and stethoscope.
• Due to the dynamic, changeable nature of blood pressure, the doctor may take multiple readings to get an average blood pressure and to spread the readings out over time.
• He or she may also take the readings under controlled circumstances (for instance, always sitting after having relaxed for 1 minute and before meals) so as to get the most accurate and comparable reading possible.
• The diagnosis of hypertension is usually made over several visits.
• If your blood pressure is mildly elevated, a doctor will likely re-check it within a couple of months.
• If your blood pressure is moderately to severely elevated the doctor may re-evaluate it within a week or so, or may start treatment immediately.

• The following lifestyle changes are important for reducing hypertension:
• Exercise - Experts recommend at least 30 minutes of moderate exercise (brisk walking or stationary bike) on most of, if not all, days of the week. Intense work-outs (such as shoveling snow or heavy lifting) and competitive contact sports may be dangerous for people with high blood pressure.
• Modified Diet - using the DASH or Dietary Approaches to Stop Hypertension diet, people can lower their high blood pressure. This involves avoiding saturated fats, choosing whole grains, eating fresh fruits and vegetables every day, and eating nuts, seeds or beans every day. Eating potassium-rich foods, restricting salt, cutting down or abstaining from alcohol use, and avoiding caffeine can also help.
• Lifestyle modifications can substantially reduce hypertension, but they can be difficult for most people to follow, and even when followed correctly may not completely eliminate hypertension.
• Various medications will commonly also be prescribed to help control blood pressure.
• Commonly known as 'water pills', diuretics work by adjusting the fluid levels within the body.
• Angiotensin Converting Enzyme Inhibitors (commonly known at ACE inhibitors) are not only useful for people with high blood pressure but are also important for people with heart disease and diabetes. They work by blocking chemical signals that can increase blood pressure.
• Angiotensin Receptor Blockers (ARB's) reduce the effects of the angiotensin chemical signal system in a different way than ACE Inhibitors, but may have similar results.
• Beta-blockers have their effect by reducing the frequency of heart beats.
• Vasodilators open up the blood vessels and are often used in combination with other medications.

• A combination of medication and lifestyle changes can bring most cases of hypertension under control.
• It is necessary to stop eating some tasty foods, to exercise more frequently than may be comfortable (at least at first), and to take medicines as prescribed day in and out - possibly for the rest of your life.
• It can be difficult for people to truly accept and recognize the need for such changes when they do not feel particularly impacted by their illness and when there are no obvious symptoms.
• Failure to maintain treatments and lifestyle changes will likely result in the slow but cumulative and progressive damage to the body's vital organs (the heart, kidney and brain in particular).
• It can be very discouraging to be diagnosed with a chronic condition and can lead to feelings of depression and helplessness.
• Finding support systems (church, clubs, community centers), as well as family and friends to talk with can help defuse this negative stress, as can seeking out counseling and medical treatments for depression (such as antidepressant medications).
• Taking steps to insure your mental wellness and positive outlook make it easier for you to improve your physical health and make necessary lifestyle changes.

• Infertility is typically defined as the inability to become pregnant after one year of sexual intercourse without contraception.
• For women over age 35, this condition is diagnosed after 6 months of an inability to conceive.
• In a lifetime, 10-15% of couples will experience infertility and this number jumps to 33% in couples when a woman is over 35 years of age.
• In about 45% of cases there is a male-origin for the infertility, female-origin infertility accounts for 30% of cases, and 20% of the time both partners are the source of difficulties.

• Fertility involves a complex set of coordinating biological process, all of which must work more or less perfectly, more often than not, in order to avoid infertility.
• In the man, hormones that cause sperm to be produced act on the testicles and the testicles must be responsive to such hormones in order to begin or continue sperm production.
• The prostate and other glands must produce seminal fluid that is nourishing and protective of the sperm. In order to send the sperm out of his body, a man must be able to obtain and sustain an erection (hardening of the penis) until he can ejaculate (when sperm mixed with other fluids exit the penis) inside the female.
• Sperm that is released must be strong enough to swim up the woman's reproductive tract.
• Along the way, many sperm will die trying to get to the egg, so it is also important that the sperm be numerous enough to allow some survivors after these casualties.
• Male-Factor Infertility is most commonly due to low sperm count.
• Men can also have damaged or blocked sperm ducts for several reasons or scarring from an untreated sexually transmitted disease.
• Hormonal abnormalities that affect the development and maturation of sperm can also be an issue.
• Testicles may also be non-responsive to hormones, and not listen to the signals that turn on sperm development.
• About 10% of infertile men have antibodies (immune cells that attack other cells) to their own sperm.

• Fertility involves a complex set of coordinating biological process, all of which must work more or less perfectly, more often than not, in order to avoid infertility.
• A woman must produce specific hormones that cause eggs to mature and ovulate and her ovaries must be healthy and capable of responding appropriately to these hormonal signals.
• Once an egg is mature enough to leave the ovary it must travel down healthy, unblocked fallopian tubes. The cervical mucous must change consistency to help facilitate the travel of sperm up the reproductive tract to the spot where it will meet the egg.
• In addition, the woman's uterus must have a good lining and surface for the pregnancy to attach to and start developing.
• Finally, her body must be able to "recognize" the developing embryo and not reject it as foreign matter.
• Female-factor infertility is most commonly caused by lack of ovulation (e.g., the development and release of eggs from the ovary), which can be caused by hormonal deficiencies or lifestyle factors, such as obesity, alcohol intake, or being severely underweight.
• Fallopian tube blockage is another common cause of infertility and is most commonly caused by scarring from a previous, and often untreated, sexually transmitted disease.
• Endometriosis, which occurs when uterine tissue grows outside the uterus, can also contribute to infertility.
• Anatomical abnormalities, such as fibroids or scar tissue, can contribute to the inability of sperm to meet the egg or cause the egg to fail to implant in the uterine wall.
• Women have more difficulty getting pregnant as they reach "advanced maternal age," which is currently defined as over age 35, due to a decrease in the number of eggs which ovulate, as well as a decrease in the quality of eggs.

• Before trying to become pregnant, there are many preparations you should make to ensure optimal health of your embryo and fetus.
• It is important to quit smoking tobacco, drinking alcohol and using any other types of drugs (including marijuana).
• You should review your medications with your doctor to make sure none of them are dangerous in pregnancy.
• Your partner should evaluate his current health and lifestyle and make similar changes if necessary.
• It is usually recommended that birth control pills be stopped two to three months prior to when you wish to become pregnant.
• You should also begin taking a prenatal vitamin or another source of folic acid as folic acid helps prevent birth defects, specifically 'neural tube defects,' that can occur early in pregnancy.
• Timing your sexual intercourse to occur on those days that you are most fertile can increase your likelihood of pregnancy.
• In general, women who have 28 day cycles (the number of days from the start of one period to the start of the next) are most fertile 13 to 15 days after the start of their menses (period).
• Tools such as ovulation predictor kits (OPK's), basal body temperature monitoring and cervical mucous monitoring can also help to time intercourse and increase the likelihood of conception in any given month/cycle.

• When a year (or six months, depending on your age) has gone by without conception, then you and your partner are considered to have an infertility problem.
• Once the label "infertility" fits your situation, it is time to consult with an infertility doctor.
• Because of the multiple possible causes of infertility, doctors will conduct a variety of tests and evaluations.
• Often these procedures may seem embarrassing or uncomfortable and discussion will involve personal details, such as the timing and frequency of sexual intercourse, monitoring of vaginal secretions, and the like.
• It is important to approach the interactions with doctors and medical personnel with the aim of being very honest and open, as this will allow doctors to better understand the problem, and tailor your medical care to meet your needs.
• The doctor will conduct a thorough interview of you and your partner and will want to know how often you have a period, if it happens at regular intervals, and if you have ever had any problems with your reproductive system.
• The doctor will ask for a health history for both you and your partner, including any history of sexually transmitted illnesses (STI's) as these can cause damage that can lead to infertility.
• The doctor will also want to know if either of you have had exposure to large amounts of radiation.
• In addition, the interview will involve a sexual history, including the frequency and timing of sex.
• Your accurate responses to medical history questions will help doctors to select specific and relevant tests to help understand what is causing your infertility.

• A variety of treatments may be pursued to help undo infertility.
• The selection of a particular plan depends on the cause of infertility as identified by medical testing, as well as your own preferences, and the opinion of your physicians.
• Women can increase their chances of getting pregnant by pursuing a weight loss (or gain) diet and regular exercise program until a healthy weight is achieved and then maintaining that healthy weight.
• Other lifestyle choices that can increase fertility or chances of conception include stopping smoking of all types, as well as stopping alcohol consumption and recreational drug use.
• Intake of caffeine (often present in coffee, many sodas, chocolate and over-the-counter diet and/or alertness pills) should also be kept to a minimum (1 caffeinated drink per day).
• As much as possible, you should also minimize stress and emotional strain.
• Hormone therapy may be used to stimulate ovulation or to make the lining of the uterus (called the endometrium) better prepared to hold a fertilized egg.
• Intrauterine Insemination (also known as Artificial Insemination) is used when the male partner has a low sperm count or when the female's cervical mucosa is not adequate to assist the sperm on its travel to the egg. This procedure involves placing specially prepared sperm directly into the uterus via a flexible tube which is inserted into the vagina and through the cervix.
• Surgery can repair damaged or blocked structures (e.g. fallopian tubes) or be used to treat endometriosis.

• Assisted Reproductive Technology is an umbrella term for multiple types of fertility treatment which use laboratory and other technology to help a couple get pregnant.
• In Vitro Fertilization (IVF) is one type of ART and consists of harvesting a woman's eggs (usually after medications have been given to mature more than one egg), collecting a sample of her partner's sperm, and joining them in a laboratory.
• Though IVF is the most well-known type of ART, there are others that may be useful to infertile couples:
• Gamete Intrafallopian Transfer (GIFT) occurs when a laprosope, which is a fiberoptic surgical instrument requiring only a small incision to place, is used to place unfertilized eggs and sperm into a woman\'s fallopian tubes. In successful situations the egg and sperm then unite and an embryo implants into the woman\'s uterus.
• Zygote Intrafallopian Transfer (ZIFT) is similar to GIFT except that the fertilization occurs in the laboratory and then the embryo is placed using laproscopic surgery into the woman's fallopian tube.
• Intracytoplasmic Sperm Injection (ICSI, pronounced "ick-see") occurs when an individual sperm is directly injected into an egg, bypassing the usual struggle that sperm undergo to penetrate the egg's outer membrane. Fertilized embryos resulting from ICSI are then implanted into the woman's uterus as per IVF.
• Embryo Cryopreservation is used to preserve embryos that have been created in the laboratory using harvested eggs and sperm but which have not been selected for implantation. These embryos are frozen so that they may be thawed and transferred to the woman's uterus at a later date, so that additional pregnancies may be produced from the single harvest of eggs and sperm. Freezing takes a heavy toll on embryos and only roughly 50% of thawed embryos are viable.
• Egg Donation - Whenever possible, the eggs used for ART techniques are collected from the woman who is planning to become pregnant, but when this is not possible, eggs must be sourced from a third party known as an egg donor.
• Sperm donation operates on the same basic principles as egg donation. Some couples cannot produce viable sperm and must reach out to a third party donor for such material.

• The inability to conceive a child is emotionally difficult at best and can easily become devastating.
• Infertility treatment itself is physically and emotionally demanding, expensive (and not typically covered by insurance) and offers no guarantees of success.
• There are several things that can help you cope with these painful realities.
• First, it is important to understand that a great sense of loss, disappointment, or the like, is completely normal in the face of infertility.
• Throughout the process of discovering and trying to remedy infertility it is also important to use existing supportive relationships and there are also support groups in surrounding communities and online sites that can be attended for support.
• If you are undergoing infertility diagnosis and treatment with a partner, it is especially crucial to use open communication and mutual support and not blame each other.
• Frustration is the normal experience of infertile couples that want to become parents and both partners may experience a range of intense emotions, from hope to excitement and regret, as well as disappointment, guilt, sadness, and happiness.
• One way to create good support between you and your partner is to take time away from the pressures of infertility and take part in a mutually-enjoyable activity; a mental and/or physical get-a-way or holiday.
• While thinking about or undergoing fertility treatments, it is important to also maintain other past-times and hobbies to have balance in your life.
• Serious conditions such as major depression can result, in part from the disappointments, which may be associated with infertility treatment.
• It is appropriate to seek out professional mental health counseling in the event that your relationship deteriorates significantly, or if your own mental health or the mental health of your partner suffers.

• An intellectual disability (formerly mental retardation) is a type of disability that results from limited mental capacity.
• Limited mental capacity makes it difficult to develop important mental abilities including reasoning, planning, thinking, and judgment, and makes it difficult to learn new things.
• There are three main criteria for intellectual disabilities (IDs):
• Significant limitations in intellectual functioning (mental abilities);
• Significant limitations in adaptive functioning (conceptual skills, social skills, and practical life skills);
• The problems begin before age 18
• Some medical conditions that can cause ID are associated with obvious physical features and are so noticeable that they are easily identified at birth.
• Another early sign of an intellectual disability is developmental delay where children with ID sit, walk, and talk later than other children do.
• A related issue is the slower development of social skills, which becomes evident when children play together as individuals with ID struggle to understand and follow social rules and customs.

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• Intellectual disabilities affect three different types of learning, including academic learning, experiential learning, and social learning.
• Experiential learning occurs through cause and effect. For example, suppose a child touches a hot stove. This experience causes the child to learn to avoid touching a stove. However, a child with an ID does not learn from this painful experience and does not understand the stove (the cause) caused the painful burn (the effect).
• Social learning occurs by watching other people in social situations. For example, we might notice it is normal to greet people by shaking hands or offering a hug.
• Social learning allows us to learn social skills that are needed to get along well with other people and that are critical to life success.
• Academic learning happens through formal education and includes the skills of reading, writing, and math.

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• An estimated 7 to 8 million Americans have an intellectual disability, which means that about 1 in 10 families in the United States are affected by an intellectual disability.
• As a group, people with intellectual disabilities have a shorter life expectancy than the general population.
• However, it really depends on the underlying cause of the disability and some people with intellectual disabilities are at greater risk than others of premature death.
• The life expectancy for people with intellectual disabilities has dramatically improved over the past few decades. For example, 20 years ago, people with Down syndrome were not expected to live past age 35, but today, these same people would live to 55 years of age.

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• Intellectual disabilities have many causes - some are preventable and others are not.
• These causes can be grouped into four categories:
• Medical Conditions
• Brain Damage
• Genetic Conditions
• Psychiatric Conditions
• Four conditions that are the most common causes of ID are:
• Autism (a psychiatric cause)
• Down syndrome (a genetic cause)
• Fragile X syndrome (a genetic cause)
• Fetal Alcohol Syndrome (FAS) (a medical condition and the only cause that is completely preventable)
• Medical Causes - Pre- and post-natal exposure to alcohol, drugs, toxins, and certain infections can have a devastating effect on brain development and can result in physical and mental defects, and even death of an infant.
• Several types of brain damage including Traumatic Brain Injury (TBI), congenital brain damage, and progressive brain damage can lead to intellectual disabilities.

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• The first indication of an intellectual disability is usually a child's physical and behavioral characteristics.
• Once an intellectual disability is suspected, a formal evaluation and assessment begins.
• The evaluation begins with a complete physical examination. A thorough review of medical history identifies any physical or medical causes of the troubling symptoms.
• A thorough assessment usually includes the following:
• comprehensive medical exam;
• possible genetic and neurological testing;
• social and familial history;
• educational history;
• psychological testing to assess intellectual functioning;
• testing of adaptive functioning;
• interviews with primary caregivers;
• interviews with teachers;
• social and behavioral observations of the child in natural environments

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• The DSM-5, provided by the American Psychiatric Association, has severity codes that indicate the diagnosing clinician's impression of the severity of adaptive functioning.
• Severity is assessed across three domains, which are conceptual, social, and practical life skills.
• Mild intellectual disability includes about 85% of people with intellectual disabilities. In many cases, people in this category can live independently within their communities with a minimal level of additional supports.
• Moderate intellectual disability includes around 10% of the individuals with intellectual disabilities and people in this range have adequate communication skills but complexity is more limited. Most self-care activities can be performed but may require extended instruction and support and independent employment can be achieved in positions that require limited conceptual or social skills. Independent living may be achieved with moderate supports such as those available in group homes.
• Severe intellectual disability describes 3 to 4% of this population and communication skills are very basic. Self-care activities require daily assistance and residence in supported housing is usually necessary.
• Profound intellectual disability describes a very small portion of the persons with intellectual disabilities. Only 1 to 2% fall into this category and people in this category are dependent upon others for all aspects of daily care.
• The American Association on Intellectual and Developmental Disabilities (AAIDD) also has a category system for classifying severity.
• This system evaluates a person's strengths and abilities, not just their limitations, and categorizes each person's level of functioning based on the level of support that person needs to function reasonably well in his or her preferred environment.
• Intermittent support: Those in this category usually only require additional supports during times of transition, uncertainty, or stress. This level of support would be categorized under the APA standards as mild intellectual disability.
• Limited support: With additional training, those in this category can increase their conceptual skills, social skills, and practical skills. They may still require additional support to navigate everyday situations. People in this group would often be categorized by APA standards as moderate intellectual disability.
• Extensive support: These individuals have some basic communication skills and can complete some self-care tasks, but will usually require daily support. This level of support is usually associated with severe intellectual disability by APA criteria.
• Pervasive support: Pervasive support describes the most intense level of support and daily interventions are necessary to help the individual function. This classification is associated with those who have profound intellectual disability.

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• Various therapeutic services can improve a person's adaptive behavioral skills and these therapies are helpful for many people with intellectual disabilities.
• Occupational therapy can teach meaningful and purposeful activities; Self-care (e.g., grooming, dressing, feeding, bathing); Employment activities and skills; Leisure activities (e.g., knitting, playing games); and Domestic activities (e.g., cooking, cleaning, laundry).
• Speech therapy can improve communication skills, receptive and expressive language skills, speech articulation, and vocabulary.
• Physical therapy enhances quality of life by maximizing mobility and providing adaptive solutions to mobility problems, and increasing sensory integration.
• There are no reliable research studies to support claims of effectiveness of the following types of therapy:
• Orthomolecular therapy claims vitamins and minerals can treat, or reverse a number of different conditions including intellectual disabilities, but diet and nutritional supplements have not been proven to enhance cognitive functioning, performance, or learning in individuals with intellectual disabilities.
• Medications - currently, no medication can treat the entire spectrum of disorders that cause intellectual disabilities. Medications are legitimately prescribed when neurocognitive disorders are the root cause of the disability.
• Talk therapy, which refers to psychotherapy, is useful for many psychiatric disorders. However, psychotherapy cannot treat, stop, or cure disabilities. Such therapies rely on a person's cognitive, emotional, and verbal abilities in order to promote change and as a result, people with intellectual disabilities are not good candidates for such therapies.
• Genetic manipulations: Someday it may be possible to use genetic manipulations to correct the genetic causes of some intellectual disabilities, but at this time, it is not possible.

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• Obsessive-compulsive spectrum disorders are a group of similar psychiatric disorders that are characterized by repetitive thoughts, distressing emotions, and compulsive behaviors.
• The specific types of thoughts, emotions, and behaviors vary according to each disorder.
• These disorders include Obsessive-Compulsive Disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking disorder).
• Obsessions are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted. Common themes include concerns about contamination, harm happening to oneself or others, repeated and excessive doubts about safety and security, and perfectionism.
• Obsessions create anxiety and distress when they occur and to reduce this discomfort people perform compulsions, which are behaviors or mental acts that a person feels "driven" to perform in response to an obsession. This might include behaviors such as excessive hand washing, re-ordering objects in a specific way, checking on door locks or appliance status, and counting (aloud or silently).

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For more information on the symptoms of Obsessive-Compulsive Disorder (OCD)
For more information on the symptoms of Body Dysmorphic Disorder (BDD)
For more information on the symptoms of Hoarding Disorder
For more information on the symptoms of Trichotillomania (hair pulling disorder)
For more information on the symptoms of Excoriation (skin-picking disorder)

• Panic attacks are a common symptom of many mental disorders, but since Obsessive-Compulsive Spectrum Disorders all have a fearful component to them, it's important to be aware of this issue.
• Panic attacks are sudden, extreme feelings of fear and/or discomfort lasting for a distinct period of time. This sudden surge peaks in intensity within a few minutes, at which point it begins subside.
• There is often a sense of doom and gloom and a powerful desire to escape.
• Common symptoms include palpitations and/or pounding heart; sweating; trembling or shaking; chest pain or discomfort; feeling dizzy; numbness or tingling sensations; hot flashes or chills; fear of losing control or "going crazy" or a fear of dying.
• Panic attacks are a false alarm that triggers the "fight or flight" response system.
• There are 2 types of panic attacks - uncued and cued.
• Unexpected, or uncued, panic attacks seem to come from "out of the blue." They do not have an identifiable source that sets them off. It is believed these occur in response to some kind of life stress.
• Expected, or cued, panic attacks are attacks with an obvious trigger. They occur when a person is exposed to certain situations or objects where panic attacks have happened before. The onset is sudden and occurs immediately upon exposure to the situation or object.
• Cued panic attacks are the type that is most common in the Obsessive-Compulsive Spectrum Disorders.

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• The biopsychosocial model proposes there are multiple and inter-related causes of Obsessive-Compulsive Spectrum Disorders that can be divided into 3 groups - 1. biological causes, 2. psychological causes; and 3. sociocultural or environmental causes.
• The biological causes include factors such as genetic vulnerabilities, as well as neural or brain abnormalities.
• Psychological vulnerabilities result from early life experiences such as trauma, as well as certain dysfunctional beliefs that may develop over time.
• Research has identified several variables that may contribute to a psychological vulnerability. These include: 1) perceived control, 2) cognitive appraisals/thoughts, and 3) cognitive beliefs and distortions.
• The sociocultural causes refer to things we learn by observing others, as well as cultural norms and standards of behavior.

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• Because there is considerable symptom overlap among these disorders, the basic treatment strategy is similar for each disorder.
• However, each disorder requires some specific treatment techniques to be most effective.
• There are several highly effective treatments available.
• Therapists pick and choose among these various treatments to form an individualized treatment plan.
• The specific combination of treatments will depend upon a number of factors including:
• the unique characteristics and preferences of each person
• their social support system and living environment
• their degree of insight into their disorder and symptoms
• their motivation for treatment and recovery
• the specific disorder
• the presence of co-occurring mental or physical disorders
• previous treatment attempts and their outcomes.

For more information on General Treatments
For more information on treatments for Obsessive-Compulsive Disorder (OCD)
For more information on treatments for Body Dysmorphic Disorder (BDD)
For more information on treatments for Hoarding Disorder
For more information on treatments for Trichotillomania (Hair-Pulling Disorder)
For more information on treatments for Excoriation (Skin-Picking Disorder)

• Personality disorders are characterized by a chronic inflexible pattern of relating to the world that appears in the way a person thinks, feels, and behaves.
• A person with an untreated personality disorder is rarely able to enjoy ongoing, meaningful, and rewarding relationships with others, and any relationships they do form often have many problems and difficulties.
• This pattern consists of problematic behaviors and traits, starting early in life, observed across many different situations, over a long period of time, that cause significant distress.
• The defining features of a personality disorder are: a) rigid and distorted thinking, b) problems with emotional response patterns (feelings), c) impulse control problems/behaviors, and d) significant problems relating to and with others.
• When people have distorted ways of thinking about themselves and others and have difficulty controlling their emotions and their impulses, it will affect the way they handle conflict with others, and the way other people will react to them.

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• There are 10 Personality Disorders that are split into 3 Clusters.
• Cluster A includes Paranoid, Schizoid, and Schizotypal Personality Disorders, which share features of social awkwardness, social withdrawal and distorted thinking.
• Cluster B includes Borderline Personality Disorder, Narcissistic Personality Disorder, Histrionic Personality Disorder, and Antisocial Personality Disorder, which share problems with impulse control and emotional regulation.
• Cluster C includes Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders, which share a high level of anxiety.

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For information on symptoms of Cluster A disorders
For information on symptoms of Cluster B disorders
For information on symptoms of Cluster C disorders

• There are 2 main factors that contribute to the development of a personality disorder.
• These are 1) biological factors, meaning people's genetic make-up and temperament, and 2) social and environmental factors, meaning people's life experiences, particularly early childhood experiences.
• These two areas interact in complex ways to influence the development of personality and therefore, a person's vulnerability to the development of a personality disorder.
• The influence of biology on behavior is often revealed in temperament, or the inborn personality disposition of a person. Some children are born with milder, calmer dispositions while others are more anxious and irritable.
• Traumatic or adverse childhood experiences have been identified as risk factors that increase the likelihood a personality disorder may develop. This can include physical, sexual, or emotional abuse and neglect, the death of a parent; the separation or divorce of parents; poor family communication; a harsh and controlling parenting style; or bullying.

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• Research about the treatment of personality disorders is still somewhat beginning and most of what is known about the treatment of a specific personality disorder cannot be generalized or applied to all personality disorders.
• There is little, if any, research information on treatment of Paranoid Personality Disorder, Schizoid Personality Disorder, or Schizotypal Personality Disorder. People with these disorders tend to be distrustful and avoid relationships with others, which may prevent them from seeking treatment.
• Only a few studies have been conducted on treatment of Avoidant Personality Disorder. There is some indication that cognitive-behavioral therapy can be an effective treatment.
• There is very limited research on the treatment of Narcissistic Personality Disorder. It appears that they may benefit from psychotherapy, but the data also suggests that people with this disorder are extremely likely to drop out of treatment, which makes definite research answers difficult to obtain.
• For Antisocial Personality Disorder, the general recommendation is a treatment that combines medication and psychotherapy, particularly cognitive-behavioral therapy, but experts are guarded about the prognosis for the treatment of this disorder.
• There is a large amount of research on the treatment of Borderline Personality Disorder. The high rates of self-injury and other self-destructive behaviors, combined with chaotic interpersonal relationships may cause people with this disorder to seek treatment more frequently. There is sufficient research evidence to suggest that certain types of psychotherapy, particularly transference-focused psychotherapy, dialectical behavior therapy, and mentalization-based therapy are very effective in treating Borderline Personality Disorder.
• Medications are sometimes used in the treatment of personality disorders. They don't necessarily "cure" personality disorders, but can help with some symptoms that may interfere with, slow down, or disrupt treatment.

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• Schizophrenia is a brain disease that causes problems with normal brain functioning.
• People with this condition show odd and often highly irrational or disorganized behavior.
• A brain disease, like schizophrenia, changes that thinking, feeling, and understanding.
• Symptoms include difficulty thinking clearly, interacting with others, completing tasks and expressing emotions.
• A key feature of schizophrenia is psychosis. This happens when a person loses the ability to tell the difference between real and 'imagined' experiences.
• They lose touch with reality.
• People with schizophrenia commonly experience: 1) hallucinations - sensations that only they experience. This can include voices speaking to them that only they can hear. 2) Delusions - fixed, mistaken ideas that the person holds. These are often odd or incorrect ideas about themselves and the world around them.

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• It is not something caused by evil spirits, witchcraft, or being possessed by demons as was once widely believed.
• It is also not caused by poor parenting or by brain damage.
• It is not a form of an intellectual disability, dementia, delirium, or intoxication.
• It is not a form of multiple personality disorder.
• It has little to do with the tendency to be aggressive or violent.
• There are many other common misconceptions about schizophrenia as well. The following statements are all false:
• People never recover from schizophrenia
• Schizophrenia is contagious
• Most people with schizophrenia need to be institutionalized
• People with schizophrenia are not able to make decisions about their own treatment
• People with schizophrenia are likely to be violent
• Most people with schizophrenia can't work
• Jail is an appropriate place for people with schizophrenia

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• Schizophrenia is not a terribly common disease but it can be a serious and life-long one.
• Between 0.3% and 0.7% of the population is diagnosed with schizophrenia.
• According to the World Health Organization (WHO) approximately 21 million people worldwide have schizophrenia (12 million males and 9 million females).
• Schizophrenia can affect people throughout the lifespan. However, it is most likely to first appear in the late teen years and the mid-30s.
• It is fairly rare for children and older adults to develop schizophrenia, but it does happen.
• The rate of diagnosis of new cases increases in the teen years, reaching a peak of vulnerability between the ages of 16 and 25 years.
• Males are more likely to have their first episode in the early to mid-20s.
• Females have two points where the first episodes are most likely to happen. The first is in the late-20s and the second is after 40 years of age.

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• Schizophrenia is identified by two groups of symptoms. These are called "positive" and "negative."
• Positive symptoms are ones which are more than normal behavior. This group is further split into two groups. The "psychotic" group includes hallucinations and delusions. The "disorganized" one includes disorganized speech and behavior.
• Negative symptoms involve missing behaviors compared to normal functioning. Examples include limited emotional expression, limited thought and speech, and lack of motivation.
• Symptoms are not permanent things. Instead, they tend to change over time.
• When enough symptoms are present and last for one month (or a shorter period if medication has been given) with some symptoms lasting for up to six months, a diagnosis of schizophrenia can be made.

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• Data from scientific research proves that schizophrenia is clearly a biological disease of the brain, just like Alzheimer's Disease and Bipolar Disorder.
• Schizophrenia is now known to be partially caused by genetics and to be inherited.
• People with schizophrenia have up to 25% less volume of gray matter in their brains, especially in the temporal and frontal lobes. These areas are known to be important for coordination of thinking and judgment.
• Brains with schizophrenia are, on average, different in terms of total tissue volume and activity.
• Brains with schizophrenia also show neurochemical differences when compared with normal brains.
• Electroencephalogram (EEG) data are tests of brain electrical activity. About one-third of people with schizophrenia show abnormal electrical brain impulses. This also suggests irregularities in the way the brains of those with schizophrenia are wired.

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• The DSM defines schizophrenia as an individual condition characterized by a set of positive and/or negative symptoms lasting for at least six months and including at least one month of active-phase symptoms.
• The DSM-5 also holds the idea that schizophrenia exists as a part of a continuum or spectrum of related conditions that share symptoms in common, and which may share causes as well.
• When viewed as a continuum of disorders, schizophrenia can be seen to range between "normal" at one end (with no schizophrenia present at all), and severe schizophrenia at the other. Most individual cases fall somewhere in the middle of the scale.
• There are also several personality disorders (Schizoid Personality Disorder and Schizotypal Personality Disorder) that appear to be best thought of as extremely mild schizophrenia spectrum problems. These conditions sit on the scale close to the 'normal' side of the spectrum.
• Delusional disorder and schizophreniform disorder hold a middle position on the scale.
• Finally, schizophrenia itself and a related condition, schizoaffective disorder, are on the extreme and severe end of the spectrum.

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• Although there is no cure for schizophrenia, it is successfully treatable with a combination of medications and supportive counseling.
• Though both therapy types are important, medication is the most important. It is the only therapy that can effectively reduce the severe and overwhelming symptoms.
• These medications can make symptoms milder, shorten the length of an episode, and increase the time between episodes.
• Not all medications are equal and there is no single best treatment protocol. Different people respond best to different types and dosages of medicine.
• Due to medication treatments today, the frequency and length of hospital stays have been greatly reduced. It may still be needed for the most severe cases.
• Hospitalization is a time to get new patients started on medications, to evaluate or change existing medications, or to re-introduce medications to patients who have stopped taking them.
• Most ongoing care takes place in outpatient settings, often at community mental health centers.
• Individual and group therapy focuses on the person's present needs and includes medication monitoring, help in socializing and maintaining relationships, and finding needed resources.
• Another vital therapy for people with schizophrenia is assistance with housing. Once symptoms have been stabilized, people with schizophrenia can benefit from self-help efforts.

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• A pregnancy occurs when reproductive cells from a man and a woman's body become combined inside a woman's uterus.
• The normal way that this occurs is through sexual intercourse, where the man's penis enters the woman's vagina and ejaculates sperm (the male reproductive cells) into the vagina during the process of orgasm or sexual climax.
• Though intercourse is the normal method through which an egg and a sperm get together, modern reproductive medicine has opened up new possibilities.
• Despite the incredible fertility of some women, most women find that it takes a little effort to get pregnant.
• The timing of that intercourse must be just right so that sperm and egg get to meet, there must be no significant obstacles that would prevent the sperm from reaching the egg, and the sperm and egg must be must both be of good-enough quality.
• Having made the decision to become pregnant, there are a few things you can do to increase your likelihood of conceiving including predicting the best time of the month to try to become pregnant, with natural planning and over-the-counter options.

• For most women, the first signs of pregnancy are a missed period, breast fullness, breast tenderness, nausea, frequent headaches, and fatigue.
• While some symptoms of pregnancy can occur as soon as one week after conception, the same symptoms can also indicate other non-pregnancy related conditions.
• Once you have determined that your symptoms are not caused by illness, you may want to use a home pregnancy test to confirm that you are pregnant.
• Although most tests claim to be able to detect pregnancy as soon as the first day of your missed period, you will obtain a more accurate result by waiting to take the test until 7 days after the day you expected your period to occur.
• Although home pregnancy test results are generally accurate, they aren't as definitive as the blood test for pregnancy that your doctor can administer.
• You should ask your doctor to perform a blood test a week after your missed period if you suspect you may be pregnant despite a negative home pregnancy test result, or if you want positive confirmation as to whether you are pregnant or not.

• Beginning with your first prenatal visit to your doctor, you may be asked to undergo various tests to monitor your health and the health of your developing baby.
• Some of these tests are capable of detecting genetic or developmental problems in the fetus.
• The following are some of the tests that are commonly performed during pregnancy.
• The Triple Screen Test (or Triple Marker) is a blood test capable of determining whether or not your baby may be at risk for birth defects, such as Spina Bifida, or chromosomal abnormalities, such as Down Syndrome (a common form of mental retardation).
• The Nuchal Translucency Screening Test, also known as the nuchal fold scan, uses ultrasound to measure the translucency, or clear space, at the back of the developing fetus's neck.
• In Amniocentesis, a sample of the amniotic fluid that surrounds the fetus while it develops inside its mother is collected and analyzed so as to learn about the baby's genetic development or to check for infection.
• Chorionic Villus Sampling (CVS) is another technique for testing the fetus' genetic development. CVS involves the removal of placental tissue and is generally recommended for the same reasons as Amniocentesis, and carries many of the same risks of associated miscarriage. It can be performed earlier than the Amniocentesis (between 10 and 12 weeks of gestation), and it offers better than 99% accuracy in detecting many genetic disorders and chromosomal abnormalities.
• You should consider your age, your previous medical history, and the medical history of your family when deciding whether or not to go forward with genetic testing during your pregnancy.
• Additionally, it is important to consider what positive results (indicating problems) would mean for you and your family.
• Discuss the options and risks associated with each of these tests with your doctor to decide which might be important for you.

• Pregnancy lasts about nine calendar months (about 40 weeks total). It is typically broken down into three "trimesters" or stages of fetal development.
• The first trimester of pregnancy lasts from conception until 12 weeks gestation (pregnancy length) and during the first trimester, the growing baby is developing at an amazing rate.
• The Second Trimester lasts from weeks 13-27, and for many women, this is the most comfortable trimester, and a good time to prepare yourself and your home for the arrival of the new baby.
• The final stage of pregnancy, weeks 28 through 40, is often marked by excited expectation of the baby's arrival.

• Labor is the process through which a pregnancy ends and a baby is born.
• It is a good idea that you establish a plan for labor and delivery well in advance of your due date.
• The first decision you need to make when thinking about the birth of your baby is where you would feel most comfortable delivering.
• You'll also need to start thinking about who you want to be present throughout your labor and the delivery of your baby.
• Another choice you will need to make in preparation for labor is whether or not you want to use pain medication.
• In preparing for a delivery, you may choose to take relaxation and breathing technique classes, or to do exercises to help strengthen the muscles you will use during labor.
• It is important to educate yourself about your options for pain management during labor, and to decide which methods will best fit your needs.
• There are various methods, some common and some lesser-known that can help reduce pain during labor including the Lamaze technique, the Bradley Method, Acupuncture, Transcutaneous Electric Nerve Stimulation (TENS), massage, warm water tub, sedative medications, narcotic medications, and regional anesthesia (commonly called an epidural).

• The labor process has three stages.
• Contractions occur during the first stage of labor, resulting in the opening (dilation) of your cervix (the opening between the vagina and the uterus).
• This first stage usually lasts several hours, and has three phases.
• "Active labor" (phase two) begins when the cervix reaches 3 to 4 cm in diameter. Contractions usually become stronger, more regular, and more frequent during this phase, and the cervix begins to dilate faster as well.
• The third phase of stage one labor is called "transition". During transition, the cervix dilates to between 7 and 10 centimeters. This is often the most difficult phase, but it is also the shortest in duration.
• The second stage of labor occurs when the baby moves through the birth canal and is delivered into the world. This stage typically lasts between 20 minutes and two hours.
• The third and final labor stage occurs when the placenta (the sac of blood vessels that accompanied the baby in the uterus) is delivered. This final stage begins immediately after the birth of your baby, and continues until the placenta is removed from your body. The process is typically fairly brief, lasting between 5 and 30 minutes in duration.

• The weeks and months that follow after the initial excitement of the new baby's birth can be an emotion roller coaster for new mothers.
• Many women experience the "baby blues", a mild form of depression that lasts one week to ten days after the baby is born.
• However, for some women (especially young moms) these blues can become more severe and long-term and are then called Postpartum depression, which can occur anytime within six months of giving birth, and if left untreated, can last longer than one year.
• One difficult decision you may face during your pregnancy is deciding whether or not to breastfeed your newborn baby.
• There are several options available to you should you choose to bank (save) your baby's cord blood and you should speak to your doctor about the various pros and cons regarding chord blood banking.

• Not every woman who gets pregnant is necessarily healthy or young.
• When medical conditions exist prior to pregnancy, doctors will need to modify prenatal care recommendations.
• These conditions include:
• Hyperthyroidism
• Hypothyroidism
• Diabetes mellitus
• Lupus
• Herpes
• AIDS
• Heart Disease
• Paralysis
• Obesity

• Partners in healthy marriages come to agree upon common agendas regarding the directions their marriage will take, and the way each partner will behave.
• Areas of agreement that partners will have dealt with will generally include:
• Friendship - successful partners develop a significant friendship at the core of their relationship. They genuinely like one another, amuse and comfort one another, and prefer to spend time with each other.
• Role expectations - the partners reach agreement with regard to how household responsibilities are divided and how they will behave towards each other.
• Emotional intimacy - successful partners learn to trust each other, to be vulnerable with each other, to laugh together, and to support one another in times of need.
• Sexual expectations - partners come to basic agreements as to how they will be sexual with each other.
• Vision/Goals - successful partners agree that they want to pursue the same life paths, values and goals and mutually commit to those paths, values and goals.
• In general, however, the more domains you and your partner are in agreement on, the better are your chances for a healthy marriage.

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• There is no single reason why a relationship begins to break down.
• However, once a relationship does start to break down, there is a predictable sequence of events that tends to occur.
• Highly regarded psychologist and researcher John Gottman, Ph.D. suggests that there are four stages to this sequence which he has labeled, "The Four Horsemen Of the Apocalypse".
• The first stage of the breakdown process involves conflict and complaints. All couples have conflicts from time to time, but some couples are able to resolve those conflicts successfully or 'agree to disagree', while others find that they are not.
• In the second stage of the breakdown process, one or both spouses starts to feel contempt for the other, and each spouse's attitudes about their partner change for the worse.
• Most people find conflict and contempt to be stressful and react to such conditions by entering the third stage of breakdown, characterized by partner's increasingly defensive behavior.
• Then partners start avoiding one another so as to minimize their conflicts. Gottman calls this final stage, "Stonewalling" and unfortunately, there is no way to love your partner when you are hiding behind a wall to protect yourself from him or her.
• Basically compatible partners may demonstrate a whole lot of conflict, but they don't often become contemptuous and angry with their partners, because there are by definition few things that they will disagree upon.
• In contrast, partners who start out with incompatible goals, values or dreams are far more likely to get into seemingly irresolvable conflicts.
• Once the process of contempt, defensiveness and avoidance begins, small incompatibilities can become magnified as spouses pursue other interests as an alternative to conflict.

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• The common definition of what constitutes an affair seems to be sexual relations outside of marriage.
• This narrow definition fails to recognize that marriages can be threatened by any relationship, sexual or otherwise, that threatens to break the bonds of intimacy and trust between spouses.
• In an important sense, any outside relationship that drains one spouse's ability to attend emotionally, sexually and/or intimately with/to his or her spouse is a potentially damaging affair.
• Affairs can happen at any time, although they are particularly likely to occur during the middle years of marriage.
• Affairs can also start in the context of healthy marriages as platonic extra-marital friendships that becomes passionate and sexual.
• In most cases, if married partners understand themselves to be more or less compatible with their original spouse, they will not gain anything by pursuing another and may lose a lot.
• Affairs don't always signal the end of a marriage, but they surely point to marital disengagement that must be addressed if the marriage is to survive an affair and become healthy again.

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• Marital therapy is probably the best single thing that people in troubled marriages can do to help heal their marriages.
• A skilled marriage therapist offers support and intervention that can help distrusting disengaged partners to safely address their difficulties and begin the process of problem solving and healing.
• These supports and interventions can include:
• Safety - therapists work to provide a trustworthy and safe environment which can contain and manage couples' anger, frustration and contempt. Therapists remain neutral and do not take sides.
• Normalization and Reality Testing - experienced therapists have "seen it all before" and are able to help couples understand when their desires and expectations (of each other and/or of themselves), indiscretions and reactions are normal and when they are unusual, inappropriate or even abusive.
• Traffic Control - therapists function as traffic cops to make sure that partners take turns talking and listening to each other, no one is shut down and unable to speak and all have a better chance to feel listened to than would otherwise be possible.
• Skills Education - therapists teach problem solving, communication and soothing skills which can help couples gain tools to help them better address and manage issues in their relationship. Interpretation - therapists teach listening skills, promote sharing of feelings and desires that may be difficult to express and encourage partners to repeat what their partners have said so as to demonstrate their comprehension.
• Marital therapy generally takes place outpatient-style in a therapist's office and is offered once per week with each session lasting between 60 and 90 minutes.
• The number of therapy sessions will vary according to the severity of the presented problems, the therapist's training and technique, and (unfortunately) the couple's ability to pay for services.

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• Healthy partners communicate trust and affection towards each other via words and gestures in a manner that brings about more positive communication.
• Therapists teach conflicted couples communication skills designed to help them interrupt their negative communications and replace them with more positive (or at least neutral) ones.
• "I" statements communicate feelings rather than accusations, elicits a helpful, supportive response rather than a defensive one, and helps to defuse potential fights and arguments.
• Focal, Not Global Criticism - in troubled relationsihps, criticisms tend to turn from specific complaints (e.g., "you forgot to bring milk") to general (sometimes over-general) conclusions which may be exaggerated (e.g., "you don't care about me at all"). Therapists may encourage clients to stick to the indisputable facts and to not draw conclusions from these facts which might be mistaken.
• Traffic Control; Active Listening and Repeating - therapists act as traffic cops and teach active listening skills to counter partner's obsessive defensive arguing. The therapist will set up and enforce times when each partner can speak and the other partner is asked to listen.
• Interpretation - while teaching couples ground rules and procedures for how to communicate effectively, therapists may also help couples to better understand each other by offering the couple their outsider's informed opinion as to why each partner has chosen to act as they have.

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• Chronically conflicted couples become easily overwhelmed, agitated and tense while communicating.
• Therapists often encourage such couples to practice soothing skills and techniques to help them reduce arousal and emotion, enabling them to communicate and problem solve more efficiently.
• Soothing skills practice help couples to better tolerate stressful provoking situations and to recover faster after they have become overwhelmed.
• Time-Out. The tried-and-true 'time-out' technique is very useful in helping couples to disengage from a fight. The couple agrees that they will ask their partner for a 'time-out' on their discussion for an agree-upon period of time when they start to feel overwhelmed.
• Talking and venting feelings about one's situation is very stress relieving for some people. Trusted family members or friends, or an individual therapist can offer support, a shoulder for crying on and a place to discuss feelings and seek counsel.
• Organizing helps some people to calm down. Cleaning one's house or making lists of errands to be run and then checking them off as they are completed can be soothing activities.
• Relaxation techniques help relieve muscular tension associated with stress.
• Soothing environments, either imagined, visualized or experienced, help to calm jangled nerves.
• Exercise can be a very effective means of calming one's self down.
• Distraction, or taking one's mind off of disturbing thoughts and feelings can also be a very effective means of coping with tension.

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• Whereas communication and soothing approaches help couples to work through their conflicts, relationship strengthening approaches help couples to strengthen the bonds that hold them together in spite of conflicts.
• Relationship Inventories. Prompting remembrances of times when things were not so tense can help reawaken in each partner the feelings that first brought them together.
• Partner Pleasing Exercises. Therapists also sometimes will ask conflicted couples to commit to doing something, one thing, which will please their partner, and to commit to doing this thing for their partner as a gift, without expectation of reciprocation.
• Forgiveness. Taking a cue from religious practice, some therapists ask conflicted partners to find it within themselves to forgive their partners for their transgressions.
• Sex. Reasonably frequent sexual relations between committed partners are often an important part of what keeps a relationship healthy.

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• In an ongoing sexual relationship, both partners should be aware of the important role that sex plays in their lives.
• While it is important not to make sex an exaggerated area of focus, it is certainly important to recognize sexuality as a natural part of being human.
• There are also several formal definitions of what makes up healthy sexuality.
• One definition reviewed included having an appreciation for one's own body; learning about reproduction; understanding that human development includes sexual development, such as reproduction and genital sexual experiences); interacting with both genders respectfully and appropriately; understanding and respecting sexual orientation; appropriately expressing love and intimacy, and developing and maintaining meaningful relationships while avoiding exploitative or manipulative ones.
• Healthy sexuality has also been suggested to include communicating and accepting love, expressing emotion, giving and receiving pleasure, and having the ability to enjoy and control sexual and reproductive behavior without feelings of guilt, fear, or shame.
• It is important to be aware that there are differences in sexuality based on gender and also that sexuality changes throughout the lifespan and these changes must be understood.

• There are several direct, biological risk factors including:
• Vascular disease may limit blood flow. As we know, for women and men to become physically aroused increased blood flow to the genitalia is necessary. Vascular disease may also allow blood that has entered the genitalia to slowly escape.
• diabetes impacts blood flow and can even cause nerve damage, which can lead to vaginal dryness in women and erectile difficulties in men.
• Hormonal levels (testosterone in men and women and estrogen in women) can impact sexual function.
• Researchers have identified heavy alcohol use as a risk factor for sexual dysfunction.
• Medication side effects can impact desire, arousal, or orgasm in both men and women.
• In terms of indirect biological risk factors, the natural aging process and certain lifestyle choices create indirect risk factors for sexual dysfunction.
• Psychosocial risk factors include:
• psychological disorders, such as depression, anxiety, substance use disorders, and eating disorders
• emotions (i.e., anxiety)
• maladaptive thoughts (being distracted during sex)
• negative attitudes towards sex (masturbation is dirty, premarital sex is wrong, sex within marriage is solely for the purpose of procreation)
• racial, ethnic, and religious background impact what we believe and expect with regard to sex. If these expectations and beliefs are negative they may serve as a risk factor
• the quality of one's relationship is a risk factor for developing, or worsening sexual dysfunction
• lack of education about normal sexual functioning is also a risk factor for developing sexual dysfunction

• Men and women experience sexual desire at different levels. To recognize this, the DSM-5 now offers 2 disorders - Female Sexual Interest/Arousal Disorder and Male Hypoactive Sexual Desire Disorder. Each has its own criteria that must be met for a diagnosis to be made.
• Sexual addiction refers to a preoccupation with sexual thoughts or sexual behavior to the extent that this preoccupation continues even though it causes substantial harm.
• Erectile Disorder, or "ED" as it is commonly known, is defined as an inability to achieve and/or maintain a satisfactory erection necessary for the completion of sexual activity.
• Men with delayed ejaculation can have an erection, but have difficulties in ejaculation.
• Female Orgasmic Disorder involves marked delay in, marked infrequency of, or absence of orgasm, or marked reduced intensity of organismic sensations.
• Premature Ejaculation is a persistent or ongoing pattern of ejaculation happening during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
• Genito-Pelvic Pain/Penetration Disorder is a female sexual disorder that involves pain during penetration.
• Paraphilic Disorders require a paraphilia to be present - this involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one's self during sexual activity.
• Gender Dysphoria includes strong and persistent cross-gender identification.

• Sexual health should not be taken for granted, and many sexual disorders are not easily prevented.
• There are many self-help steps that can be taken and these self-help actions are beneficial because they may: 1) maintain or improve one's sexual health 2) reduce the risk of developing a sexual disorder and 3) limit the negative impact of having a sexual disorder.
• Get Regular Medical Screening & Evaluation - It is important that you establish a comfort level with your doctors so that you can ask questions and receive appropriate screenings.
• Make Healthy Lifestyle Choices - Choosing not to smoke and limiting alcohol consumption can help improve sexual health and function. Eating a healthy diet and exercising regularly can improve circulation, which in turn can help to improve sexual health .Being aware of medical conditions and medications and their side-effects that can cause sexual dysfunction is also important.
• Maintain A Healthy Body Image - You might want to explore how you feel about your body. If you find that you have low body-esteem and that you are critical of your appearance, you may want to consider that this could be impacting other aspects of your sexuality.
• Increase Physical Comfort - Some simple things can make sexual activity more comfortable.
• Increase Intimacy & Passion in Your Relationships - Just like a car, a relationship requires maintenance to run smoothly. If you notice that passion has dwindled, keep in mind there are certain things you can do to spice things up.
• Educate Yourself: Become a "S-Expert" - There are many myths and misperceptions that can create or worsen sexual problems. Education can solve many problems that happen when people have false or unrealistic expectations of themselves, or their partner.

• Out of a group of 1000 smokers (age 30), a full quarter of them (250!) will die of smoking-related illnesses prior to completing middle age, an additional quarter will die prematurely from smoking-related illnesses shortly after retirement age, and another large group will develop debilitating chronic illnesses as a result of their smoking.
• Smoking is currently responsible for approximately 3.5 million deaths worldwide each year.
• Smoking is the leading preventable cause of death in the United States, and it kills more than 400,000 U.S. citizens each year.
• The World Health Organization predicts that by 2020, the worldwide death toll from smoking will reach 10 million each year, causing nearly 18 percent of all deaths in the developed world.
• Tobacco use also accounts for one-third of all cancers.
• Smokers die from cancer at a rate that is twice as high as nonsmokers, and heavy smokers die at a rate that is four times higher than nonsmokers.
• Cancer is not the only disease caused by smoking. It also causes chronic bronchitis and emphysema, and worsens asthma.
• Cigarette smoking substantially increases the risk of coronary heart disease, including stroke, heart attack, aneurysm and vascular disease.
• It also contributes to peptic ulcers, varicose veins, osteoporosis, periodontal disease, Alzheimer's disease, atherosclerosis, high blood pressure, allergies, and impotence.
• Secondhand smoke, which is caused by smokers and inhaled by people nearby, kills 53,000 nonsmokers in the U.S. each year.
• For every nine people killed by tobacco smoke, one is a nonsmoker.
• Secondhand smoke contributes to 3,000 lung cancer deaths in nonsmokers and as many as 40,000 deaths from cardiovascular disease each year.

• Cigar smoking increases the risk of death from lung, oral cavity, esophagus and larynx cancer.
• Cigar smokers are 4 to 10 times more likely to die from laryngeal, oral or esophageal cancers as nonsmokers.
• Cigar smokers who inhale are at increased risk for pancreas and bladder cancer, as well as for heart disease and lung diseases such as emphysema and chronic bronchitis.
• Cigar smoking has been linked to erectile dysfunction in men.
• Recent research by the American Cancer Society has found that pipe smokers face similar risks for cancer and other diseases as cigar smokers do.
• Pipe smokers were found to have an increased risk for lung, throat, esophageal, colon, and larynx cancers, as well as heart disease, stroke, and chronic obstructive pulmonary disease (emphysema and chronic bronchitis). Risks were generally less than those due to cigarette smoking but equal to or larger than the risks of smoking cigars.
• Smokeless tobacco delivers a higher dose of nicotine than cigarettes, so that a person who uses smokeless tobacco 8-10 times per day might have the same amount of nicotine in their body as a person who smokes 30-40 cigarettes each day.
• After using smokeless tobacco for 3 to 5 years, white, leathery patches or lesions (called leucoplakia) often form on the cheeks or gums of users. These lesions sometimes develop into cancers of the lip, tongue, and cheek.
• Individuals who use chewing tobacco and snuff are 2 to 3 times more likely than non-smokers to develop severe dental problems, including tooth loss, abrasion of the teeth, and bone loss around the teeth.

• Nicotine is a highly addictive substance because of the way it makes us feel, both emotionally and physically, and because the way we obtain nicotine becomes a normal part of our daily lives.
• When a person becomes addicted to smoking, they smoke in order to achieve the physiological (physical) and psychological (mental) satisfaction that smoking provides. Smoking-related satisfaction is very short-lived and new cravings develop quickly.
• One of the main reasons that people become addicted to nicotine is because it activates the pleasure center of their brain.
• Some people say that smoking relaxes them while others say that it gives them a boost.
• Frequent use of tobacco products results in addiction to nicotine, and repeated exposure to nicotine results in the development of tolerance for the drug. As tolerance builds, it takes a higher dose of nicotine to produce the same level of stimulation.
• Psychological factors are often one of the reasons that breaking the nicotine addiction is so difficult.
• For many smokers, the act of smoking has become such a part of their lives that they feel like they have lost a part of themselves when stop smoking.
• Smoking cessation is often difficult because you have become so accustomed to the behavioral aspect of smoking.

• The most effective way to stop smoking is to make the commitment to never light another cigarette again. Most successful smokers quit all at once, removing tobacco and tobacco-related items from their environments and making the commitment to avoid them from that day forward.
• However, because of the symptoms associated with nicotine withdrawal, many people find that it is easier to quit with the aid of either a nicotine replacement therapy (NRT), or a combination of NRT and prescription antidepressants.
• Another popular option is a scheduled smoking reduction program, which can take several forms. The disadvantage to scheduled smoking reduction programs is that tobacco remains in your environment and becomes a constant temptation.
• A combination of behavioral interventions and nicotine replacement therapy has been shown to be the most effective because both physiological and psychological issues are addressed.
• In addition, a relapse prevention strategy is essential since most tobacco users relapse in the first 6-12 months after quitting.

• You should plan not only the method or methods you will use to assist you in quitting, but also how you are going to change your environment and your habits to help ward off cravings.
• Your commitment and your likelihood of quitting successfully will be greater if you formulate a plan and prepare yourself for the difficulties you may experience.
• The first step is to choose the date on which you plan to quit. This is the day that you will change your habits and begin the method you have chosen to help you quit.
• Choose the date at least a month in advance, and give yourself time to prepare.
• Prior to your quit date you should purchase a blank notebook small enough to carry around with you wherever you go and use it to start a smoking diary. Write down in this diary when, where, and why you use tobacco each time you use it. You should also record how you were feeling each time you used tobacco.
• If you do decide that nicotine replacement therapy is your best bet, be sure to discuss you options with your physician.
• Eliminating smoking from your life also means eliminating the signs and reminders associated with smoking.
• The best defense against temptation is to plan for and practice new coping skills.
• Prepare yourself by reading through your smoking diary, writing down the strategies you think will help you to stay on track, and keeping the list on hand so you can access it when you need it.
• Once you decide to quit smoking, one of the most important things you can do for yourself is to establish a support system-either a person or a group of people you can count on to help you to work through the difficult times and to stay motivated.

• You will need to be constantly aware of the best way to keep yourself smoke free.
• Practice how you will respond to smokers when they try to tempt you to have a cigarette with them.
• Keep in contact with your support people. Think about what you are learning and when you will be ready to help someone else to quit.
• Remind yourself as often as necessary that there is no such thing as just one cigarette.
• Think about all the benefits you receive from not smoking, and how the changes benefit your health and your family's health.
• Think about the money you save from not smoking and what you can do with it.
• Continue to eat well, exercising daily, and working to increase your personal repertoire of methods for stress relief.
• Continue to reward yourself periodically for maintaining your nonsmoking status.
• Think about how much better you feel today than you did during the week before you started your program.
• Congratulate yourself frequently on having quit smoking. Feel the sense of self-empowerment that you have earned.
• Smoking is hard to quit, and the chances are fairly good that you'll lapse and/or relapse a few times before you'll be able to quit for good.
• A relapse occurs when the single moment of weakness (the lapse) turns into an excuse to go back to smoking on a full time basis.
• The most important thing you can do is REFUSE to give up your effort.
• Whether you lapse or relapse, the thing to do is to get back immediately to not smoking.
• Following a lapse or relapse, look carefully at what was happening when you began to smoke again and determine what you can do this time to be successful.

• Stress is a reaction to a changing, demanding environment.
• Stress is really more about our capacity to handle change than it is about whether that change makes us feel good or bad.
• Change happens all the time and stress is in large part what we feel when we are reacting to it.
• Every event in the environment, from the weather to the ringing telephone, has some sort of impact on us, and the instant we become aware of that event taking place, we have recognized a demand.
• Understanding that a demand has occurred does not automatically cause us to experience stress. Instead, we appraise a demand by asking ourselves two questions: 1) Does this event present a threat to me? and 2) Do I have the resources to cope with this event?
• If we appraise an event as threatening, the sympathetic nervous system automatically signals our body to prepare for action.
• Once your body has been prepared for action by the various hormones and neurotransmitters, you are ready to respond to the stressor by taking physical action.
• Physiologists call what happens next the "fight-or-flight" response to highlight the two most common forms that this physical response tends to take.
• Once a stressor has been neutralized (or has been avoided successfully), the parasympathetic nervous system starts to undo the stress response by sending out new signals telling your body to calm down.

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• Chronic and persistent negative stress can lead to many adverse health problems, including physical illness, and mental, emotional and social problems.
• Chronic stimulation of the immune system causes the system to become suppressed overall, and thus become less effective at warding off diseases and infections.
• Many people experience a stomachache or diarrhea when they are stressed.
• Chronic activation of stress hormones can raise your heart rate, cause chest pain and/or heart palpitations (sensations that your heart is pounding or racing), and increase your blood pressure and blood lipid (fat) levels.
• People who respond to stress with anger or hostility have an increased risk of developing cardiovascular disease.
• Unhealthy stress coping strategies such as smoking, drinking, or overeating can also damage the heart and surrounding blood vessels.
• Stress often causes muscles to contract or tighten and over time, sustained stress can cause aches and pains to occur due to muscle tension.
• The hormones accompanying stress can cause reproductive problems for both women and men.
• Stress also worsens many skin conditions.
• Stress hormones can contribute to a sustained feeling of low energy or depression.
• Chronic and/or severe stress can also negatively affect people with Bipolar Disorder.
• Some people who are stressed may show relatively mild outward signs of anxiety, such as fidgeting, biting their fingernails, tapping their feet, etc.
• In other people, chronic activation of stress hormones can contribute to severe feelings of anxiety (e.g., racing heartbeat, nausea, sweaty palms, etc.), feelings of helplessness and a sense of impending doom.
• People who are chronically stressed may experience confusion, difficulty concentrating, trouble learning new information, and/or problems with decision-making.

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• Restorative techniques are used for reducing the unpleasant and unhealthy emotional effects of stressful events that have already occurred.
• Conscious deep rhythmic breathing has a calming effect on the body, and tends to help the heart rate to slow down, the mind to quiet and attention to turn inward towards the sensation of inhalation and exhalation.
• Meditation is putting your mind at ease by controlling the focus of your attention and can also help reduce anger and hostility feelings by teaching you to suspend automatic judgments.
• Physical activity is one of the best methods for fighting stress. Exercise helps you feel better by harnessing the body's natural fight or flight response, rather than suppressing it.
• Yoga, Pilates and Tai Chi are excellent stress-relieving practices.
• Progressive muscle relaxation is a stress relief technique that relies upon subtle rather than gross (large) muscular movements to promote relaxation and tension relief.
• There are several other methods and techniques based on using kinetic (body) movements to reduce stress, as well as those that involve therapeutic touch like in massage, or manipulating specific body points as done in acupuncture.
• There are a wide variety of medications that can be used to aid in the process of stress relief and prevention.
• Psychological strategies for stress relief draw upon the broad discipline of psychology to provide insight into why people become stressed and methods for how that stress can be lessened.
• Visualization and imagery (sometimes referred to as guided imagery) techniques offer yet another avenue for stress reduction.
• Rather than directly manipulating one's body or mind to reduce stress, you can also change the environment around you to produce a transformative and stress-relieving effect.

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• It is much smarter to spend some time developing good stress prevention skills that minimize the need for strenuous self-soothing efforts after stress has occurred.
• Reducing stress generally includes becoming aware of what true needs are and are not, understanding how to meet true needs and becoming able to resist being exploited or manipulated by other people.
• Stress prevention is not a one-time effort but rather an ongoing discipline.
• Developing a clear and prioritized understanding of one's values lies at the core of effective stress prevention.
• Time management methods involve finding ways to work more efficiently, so as to maximize one's use of time.
• Another absolutely vital skill for maintaining a healthy balance between work and life responsibilities is the ability to be assertive when necessary. Being assertive means being able to say no, and to refuse requests and demands when they are not healthy for you to take on.
• Stress Inoculation Therapy (SIT) is a psychotherapy method intended to help patients prepare themselves in advance to handle stressful events successfully and with a minimum of upset. 

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• Effective stress prevention strategies require people to change their lifestyles so that they take proactive steps to avoid stress and enhance their health every day.
• The best prescription for reducing stress is one created by you based on your knowledge of the stresses you are facing as well as an appreciation of your strengths and weaknesses.
• Try to pick goals that you think you will enjoy performing, because these goals will be easier to stick with than ones you anticipate will be aversive.
• Write down your goals using positive language, saying what you will do, rather than what you won't.
• When you have a plan you can live with, the next thing you will need to do is to make a commitment to carrying it out.
• Announcing your goals publicly to people who care about you can also become a way to ask for and receive support.
• Another way to formalize your goals is to write or type them out in the form of a contract. On this contract, spell out your goals and specify the time frame in which you will meet them.
• It's important to keep a record of your actions as you work towards your change goals.
• Lifestyle change goals are not like most other goals, which have a defined ending point.
• If you lapse from your plans (and you almost certainly will, simply because you are human), don't make a big deal out of it. Instead, simply get back on track as soon as you can.

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• A stroke is similar to a heart attack, only in this case, blood flow to brain, rather than the heart, is blocked.
• The term "stroke" comes from the once popular idea that someone had received a "stroke of God's hand" and was therefore damaged.
• Strokes are also called cerebrovascular accidents (CVA's; "cerebrum" is Latin for brain, while "vascular" refers to the blood vessels) or "brain attacks" to emphasize the need to call 911 and get immediate medical attention when they occur.
• Approximately 700,000 Americans suffer a stroke each year and it is the third major cause of death in the United States each year after heart disease and cancer.
• Arterial blood vessels feeding the brain can become blocked on a permanent or temporary basis.
• The term stroke is generally reserved for more permanent blockages that do not rapidly and spontaneously resolve themselves.
• Transient and temporary blockages are called Transient Ischemic Attacks (or TIAs for short).
• Ischemic strokes occur when a blood clot (called a "thrombi") or a fatty plaque (composed of fat deposits, cholesterol, and waste products) blocks blood flow to an area of the brain, causing death of the associated neurons (brain cells). Approximately 88% of strokes are ischemic events.
• Hemorrhagic stroke, occurs when a cerebral (brain) artery ruptures and spills blood over the brain tissue.
• Though strokes can be lethal, there are many people who survive them. These stroke survivors typically experience a range of limitations.

• Your risk of stroke is influenced by many factors. Some factors, like age, cannot be changed, but other factors (like high blood pressure) can be minimized by healthy lifestyle choices and medication (if necessary).
• Here is a list of some of the risk factors for stroke over which people have little control:
• Age. The risk of stroke increases as people grow older.
• Family History. Your risk for stroke is greater than average if you have a close blood relative who has had a stroke.
• Race. The risk of stroke is higher in African Americans, but lower in Asian Americans.
• Gender. Men are slightly more likely than women to experience a stroke. However, women are slightly more likely to die of stroke than men.
• Previous History of Stroke or Heart Attack. If you have had a previous stroke you more likely to have another. Similarly, individuals who have had heart attacks (Myocardial Infarction or MI\'s) also have a higher risk of stroke.
• Transient Ischemic Attack. A person who has experienced a TIA is more likely to have a stroke than an individual who has not had a TIA.
• Hypercoaguable State: Genetically, some individuals tend to make blood clots more easily than other people, a condition referred to as being "hypercoaguable". Hypercoaguable people are at a higher risk of a stroke.
• There are also many risk factors for stroke that people can control or manage through careful lifestyle choices and the appropriate use of medicine:
• Hypertension. Commonly known as high blood pressure, hypertension is a major risk factor for stroke. Without treatment, a hypertensive person's stroke risk can be four to six times that of people with normal or controlled blood pressure.
• Atrial Fibrillation. An estimated 15% of strokes occur in people with atrial fibrillation, a type of heart disease.
• Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches and other food into energy. Having diabetes raises a person's stroke risk significantly (diabetics are 3x more likely to have strokes than non-diabetics).
• High Cholesterol - while some cholesterol is necessary for the body, too much cholesterol (either because of genetics or diet) increases the chance of ischemic stroke.
• Tobacco Use - Smoking doubles a person's risk for stroke.
• Alcohol Intake - People who drink alcohol excessively are more likely to have a stroke.
• Sedentary Lifestyle - Physical inactivity directly contributes to many of the risk factors associated with stroke described above, including obesity, diabetes, hypertension, and high cholesterol.

• The longer a stroke continues, the more likely it is that you will end up with permanent and irreversible brain damage.
• The ideal goal is to start treatment for a stroke within 3 hours of the onset of symptoms in order to minimize damage. For this reason, a stroke is considered an emergency medical situation.
• It is vital that you and your family become familiar with the symptoms and signs of a stroke so that you can recognize when one is occurring.
• Some of the more common symptoms of stroke include:
• Numbness in the face or limbs on one side of the body
• Sudden, painless weakness on one side of the body.
• Sudden confusion
• Sudden trouble in understanding language.
• Sudden slurring of the speech or difficulty speaking.
• Trouble walking, sometimes accompanied by loss of balance.
• Sudden onset of a severe headache with no apparent cause.
• Sudden painless loss of vision in one or both of eyes.
• Drooping of one side of the face

• The ideal goal is to start treatment for a stroke within 3 hours of the onset of symptoms in order to minimize damage.
• Therefore, doctors will move quickly to diagnose a suspected stroke using one or several of the following methods:
• CT (or CAT) Scan. CT-scans are one of the most commonly used diagnostic tests for stroke, as they are relatively quick, and easy to perform in most medical centers. Doctors often use CT scans to make certain that a hemorrhagic stroke has not occurred. Once doctors have verified that there is no brain bleeding, medication can be used to dissolve remaining clots (which can cause an ischemic stroke).
• MRI, or magnetic resonance imaging, uses magnetic fields to create detailed images of the body and brain tissue. MRI provides a more detailed brain image than does CT scanning, allowing for more sensitive detection of small changes.
• An angiogram provides an image of the blood flow in a person\'s arteries. Angiography is currently the best method for determining the location of a stroke in the brain (i.e., which blood vessel) as well as the type of stroke (ischemic or hemorrhagic), but is typically reserved for times when there is uncertainty that is not clarified by a CT or MRI scan.
• In an ultrasound test, sound waves are aimed at areas of the neck or head, where blood flow may be abnormal. The images provide doctors with a picture of blood flow through these arteries. Ultrasound can be helpful for identifying the causes of stroke such as plaques, carotid artery stenosis (blockage), or emboli (blood clots that have broken loose).

• The key to successful treatment of stroke when it is occurring is getting help as soon as possible.
• Receiving faster medical care results in a greater chance of recovery and minimizing brain damage.
• The type of stroke that has occurred, as well as the length of time between when the stroke occurred and treatment is initiated determine which therapies doctors can use.
• The goals of treatments for ischemic stroke are to remove blockage and restore blood flow to the brain as quickly as possible. Doctors may use one or more of the following techniques in the service of these goals:
• "Clot Buster" Medications (e.g., TPA or tissue plasminagen activators). Clot busting drugs (otherwise known as "thrombolytics") work to dissolve blood clots that can block arteries, decreasing the disability caused by a stroke. In order to work, they must be administered within three hours of the onset of stoke symptoms.
• Aspirin blocks the ability of platelets to clot, which might decrease the chance of death or disability from stroke.
• Immediately during and following a stroke, your blood pressure, oxygen, and glucose levels will be monitored.
• The goals of hemorrhagic stroke treatment are to seal off the ruptured artery to prevent further blood loss, and to prevent uncontained blood from contacting brain tissue. Doctors use the following techniques in the service of these goals:
• In many instances of hemorrhagic stroke, surgery will be necessary to seal the ruptured artery. Surgery also allows removal of the extra blood, so pressure does not increase in the brain and cause damage.
• Endovascular Treatment - In this procedure, doctors insert a tube called a catheter into a major artery. The tube is guided through the blood vessel until it reaches the affected area in the brain at risk for rupture and a stabilizer is inserted into the arterial wall, making a rupture less likely. Endovascular treatment is most useful as a preventative measure (rather than a treatment for a stroke that has already occurred).

• A range of therapies are available to help patients work towards recovery of lost functioning (in as much as that is possible) and to prevent them from experiencing future strokes.
• In general, the severity of the stroke determines the amount of time a person will need to spend in post-stroke rehabilitation.
• Physical therapists can help stroke patients to relearn important everyday activities such as sitting, standing up, walking, and balancing.
• Occupational therapists can help people relearn important activities of daily life (such as eating, drinking, using the restroom, preparing food, bathing, reading and writing) to the greatest extent possible.
• Speech therapists can work with a stroke patient to help them regain some of their communication abilities to the extent that is possible.
• Approximately 20% of individuals will go on to develop Major Depression. Psychotherapy and/or anti-depressant medication are effective strategies for treating depression in most people.
• Stroke patients also need to lean on a strong support group of family and loved ones to provide encouragement and assistance during the often difficult rehabilitation stage.

• Quit Smoking - the first change in your life (if applicable) should be to quit smoking.
• Eat A Healthy Diet - your dietary choices can inflate or lessen your stroke risk. In addition to the amount of food (and calories) you consume, it is also important to pay attention to the types of food you eat.
• Exercise Regularly - getting regular aerobic exercise that raises your heart rate for extended periods of time (brisk walking, jogging, swimming, court sports, etc.) is another way to lower your stroke risk.
• Get Your Affairs In Order - stroke is a sometimes disabling event that can rob people of the ability to communicate their wishes. All adults should prepare a "living will" in advance of developing health problems such as stroke. These documents help people articulate their desires for medical intervention and life support in the event that they are not able to speak for themselves. Stroke survivors who don't have such a document prepared should strongly consider preparing such a document now. Discussing end-of-life issues can be hard for some people, but having this discussion with family members allows all relevant parties to be aware of an individual's wishes ahead of time.

• Within this article, we are referring to suicide in the conventional sense, in which someone plans out or acts upon self-destructive thoughts and feelings, often while they are experiencing overwhelming stress.
• Suicide is the third leading cause of death for adolescents and young adults from age 15-24.
• Suicide victims under the age of 30 are also more likely to have dual diagnoses (a combination of a mental illness and a substance abuse disorder), impulsive and/or aggressive behavior disorders, and legal problems than people over 30 who commit suicide.
• Older Caucasian males (85 years or older) committed suicide at the highest rate of any age group.
• Whites and Native Americans (especially adolescents) have the highest suicide rates than any other ethnic group in the US. In addition, the rate of suicide among young African American males has been steadily increasing.
• Men are more likely to commit suicide than women and men are more likely than women to use highly lethal methods to commit suicide.
• Women are more likely than men to attempt suicide.
• Living alone and being single both increase the risk of suicide. Marriage is associated with lower overall suicide rates; and divorced, separated and widowed people are more likely to commit suicide.
• Being a parent, particularly for mothers, appears to decrease the risk of suicide.
• The Rocky Mountain and Western states have the highest rates of suicide in the U.S.
• Suicide rates are higher in rural areas.
• Industrialized countries generally have higher rates of suicide than non-industrialized countries.
• Religiosity seems to have a protective effect against suicide.
• Unemployment is associated with increased rates of suicide.
• Sixty percent of all suicides are committed by people with mood disorders.
• Approximately 30% of suicides are committed by people who have psychiatric disorders other than mood disorders.
• There is a significantly higher rate of suicide among people who abuse alcohol and/or drugs.
• People who have access to firearms are more likely to commit suicide.
• Emotional insults, such as rejection, public humiliation or shame, may be experienced as painful enough by some people to push them towards suicide.
• Significant grief and loss can also be associated with suicidality.
• People with a family history of suicidal behavior are more likely to attempt or commit suicide.
• People who were abused or neglected as children have a higher risk of suicide than others.
• Victims of domestic violence are at higher risk of suicide than people who have not had this experience.
• People involved in, or arrested for, committing crimes are at higher risk of committing suicide than other people.

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• Suicidal thoughts and behaviors start when vulnerable individuals encounter stressful events, become overwhelmed, and conclude that suicide is the only reasonable way (given their very likely biased way of thinking) to stop the pain they are experiencing.
• Both negative and positive events can be sources of significant stress.
• The most frequent stressful event leading up to suicide in the US today is mental illness, which is estimated to account for about 90 percent of all suicides.
• Depression is the most common mental illness in people who commit suicide.
• Individuals with anxiety disorders may feel overwhelmed, ashamed, or frustrated that they are unable to control their symptoms. Many individuals with severe anxiety symptoms also become socially isolated and/or try to relieve their feelings by using alcohol and/or other substances. These features of anxiety disorders can lead someone to attempt or commit suicide.
• Individuals with PTSD have the highest rate of suicide when compared to all other anxiety disorders. 4 to 10% of people with schizophrenic disorders commit suicide.
• Between 4 and 8% of people with a personality disorder complete suicide, and approximately 40 to 90% have attempted suicide.

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• Having suicidal thoughts is the most important and most common warning sign for suicidality.
• If you/someone regularly focuses on themes of suicide or death in conversation (e.g., talking about giving up on life, or how others would be better off without you), thinking, writing, music or artwork, the person may be at risk.
• Additional warning signs of suicide can include:
• decreased performance in school or work
• an unusual desire for social isolation
• a significant decrease in self-esteem
• increased emotionality (expressed as anger, agitation, anxiety, hopelessness, sadness, or similar emotion)
• a sudden decrease in emotionality; particularly, a movement from depression or agitation to remarkable and uncharacteristic calm
• uncharacteristic behaviors or emotions
• uncharacteristic carelessness concerning personal safety
• increased drug and/or alcohol use
• losing interest in things that someone used to enjoy
• failing to take prescribed medications or follow required diets
• preparing for death by getting one's affairs "in order"

For more information about your own suicide warning signs
For more information about suicide warning signs in another person

• If you are presently assembling the means of your own death, the time to go to the hospital so as to prevent yourself from killing yourself is now.
• You need a safe environment to be in for a while where you can be protected from acting upon suicidal urges.
• You may also benefit from medication to calm you, help you sleep or to serve as an anti-depressant.
• Most acute suicidal urges pass, or at least decrease in urgency, after a period of time has gone by, so if you can hold out and not act, there is a very good likelihood that you will shortly feel better.
• It is much easier to hold out and not attempt suicide if you are hospitalized in an environment designed to keep you safe, than if you are out and about in your normal environment.
• Unless you have pre-existing arrangements set up already with a therapist or doctor, the only surefire way to get the care and safe environment you need is to go to a local Emergency Room (ER).
• Go to the hospital immediately if you are acutely suicidal. Recruit a friend to take you if you cannot get yourself there safely.
• As a last resort, you should call the emergency operator who can dispatch an ambulance or police officers to your location. This can be a rather expensive way to go, but if it is the only reasonable way to get yourself to the hospital, then don't let the expense get in your way.
• It may cross your mind to call an emergency telephone crisis line and this is a good idea if you are just feeling vaguely suicidal and want human contact with someone who can help you work through your thoughts.
• If you are acutely and dangerously suicidal, however, calling a crisis line is not the best thing to do, as it will distract you from getting the hands-on assistance you need.

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• Continue to practice your newly-learned problem solving and adaptive coping skills.
• Go back to your psychotherapist if you need a "tune up" and you find yourself sliding backward into old, negative habits.
• Consider joining a support group and/or using the Internet to remind yourself that you are not alone, obtain new ideas for coping with difficult times, and reach out to other people who need assistance.
• Keep a copy of your anti-suicide plan handy.
• Identify your triggers and develop a list of preventative strategies.
• Follow through with referrals to other resources, such as a substance abuse program or rehabilitation program to help you address addiction issues.
• If you are suicidal and own guns, take steps to get those guns out of your house so that they cannot tempt you.
• Alter the components of your environment that are stressful (as much as possible).
• Reconnect with family and friends who you find supportive to be around, and ask them for help before your next suicidal crisis gets out of hand.
• Make use of crisis telephone hotlines and online support communities.

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• You can help interrupt and help disarm any active suicide attempts and defuse the danger of the immediate crisis situation.
• You can help the suicidal person get connected to a mental health professional who can offer him or her effective support and intervention.
• You can provide ongoing support and "cheerleading" as the person participates in treatment, practices new methods of coping and continues on with the often stressful business of day to day living.
• You must keep in mind that stress effects each person differently, and that just because you might be able to handle something doesn't mean that everyone else can too with similar ease.
• Do what you can to put judgment aside and simply act compassionately.
• Try to provide true assistance by helping the suicidal person find the professional help that he or she needs in order to safely resolve the crisis.
• Having an honest and open conversation about your concerns with regard to medication safety, storage and proper use may help.
• Be sure to remove guns, knives and other lethal weapons from the suicidal person's house or otherwise secure guns and weapons in a manner that makes it inconvenient for the potentially suicidal person to get at them.
• You can help the suicidal person to anticipate likely suicide triggers.
• You can watch for new signs of suicidal thinking (e.g., a suicide relapse), or watch for a worsening of someone's level of suicidality.
• It is also important to keep in mind that despite your best efforts; no matter how helpful and loving you are toward suicidal people, they still may feel badly about themselves and their situation, and they may still ultimately take their life.

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• Suicide goes way beyond the pain of the suicidal individual and affects all of the people who care about or who depend upon that suicidal person.
• If you are trying to help a suicidal person to feel better, odds are that you yourself will have a difficult time as well.
• If you have recently lost someone to suicide, odds are that you will be devastated or at least experience a grief reaction for some time.
• Don't underestimate the emotional impact on yourself of the work you do to support someone through a suicidal crisis.
• You may end up feeling angry, guilty, helpless or depressed yourself in the wake of a suicide attempt or a completed suicide.
• You may benefit from speaking with a therapist so as to help work through your powerful emotional reactions.
• Take care to balance the effort you put into supporting the suicidal person with the demands of keeping your own family and work commitments running, and supporting and nurturing your own mental health.
• Don't try to be the sole support for a suicidal person. Instead, enlist the help of competent others around you who can share the load.
• If the situation requires professional intervention, then go about arranging for that professional intervention and do so without feeling guilty.
• While you may need to over-extend yourself during the immediate crisis, don't try to operate that way for an extended period. Make it a priority to recover your normal rhythms as soon as you can.

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• Overweight and obese people are at increased risk of developing serious and sometimes life-threatening illnesses as they age, including:
• Heart Disease, Heart Attack and Heart Failure
• Coronary Artery Disease (CAD)
• High Blood Pressure
• Angina
• Abnormal heartbeat
• Cholesterol problems (leading to heart disease)
• Elevated LDL ("bad") cholesterol and triglycerides levels
• Lowered beneficial HDL ("good") cholesterol levels
• Stroke
• Type 2 Diabetes (the kind you develop rather than are born with)
• Cancers (prostate, gallbladder, colorectal, breast, endometrial and kidney)
• Liver problems (such as an enlarged liver, cirrhosis or a fatty liver)
• Gastroesophageal ("Acid") Reflux Disease (GERD)
• Sleep Apnea (Snoring and difficulty breathing while sleeping)
• Asthma Shallow breathing (Pickwickian syndrome which can lead to heart disease)
• Arthritis
• Gallstones (in women)
• Reproductive problems (irregular periods, increased birth defects, especially neural tube defects, and an increased risk of death of the mother and baby).
• Memory and learning problems (in men)
• How fat is distributed on the body has important implications for health risks as well. Fat that accumulates around the abdomen and stomach areas (e.g., the so called "beer belly" or "love handle") predicts more serious health problems than does fat that accumulates around the hips and thighs.
• Men with waist measurements of more than 40 inches or woman with waist measurements greater than 35 inches are at higher risk for developing type 2 diabetes, high blood pressure, high cholesterol, and coronary artery disease than are normal weight individuals or those whose fat accumulates around the hips.

• Psychological consequences of being overweight or obese can include lowered self-esteem and anxiety, and more serious disorders such as depression and eating disorders such as binge eating, bulimia and anorexia.
• If the negative health and shame aspects of being overweight aren't enough, overweight people also tend to have less energy than their normal weight peers.
• Because it takes them more effort than their peers to be active, they tend to gravitate towards low-activity lifestyles and become sedentary.
• An unfortunate circle develops wherein the less active people become the greater their risk of gaining still more weight, and the more weight people gain, the less likely they are to become more active.
• Life stresses seem more overwhelming as exercise (which could begin the process of reversing this downward spiral of decreasing energy levels) is avoided and a major opportunity for the reduction of muscle tension, stress and anxiety is lost.
• Over time, even ordinary tasks of daily life like going up a flight of stairs can lead to exhaustion and a sense of premature aging.

• People's weights are determined by multiple factors including their genetic background, eating habits, metabolic rate and their general activity level.
• Genes influence body weight by setting basic parameters on the body's metabolic efficiency (the efficiency with which the body burns calories).
• Genes governing metabolism run in families. If one of your parents is obese you are several times more likely to be obese yourself than someone who has parents of a healthy weight, and if both of your parents are obese you are at a very high risk of becoming obese yourself.
• Apart from genetics, people's metabolic rates are largely determined by how active they are.
• Inactivity accelerates loss of muscle tissue over time which decreases metabolism, making it all but certain that weight will be gained.
• People's food related habits and cultural expectations are also important determinants of their weight, influencing the types and amounts of foods consumed.
• People who eat quickly tend to eat more than people who eat slowly as it takes a few minutes for your stomach to tell your brain it is full.
• Exercise is an essential component of a healthy weight management program. Where a person's genetics are more or less set at conception, the amount of energy a person expends in physical activity is under voluntary control.

• A good starting place for diet and nutrition information is the USDA's research-based Food Pyramid guide which starts by dividing foods into the following six food groups: Grains, Vegetables, Fruits, Oils, Milk, and Meat & Beans.
• The six groups are then arranged into a pyramid shape to indicate the relative proportions of each food that people should eat each day.
• The pyramid now includes a physical exercise component as part of the essential food groups, to indicate that regular physical exercise for at least 30 minutes a day, most days of the week (60 minutes a day for children and teens!), is vital for everyone's health.
• There are six classes of necessary nutrients found in foods: carbohydrates, fats, protein, vitamins, minerals and water.
• These nutrients perform three vital life functions: they provide energy, they promote body growth and maintenance, and they assist in regulating bodily processes.
• With the exception of water, each nutrient class contains a variety of different subtypes of that nutrient.
• Some of these nutrient subtypes can be better for health than others. For example, within the fats class, there are saturated fats, mono-unsaturated fats and poly-unsaturated fats.
• Like fats, carbohydrate subtypes are not all equally nutritious.
• All nutrients, including carbohydrates, fats and proteins, are essential for life and should be present in a healthy diet.
• Rather than attempting to eliminate nutrient classes as some reducing diets seem to suggest, the wisest course is to select a diet based heavily on the healthier types of nutrients from each nutrient class including fresh fruits and vegetables, whole grain breads and cereals, lean meats, fish and poultry, low fat or nonfat dairy products, and the sparing use of healthy fats such as olive oil.
• Refined sugars, white flour, and partially-hydrogenated oils should be avoided.
• Less nutritious foods, including steaks, hot dogs and sausages, cream and butter, and cake and ice cream can be eaten on an occasional basis but should not become staples of an everyday diet.

• Various "diet" pills have been around for decades. All existing pills produce at best only moderate results, and come with significant negative side effects, may not work for everyone, and the lost weight is usually regained when the drugs are stopped.
• Any dieter considering the use of medicines or herbal preparations to assist with their weight loss program should check with their doctor and pharmacist first, especially if they are taking prescription medicines.
• Medicines, supplements and herbal preparations can potentially interfere with the functioning of other prescription medications.
• Weight loss surgery (otherwise known as bariatric surgery) changes the anatomy of the digestive tract so to limit the amount of food people can eat and digest.
• Bariatric surgery carries significant risks, including the possibility of death, and requires significant lifestyle changes of patients when it is successful.
• Because of these risks and responsibilities, bariatric surgery is usually reserved as a treatment of last resort for severely obese people whose lives are threatened by serious health problems as a result of their obesity.
• Gastric bypass, the most common type of bariatric surgery, restricts stomach size.
• Candidates for gastric bypass surgery are usually screened in advance by a multidisciplinary medical team which attempts to determine if the surgery is right for each patient.
• Gastric bypass surgery can produce dramatic results at the price of substantial risk.
• Bypass patients have less opportunity to absorb nutrients from food and are at risk for mineral and vitamin deficiencies.

• Preparing a weight loss program means setting up the conditions that will make it most easily possible for you to achieve your weight loss goals.
• There are numerous important choices to make during the preparation stage, including the form your diet will take, how much weight you will attempt to lose, how you will keep yourself motivated to make progress towards your goals, and how you will monitor your progress.
• An important first step is to examine your motives for wanting to lose weight. Deciding to make a lifetime commitment to diet and exercise is a big step. You will be most likely to succeed in such a program if you want it for yourself and are not merely trying to please other people.
• Having decided to go forward with your planning, you need to choose a realistic and personally desirable weight loss target goal.
• Do a review of literature describing several popular reducing plans to decide which one appeals to you best.
• Keep in mind that all reducing plans work the same way, by restricting the total number of calories you eat so that you achieve a negative energy balance.
• Also keep in mind that the diet changes you'll need to make are permanent and will not end with you achieving your weight loss goal.
• Having made a reduction diet choice, use your knowledge of past diet efforts to customize it so that you are less likely to fail. Think about the things that trigger you to overeat and generate plans to address these triggers.
• There is no need for speed in dieting, and in fact, speed can be dangerous to your health. A healthy weight loss rate is one or two pounds a week maximum.
• It's an excellent idea to combine your dietary weight loss efforts with an exercise program. Exercise is the key to sustained weight management.

• While having met your weight loss goals is definitely a cause for celebration, it is not a license for going back to your old "eat what I feel like" ways.
• Sustaining weight loss is not a sprint but rather a marathon of lifelong change.
• Long term weight loss and maintenance depends on dozens of daily choices made correctly more times than not over long periods of time.
• In order to keep your weight off, you'll need to start on a maintenance diet sooner rather than later.
• If your reducing plan wasn't itself a nutritionally balanced diet make sure that you move towards eating such a diet as soon as you have met your weight loss goals.
• Continue to eat a balanced and nutritionally sound diet on an ongoing basis, limit your sweets intake, and include more fresh fruits and vegetables, whole grains, healthy unsaturated fats and lean meats in your diet.
• It may take you a while to determine the proper amount of food you can eat post-diet without gaining weight.
• While it's likely that you'll be able to eat more than you were while on your reducing diet and still maintain your gains, you will never again be able to eat whatever you feel like eating whenever you feel like it without risking weight gain.
• Your chances of sustaining your weight loss will rise dramatically if you begin and stick with a program of regular physical exercise of a sort you enjoy.
• There will be times when, for whatever reason, you will give in to temptation or fatigue and eat things you should not, or fail to exercise when you should.
• Your chances of sustaining your weight loss will also rise significantly if you create contingency plans to help you minimize the impact these lapses will have on your maintenance compliance.
• In addictions counseling the acronym HALT stands for four conditions that addicts are taught to avoid so as to minimize relapse: Hungry, Angry, Lonely and Tired. These same distressing conditions can make dietary lapses more likely too.
• Consciously plan for occasional indulgences. If you are really craving something, allow yourself permission to occasionally have a normal portion of that food.
• Actively plan for how you'll manage your diet over the holidays, rather than simply getting depressed about what you are missing.
• When lapses occur, do what you can to learn from them. Have a sense of humor about the situation, and then react appropriately.
• Truly long term weight loss is possible only when people make lifestyle changes that support weight loss; remaining committed to watching their diet and meeting their exercise goals on an ongoing basis.

• Heart disease is the number one killer of both men and women. A women's best chance of decreasing her risk for developing heart disease is a healthy lifestyle, which includes not smoking, exercising regularly, maintaining a healthy weight, eating a low fat, high fruit and vegetable diet, and restricting dietary sodium to less than 2.3 gm a day.
• After heart disease, cancer is the most common cause of death for women in the United States. Cancers women can face include breast, lung, colorectal, cervical, and uterine/endometrial.
• Much of the focus on decreasing deaths from cancer goes toward ensuring that women have routine screening tests such as mammograms, colonoscopy, sigmoidoscopy, and pap smears. In terms of cancer prevention, a women's risk of developing cancer is affected by her lifestyle and dietary choices.

• A number of other reproductive health concerns besides cervical and uterine cancer impact women. These female-specific concerns include: problems with the onset of the menstrual cycle and ongoing hormonal fluctuations; organ-specific conditions such as benign fibroid tumors; and the final hormonal changes that occur with the onset of menopause.
• Premenstrual Syndrome (PMS) is a condition where physical and emotional symptoms (such as tiredness, food cravings, bloating, sleep changes, body aches, and breast tenderness) develop just prior to the onset of a women's monthly cycle.
• Endometriosis occurs when the endometrium, or the uterine lining, grows outside of the uterus. Most commonly this growth occurs in the abdominal cavity. Endometriosis occurs in approximately 10% of women.
• Fibroids are a benign (non-cancerous) tumor of the uterine muscle wall that occurs with over-growth of the smooth muscle cells. This type of tumor occurs in 5 to 80% of women.

• A woman enters menopause when she has not experienced a menstrual period for more than a year.
• The perimenopause time occurs when there is a change in menstrual flow and a lengthening of the time between periods.
• We know that menopause is affected by a decrease in the hormone estrogen, but we don't know precisely which changes in a woman's body chemistry cause the specific symptoms that accompany menopause.
• Treatments for menopause syptoms often include herbal remedies and alternative treatments.
• Historically, physicians recommended hormone replacement therapy (HRT) at the time of menopause because estrogen best controlled hot flashes. An "about face" on the use of HRT at the time of menopause occurred following the release of information from a study called the Women's Health Initiative (which concluded in 2002), which found a possible increased risk of heart attacks and stroke for women using this therapy.
• Many women experience mood swings during the menopausal transition, but it is unclear if there is an increased rate of depression at the time of menopause. It is also difficult to sort out whether mood changes are actually caused by menopause itself, or by the associated life stressors common in this stage of life such as aging parents, job transitions, children leaving home, and deaths in family or friends.
• Once a woman begins to experience bone loss she is at risk for developing osteoporosis. Other risk factors include advancing age, low body weight, maternal history of osteoporosis, history of previous fracture(s), and poor calcium or vitamin D consumption.

• Our immune system protects us from diseases. Ideally, antibodies, which are part of the immune system, recognize and destroy infections like bacteria and viruses so we do not get sick.
• Autoimmune diseases occur when the body misinterprets "self" as "non-self," resulting in the destruction of its own cells.
• Approximately 5% of the population in Western countries have autoimmune diseases, and of people with autoimmune conditions, 75% are women.
• The two most common conditions are rheumatoid arthritis and autoimmune thyroiditis.
• Rheumatoid Arthritis is a chronic disease that results in inflammation and swelling of the joints.
• The thyroid is a gland located in your neck that secretes thyroid hormone and affects many organ systems throughout the body. Thyroiditis (inflammation of the thyroid) can cause an overproduction or underproduction of the thyroid hormone.

• A woman's health needs change with her age and while we have no control over our genetic makeup, we all know that our health is influenced by diet and lifestyle choices that we can control.
• No matter what their individual family risk factors are for given diseases, all women can stay healthier longer by not smoking, exercising regularly, maintaining a healthy weight, keeping alcohol intake to one drink a day, and eating a healthy diet high in fruits and vegetables while low in saturated and trans fats.
• Women can also help themselves by keeping current on screening tests, which allow doctors to diagnose diseases earlier, which means that that women can obtain quicker treatment and have fewer health complications.
• Immunizations play another important role in promoting women's health.
• At routine visits a women and her health care provider can make certain she is current on her preventive care (such as cancer screening and immunizations), evaluate for healthy lifestyle habits, as well as discussing any physical or emotional issues that are impacting her quality of life.
• For women, the most frequent preventive advice given by physicians is to improve their diet and to increase their frequency of exercising.
• Medicines can also have a place in preventative health care. Any routine medication should only be used under the advice and consultation with your primary care physician.

• There are four main areas or channels in which children grow: physical, psychological and cognitive, social and emotional, and sexuality and gender identity.
• Children's bodies grow in height and weight over the years and change appearance during puberty.
• Children also develop certain physical abilities during their progression towards adulthood, including crawling, walking, running and (possibly) writing or shooting a basketball.
• Children develop psychologically and cognitively as their brains absorb more information and they learn how to use that information.
• Children grow socially and emotionally and they learn how to interact, play, work, and live with other people such as family, friends, teachers, and employers.
• They learn how to understand both their own feelings and others' emotions and ways of dealing with strong emotions.
• Children must develop a sense of self-esteem as they go through the long process of figuring out what shape their identity, or who they are, will take.
• They also develop a sense of morality as they learn the difference between right and wrong.
• Finally, children have to develop sexually and form a gender identity.
• Early on, children learn how their bodies work and look and what it means to be a boy or a girl; they learn how boys and girls are different.
• As they grow older and enter adolescence and puberty, they continue to learn how their bodies work sexually and how to responsibly handle their sexuality so as to balance their sexual desires and appropriate behavior.

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• Sigmund Freud (1856-1939) was a Viennese doctor who came to believe that the way parents dealt with children's basic sexual and aggressive desires would determine how their personalities developed and whether or not they would end up well-adjusted as adults.
• Freud described children as going through multiple stages of sexual development, which he labeled Oral, Anal, Phallic, Latency, and Genital.
• In Freud's view, each stage focused on sexual activity and the pleasure received from a particular area of the body.
• In the oral phase, children are focused on the pleasures that they receive from sucking and biting with their mouth.
• In the Anal phase, this focus shifts to the anus as they begin toilet training and attempt to control their bowels.
• In the Phallic stage, the focus moves to genital stimulation and the sexual identification that comes with having or not having a penis.
• Another part of Freud's theory focused on identifying the parts of consciousness.
• Freud thought that all babies are initially dominated by unconscious, instinctual and selfish urges for immediate gratification which he labeled the Id.
• As babies attempt and fail to get all their whims met, they develop a more realistic appreciation of what is realistic and possible, which Freud called the "Ego".
• Over time, babies also learn about and come to internalize and represent their parents' values and rules, which he called the "Super-Ego."
• The Super-Ego is the basis for the the child's conscience that struggles with the concepts of right and wrong and works with the Ego to control the immediate gratification urges of the Id.
• By today's rigorous scientific standards, Freud's psychosexual theory is not considered to be very accurate, but it is still important and influential today because it was the first stage development theory that gained real attention, and many other theorists used it as a starting place.

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• Erik Erikson (1902-1994) used Freud's work as a starting place to develop a theory about human stage development from birth to death.
• Erikson focused on how peoples\' sense of identity develops; how people develop or fail to develop abilities and beliefs about themselves which allow them to become productive, satisfied members of society.
• Because Erikson's theory combines how people develop beliefs psychologically and mentally with how they learn to exist within a larger community of people, it's called a 'psychosocial' theory.
• Erikson's stages are, in chronological order in which they unfold: trust versus mistrust; autonomy versus shame and doubt; initiative versus guilt; industry versus inferiority; identity versus identity confusion; intimacy versus isolation; generativity versus stagnation; and integrity versus despair.
• Each stage is associated with a time of life and a general age span.
• For each stage, Erikson's theory explains what types of stimulation children need to master that stage and become productive and well-adjusted members of society and explains the types of problems and developmental delays that can result when this stimulation does not occur.

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• Lawrence Kohlberg (1927-1987) described three stages of moral development which described the process through which people learn to discriminate right from wrong and to develop increasingly sophisticated appreciations of morality.
• Kohlberg believed that his stages were cumulative and that each built off understanding and abilities gained in prior stages.
• According to Kohlberg, moral development is a lifelong task, and many people fail to develop the more advanced stages of moral understanding.
• Kohlberg's first 'preconventional' level describes children whose understanding of morality is essentially only driven by consequences.
• Second stage 'conventional' morality describes people who act in moral ways because they believe that following the rules is the best way to promote good personal relationships and a healthy community.
• The final 'postconventional' level describes people who instead of just following rules without questioning them, determine what is moral based on a set of values or beliefs they think are right all the time.

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• Swiss psychologist Jean Piaget (1896-1990), created a cognitive-developmental stage theory that described how children's ways of thinking developed as they interacted with the world around them.
• Piaget's theory has four stages: sensorimotor, preoperational, concrete operational, and formal operational.
• During the sensorimotor stage, which often lasts from birth to age two, children are just beginning to learn how to learn. The major tasks occurring during this period involve children figuring out how to make use of their bodies, which they do by experiencing everything with their five senses.
• During the preoperational stage, which often lasts from ages two though seven, children start to use mental symbols to understand and to interact with the world, and they begin to learn language and to engage in pretend play.
• In the concrete operational stage that follows, lasting from ages seven through eleven, children gain the ability to think logically to solve problems and to organize information they learn.
• During the formal operational stage, which often lasts from age eleven on, adolescents learn how to think more abstractly to solve problems and to think symbolically (for example, about things that aren't really there concretely in front of them).

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• Urie Bronfenbrenner (1917-2005) developed the ecological systems theory to explain how everything in a child and the child's environment affects how a child grows and develops.
• He labeled different aspects or levels of the environment that influence children's development, including the microsystem, the mesosystem, the exosystem, and the macrosystem.
• The microsystem is the small, immediate environment the child lives in and includes any immediate relationships or organizations they interacts with, such as their immediate family or caregivers and their school or daycare.
• The mesosystem describes how the different parts of a child's microsystem work together for the sake of the child.
• The exosystem level includes the other people and places that the child herself may not interact with often herself but that still have a large effect on her, such as parents' workplaces, extended family members, the neighborhood, etc.
• The macrosystem is the largest and most remote set of people and things to a child but which still has a great influence over the child, such as the relative freedoms permitted by the national government, cultural values, the economy, wars, etc.

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• Physical development occurs in several important ways, including children growing in size and weight, but also becoming better able to move themselves around and to manipulate objects, and having senses that become more refined over time.
• Babies can feel and respond to pain and touch from birth, and this is an important first connection between infants and caregivers.
• Babies can hear at birth, and doctors can test infants for hearing problems right after birth. As infants grow, their mental ability to process and use information they hear improves.
• Unlike their abilities to smell or hear, babies are not able to see as well as adults do. However by age 2-3 months they have the ability to see a full range of colors and can focus on objects just like adults.
• Infants need to learn how to move and to use their bodies to perform various tasks, a process better known as motor development.
• One way babies learn to use their bodies is by learning to achieve large physical tasks, or gross motor skills, such as crawling and walking.
• Fine motor skills develop alongside gross motor skills. Beyond just learning how to use and manipulate their bodies in large movements, babies are learning how to use their hands and how to coordinate smaller movements with their senses, such as sight.
• Babies grow at an amazing rate in the first months and years of life as they rapidly reproduce cells and grow in length and weight.
• In the first 2 years, babies grow to almost half their adult height and can quadruple their birth weight, and their bodily proportions also change.

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• Babies are not only growing physically during the first 2 years of life, but also cognitively (mentally).
• Every day while they interact with and learn about their environment they are creating new connections and pathways between nerve cells both within their brains, and between their brains and bodies.
• A major development during this period (usually around 8-12 months) is that of object permanence, the understanding that something still exists even if it can't be seen.
• As infants' brains continue to develop, infants also develop the ability to communicate; to comprehend and produce spoken language.
• Babies learn language by taking in information through their senses of hearing and sight as they learn to process the meanings behind those sights and sounds.
• Babies' and young children's language development is strongly influenced by the language they hear spoken around them and to them.
• Research has shown that young children are better able to learn multiple languages or languages other than their family's primary language because their growing brains enable them to learn a wide variety of meanings, words, and language structures.

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• Babies can feel interest, distress, disgust, and happiness from birth, and can communicate these through facial expressions and body posture.
• Infants begin showing a spontaneous "social smile" around age 2 to 3 months, and begin to laugh spontaneously around age 4 months.
• Between ages 2 and 6 months, infants express other feelings such as anger, sadness, surprise, and fear.
• Between ages 5 and 6 months, babies begin to exhibit stranger anxiety where they do not like it when other people hold or play with them, and will show this discomfort visibly.
• Around age 12 months, babies become aware of not only other peoples' expressions but also their actual emotional states, especially distress.
• Between the ages of 13 and 18 months, separation anxiety may subside as object permanence develops, and they understand their caretaker isn't gone even when they can't see them.
• By age 2, toddlers can show a wide range of emotions and are becoming better at regulating and coping with their emotions.
• Another important aspect of emotional development, temperament, has to do with babies' general emotional and social state.
• Temperament refers to babies' innate personality; the general pattern of how babies will react to and interact with their environment which is present from birth.
• Closely related to infants' emotional development is their social development; it's through relationships with caregivers and other people that children learn how to apply and use their emotions, expressions, and emotional understanding.

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• While many people believe that sexual development does not become an important issue until puberty and adolescence, children actually begin showing sexual behavior and interest in their sexual functioning from infancy.
• Babies are continually exploring their own bodies in order to learn about them.
• They want to understand what they look like and how parts work and this will include investigating their genitals or walking around naked.
• Because such behavior is a normal and natural development of their sexual, gender, and personal identity, caregivers should avoid chastising young children or labeling these kinds of exploratory actions as "bad" or "dirty."
• Instead, caregivers should set and enforce proper limits on such behavior, allowing toddlers and young children to explore themselves at home in private and discouraging them from doing these behaviors in public.
• Distracting children, and guiding them towards more socially appropriate behavior are good ways to get children to refocus without shaming them in the process.

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• Coming home from the hospital for the first time with a tiny person who depends entirely on you for all his needs can be a daunting prospect and it's normal to feel a mixture of excitement, joy, and love along with some anxiety, fear, and a little trepidation.
• It's important to support the baby\'s head and neck in order to stabilize the entire body, and holding infants securely also communicates unconditional love that helps to form the parent-child bond.
• Parents and caregivers should facilitate movement and growth by giving babies safe environments to play and to explore on their own.
• Infants need food and water to survive, to grow, and to thrive.
• Babies take in nutrients and fluids, and their bodies break them down, keep what they need, and get rid of the waste products through urination and fecal elimination. Preparation is the key to smooth diaper changes for everyone involved.
• Caregivers can help their baby learn how to sleep in more adult-like patterns and how to soothe themselves to sleep. While some babies easily adapt to more mature sleep cycles, other babies may take much more effort and patience to do so.
• Babies need to be bathed regularly and there are different ways to wash babies, according to their age, motor abilities, and preferences.
• Babies cry because they're hungry, tired, sick, hot, cold, in pain, bored, over stimulated, want affection, or are uncomfortable in some way and parents can often learn to differentiate their baby's cries.
• At a normal well-baby visit, parents should expect doctors to measure and weigh the baby and to discuss the baby's feeding and elimination, sleep habits, growth, development, and general well-being.
• Another important factor in maintaining infant health is building up their immune system, or their ability to fight off serious infections, through immunizations.
• Common baby medical concerns include teething, colic, coughs and colds, fever, and diarrhea and vomiting. 
• Babies need to be loved and nurtured from birth to create a trusting bond between them and the adults who care for them, and to help create trust and interest in the world at large, which enables them to grow and to learn.
• Another way to help babies begin to learn social skills, stay safe, and begin to learn values and morals is to provide appropriate discipline from birth.
• Caregivers need to provide their babies with a safe environment in which to live and to grow.

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• Caregivers can help babies to safely explore their world by attending to and fixing aspects of babies' environments that may be dangerous for them.
• Caregivers need to baby-proof not only a baby's primary home, but also the car that the baby will be transported in, and the community of other homes and environments that the baby may visit and explore.
• Caregivers can ensure a good night's sleep for their babies and themselves by following these tips to create a safe sleeping space for infants and toddlers.
• Caregivers can follow some simple guidelines to keep diaper changing safe.
• With a few precautionary measures, the family kitchen can be the center of a rich and busy family life.
• The bathroom can become a safe and pleasant place for bath time and other baby fun times if important precautions are observed.
• There are several things that caregivers can do to reduce the possibility that their children will be harmed in a fire-related situation.
• If a family is looking to bring a pet into the home (and no pet is presently in the home), they should consider waiting until their child is at least five years old.
• Concerned parents can also think about ways to make car outings occur as safely as possible.
• Backyard play areas and other segments of the home property need to be monitored and outfitted for safety.
• A solid emergency plan should be developed for handling worst-case scenarios, should they ever come to pass.

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• It is important to think about infant stimulation or enrichment (activities that arouse or stimulate your baby's sense of sight, sound, touch, taste, and smell).
• This stimulation can help foster physical, social, emotional, brain, and nervous system development.
• You don't have to worry excessively about making sure your baby masters a rigid set of exercises or activities in the first months of life, but by being aware of the different areas of child development, you can help enrich your child's experiences and growth.
• The foremost way you provide encouragement to children is through showing them love and nurturing.
• Another way you can show your baby love and affection is through providing them with toys, songs and games as learning tools.
• From birth, you can help your baby to develop physically by giving him or her activities that help build upper body and neck strength.
• To help very young infants develop language and other cognitive skills, you can talk to your baby.
• Between ages six to twelve months, you can continue to encourage physical growth and motor skill development through interactive games and activities.
• For more social and emotional development, you can play light chasing and surprising games by crawling around the living room or other space.
• Another way to help build sociability is to expose babies to new social situations.
• By twelve months, toddlers are generally beginning to master walking on their own and caregivers can begin to build on that skill.
• By 18-24 months, children often enjoy simple pretend play.

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• During this period, children's bodies change proportions and they start to look more like adults than babies.
• On average, young children can expect to grow 2 to 3 inches in height per year.
• Teaching children about healthy lifestyles and promoting a positive body image is vitally important at this age.
• Between ages 2 and 3 years, young children stop "toddling," or using the awkward, wide-legged robot-like stance that is the hallmark of new walkers.
• Children who are 3 to 4 years old can climb up stairs using a method of bringing both feet together on each step before proceeding to the next step, and by ages 4 to 5, children can go up and down the stairs alone in the adult fashion (i.e., taking one step at a time).
• During ages 5 to 6, young children continue to refine earlier skills. They're running even faster and can start to ride bicycles with training wheels for added stability.
• By ages 2 to 3 years, children can create things with their hands, such as build towers out of blocks, mold clay into rough shapes, and scribble with a crayon or pen.
• Around ages 3 to 4 years, children start to manipulate clothing fasteners, like zippers and snaps, and continue to gain independence in dressing and undressing themselves.
• 3 to 4 year-olds continue to refine their eating skills and can use utensils like forks and spoons.
• 5-7 year-olds begin to show the skills necessary for starting or succeeding in school, such as printing letters and numbers and creating shapes such as triangles.
• During early childhood, children learn another self-care skill that gives them more independence than any other skill they will learn during this phase of life - toilet training.
• Most often, the best way to tell that a young child is ready to start toilet training is to watch for signs of readiness.
• Just because children are physically ready to toilet train does not mean that they are mentally or emotionally ready to do so. Successful toilet training depends on having all three factors (physical, cognitive and emotional readiness) in place.

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• Between the ages of 2 and 4, children can create mental images of objects and store them in their minds for later use. For example, children can talk about people who are traveling, or who live somewhere else, like Grandma in Florida.
• Children in this stage of development learn by asking questions such as, "Why?" and "How come?"
• Children now understand that something can be both an object itself as well as a symbol for something else. For example, a stuffed toy dog is a fun, furry toy as well as a representation of living and toy dogs in general.
• By ages 2 to 5 years, most children have developed the skills to focus attention for extended periods, recognize previously encountered information, recall old information, and reconstruct it in the present.
• Between the ages of 5 and 7, children learn how to focus and use their cognitive abilities for specific purposes. For example, children can learn to pay attention to and memorize lists of words or facts.
• Between ages 2 and 5 years, young children realize that they use their brains to think and by ages 5 to 7 years, children realize they can actively control their brains, and influence their ability to process and to accomplish mental tasks.
• Young children experience a language explosion between the ages of 3 and 6. At age 3, their spoken vocabularies consist of roughly 900 words. By age 6, spoken vocabularies expand dramatically to anywhere between 8,000 and 14,000 words.
• As children move beyond using two word sentences, they start to learn and understand grammar rules.
• Children become increasingly skilled at remembering and practicing the language modeled around them, as well as modifying word use based on other people's reactions.
• By ages 5 to 7, young children can also understand and learn to use a word by being told its definition (rather than experiencing that word directly).
• In addition, children start to understand that words often have multiple meanings, opening up a whole new realm of humor and jokes that they will find amazingly funny.

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• As children's abstract thinking and language skills increase, they become better able to label and discuss their emotions with others.
• Language can also allow children to better regulate their feelings, self-soothe in response to negative feelings, and exert some control over emotion-provoking situations.
• During early childhood, children typically start to develop self-conscious emotions as they start evaluating themselves, instead of purely reacting to caregivers' or other adults' evaluations.
• Children in the early childhood stage become skilled at modifying and expressing their emotions to fit different social situations.
• Children in this stage also learn Reflective Empathy, which is the ability to take another person's perspective in order to understand what they're feeling.
• Learning in early childhood how to appropriately express and deal with anger, aggression, and fear is a valuable life and social skill.
• Aggression can also be problematic for some children during the early preschool years, peaking around age 4.
• Because children at this age often have very active imaginations and are still learning the difference between reality and make-believe, they are very susceptible to strong fears.
• During early childhood, children start to develop a "self-concept," the attributes, abilities, attitudes and values that they believe define them.
• As young children leave toddlerhood behind, they also begin to mature in their ability to interact with others socially.
• The most important factor for young children is not the structure of the family itself, but the presence of caregivers who are dedicated to caring for their physical, cognitive, emotional, and social needs by providing a loving and nurturing home.

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• Morality is our ability to learn the difference between right or wrong and understand how to make the right choices.
• Between the ages of 2 and 5, many children start to show morally-based behaviors and beliefs.
• Children between the ages 5 and 6 typically think in terms of distributive justice, or the idea that material goods or "stuff" should be fairly shared.
• During early childhood, children also grow in their ability to tell the difference between moral rules, social norms, and personal choices.
• By around age 5, children see that moral rules are intended to prevent "really wrong" behavior that could potentially hurt or take away from others.
• By ages 6 and 7, the ability to differentiate between moral rules, social norms, and personal choices matures, and children can take more circumstances and possibilities into account when thinking about the ramifications of different behavior.
• Parenting practices and daily discipline have a huge effect on a child's developing sense of morality.
• Children who receive fair consequences every time they break a rule will learn to connect their choices with consequences.

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• Young children can tell the difference between boys and girls, and will label people accordingly. However, these very young children still believe that gender can change and is not permanent.
• Children of this age also have trouble understanding that males and females have different body shapes, but also share characteristics.
• By the early school years (ages 6 to 7), most children understand gender consistency, the idea that they are one gender and will remain that gender for life. However, a small number of young children struggle with their gender identity, and continue to struggle with their true identity through adulthood.
• By age 5, children tend to play with "gender-specific" toys and around this age, children become aware of stereotypical gender-related activities and behaviors.
• Gender-based beliefs, attitudes and behaviors come from a combination of biological/ internal reasons and external/environmental reasons.
• Multiple environmental factors, such as a child's family, teachers, peers, and the media, also influence gender-based beliefs, attitudes and behaviors.
• Beyond just exploring their gender and what it means to be a boy or a girl, young children also begin exploring their sexuality.
• Young children often ask lots of questions about their bodies. Many questions focus on reproductive and elimination organs, as well as how babies are made.
• Children of this age are also interested in examining their own genitals and may also become interested in their caregivers' bathroom and bedroom behavior.
• Generally speaking, it's best if caregivers can avoid reacting in a highly emotional manner, so that children can learn that sexuality is normal behavior rather than something that's "dirty" or shameful.

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• Children need a balanced and healthy diet to fuel the amazing rate of growth and development that occurs during early childhood.
• Parents should also monitor how much their children eat, and watch portion sizes.
• Children also need adequate amounts of sleep in order to allow their bodies time to recharge for each new day.
• Mastery of toilet functions is an essential milestone in child development. It is impossible to become an independently-functioning adult without mastering this skill set.
• Children's personal hygiene needs change dramatically during this early childhood stage, from something caregivers do for their children to something children learn to do for themselves.
• Young children also need plenty of emotional and cognitive support, love, and nurturing. Adult caregivers should make it a point to express love and affection for their children every day.
• One of the most lasting ways caregivers can impact their children's overall success and joy is by instilling in them a love and passion for reading.
• It's important for young children to have routine well-child check-ups and scheduled immunizations.
• Children, just like adolescents and adults, can have disorders that affect their thoughts, behaviors, and feelings. Common childhood mental illnesses and developmental disorders include Depression, Bipolar Disorder and Anxiety Disorders, Autism and similar Pervasive Developmental Disorders, Attention Deficit and Hyperactivity Disorder, Learning Disabilities, Adjustment Disorders, Oppositional Defiant Disorder, and Conduct Disorder.
• Even though preschool children are now older, more physically capable, and more mentally mature than infants, they still need quite a bit of safety precautions taken by caregivers.
• Many children get a new sibling during their preschool years, either through birth or adoption. The addition of a new sibling can be a huge transition for young children to go through, as they must start to share attention, affection, and space with another young person for the first time.
• Many families will use some form of routine daycare while parents fulfill other work and personal needs outside the home.
• At some point during these early childhood years, most young children (in the United States, at least) will transition into their academic career starting with preschool, or kindergarten.

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• No matter how much parents beg, plead, bribe, or scold, kids will not use the potty in lieu of their diaper until they are ready and willing.
• Potty training has to be a team effort between children and parents, and not a unilateral decision on the part of the parents, or it will tend to fail.
• Toilet training requires maturity across many developmental (physical, cognitive, and emotional) realms.
• Each child is unique and will become ready to start the toilet training process at his or her own "right" moment. On average, most children in the United States start toilet training between 18 and 32 months old.
• While it's extremely important for young children to be ready cognitively, emotionally and physically prior to their potty training, it's also important for parents to be ready to undertake this large step.
• There are various ways parents can work with children who are not yet ready so as to provide them with a solid foundation for future toilet training.
• Preparation of the actual toilet training space will make the training process go much more smoothly when it becomes time to begin actual toilet training.
• Many parents choose to invest in disposable training pants or underwear that absorbs waste like a diaper, but which are put on and taken off much like "big kid" underwear.
• Parents also need to pay attention to their children's reactions throughout the toilet training process.
• Teaching little boys to use the toilet comes with an extra layer of complication.
• Rather than forcing children to use the toilet, parents should offer children plenty of reinforcements (i.e., rewards) so as to encourage their toilet use whether that use results in actual elimination or not.
• Even when young children totally master toileting within their own homes, it can remain challenging for them to maintain their progress in different environments.
• Another challenge to consistent potty training is constipation, or a reluctance to have a bowel movement.
• Some children will be afraid of the toilet itself (afraid of the toilet's size and shape and the rushing noise that occurs when it flushes), and the possibility that they might get flushed away themselves.
• Successfully managing nighttime urination is the hardest task for young children to master, and as such, this step may take them the longest amount of time to achieve. Bedwetting is common challenge for families with preschool-aged children.

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• A crucial part of the parent's task is to teach children how to take care of their own needs and how to develop judgment skills so they can make good choices as they move toward adulthood. Parents teach these important skills by providing discipline.
• Often, parents use the words, "discipline" and "punishment" interchangeably. Some people don't think there's a difference. However, these words do not really have the same meaning.
• In order for children to learn how to make successful decisions on their own, they must be granted both the proper amount of freedom and the proper amount of limitation.
• Parents need to help children to understand appropriate family rules and what is expected of them and to encourage children's positive behavior and conformity with the rules.
• Another way to create harmony and obedience in children is by using the "choice" technique. In this technique, parents present children with a limited number of choices from which they must choose.
• Communication is the key form of discipline to administer when particular forms of misbehavior are new, or when rules have been newly set and are not yet well understood.
• Creating fair, age-appropriate consequences that actually teach a lesson rather than just causing discomfort can take some creativity and thought.
• Parents should come up with consequences in advance of misbehavior whenever possible. Parents who try to come up with consequences in the heat of the moment often end up blurting out unworkable, unreasonable or unenforceable consequences with limited deterrent effect.
• Parents can combine discipline techniques in order to better teach their children how to behave appropriately. A particularly good combination of discipline techniques occurs when the choice technique is combined with the process of setting consequences on children's behavior.
• Another discipline technique that can be effective with young children and that can help preserve parents' sanity is the time-out.
• Spanking and similar corporal punishments are often effective in the short-term. However, spanking tends to lose its effectiveness as time goes by and children become more experienced and the child can engage in other unwanted behaviors, such as lying or sneaking around, in order to avoid the punishment.
• It's important that all primary caregivers get together at some point to share with one another their attitudes and beliefs about parenting and discipline.
• The best way for parents and caregivers to discourage lying is to firmly, calmly, and patiently talk to their preschoolers about it.
• Parents can also develop a relationship with their children in which open honest communication flourishes.

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• Nurturing is vital to children's development, a secret ingredient that enables children to grow physically, mentally, socially, emotionally, culturally, and spiritually.
• Creating nurturing spaces includes not only the physical area and objects for playing and learning, but also encompasses the time, attitude, and energy necessary for creating nurturing child-parent interactions.
• Parents can help encourage children's physical growth and development by promoting activities that require children to display increasing levels of physical strength and skill.
• When parents nurture young children's fine motor skills, they are encouraging activities that develop hand-eye coordination and other smaller hand skills such as drawing, cutting, and crafting.
• Parents can encourage activities that enhance young children's mental development.
• Early childhood years are a perfect time for adults to nurture children's musical and creative interests.
• Homework offers parents a wonderful opportunity to spend time nurturing their children, encourage their love of learning, and reinforce concepts that children are learning in the classroom.
• Activities designed to foster children's social development requires their involvement with other people, both children and adults. Parents can help encourage socialization by planning opportunities for children to interact with their peers.
• Parents encourage children's emotional development by expressing their unconditional love and affection, by helping children to feel special and valued, and by helping them learn to understand their emotions and feelings.
• Children are more likely to become adults who identify with their cultural and spiritual heritage if they grow up feeling included in cultural and spiritual communities.
• Venturing out of the home into the surrounding community on "field trips" can also provide wonderful learning opportunities for young children.

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• Children require a balanced and healthy diet in order to fuel the amazing physical growth and bodily change occurring during Middle Childhood.
• The trick for parents at this stage is to manage to foster children's independent healthy eating choices without over-stepping and over-controlling children's food selections, possibly setting the stage for children's later unhealthy relationship with food.
• Parents should provide children with a menu that includes foods from all of the basic food groups, offering mostly nutrient-dense foods and minimizing "junk foods" that are low in nutrient value and high in sugar, fat, and salt.
• Children need to learn how to make healthy food selections and to control how much they eat when parents are not present to do these things for them.
• Children should be included in family grocery shopping and cooking chores so as to teach them by example how to read food nutrition labels, how to measure portions, how to follow recipes and how to prepare foods using healthier cooking methods, including grilling, steaming and baking.
• On average, 8-year-olds require between 1400 and 1600 calories every day. Between the ages of 9 and 12, girls need approximately 1600 to 2000 calories each day. In contrast, boys between the ages of 9 and 12 need approximately 1800-2200 calories per day.
• Children over the age of two should be eating whole grains, fruits, vegetables, lean protein, calcium-rich dairy products, and some oils every day.
• Children also need to drink plenty of water each day. Approximately 64 ounces are required each day in order to keep their bodies well hydrated.
• Beyond just providing the fuel and nutrients for growing up healthy, eating can also be an activity that promotes social development and family bonding.

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• Well rested children are better able to focus attention and learn during classes or extracurricular activities.
• They are also more likely to be in a better mood than are poorly rested peers, and more likely to follow rules at home and school.
• In general, children in middle childhood require about 9 to 10 hours of sleep each night.
• A well-planned bedtime routine, enforced by parents and through repetition, enables school-aged kids time to prepare themselves mentally and physically for sleep.
• The goal of the bedtime routine is to gradually transition children from activities to sleep.
• Night-time routines are still a perfect opportunity for parents and children to spend one-on-one or whole-family "quality time" with one another.
• Some children will still have problems falling asleep, or staying asleep throughout the night, and several different strategies can be used to address children's insomnia.

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• "Personal hygiene" refers to people's personal health-promoting habits, such as hand washing, tooth brushing, and covering one's nose when sneezing.
• Parents should be teaching children to brush their teeth at least twice a day and to floss between their teeth at least once a day.
• After dental hygiene, thorough and careful hand-washing is perhaps the second most important personal hygiene habits children need to practice in middle childhood.
• Children should be educated about the nature of germs, including bacteria and viruses that cause illness, and how these invisible but very real germs can contagiously spread through the air when people cough or sneeze.
• Children should be encouraged to bath themselves regularly so as to remove dirt, oils, sweat and the like from their hair and bodies.
• Hair care is another important aspect of keeping one's self clean and healthy-looking.
• Parents should model and teach young children to change their clothes every day, especially making sure to change their socks and underwear which may accumulate odor more than outer clothing.
• As children near puberty, they may also need to start using a daily underarm deodorant or antiperspirant to prevent body odor from becoming a problem during the day.
• As children enter puberty, they may begin to develop acne, otherwise known as pimples or zits.
• Girls entering puberty need to learn how to care for feminine hygiene needs, including proper and safe methods for using and disposing of tampons and sanitary pads.
• Parents should take care to balance children's expressed desire for particular high status clothing items against family resources.
• Allowing children to have a say, if not the deciding vote, in determining their individual hairstyles is important.

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• The USDA recommends that children get in at least 60 minutes of physical activity most days (every day if possible).
• Routine health care appointments should be a regular fixture in children's lives during middle childhood.
• Parents should make every effort to take their children to the dentist twice a year (or as recommended by the family's dentist).
• Children should have their vision and hearing checked regularly so as to identify and address as quickly as possible any vision or hearing problems.
• Sun safety is today recognized as a vital part of preventative healthcare - for young children and for adults alike.
• Even if parents follow all preventative health care recommendations perfectly, there will still be occasions when children will get sick.
• Common childhood medical conditions include:
• Colds, Sore Throats and Ear Infections
• Stomachaches, Diarrhea and Vomiting
• Fever
• Bug Bites
• Poison Ivy and Oak, Eczema and Pink Eye
• Childhood Diabetes
• Obesity and Malnutrition
• Headaches and Migraines
• Allergies
• Asthma
• Vision Problems

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• Even though children are now past the age and size where they require a car seat or booster seat, they still need to ride in the back seat of the car until they are at least 12 years old.
• Prescription medications and household cleaners offer another example of a common danger school-aged children need to be protected from.
• Middle-childhood aged children continue to benefit from regular reminders regarding traffic and road safety, particularly when they may be walking or biking about unsupervised.
• Parents should instruct and remind children to never follow or go someplace with a stranger, even when that stranger claims to know or be acting on instructions from known caregivers.
• The American Academy of Pediatrics recommends that children should not be left home alone before the age of 12. Parents need to communicate, and children need to show that they understand, any house rules for how they should act when home alone.
• When using bikes or scooters, children should wear helmets and appropriate elbow and knee pads in order to protect them from falls or other impacts which could damage their bones, joints or brains.
• Constant, vigilant adult supervision of children while they are swimming near a pool is essential.
• Parents need to consider children's safety when purchasing a new pet or maintaining a veteran pet. When selecting pets for homes with school-aged children, dogs and cats seem to be the best pets as playmates and pals.
• One final area of home safety that needs to be considered by parents of (American) school-aged children is the appropriate storage and use of guns.

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• A variety of factors should be considered when selecting a school including the school's mission and philosophy of teaching, student-teacher ratio, academic expectations, the culture and diversity of the students and staff, average student performance on external rating criteria (such as standardized test scores) and the safety of the school environment are all important considerations.
• No matter which school is selected, parents need to make sure to complete all of the required steps necessary to successfully enroll their children.
• Once children are enrolled in a school, it is important that parents do what they can to form a close working relationship with the teachers, administrators and other staff associated with that school and generally to become involved in their children's school life as much as possible.
• It's important then that parents pay attention to children's homework assignments, prompting children to complete them and, as much as possible, providing children with the resources they need to successfully complete the work.
• From time to time, more often for some children than for others, children may be disciplined at school. To gain the most objective understanding of what has occurred, parents will need to listen to both the school's version of events and the child's as well and try to put together from these multiple sources what actually happened.
• Parents should also develop a plan for how they will handle school closings (scheduled and unscheduled), and days when children are too sick to attend school.

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• Calm, direct, and honest communication remains the basic foundation for positive discipline and guidance of children in middle childhood.
• Parents can use the communication technique known as reflection to guide children's conversations about their friendships, pointing out for inspection the positive aspects of healthy friendships and the negative aspects that accompany unhealthy or hurtful friendships.
• As school-aged children spend more time with friends and classmates away from the direct supervision of adults, they start needing to choose how they will behave (as opposed to simply complying with how caregivers want them to behave).
• Though teaching children to think critically for themselves is the ultimate goal, many children will not be in a position to make the right decisions on their own at first, and thus it is practical to also offer children clearly verbalized expectations for how they need to behave and a description of the consequences that will occur if they make wrong choices.
• Time outs continue to be a powerful and effective means of motivating children's compliance through about age 11 or 12.
• Because grounding involves a prolonged isolation, it should be used very sparingly, and then only in sensible proportion to the magnitude of misbehavior.
• Giving children age-appropriate chores is an important way to increase their self-esteem, pride, responsibility, and independence.
• Parents can help children to become more sophisticated and thoughtful about money by introducing them to important money-related concepts such as the importance of saving or banking money, distinguishing between needs and wants, learning budgeting skills, and learning to pay bills responsibly.
• School-aged children also need and benefit from loving nurturance expressed by parents and caregivers.
• Middle-childhood aged children need to have some area within their homes that is their own private space and which they can expect to control.

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• For the first time, children in middle-childhood have to cope with some or all of the following experiences that leave them feeling vulnerable and force them to understand that they are not entirely in control of their lives when it counts the most.
• In an important sense, these difficult experiences assist children with their maturation process.
• It is through the experience of successfully coping with such challenging crises that children learn about themselves, gain coping experience, and revise their self-esteem and self-efficacy expectations.
• However, children do need the love and support of their parents and caregivers as they struggle with these life crises in order to understand how to cope and to come to terms with the meaning of these events.
• These issues may include:
  • the realization that childhood fantasies aren't "real", such as Santa Claus, the Easter Bunny and the Tooth Fairy
  • the death of a beloved pet or family member
  • parents' divorce and remarriage
  • romantic feelings and "crushes" for peers which may be unrequited
  • questions about sex
  • moving, separation from friends, difficulties making new friends
  • sibling rivalry
  • bullying
  • prejudice
  • encounters with cigarettes, alcohol, and other drugs
  • other peer pressure situations, such as fitting in

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• During middle childhood, children's bones broaden and lengthen dramatically and in general, they will grow an average of 2-3 inches taller each year throughout this period.
• Both boys and girls are building muscle and on average, they will gain 6-7 pounds a year, each year during middle childhood.
• It's extremely important for kids of this age to continue (or to start) to lead a healthy lifestyle, including eating nutritious meals as well as getting plenty of exercise and adequate sleep every day.
• During middle childhood, children continue to build on and improve gross motor skills.
• Children in middle childhood also continue to hone their fine motor skills which can be distinguish from gross motor skills in that they require hand-eye coordination.
• Specifically, middle-childhood-aged children show dramatic improvements with regard to their printed handwriting and ability to write in cursive letters (e.g., "script" forms of handwriting).
• Children's easy use of communications tools such as cell phones and computers, which becomes possible as they master increasingly complex fine motor skills, exposes them to a world much larger and more complicated than they can possibly imagine.

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• The mental (cognitive) changes children undergo during the middle childhood era are often more pronounced and noticeable than their physical changes.
• Children's ability to consciously, thoughtfully and pro-actively choose to pursue goals (instead of simply reacting to the environment) appears during this developmental period.
• Children's thinking style gradually becomes more logical, organized, and flexible as well.
• Children in middle childhood master hierarchical classification, which is the ability to simultaneously sort things into general and more specific groups, using different types of comparisons.
• Children become able to discriminate objects that are nearby and far away based on their apparent size.
• Children become more efficient at processing "inputs," their attention span lengthens in duration and their ability to focus and concentrate their attention becomes more pronounced and reliable.
• Children's memory capacity and the ability to use their memory also increases and improves during middle childhood.
• A more visible expression of children's cognitive development during middle childhood can be found in their ability to use and appreciate increasingly sophisticated forms of language.
• In most American public schools today, IQ tests (in conjunction with achievement tests) are primarily used to determine whether a particular child needs supplemental educational programming or services above and beyond a traditional classroom.

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• During middle childhood, children make great strides in terms of their ability to recognize emotions in themselves and others, control their own emotions, and communicate about emotions, both expressively and with language.
• As children practice interpreting people's complex emotional displays, their perspective taking abilities and their empathy skills increase.
• During middle childhood, children's personal identity develops so as to become more complex, multi-faceted and abstract in nature.
• Children's overall self-esteem may fluctuate or decrease as they start the process of social comparison with their peers.
• It's especially important that parents, teachers and other concerned adults in children's lives look out for any challenges or problems that may negatively impact the development of their overall self-image and self-esteem and do what they can to help address those problems early on so that they do not contribute to children's more permanently low self-esteem.
• During middle childhood, peer friendships take on a more prominent role than ever before.
• Children become better at reading and responding to other kids' emotions, and understanding other kids' intentions and needs; why they behave in specific ways at specific times.
• Though children's peer relationships mature and become increasingly prominent during middle childhood, children's connection to their parents and core family continues to be of tremendous importance for their well-being and functioning.
• Children's increased interest and investment in relationships with peers and adults in middle childhood makes them sensitive to the self-conscious emotions of pride, guilt and shame.

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• As children develop the ability to put themselves into someone else's shoes, their appreciation of morality becomes more self-directed and less black and white and absolute in nature.
• Starting at about age 10 or 11 and continuing through adolescence, children will have generally begun to view moral rules as socially-agreed upon guidelines designed to benefit the group.
• Children realize that making choices about following the rules should be based on something more than fear of negative personal consequences or desire for individual gain.
• Older children start to make moral decisions based more on how they would like others to treat them if the tables were turned, than based on what they can gain for themselves.
• By middle childhood, most children are able to stop and to think about what is the right thing to do, and to consider the potential consequences and benefits of different behaviors before they act.
• Children learn in part by modeling the behavior and attitudes of other trusted adults and older peers with whom they interact.

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• Boys' and girls' gender identities seem to develop differently during middle childhood.
• Boys tend to use more masculine traits to describe themselves, to behave in more stereotypically masculine ways, and to cultivate (but not necessarily achieve) a more concentrated and pure masculine identity free of feminine attributes.
• In contrast, many girls at this age will tend to be more androgynous in their self-descriptions, endorsing and embracing both feminine and masculine traits and behaviors.
• Children's interests, preferences, behaviors and overall self-concept are strongly influenced by parental and authority figure teachings regarding sexual stereotypes occurring in or before the early portion of middle childhood.
• For most children, the early portion of middle childhood is a time of relative sexual dormancy and disinterest.
• Starting at about the middle of the middle childhood period or later, children will begin to explore girl/boy friendships with peaked, romantic interest, and some children will develop "crushes" on peers.
• At this age, children become interested in exploring how romantic relationships differ from friendship relationships.
• Parents of school-aged children need to be alert for signs their child is acting out sexually in ways that seems inappropriate or premature.
• Age-inappropriate sexual behaviors may indicate that participating children have been sexually abused, or exposed to a peer who has been sexually abused.

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• Adolescents experience a tremendous amount of physical growth and development that begins during the prior developmental stage called Puberty and continues during adolescence.
• Because the rate of physical development is so varied during adolescence, it often becomes a source of difficulty and discomfort for youth as some teens will develop more slowly than their peers.
• During adolescence, most growth in height generally occurs during one, single growth period, or "growth spurt."
• For girls, the most rapid growth generally occurs between the ages of 10 and 13 years, but for boys, it's between the ages of 12 and 15 years.
• While their bodies are changing and growing it's particularly important for teens and older adolescents to maintain a healthy lifestyle that includes a balanced, nutrient-rich diet, with plenty of exercise, and adequate, restful sleep.
• As adolescents continue to mature they become better able to move their bodies with greater skill and precision.
• Young teens develop both primary and secondary sexual characteristics that are brought about by hormonal changes. Primary sexual characteristics refer to the reproductive organs themselves; e.g., the ovaries and testes. Secondary sexual characteristics refer to other characteristic indicators of adult male and female bodies (e.g., body hair).
• Teen guys will notice their voices begin to deepen between ages 12 to 15 years as their vocal cords grow longer, and their larynxes, or voice boxes, grow larger.
• Most teens will notice that their perspiration becomes more odoriferous which can be quite unpleasant.
• Hormonal changes can also cause skin problems by increasing the production of skin oil (sebum) and creating a greasier look and feel to the skin.
• Most teens also struggle with acne blemishes at some point during their adolescent period.

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• In this stage, youth can now represent in their mind circumstances, or events that they have never seen, nor personally experienced.
• Youth can also now consider a problem, or situation, and can identify the many variables that may influence or affect the outcome. They can estimate the most likely outcome if one or more variables are changed or manipulated.
• Adolescents can determine whether a statement is logical based solely on the wording of the statement, rather than having to observe or re-create the actual scenario to determine if it is logical.
• By observing other people's behavior, expressions, comments, and appearance you can interpret this information and make reasonable guesses about what another person may be thinking, wanting, needing, or feeling.
• While the ability to use abstract thought and keen observational skills enables youth to become more attuned to others and more sensitive to people's needs, it can also lead to some new social and emotional difficulties when youth use their new cognitive abilities to compare themselves to others.
• Youth can now recall a large amount of detailed information such as lengthy, complicated, driving directions, and can remember and apply patterns or formulas such as when solving a complex calculus problem.
• Teens' vocabularies continue to grow as they develop an impressive working vocabulary of over 40,000 words. This includes the acquisition of words with more abstract meanings, which mirrors their new ability to think in more abstract ways.
• Adolescents' grammatical skills also improve to become more refined and sophisticated.

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• Adolescent emotional development is often characterized by rapidly fluctuating emotions.
• Social support enables youth to practice handling stressful and challenging circumstances while simultaneously knowing that if they should need help someone is nearby and willing to assist them.
• Emotional maturity is indicated by the ability to identify and express emotions appropriately, and the ability to demonstrate a variety of positive coping responses to stress.
• Self-esteem seems to be at an all-time low during early adolescence, but during middle to late adolescence, youths' self-esteem begins to improve because their increased maturity enables them to enjoy many new experiences.
• Self-esteem also begins to improve as youth begin to understand the difference between performance outcomes resulting from inherent, natural talent and ability; versus, performance outcomes resulting from hard work and perseverance.
• Youth will experiment with different social skills and social strategies and will also observe their peers, and adults they admire, to develop and improve their social skills.
• As youths' self-identities evolve, a value system emerges. A majority of youth will explore their value system, at least to some degree, and this exploration may range from a simple questioning of why things are the way they are, to experimentation with a different set of values and beliefs, to outright rejection of generally accepted values and beliefs.
• Sometimes experimentation goes a step further by testing the limits and boundaries set by their parents, teachers, and other authorities.

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• Adolescents will begin to form many different types of relationships, and many of their relationships will become more deeply involved and more emotionally intimate.
• Youth must also learn to balance multiple relationships that compete for their time, energy, and attention.
• During the adolescent years, teen peer groups become increasingly important as teens experience more closeness in these friendships and more gratifying relationships with their peers as a result.
• Because acceptance by a peer group becomes so important, teens may modify their speech, dress, behavior, choices, and activities in order to become more similar to their peers.
• By late adolescence peer groups may resemble a close-knit, second family and may provide youth with a large portion, if not most, of their emotional support.
• During early and middle adolescent years, there is usually more frequent conflict between teens and their parents as the youth are trying to assert their individuality and are exercising their independence. Typically youth will become closer to their parents again during late adolescence.
• Sibling relationships will also change during this time and the extent of these changes will depend upon the number of siblings in the family, whether the siblings are older or younger than the adolescent youth, and the number of years between siblings.
• Youth in early and middle adolescence will usually begin dating. By late adolescence, youth continue to explore dating and romantic relationships.
• Youth may become more involved with team sports, student organizations, and other activities that will put them into contact with even more adults outside their family.
• In middle adolescence, youth may begin either paid or volunteer employment and then must determine how to please their supervisors, how to negotiate with management about scheduling or pay, and how to successfully meet the requirements of the job.
• A socially mature adolescent will have learned to achieve balance and satisfaction in their relationships with others despite the increasing complexity of their social networks with family, friends, romantic partners, co-workers, teammates, coaches, teachers, classmates, etc.

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• During adolescence, a teen's understanding of morality expands and their behavior becomes more closely aligned with their values and beliefs.
• Teens must make moral judgments on a daily basis.
• Peer pressure can exert a powerful influence because friends play a more significant role in teens' lives.
• By late adolescence most teens are less rebellious as they have begun to establish their own identity, their own belief system, and their own place in the world.
• Youth begin to realize that when situations are handled in a manner that seems fair, reasonable, and/or beneficial to all parties, it becomes easier for people to accept and honor the decision.
• Teens generally begin to be able to imagine a problem from another person's perspective and try to place themselves in another person's "shoes," before making a moral decision.
• In later adolescence, people often begin to understand that governing bodies, such as the United States Congress or the school administration, are morally obligated to design and enforce rules and laws in a manner that balances individual freedom, with the needs of the larger group, in order to protect the safety and welfare of all.

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• As youth grow into adult bodies capable of sexual reproduction, their sexual interest is piqued just as they are becoming interested in forming adult-like, romantic relationships.
• During adolescence, youth must make many decisions about their sexuality, and will come to learn a great deal about themselves including an understanding of their own sexual identity and sexual orientation.
• Youth must form a gender identity; i.e., whether they consider themselves to be masculine, feminine, or both (transgendered).
• For transgendered people their biological sex does not predict a single, corresponding gender identity. Instead, their internal experience of themselves is that of the opposite gender, or of both genders.
• Throughout adolescence, most youth will question their sexual orientation in one way or another.
• The current working hypothesis of scientists and researchers is that people do not willfully "choose" their sexual orientation or their gender identity.
• Parents and other caregivers can assist youth to understand that sexual thoughts, sexual questions, and sexual desires are perfectly natural and normal at this age.
• There are several ways that parents can positively influence youths' sexual choices by: 1) applying appropriate discipline and proper guidance, 2) offering emotional support and understanding, and 3) providing objective and accurate sexual information.

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• Despite the abundant supply of food in the United States, most adolescents do not receive adequate nutrition at a time when their bodies' growth and development is accelerating.
• In general, adolescent diets include too much fat, sugar, caffeine, and sodium and not enough nutrient-dense foods such as fresh fruits and vegetables and calcium-rich foods such as dairy products.
• Sedentary 12-year-old males need about 1800 calories each day. This peaks at 2600 calories around age 19-20 years old and then decreases to 2400 calories a day from ages 21 through 24 years.
• Sedentary teen girls around the ages of 12-13 years need about 1600 calories per day, and their daily calorie requirement reaches the highest level around age 19 years at 2000 calories.
• Not only do adolescents need to eat the right amount of food, but they also need to eat foods which contain the right type of nutrients, and in the right proportions.
• There are four key methods parents can use to assist their youth to develop healthy eating habits: 1) provide nutritional information, 2) provide opportunities to practice making healthy choices,3) model healthy eating habits, and 4) ensure the availability of quick, convenient, nutrient-rich snacks.
• Nutritional problems can still arise or worsen during adolescence including problems of overeating and/or consistently making poor food choices, resulting in obesity; developing problems with unhealthy and extremely restrictive dieting without meeting the minimum nutritional requirements necessary for healthy growth and development; and Diabetes.

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• It is important for adolescents to develop habits that incorporate regular physical activity into their daily lives so that these habits are carried into adulthood.
• It can be difficult for youth to get sufficient exercise due to the increased popularity of sedentary entertainment (television, video games, etc.) and a decrease in physical education opportunities at school.
• Any physical activity that requires the body to move enables youth to reap the health benefits of exercise.
• Many youth enjoy playing organized, competitive sports such as basketball, cheerleading, baseball, gymnastics, football, golf, tennis, soccer, lacrosse, track and field, etc.
• Youth can also receive the benefits of exercise by participating in regular physical activity through informal and unstructured activities, such as gardening, shooting hoops in the driveway, dancing in their bedroom with their friends, riding bicycles around the neighborhood, skateboarding at the skate park, walking the dog after dinner, or hiking on a trail in the woods.
• Parents need to be informed about the training methods used by their children's coaches and trainers, and ensure their teens take certain precautions to prevent sports-related injuries.
• Youth should be spending at least one hour a day, most days of every week, engaged in some form of physical activity.
• The best way parents can encourage their teens' participation in regular physical activity is by modeling this behavior themselves.
• Parents can also help their children by assisting them to find physical activities that match their children's interests and talents.

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• Adolescents need an average 8.5 to 9.25 hours of sleep every night just to function.
• Teens' bodies' natural sleep rhythms (called circadian rhythms) shift during adolescence causing them to remain alert and awake later in the night, with a corresponding desire to sleep later in the day.
• Parents can help teens to identify and limit caffeinated beverages in the evening.
• Teens should establish regular sleep and wake times that allow for an adequate amount of sleep each night.
• Teens will also benefit from developing and maintaining a consistent bedtime routine.
• Beyond bedtimes and bedtime routines, youth should learn to structure their time so that important activities do not detain them from getting to bed on time.
• It is best to avoid strenuous exercise like running, aerobics, weight lifting, or playing basketball right before bed, as these types of activities will release hormones into the body that cause people to feel more awake and alert.
• Anxiety and worry are great sleep disrupters and prevent youth from feeling sleepy.
• Chronic sleep disturbance (sleeping too much or sleeping too little) can be a symptom of a more serious problem such a depressive disorder, or drug and alcohol use.

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• During early and middle adolescence (roughly ages 12-17) parents and teens often argue about clothing.
• Parents can use these decisions about clothing purchases as an opportunity for youth to learn valuable lessons about finances and budgets.
• Before youth finish high school, parents need to decide whether they will be providing their youth any financial assistance during their transition to independent living.
• Parents still have an important role regarding their youths' health and hygiene.
• Teens will need to care for their skin in news ways, such as taking precautions to limit acne and other skin blemishes, and to avoid excessive sun exposure and/or other unsafe tanning practices.
• Wearing makeup, dying hair, and getting a tattoo or a body piercing are all ways that youth experiment with enhancing their personal appearances.

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• Adolescents will need to learn to manage their own healthcare and should be developing a healthy lifestyle that will be maintained throughout their adult lives.
• Parents will want to ensure their youth continue to receive routine, annual physical examinations.
• Annual physicals are the perfect time to make sure that youth are caught up on their vaccinations.
• It's also important that youth also receive routine dental and vision check-ups.
• Annual physical exams should also be screening adolescents for behavioral health concerns such as depression; anxiety; or possible problems with tobacco, alcohol, and other drugs.
• Parents have an important role in identifying the early warning signs of a behavioral or emotional problem because they regularly observe their teens' behavioral and emotional patterns.
• Parents should be on the look-out for possible warning signs that their child may be at risk for suicide.
• All adolescents who are sexually active should get regularly tested for sexually transmitted infections including but not limited to HIV/AIDS, syphilis, gonorrhea, Chlamydia, and Hepatitis B.
• They key to empowering youth to independently manage their own healthcare is to gradually give youth more and more control over their healthcare, while teaching them the skills they need for self-care.

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• One of the difficulties of raising teenage children is achieving the right balance between love and discipline; liberties and limitations; and, independence and responsibility.
• Parents should help children to become resilient, which means that they have the ability to "bounce back" or to readily recover from painful, stressful, and difficult experiences.
• One thing parents can do to build resilience is to provide the proper amount of support and guidance.
• When parents are overly protective to the point of being smothering, or provide too much direction without letting youth work out some problems on their own, they rob youth of the opportunity to develop and practice independent problem-solving skills.
• Youth should have an understanding of what privileges are available to them for following the rules and meeting expectations, and what consequences will occur when they fail to follow the rules, or make poor choices.
• Parents can begin to help adolescents develop time management skills by having high (but attainable) expectations for school achievement, household chores, and other important activities.
• Family rules should also establish clear expectations about the responsibilities of family members toward each other.
• If parents become aware of activities or rules at another child\'s home that they do not agree with, they should calmly discuss their concerns with the parents of the other child.
• Parents need to express clear rules and expectations around teen substance use.
• By late adolescence (18 years of age and older), parents need to set clear boundaries about any assistance they will (or won't) provide while their children are becoming independent adults.

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• Parents must be fully aware of the risks and dangers associated with tobacco, alcohol, and other drugs. 
• While parents cannot completely prevent their children's eventual exposure to alcohol and other drugs, there are steps parents can take to reduce the potential risks.
• Parents will want to ensure their youth learn to drive safely and always use good judgment when operating a motor vehicle.
• There are several warning signs parents should pay attention to that could indicate that their adolescent may be a victim of dating violence.
• If parents are concerned about their teens' involvement with fighting or gang activity, they can do several things.
• Teens can encounter all types of violence online, including violent videos, hate messages on blogs and in chat rooms, and violent computer games. Youth who are curious about sex can find plenty of pornography on the Internet, some of which depicts sexual acts coupled with violence.
• Bullying is the repeated abuse, hostility, aggression, manipulation, or violence between two youth where one youth possesses greater power than the other.
• Parents can ensure their children's continued safety by providing education about making their new dorm, apartment, or home the safest it can be.
• Youth also need to make sure they know how to protect themselves while they are traveling in public places.

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• Intellectual disabilities are a specific type of disability that is caused by limited mental capacity (intelligence). These limitations make it difficult for someone to care for themselves without additional support.
• Children that appear to have extremely poor coordination that interferes with achievement or age-appropriate activities of daily living (e.g., walking, playing catch, etc) may be suffering from a Motor Skills Disorder.
• Children or adolescents may be diagnosed with a Learning Disorder when their achievement on standardized tests in reading, mathematics, or written expression is significantly below what is expected for their age, schooling, or level of intelligence.
• Communication Disorders are problems of childhood that affect learning, language, and/or speech.
• A child who demonstrates severe and persistent difficulties in several areas of development (social interactions, language and communication, repetitive and stereotypical behavior) may be affected by a Pervasive Development Disorder.
• Children who have chronic difficulties in maintaining attentional focus, completing work, being impulsive, or repeatedly engage in antisocial behaviors such as lying and cheating may have one or more Attention-Deficit and Disruptive Behavior Disorders. The disorders in this category include Conduct Disorder, Attention-Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder.
• Disorders in the "Feeding and Eating Disorders of Infancy or Early Childhood" category include Pica, Rumination Disorder, and Feeding Disorder of Infancy or Early Childhood. 
• Elimination disorders (Enuresis and Encopresis) occur when children who are otherwise old enough to eliminate waste appropriately repeatedly void feces or urine in inappropriate places or at inappropriate times.
• Selective Mutism occurs when a child persistently fails to speak in certain social situations where speaking is expected.
• Children and adolescents affected by Separation Anxiety Disorder become severely distressed when separated from their familiar surroundings and caregivers.
• In Reactive Attachment Disorder, children develop abnormal relationships with caregivers that are described, in the language of the DSM criteria for the disorder as either Inhibited or Disinhibited.
• Children with Stereotypic Movement Disorder can't seem to stop themselves from engaging in repetitive, and seeming nonfunctional motor behavior.
• Tic Disorders are diagnosed when people have chronic (i.e., repeated across time) motor and vocal tics that interfere with their daily activities.

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• Special needs children are children who, due to significant medical, physical, cognitive, emotional, or learning issues, require different, usually more intensive accommodations from schools and learning environments than do typical children.
• Within the United States public education system, children\'s special needs are protected by law.
• Special needs children are entitled to be educated according to an individualized education plan (IEP) designed to meet their unique educational needs. The IEP details the adjustments to traditional education that they require so as to best meet their learning needs.
• The basic goal of special education is to provide exceptional children with disabilities which will prevent them from fully benefiting from traditional educational approaches with specialized instruction and intervention sufficient to enable them to benefit from their education.
• Special education differs from regular education in two ways. First, different instructional methods are used. Second, additional specialists (specialized teachers, speech therapists, occupational therapists, physical therapists, aides, social workers, etc.) are involved. These professionals\' specialized skills are matched to the specialized needs of identified children.
• Special education uses intensive, individualized instructional methods.
• In addition to traditional academic content, many exceptional students also benefit from a functional curriculum, which is designed to help students learn basic daily living skills they have not developed on their own such as toileting, eating, grooming, using money, filling out forms, communicating basic needs, and following directions that a teacher or boss gives them.

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• The Individuals with Disabilities Education Act (IDEA) is a United States Federal law that regulates how students with disabilities are identified and how they will receive special education services through their local public school system.
• There are six mandates contained within the IDEA legislation that guide what children with disabilities are entitled to, and how students and their families should be provided special education services.
• The primary mandate of IDEA is that all children are entitled to an education, no matter their level of disability.
• Another central mandate of IDEA ensures that public school districts provide a Free, Appropriate Public Education (FAPE) to all students with disabilities.
• Another major mandate of IDEA states that the process used to identify and evaluate children with disabilities must be done in a non-discriminatory way.
• IDEA also mandates that students with disabilities should be educated in the Least Restrictive Environment (LRE), which means children with disabilities should be educated with other typically-developing children as much as possible, and they should be educated in a setting as close to the regular classroom as possible.
• Yet another core mandate of IDEA is the idea that parents and students should be involved in the special education process and be included in each step along the way: identification, evaluation, planning, and implementation processes.
• The final central mandate of IDEA is due process protection, which ensures that families have a legal way to challenge special education decisions in evaluation, planning, and instruction and directs school districts to respond to these challenges in a timely and appropriate manner.
• The Federal IDEA outlines a list of specific list of 13 disability categories that qualify children for needing special education services.  These include Mental Retardation, Traumatic Brain Injury, Specific Learning Disabilities, Emotional Disturbance, Autism, Speech or Language Impairments, Deafness, Hearing Impairment, Visual Impairment (including blindness), Deaf-Blindness, Orthopedic Impairments, Other Health Impairments, and Multiple Disabilities.

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• The process begins with a formal evaluation of a child's need, which can be initiated by parents, teachers or other school staff who suspect that a child's educational success is being affected by a disability.
• Parents need to call their child's school and ask to speak with the special education coordinator. They can then identify themselves and their child, share their concerns about their child, and ask about the school's evaluation process. This phone call should be followed up with a written letter to be kept as a record.
• Many schools may try to suggest some preliminary interventions be undertaken with the child before completing the full special education evaluation, but parents still have the right to insist that the evaluation be scheduled.
• Once the school receives the request for evaluation, it must send back an evaluation plan in writing to the parents for approval and consent.
• This evaluation plan should outline what methods, tests, or other tools, will be used to evaluate for the disability, and the plan will identify the individual providing the evaluation and that individual's credentials.
• IDEA requires that schools use a variety of tests; they cannot just use one test.
• These tests generally have both oral and written components, and are administered individually to the child by a Psychologist or other professional who has expertise in that particular area.
• Evaluations also take into account a child's behaviors, including the child's social skill with peers, classroom behavior, and signs of emotional problems.
• Once the caregiver receives the school's evaluation plan, they can do one of three things: 1) They can accept it "as is" and sign consent on the plan. 2) They can accept it with conditions, such as requesting additional assessments be performed or other documentation from the children's other therapists, doctors, and specialists be included. 3) If parents totally disagree with the evaluation plan, they should return a letter explaining their concerns. If parents do not agree with the evaluation plan and do not sign consent, the process will not move forward until the parents sign off on an evaluation plan.

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• Once the school has completed the evaluation, they will arrange an Individual Education Plan (IEP) eligibility meeting with the student's family.
• At the disability eligibility meeting, everyone present will introduce themselves and describe how they interact with the student.
• The evaluator will review the results of all the evaluations and based on the results, the school will determine whether the child is eligible for special education.
• Parents can also discuss any outcomes or information they have about their child's condition or behavior relates to their educational functioning.
• If the school has determined that the child does have one or more qualifying disabilities, the IEP team may launch directly into the task of developing the child's Individual Education Plan (IEP) at the eligibility meeting.
• It may occur that the evaluator concludes that the child does not qualify for a disability.
• Parents should express their disagreement calmly but firmly, and only after having listened carefully to what each staff member has to say. They should use their disagreement to move the discussion towards the generation of alternative plans likely to help their child, rather than as an opportunity for righteousness.
• In the event that parents and the school cannot resolve their disagreement over whether the child has a disability or not, there are a few options. Parents can agree to go along with the school's determination, but then talk with the school about other, non-special-education-related options for helping their child to do better in school. Parents can talk to the school about developing a 504 plan for their children. Or they can press forward and continue to try to get full special education services for their child, either through mediation or through a formal appeal known as due process.

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• The Individual Education Plan is a very detailed plan for a specific child's special educational needs and identifies the services that will be provided to meet those needs.
• The plan generally contains six main components:
• it documents the skills and abilities of the student at the start of the plan,
• it describes specific goals and accomplishments that are expected by the end of one year,
• it identifies how that progress will be measured and reported,
• it defines what special services, equipment, or curriculum modifications are necessary to achieve the plan's goals,
• it defines how often a student will receive those services, and,
• it specifies where those services will be delivered.

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• When student reaches age 16, a Transition Statement and Plan (TSP) will be included in with their IEP.
• The purpose of the TSP is to document the student's goals for postsecondary education, vocational training, job placement, and independent living needs after high school is over.
• A good transition plan will also discuss a student's social and recreational needs, as well. IDEA requires that the TSP document the student's own plans, goals, and desires.
• The TSP is also mandated to include plans for "instruction related services, community experiences, the development of employment and other post-school adult living objectives, and when appropriate, acquisition of daily living skills and functional vocational evaluation."
• This plan helps youth with disabilities take control of their future by helping them create a meaningful and workable plan for achieve their goals for work, social interests, and community participation after school has ended.
• According to IDEA, youth can continue to receive free, appropriate education until age 22. After age 22, the public school system is no longer responsible for providing an education to students. However, depending on the individual's disability, he or she may be eligible for receiving other services through the local, county, or state social service agencies.

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• The flip side of the need to accommodate disabled students is the need to accommodate gifted and talented students who show exceptional intellectual or artistic abilities.
• The traditional classroom can be just as poor a fit for gifted students as it can be for students with disabilities, necessitating a strategy on the part of the school to provide appropriate learning environments for gifted children.
• These students are not covered by IDEA, but are covered in federal statutes that define gifted and talented (G/T) students as children who, "give evidence of high achievement capability in areas such as intellectual, creative, artistic, or leadership capacity, or in specific academic fields, and who need services and activities not ordinarily provided by the school in order to fully develop those capabilities."
• Generally, states' eligibility requirements for G/T services include some combination of demonstrated exceptional ability or talent, and demonstrated and creative use of those abilities or talents in the form of advanced achievements or significant accomplishments well beyond what is considered above-average for that age group.
• Gifted students who are not challenged by the material in a traditional classroom often develop poor self-esteem, or overly-inflated self-esteem.
• Once a youth has been identified as "gifted and talented", the school works closely with the student and parents to determine how to best change that youth's curriculum in terms of acceleration and enrichment.

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• Navigating the many stages of the special education system can be stressful, if not downright overwhelming for parents.
• The first stress relieving suggestion is that hesitant parents make a practice of speaking up to offer information and suggestions about their child's needs.
• Parents can also reduce their stress by keeping a careful and well organized paper record documenting their child's entire special education process. A single notebook designated for this purpose, as well as a filing system in which to store documents should be set up for this purpose early on in the process.
• Parents can help reinforce and strengthen children's learning of new skills by working with children to practice those skills at home.
• Finally, parents can reduce their own stress by taking time out to care for their own needs. Parents should find a way to rest, to relax, and to treat themselves well at least a little bit on a regular basis.

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• Primary sex characteristics refer to changes to the sexual organs themselves (uterus, vagina, penis, and testes).
• Secondary sex characteristics refer to other visible changes that mark adult maturation such as changes in height and body shape.
• Primary sex characteristic changes for boys include the enlargement of the testes, penis, prostate gland, and seminal vesicles. These changes are generally completed between ages 12 and 16 years.
• The most significant and noticeable puberty-related change for young men is spermarche, or the first ejaculation, which generally occurs between the ages of 12 and 16.
• The primary sex characteristic changes for girls includes the uterus starting to build a lining that will later be shed through the process of menstruation, and the vagina beginning to produce a mucus-like discharge.
• The most significant and noticeable primary sex change for young women is menarche, or the first menstrual period. On average, this occurs between ages 10 and 15 years for North American girls.
• One of the first noticeable secondary sex changes is a growth spurt in height. On average, the growth spurt for girls begins between the ages of 8 and 13 years; and in boys, between the ages of 10 and 16 years.
• Another obvious secondary sex change for both sexes is body hair. Youth begin developing pubic hair around their external genitals. For girls, this occurs between the ages of 8 and 14 years, and for boys between the ages of 10 and 15 years.
• Underarm hair appears in youth between the ages of 10 and 16 years.
• Boys begin developing facial hair between the ages of 12 and 15 years.
• For girls, breasts begin to bud on average between the ages of 8 to 13 years.
• Boys experience their voice changing, or deepening.

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• Parents can best support their children's effort to cope with puberty-related change by educating them and by being an accepting and understanding presence in their lives.
• Ideally, parents should teach children: 1. what puberty is and what changes to expect, 2. how to care for their bodies, 3. how to make wise and healthy decisions regarding their bodies, 4. how to understand sexual feelings and attraction, and 5. potential consequences of sexual activity.
• Children who have been educated regarding these points will have the foundation they require for making healthy decisions, and may be more likely than before to come to parents when confronted with troubling problems later on.
• Preparing children so that they know what they are dealing with regarding puberty doesn't make their adjustment problems go away, but it does give them a significant advantage with regard to the resources they can bring to problem solving.
• It is very important that parents and caregivers take time to coordinate their message.
• Educating children about puberty in a way that helps them feel empowered and cared for rather than embarrassed is actually a difficult task as it involves two way communication between parents and children.
• It's important that parents do what they can to stay relaxed, calm and normal throughout the process.
• When parents approach these topics in a relaxed matter-of-fact manner, children instead determine that talking about puberty and sexuality is routine, nothing to be ashamed about, and important.
• In our view, children need to learn about reproduction, sexually transmitted disease and birth control before they hit puberty and before their friends, or the media, provide them with false or misleading information.

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• Apart from communicating the basics of reproduction, parents also need to provide pubescent youngsters with practical information about how to cope with the puberty-related physical changes that their bodies will shortly undergo, and to teach children how to properly care for their developing bodies.
• Young men need to learn how to cope with spontaneous erections and ejaculations.
• Caregivers can teach youth to avoid embarrassment by suggesting ways to hide erections while in public and can also be taught how to hasten the end of a spontaneous erection by thinking or imagining about unpleasant or disgusting situations, which will be followed by a deflating biological response.
• The first spontaneous ejaculation often happens during sleep, hence the term nocturnal emission or "wet dream" and boys will generally be between ages 12 and 16 when this event first occurs.
• Caregivers should let youth know that wet dreams are just a natural part of growing up that happen to all young men at some point.
• Parents may want to teach their boys how to do laundry by themselves and have them get into the habit of routinely changing their own sheets prior to the typical age of their first wet dream.
• Parents should try to convey the following information at a minimum: 1) Masturbation is a normal part of sexuality the vast majority of adult men engage in it, at least on occasion. 2) Though it is quite common for men to use pornography as a masturbatory aide, it is best to not do so, or at least to use judgment while doing so. 3) It is best to clean up after one's self using disposable toilet tissue which can be hygienically flushed away.
• All pubescent youth need to learn that pregnancy occurs when sperm contained in the male's ejaculate comes into contact with the female's egg.
• Pubescent youth also need to be educated about sexually transmitted diseases (STDs) and how they can be prevented.
• Another aspect of teaching healthy sexuality has to do with helping kids to learn how to protect themselves from dangerous, abusive, invasive or controlling sexual relationships.

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• Pubescent girls need to learn how to cope with the unprecedented event of their first menstrual periods and other vaginal discharge.
• Caregivers will want to educate girls regarding the advantages and disadvantages associated with tampons and pads and about how to care for each product.
• It is particularly important for caregivers to educate their girls about possible health risks associated with improper tampon or pad usage, including toxic shock syndrome, unpleasant odors, and the signs and symptoms of vaginal infection.
• Young ladies will feel a greater sense of control and will be best able to preserve their privacy if they have already learned how to properly pre-treat and launder blood-stained clothing and bed linens.
• All pubescent youth need to learn that pregnancy occurs when sperm contained in the male's ejaculate comes into contact with the female's egg.
• Pubescent youth also need to be educated about sexually transmitted diseases (STDs) and how they can be prevented.
• Another aspect of teaching healthy sexuality has to do with helping kids to learn how to protect themselves from dangerous, abusive, invasive or controlling sexual relationships.

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• It is important for parents to teach their children how to recognize and decline to participate when people try to manipulate or seduce them into sexual activity that is not in their best interests.
• Boys and girls both may benefit from role playing troubling seduction scenarios in which they have the opportunity to assertively say "No".
• Useful role playing will go beyond simply teaching kids to say No, and additionally help children practice responding to seducers' (or predators') further manipulative taunts and shaming tactics. For instance, a boy who is being pressured to have unwanted sex might be told that his refusal to participate means he "must be gay".
• Similar manipulative remarks which children may hear from peers and ought to know how to respond to include, "If you loved me, you would do this", or "If you don't do this, I won't be your boy/girlfriend anymore".
• During puberty, most children will begin to assert their independence through numerous actions and efforts designed to demonstrate - to themselves and the world - that they are now grown up and no longer need or want parents and other authorities to make choices and decisions for them.
• Pubescent children very much continue to need parents to guide them, express concern, and provide consequences when they move in dangerous directions.
• Children's experimentation should minimally meet the following criteria: 1. Activities and choices must not be truly dangerous 2. They should not interfere with schooling or otherwise affect future well-being 3. It should not contradict the family's most basic values.
• These criteria afford children a great deal of freedom while also leaving room for parents and caregivers to "put their foot down" when children stray into non-negotiable areas where safety, future well-being, or values issues are at stake.

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• It is important to educate children so that they understand the nature of the danger, what their rights are, and what they can do to protect themselves.
• Boys and girls need to know they have the exclusive right to decide how to use their bodies, who they allow to see and to touch their bodies, and to decide what they are willing, and not willing to do, sexually.
• Children need to clearly understand that it's never okay to use physical violence, abusive language, intimidation, or emotional cruelty toward anyone; especially dating partners.
• Children need to be clear that when a friend or dating partner says, "No," to a sexual act or another act of intimacy, they must accept and honor their friend or partner's decision.
• Children should be taught that it is perfectly okay for them to refuse to participate in a sexual or non-sexual situation that makes them feel uncomfortable. It's okay to say "No".
• Youth need to know that if someone insists upon hurting them in any significant way, or treats them disrespectfully after being asked to stop, that person doesn't really love them properly (even if they say they do!) and they should not stay with that person.
• Parents can also help prevent their children from being victimized by keeping a careful and attentive eye on their children's relationships with both peers and other adults so as to learn who their children' socialize with.
• Parents should also take the time to educate children about the possibility of online sexual solicitation and sexual predators and take steps to monitor their children's Internet usage.

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• Though children may not speak about abuse, they may nevertheless communicate that something significant and disturbing has happened to them in a non-verbal manner.
• Changes in mood may include signs of depression: sadness, tearfulness, lethargy, anger, or mood swings.
• Behavioral changes which may indicate abuse include: significant changes in sleeping patterns and habits, significant or sudden changes in appetite and eating patterns, or significant weight gain or loss.
• When children have been sexually assaulted (raped) they may show medical signs of their attack including sexually transmitted infection, urinary tract infection and other hard-to-explain injuries.
• Some abused youth will act out their inner pain by self-harming; often by cutting themselves with a blade in an effort to distract from emotional pain.
• Parents who believe their children may have been sexually abused should take quick action.
• If the sexual abuse occurred within the last 24 hours, parents should immediately take their children to an emergency room, urgent care, or local child and family advocacy center, and do so before the child takes a shower, changes clothes or even has a drink.
• In addition to receiving vital medical attention, abused children should strongly consider talking with a supportive rape counselors or social worker whose job it is to help the entire family access the emotional support and treatment they need.

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• In striving to push beyond previous limitations, children sometimes push too far, and find themselves engaging in dangerous or unsafe behavior.
• In such cases, parents may wish to get support and guidance from professionals, such as family doctors, and behavioral health specialists including social workers, counselors and psychologists, who specialize in helping families cope with adolescent distress and illness.
• Parents should teach children why alcohol and drugs are harmful, express genuine concern for their welfare, and provide disciplinary consequences for substance use.
• Parents should recognize their children as having a serious substance abuse problem if they become aware that their child is using drugs and/or alcohol on a regular basis despite receiving parental discipline and warning that this is unacceptable, unsafe behavior.
• Parents should take seriously any suggestion that their children are involved in and cannot remove themselves from violent, abusive or obsessive relationships.
• Parents should consider professional help in the event that their children repeatedly break house rules, or put themselves in risky or unsafe situations, despite parents' previous attempts to discipline them.
• Children who show pronounced or exaggerated mood change, such as marked sadness, increased irritability or aggression, frequent tearfulness, or significant worry or anxiety, any of which lasts for a week or more, and which do not appear to be appropriate reactions to sad or worrying events, may be developing a mental health condition such as depression which would benefit from professional diagnosis and treatment.
• Changes in children's appetite, sleeping patterns, socialization, or motivation at school may also indicate that potentially serious problem are occurring that should be checked out.

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• Choosing a doctor is one of the most important decisions anyone can make. The best time to make that decision is while you are still healthy and have time to really think about all your choices.
• Studies show that endurance activities help prevent or delay many diseases that seem to come with age. In some cases, endurance activity can also improve chronic diseases or their symptoms.
• You can improve your health if you move more and eat better!
• As you grow older, you may need less energy from what you eat, but you still need just as many of the nutrients in food.
• The Federal Government's Centers for Disease Control and Prevention (CDC) strongly encourage older adults to be immunized against flu, pneumococcal disease, tetanus and diphtheria, and chickenpox, as well as measles, mumps, and rubella.
• Sunlight is a major cause of the skin changes we think of as aging ? changes such as wrinkles, dryness, and age spots.

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• Age can bring changes that affect your eyesight.
• About one-third of Americans older than age 60 and about half the people who are 85 and older have hearing loss. Whether a hearing loss is small (missing certain sounds) or large (being profoundly deaf), it is a serious concern.
• Menopause is the time around the age of 51 when your body makes much less of the female hormones estrogen and progesterone and you stop having periods, which can cause troublesome symptoms for some women.
• The risk of osteoporosis grows as you get older. Ten million Americans have osteoporosis, and 8 million of them are women.
• Prostate problems are common in men age 50 and older. There are many different kinds of prostate problems and treatments vary but prostate problems can often be treated without affecting sexual function.
• Loss of bladder control is called urinary incontinence and at least 1 in 10 people age 65 or older has this problem.
• In order to meet the criteria for an Alzheimer's disease diagnosis, a person's cognitive deficits must cause significant impairment in occupational and/or social functioning.

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• Because the aging process affects how the body handles alcohol, the same amount of alcohol can have a greater effect as a person grows older. Over time, someone whose drinking habits haven?t changed may find she or he has a problem.
• There are many reasons why depression in older people is often missed or untreated. The good news is that people who are depressed often feel better with the right treatment.

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• Assertive communication is respectful, direct, honest, open, non-threatening and non-defensive. It is not demanding, aggressive, or manipulative.
• Understanding the emotional side of conversations can cause behavior to shift.
• Trust and affection are the glue that hold couples together. Healthy partners communicate these positive feelings towards each other via words and gestures in a cyclical manner that breeds more positive communication.
• Knowing more about how to communicate clearly and with sensitivity can help you to avoid problems before they start.

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• It?s normal to have conflict in relationships, but resolving disagreements in a healthy way creates understanding and brings couples closer together.
• Learn the 3 most common and ineffective ways conflict is handled in intimate relationships and how to better handle it.
• Discover 4 strategies will help couples and families balance the needs of others with their own, and make the holiday season more enjoyable for all.
• In your quest as a parent to help your child understand the difference between good and bad, right and wrong and what it means to be respectful to others, there will inevitably be times when your child resists or you miscommunicate.
• Repairing damage while disagreeing with your partner can require learning new habits and skills.
• Whether in a marriage, between parents and children, or among friends, conflict is an inevitable part of any ongoing relationship and the question isn't if there will be conflict but how you will navigate the conflict when it occurs. Here are three skills you can practice to enhance your conflict-resolution and two to avoid.
• People who remarry find themselves blending two sets of families from former marriages and it's common to find a wife or husband complaining that their new spouse seems to love their biological children more than their new spouse.

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• Physically active individuals have a much better health outlook than their sedentary peers.
• A minimum of 20 to 30 minutes of moderate activity a day most days of the week will benefit health and assist with weight loss.
• Exercise reduces people's chances of developing and dying of illnesses such as heart disease.
• Sedentary individuals often complain of being too tired to work out. Ironically, exercise improves people's capacity for work so that people who exercise on a regular basis actually have more energy and greater strength and endurance for daily activities than do their sedentary peers.
• Physically fit people are stronger, healthier and more energetic than sedentary people.
• An exercise session burns calories and elevates metabolic rate both during exercise and then for hours after exercise is completed.
• Exercise helps to preserve and build lean muscle mass and works to suppress appetite.
• Exercise helps people to relax, improves sleep and reduces muscular tension.
• Exercise improves self-confidence.
• Exercising outside the home, whether in the great outdoors, at a gym or recreation center, in an exercise class, sport group, walking or running club, etc., all lead to encounters with other people who also enjoy working out.

• Selecting a form of exercise you actually find enjoyable is perhaps the most important thing you can do to insure your exercise success.
• When you find an exercise you actually like you will have won a major part of the battle in being able to sustain an exercise program.
• The exercise format that is most right for you will be one that closely matches your lifestyle, personality and health needs.
• The following questions may help you to get thinking about what you want from an exercise program:
• What do you want most from your exercise program? Health benefits? Strength and muscular definition? Social opportunities?
• What sort of exercise might benefit you most, given your present health?
• Are you more interested in individual or group fitness options?
• Do you have any pre-existing curiosity about particular forms of exercise?
• Are you interested in a formal workout, or in simply finding ways to do more exercise-like everyday activities that will help you meet a minimal exercise goal?
• Do you need to design your own program or would you be more satisfied by having someone else do this for you?
• Are you a morning or a night person?
• Are you self-motivated or do you need the pressure of a defined schedule to keep you on track?
• Do you crave routine or do you relish change?

• Lifestyle exercise is an exercise program for people who are too busy to exercise. This simply involves choosing to handle everyday activities in such a way that they become small exercise opportunities.
• A popular way to make exercise fun is to pursue it on a recreational basis through participation in sports.
• A formal workout program is, obviously, more formal and scheduled than are informal exercise efforts such as lifestyle exercise or sports participation.
• There are several basic types of formal workouts: aerobic workouts, strength training workouts, and flexibility workouts.
• Most often, formal exercise programs vary between these types, intermixing strength training with aerobic workouts for example, so as to best promote overall health.
• Aerobic workouts are formal workouts designed to increase endurance and promote physical (and heart) health.
• The process of exercising with progressively heavier resistance in order to improve the musculoskeletal system is known as strength training.
• Flexibility training has as its goal to increase or maintain an adequate range of motion in the body's many joints (shoulders, back of the legs (hamstrings), hips, back and spine, etc.) so as to better perform tasks of daily life, including recreational activities, with comfort and safety.

• In order to fully benefit from exercise, one must actually exercise in a disciplined way over sustained periods of time.
• Maintaining an exercise program is difficult. One must stick to it day after day despite the many distractions and emergencies that life throws in one's path.
• There are a few things that can be done to make the task easier, however:
• Pick an exercise partner - Having an exercise partner helps to keep people motivated and working out at times when they would otherwise succumb to stress, fatigue or distraction.
• Define reasonable, achievable small steps en route to long term goals.
• Make a public exercise contract - Making your plan public improves your commitment to carrying out your plan by making it embarrassing for you to not follow through.
• Pick the right type of exercise for you - it's very difficult to stay with an exercise program unless it personally brings you satisfaction and joy.

• Many people are able to stay independent and take care of business by themselves as they age, but for some people, there may come a time when they are unable to make or communicate their decisions about health care or finances.
• You are probably aware of the need to plan for the future by making a will or some other arrangement to handle your affairs after your death.
• It is just as important to plan for the time in your life when you may be unable to communicate or make responsible decisions about your living arrangements, care and finances.
• The law states that a person is incompetent or incapacitated when the person is unable to make or communicate responsible decisions about his or her person or property because of a physical or mental illness or disability.
• The time to plan for that possibility is now while you are competent and can stillmake responsible decisions about what you want in the event you become incapacitated.
• A Power of Attorney for Health Care lets you choose another person to make health care decisions for you right away or when you are too ill to make decisions about your own care.
• A ?Living Will? refers to a set of written instructions that explain your wishes regarding end-of-life decisions in the event that you are unable to communicate with your doctor.
• A Guardianship or Conservatorship is generally only considered after other alternatives have been explored. The Probate Court makes the decision about whether it is needed and who the Guardian or Conservator should be.
• A Joint Bank Account is a common arrangement that people use to allow more than one person to access money in an account.
• The Durable Power of Attorney (DPOA) for Finances allows a trusted person to spend money on your behalf and manage your property.
• Under a typical Trust, one person (called a ?Trustor? or ?Settlor?) allows someone (called a ?Trustee?) to control his property and to make it available for the benefit of himself or others (called ?Beneficiaries?).
• A Representative Payee is responsible for receiving the older person's check from a federal agency (usually Social Security or Veteran's Administration) and spending it on the elder's care and support.

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• Medicare is for people 65 and over; people of any age who have kidney failure or long term kidney disease; or people who are permanently disabled and cannot work.
• The different parts of Medicare help cover specific services:
• Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals and skilled nursing facility, hospice, and home health care.
• Medicare Part B (Medical Insurance) helps cover doctors' and other health care providers' services, outpatient care, durable medical equipment, and home health care. It also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
• Medicare Part C (also known as Medicare Advantage) offers health plan options run by Medicare-approved private insurance companies. These plans are a way to get the benefits and services covered under Part A and Part B, and most cover Medicare prescription drug coverage (Part D). Some plans may include extra benefits for an extra cost.
• Medicare Part D (Medicare Prescription Drug Coverage) helps cover the cost of prescription drugs. It may help lower prescription drug costs and help protect against higher costs in the future.

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• Long-term care is a type of personal care you may need if you are unable to care for yourself because of a physical illness, a disability, or a cognitive impairment, such as Alzheimer?s disease.
• Long-term care helps a person keep a current lifestyle, but it may not improve or fix medical problems.
• Care can be received at home or in a hospice, adult day care center, nursing home, or assisted living facility.
• Skilled care is for conditions that require a medical professional, such as a nurse or a therapist. This type of care is usually provided in a nursing home or other care center.
• Personal care (sometimes called custodial care) helps a person carry out normal daily activities, like bathing, eating and moving around. Personal care is less involved than skilled care, and it may be provided in many places.
• Long-term care can be very expensive. The cost depends on the amount and type of care needed, where the care is received, and what type of medical professional provides it.
• Long-term care insurance can help protect your assets against the high cost of extended long-term care. However, long-term care insurance usually only makes sense if you have significant assets to protect other than your home, car, and a small amount of cash.
• Long-term care is typically less expensive if you purchase it when you?re younger and yu may want to seek help from a trusted financial advisor to decide if it meets your needs.

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• One of the first decisions many prospective adoptive parents make is whether to adopt a child from the United States or from another country.
• In domestic adoption, you may choose to work with a public agency, a licensed private agency, an attorney ("independent adoption"), or an adoption facilitator (if allowed by laws in your State) or unlicensed agency.
• Intercountry adoption differs in several significant ways from domestic adoption. Children eligible for intercountry adoption must have lost their birth parents to death or abandonment, or the birth parents must prove that they are incapable of caring for the children. In some cases, children adopted through intercountry adoption may have been raised in orphanages or institutional settings.
• There are many paths to building your family through adoption and it's important to understand the steps involved and resources available at each step.
• The laws of every State and the District of Columbia require all prospective adoptive parents (no matter how they intend to adopt) to participate in a home study.
• There are a number of significant differences between foster care and adoption for the foster/adoptive family involved, even when a child remains in the same household.
• The landscape for LGBT adoption is changing, with an increasing number of LGBT individuals and couples choosing to build families through adoption. Many agencies, both public and private, welcome the LGBT community.
• Consent refers to the agreement by a parent, or a person or agency acting in place of a parent, to relinquish a child for adoption and release all rights and duties with respect to that child. This is regulated by State statutes, and States differ in the way they regulate consent.

• If you legally change your name because of marriage, divorce, court order or any other reason, you need to tell Social Security so that you can get a corrected card.
• If you are working, also tell your employer.
• A mismatch between the name shown on your tax return and the SSA records can cause problems in the processing of your return and may even delay your refund.
• You can determine what your state requirements for name changes are by contacting a local lawyer, contacting your county court, or looking up the state statutes in a law library.

• The divorce process is started when one spouse files a legal document with the court called the 'complaint' or 'petition' requesting a divorce.
• Divorcing couples must decide how their jointly held property and debt will be divided before their divorce can become final.
• When a divorcing couple has minor children the division of child custody becomes a critical part of their divorce settlement.
• Child Support involves taking wages so as to insure that minor children can receive adequate care.
• Spousal Support (also known as alimony), involves taking wages so as to insure that an economically disadvantaged spouse can continue to live comfortably after marriage has terminated.
• Learn about the practical ways that divorcing people can cope with and make the best of their stressful circumstances.
• Divorce is very hard on children because it changes their entire lives by changing their families, living conditions and their ability to trust in the stability and reliability of support from their parents.
• Divorce offers people the opportunity to reflect on and learn from the mistakes they have made in order to reduce the chances that they will make those same mistakes again.
• A parenting plan is a legal document that explains the basic arrangements for caring for children, including where the children will live, who will make decisions for the children, and how disputes about the parenting arrangements will be resolved.
• A main objective of the Child Support Enforcement (CSE) Program is to make sure that child support payments are made regularly and in the correct amount.

• Adoption and guardianship offer children and parents two similar paths to permanency.
• Both options provide permanent caregivers with many of the same legal rights as birth parents.
• Adoption is a lifetime relationship that gives the child all of the legal benefits of a child born into the family.
• Guardianship builds family relationships that can last a lifetime, the legal relationship established by a juvenile court guardianship ends when the child turns 18 and is considered an adult.
• For a child to be adopted, the rights of the birth parents must be legally terminated, voluntarily surrendered, or the birth parents must have signed a consent to the adoption. The birth parents rights do not have to be terminated with guardianship.
• Depending on what is in the best interest of the child, the birth family connections can be maintained with ongoing contacts after an adoption or guardianship.
• There are many legal differences between adoption and guardianship including decision making powers, relationships with birth parents and siblings, the child's legal name, the child's right to inheritance, and whether a child can be returned to the state's care.

• Guardianship is often suggested for individuals who need help with regular activities of daily living, such as paying bills, managing medications, or buying groceries and preparing meals.
• Individuals who may be referred for guardianship might include: a student with a developmental disability who is turning 18, a frail elder, a person in the late stages of Alzheimer's, or a person with mental illness who is unable to make informed decisions.
• A Guardian is a person appointed by the court to make decisions on behalf of another individual. A guardian is appointed if the court finds an individual is unable to make certain decisions independently.
• Under Full Guardianship, a guardian has decision-making control over all areas of an individual's life.
• Under a Limited Guardianship, a guardian has control over some but not all areas of an individual's life. For example, a limited guardian may be responsible for providing consent for medical treatment or making all financial decisions.
• Alternatives to full guardianship include legal documents (such as Power of Attorney or a Living Will), community services (such as Meals on Wheels or Homemakers), and government programs. All of these may delay or prevent the appointment of full guardians for individuals who are not able to make decisions on their behalf.
• Limited guardianship is preferable to full guardianship because it encourages maximum independence for individuals.

• A prenuptial agreement is a contract entered into by two people before their marriage.
• The couple decide how their property will be divided if they get a divorce, legal separation, or annulment, or when one of them dies.
• Sometimes couples wait until they are married to make these agreements ? then the contract is a ?marital agreement.?
• In general, a prenuptial or marital agreement is more likely to be enforced by a court if the contract is fair and if both spouses are honest and clear about their finances, including salary, other income, possessions and property, and debts.
• It is a good idea for both of you to have independent legal advice (that means different attorneys for you and your fiancé or spouse) and help drafting such a contract.

• By law, schools must provide special help to eligible children with disabilities. This help is called special education and related services.
• The Individuals with Disabilities Education Act (IDEA), as amended in 2004, guides how special education and related services are provided to children with disabilities in the United States.
• It?s extremely important to understand that the terms you?re likely to hear in special education that come from IDEA.
• In order to fully meet the definition (and eligibility for special education and related services) as a ?child with a disability,? a child?s educational performance must be adversely affected due to the disability.
• Before a child can receive special education and related services for the first time, a full and individual initial evaluation of the child must be conducted to see if the child has a disability and is eligible for special education. 
• An Individualized Education Program (IEP) is a written statement of the educational program designed to meet a child?s individual needs and every child who receives special education services must have an IEP.
• For many students with disabilities, the key to success in the classroom lies in having appropriate adaptations, accommodations, and modifications made to the instruction and other classroom activities.

• Crohn's disease is a chronic, or long lasting, disease that causes inflammation?irritation or swelling?in the gastrointestinal (GI) tract.
• Most commonly, Crohn's affects the small intestine and the beginning of the large intestine.
• However, the disease can affect any part of the GI tract, from the mouth to the anus.
• Crohn's disease is a chronic inflammatory disease of the GI tract, called inflammatory bowel disease (IBD).
• Crohn's disease most often begins gradually and can become worse over time. Most people have periods of remission?times when symptoms disappear?that can last for weeks or years.
• Some people with Crohn's disease receive care from a gastroenterologist, a doctor who specializes in digestive diseases.
• The exact cause of Crohn's disease is unknown. Researchers believe the following factors may play a role in causing Crohn's disease: autoimmune reaction, genes and environment.
• Crohn's disease can occur in people of any age. However, it is more likely to develop in people: between the ages of 20 and 29; who have a family member, most often a sibling or parent, with IBD; who smoke cigarettes.

• The most common signs and symptoms of Crohn's disease are diarrhea, abdominal cramping and pain, and weight loss.
• Other general signs and symptoms include feeling tired, nausea or loss of appetite, fever, and anemia ? a condition in which the body has fewer red blood cells than normal.
• Signs and symptoms of inflammation outside of the intestines include joint pain or soreness, eye irritation, and skin changes that involve red, tender bumps under the skin.
• A health care provider diagnoses Crohn's disease with the following: medical and family history, physical exam, lab tests, upper GI series, computerized tomography (CT) scan, and intestinal endoscopy.
• The health care provider may perform a series of medical tests to rule out other bowel diseases, such as irritable bowel syndrome, ulcerative colitis, or celiac disease, that cause symptoms similar to those of Crohn's disease.

• A health care provider treats Crohn's disease with medications, bowel rest or surgery.
• Which treatment a person needs depends on the severity of the disease and symptoms.
• Each person experiences Crohn's disease differently, so health care providers adjust treatments to improve the person's symptoms and induce, or bring about, remission.
• While no medication cures Crohn's disease, many can reduce symptoms.
• Sometimes Crohn's disease symptoms are severe and a person may need to rest his or her bowel for a few days to several weeks. Bowel rest involves drinking only clear liquids or having no oral intake. To provide the patient with nutrition, a health care provider will deliver IV nutrition through a special catheter, or tube, inserted into a vein in the patient's arm.
• Even with medication treatments, up to 20 percent of people will need surgery to treat their Crohn's disease. Although surgery will not cure Crohn's disease, it can treat complications and improve symptoms.
• Researchers have not found that eating, diet, and nutrition cause Crohn's disease symptoms. Good nutrition is important in the management of Crohn's disease, however. Dietary changes can help reduce symptoms.

• Money gives you freedom and choices. You can decide where and how you want to live when you have a good income or financial resources.
• The best way to achieve your financial and lifestyle goals is to prepare yourself for a good career.
• Putting yourself on a budget means prioritizing your needs, and then making and sticking to a spending plan that helps insure that your most pressing needs are met first, before your less pressing needs.
• You can establish different types of accounts at a bank, some of which allow you to have remote access to your money.
• People who spend more than they earn finance the difference that they haven't earned with credit cards, home equity lines of credit, and personal loans. That means that they are in debt.
• There are many types of insurance coverage available and each is designed to cover a specific type of risk.
• In the long run, the financial benefits of homeownership generally far outweigh those of renting as owning a home is an investment.
• There are a number of issues to consider when deciding whether to buy or lease a car.
• The key to successful investing is to have a good understanding of what your goals are and then you can select investment options that best suit your needs.
• There are generally only two ways to accumulate enough money to retire.
• It is in your interest to make a legal and binding plan that will help your surviving family and friends understand how you want your assets to be distributed after you die.
• Employing good tax planning strategies will allow you to minimize the amount of your income that is subject to taxes, allowing you to keep more of your income for yourself.

• Effective modern leaders use focused work teams to solve business problems and to make business processes more efficient.
• The diversity of team member's combined experience and hands-on knowledge regarding business processes means that they are more likely to come up with innovative and effective solutions than are management types who have a more abstracted understanding of business processes.
• Efficiently cutting across layers of hierarchy to solve problems, work teams are one of the more efficient tools at a leader's disposal for orchestrating organizational change.
• When properly managed, teams can be a major asset. When poorly managed, they can be counterproductive.
• There are several key concepts that affect the achievement, problem support and morale-building potential of fully functioning teams including boundaries, how conflict is handled, the vision/mission/goals of the team, and leadership roles.

• Stress can be defined as the reaction we have to difficult, demanding or challenging events.
• People try many ways, both positive and negative, to lessen their stress levels.
• There is no shortage of urgent requests that confront us in a normal day. Some of these, no doubt, must be attended to. But many, if not most, only have the appearance of needing immediate attention.
• Work worries are not necessarily going to go away, but you can respond differently to the stress they cause using one of these 4 strategies to maintain a healthy mind and body.
• One of the key features of burn out at work is emotional exhaustion, that is, those feelings that you are overextended and exhausted by your work.
• Time management methods involve finding ways to work more efficiently, so as to maximize one's use of time.
• Employees trying to get back to work after a mental health setback often face obstacles to their reintegration and progress. Here's some ways to develop return-to-work policies that address the unique needs of employees who have faced mental health challenges.

• Knowing more about how to communicate clearly and with sensitivity can help you to avoid problems before they start.
• An assertive person communicates freely, but in a respectful, non-threatening manner. Assertiveness is a balancing act, requiring thoughtfulness and social awareness.
• Your relationships with other people are characterized by boundaries that define the degree of closeness appropriate to each relationship.
• Relationship maintenance gets a whole lot easier when you learn how to communicate what it is you want from people in clear and unambiguous language.
• Being committed to a relationship basically boils down to taking that relationship seriously: showing reciprocity towards the relationship, respecting its boundaries and doing your best to communicate and listen clearly and well.
• Effectively navigating work relationships requires that we first know our goals in the situation. It's important to know not only what specific results you want to achieve, but also how you want the other person to feel about you after the interaction and how you want to feel about yourself.

• Life issues are common problems, issues and/or crises that happen to normal people living normal lives.
• Examples include managing one's relationships so that they are healthy and functional, surviving disabilities, coping with grief, loss and self-esteem issues.
• A person's ability to be grateful is quite independent of that person's possession of things to be grateful about.
• Keeping life?s basics in mind helps us to steer in the right direction, even when the going gets tough. 
• Finding your purpose and making a difference in the world can easily get buried in the landfill of daily life.
• Studies show that cultivating gratitude and gladness has lasting and important benefits, including lifting your mood, increasing satisfaction with life, and building resilience.
• When we deliberately slow down, we are forced to make decisions about how we will use our limited time.
• Making a stress-management plan takes a little work, but it can really pay off in terms of your health, stress levels and self-esteem.
• In order to move forward when life veers off track, we must learn to first acknowledge and tolerate that life has handed us an unexpected and unwelcome circumstance.

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• A healthy lifestyle involves many choices, including choosing a balanced diet or healthy eating plan.
• A healthy eating plan:
• Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
• Includes lean meats, poultry, fish, beans, eggs, and nuts
• Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars
• Stays within your daily calorie needs
• A healthy eating plan that helps you manage your weight includes a variety of foods you may not have considered.
• Healthy eating is all about balance. You can enjoy your favorite foods even if they are high in calories, fat or added sugars. The key is eating them only once in a while, and balancing them out with healthier foods and more physical activity.

• Safe steps in food handling, cooking, and storage are essential in preventing foodborne illness.
• You can't see, smell, or taste harmful bacteria that may cause illness. In every step of food preparation, follow the four guidelines to keep food safe:
• Clean ? Wash hands and surfaces often.
• Separate ? Don't cross-contaminate.
• Cook ? Cook to proper temperatures, checking with a food thermometer.
• Chill ? Refrigerate promptly.
• Shopping - Never choose meat or poultry in packaging that is torn or leaking, and do not buy food past "Sell-By," "Use-By," or other expiration dates.
• Preparation - Always wash hands with soap and warm water for 20 seconds before and after handling food. Don't cross-contaminate. Keep raw meat, poultry, fish, and their juices away from other food.

• A cold and the flu (also called influenza) are alike in many ways. But the flu can sometimes lead to more serious problems, like the lung disease pneumonia.
• A stuffy nose, sore throat, and sneezing are usually signs of a cold.
• Tiredness, fever, headache, and major aches and pains probably mean you have the flu.
• Coughing can be a sign of either a cold or the flu. But a bad cough usually points to the flu.

• Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.
• Novel H1N1 flu is a newer influenza virus causing illness in people. This new virus was first detected in the U.S. in April 2009, and has spread to many countries around the world.
• Bird flu is commonly used to refer to Avian flu (see below). Bird flu viruses infect birds, including chickens, other poultry and wild birds such as ducks.
• Avian flu (AI) is caused by influenza viruses that occur naturally among wild birds. Highly pathogenic H5N1 is deadly to domestic fowl, can be transmitted from birds to humans, and is deadly to humans. There is virtually no human immunity and human vaccine availability is very limited.
• Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person.

• Influenza usually starts suddenly and may include the following symptoms:
• fever (usually high)
• headache
• tiredness (can be extreme)
• cough
• sore throat
• runny or stuffy nose
• body aches
• diarrhea and vomiting (more common among children than adults).
• The single best way to protect yourself and others against influenza is to get a flu vaccination each year.
• Your doctor may recommend use of an antiviral medication to help treat the flu. Four antiviral drugs (amantadine, rimantadine, zanamavir, and oseltamivir) are approved for treatment of the flu.
• If you get the flu, get plenty of rest, drink a lot of liquids, and avoid using alcohol and tobacco.
• Also, you can take medications such as acetaminophen (e.g., Tylenol®) to relieve the fever and muscle aches associated with the flu. Never give aspirin to children or teenagers who have flu-like symptoms, particularly fever.

• Although the common cold is usually mild, it is a leading cause of doctor visits and missed days from school and work.
• More than 200 different viruses are known to cause the symptoms of the common cold.
• Symptoms of the common cold usually begin 2 to 3 days after infection and often include:
• mucus buildup in your nose
• difficulty breathing through your nose
• swelling of your sinuses
• sneezing
• sore throat
• cough
• headache
• fever that is usually slight but can climb to 102 degrees Fahrenheit in infants and young children.
• Cold symptoms can last from 2 to 14 days, but like most people, you'll probably recover in a week. If symptoms occur often or last much longer than 2 weeks, you might have an allergy rather than a cold.
• There is no cure for the common cold, but you can get relief from your cold symptoms by resting in bed, drinking plenty of fluids, gargling with warm salt water or using throat sprays or lozenges for a scratchy or sore throat, using petroleum jelly for a raw nose, and taking aspirin or acetaminophen for headache or fever.

• Terrorism is the use of force or violence against persons or property in violation of the criminal laws of the United States for purposes of intimidation, coercion or ransom.
• Domestic terrorism involves groups or individuals whose terrorist activities are directed at elements of our government or population without foreign direction.
• International terrorism involves groups or individuals whose terrorist activities are foreign-based and/or directed by countries or groups outside the United States or whose activities transcend national boundaries.
• Biological agents are infectious microbes or toxins used to produce illness or death in people, animals or plants. They can be dispersed as aerosols or airborne particles.
• Chemical agents kill or incapacitate people, destroy livestock or ravage crops. Some are odorless and tasteless and are difficult to detect. They can have an immediate effect (a few seconds to a few minutes) or a delayed effect (several hours to several days).

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• The intensity of the process of grieving and working through feelings after an incident will likely be in relationship to how closely you have been impacted.
• Those people most directly impacted by the violence and death are at heightened risk for experiencing trauma disorders. A trauma disorder occurs (in the broadest sense) when a person is not able to follow a normal process of grief through to resolution, and instead gets stuck in it, reliving the emotions and memories associated with the trauma over and over.
• If you are a veteran or are caring for one, here are some mental health resources to make the journey a little easier.
• Discover twenty ideas on positive ways to promote peace in our badly broken world.
• Learn about some wartime stress survival tips.

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• Screening tests, such as colorectal cancer tests, can find diseases early when they are easier to treat. Some men need certain screening tests earlier, or more often, than others.
• Talk to your doctor about which tests listed are right for you, when you should have them, and how often. This may include cholesterol and blood pressure checks, diabetes tests, depression screenings, prostate cancer screening, and sexually transmitted disease screening.
• Don't Smoke. But if you do smoke, talk to your doctor about quitting.
• Eat a Healthy Diet with a variety of foods, including fruit, vegetables, animal or vegetable protein (such as meat, fish, chicken, eggs, beans, lentils, tofu, or tempeh) and grains (such as rice). Limit the amount of saturated fat you eat.
• Be Physically Active. Start small and work up to a total of 20-30 minutes most days of the week.
• Stay at a Healthy Weight by balancing the number of calories you eat with the number you burn off by your activities. Remember to watch portion sizes.
• Drink Alcohol Only in Moderation. If you drink alcohol, have no more than 2 drinks a day.

• People go into dating relationships with a variety of desires and expectations (psychological, social, physical, etc) they are looking to see fulfilled.
• People's desires and wishes come strongly into play as dating relationships begin; they determine to whom people are attracted, and they are also frequently projected onto potential partners, making those potential partners appear more (or less) desirable than they might actually turn out to be.
• The idealization of early dating and the thrill of early sexual relations tend to wear off as people come to know each other better.
• Because of that, it's a good idea to start out your dating process by taking time to develop an appropriate dating mindset including thinking through what one wants to accomplish through dating, whether one's goals and expectations are realistic, and how one is being perceived by others.
• An early question to ask yourself is whether you think dating should be a means to an end (of finding a lasting committed relationship) or whether dating should be more of an exploratory project you engage in to have fun and grow as a person.
• You may find that taking time out early on to learn about yourself and the way your personality works will prove a valuable investment because accurate self-knowledge can help you to better identify compatible personality characteristics to look for in your dating partners.
• Just as compatible personality and behavior are important things to be aware of in a potential partner, so too are compatible goals.

• Be initially self-centered. This means to be more focused on whether or not you like the person you're dating than whether or not they like you. Pay careful attention to what you are feeling and how your emotions react to what your date does.
• Have modest expectations. Chances are good that your date will be nice but nothing special. Relax and enjoy the dating process.
• Expect to be rejected some of the time. Rejection early on in a dating relationship is not personal, but rather is all about what is happening in your date's mind.
• Put your best foot forward. You don't need to be different than you are. How you carry yourself is ultimately more important than how you look.
• Have a plan. It's nice to have a plan for the evening defined in your head (where you'll go, what you might eat) so that your date isn't forced to figure things out for you both at the spur of the moment.
• Have fun. You're out on a date to enjoy yourself and see what can develop in the moment. Don't burden the situation with neediness from your past or hopes for the future.

• Meeting someone face to face for the first time tests whether romance is possible.
• Negotiating from one date towards a second and then a third such that intimacy grows between the two of you and that no one gets too overwhelmed too quickly is an even trickier process.
• Getting around to a physical, face to face first date with a potential partner is an important step in determining your mutual compatibility.
• People vary in terms of how they like to set up their first dates. While some people set up formal intimate dinner dates, many prefer their first contacts to be short casual public events such as going out for coffee or walking in a park.
• While on your date, encourage your date to talk and practice being a good listener.
• Be on the lookout for people whose goals do not match your own.
• Stay calm if someone rejects you.
• Growing a relationship involves growing intimacy, which involves vulnerability.
• At some point in any growing relationship there will come a time when past secrets will have to be disclosed to one's partner if one's relationship is to be honest.
• Unworkable, dangerous or unhealthy relationships can generally be identified by paying attention to one's emotions which will become persistently upset with regard to the relationship.
• You and your partner can avoid some of the pitfalls that relationships can fall into by learning to communicate well with each other, by educating yourselves about common ways relationships change over time, and common relationship problems that can occur, and by doing what you can to not take your relationship for granted.

• A disaster is a natural or man-made event that negatively affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment.
• Certain types of natural disasters are more likely to occur in particular parts of the world.
• It may be impossible to avoid disasters, but it isn't impossible to plan ahead of time so as to minimize the impact that any given disaster might have on you or your family's health, safety and property.
• Floods are the most common and widespread of all natural disasters, except fire. Most communities in the United States have experienced some kind of flooding, after spring rains, heavy thunderstorms, or winter snow thaws.
• A hurricane is a tropical storm with winds that have reached a constant speed of 74 miles per hour or more.
• An earthquake is a sudden, rapid shaking of the Earth caused by the breaking and shifting of rock beneath the Earth's surface.
• Fire is the fourth largest accidental killer in the United States and is the disaster that families are mostly likely to experience.

• Acknowledge the event as tragic and, at this point in time, perhaps ongoing.
• Provide those employees who are affected with an opportunity to talk about their fear, horror, helplessness and grief.
• Allow them to talk about what they saw, felt, and experienced, including physical reactions in response to this tragic event (such as nausea, sleeplessness, and loss of appetite).
• Let employees know that it is completely normal to be experiencing such a wide range of reactions in response to this event.
• Encourage employees to do all that they need to do to feel safe, while at the same time acknowledging and talking about the traumatic nature of the event.
• Remind employees to work towards normalizing and focusing on their daily experience as much as possible.
• Encourage employees to stay in close contact with loved ones, and keep close communication with their children.
• Provide employees with written information acknowledging the nature of the event, and what kind of services may be available to help them.
• Encourage employees to call, as needed, and speak with an EAP counselor.
• Provide written information, in the form of handouts, concerning what they can do to help themselves and one another cope and recover from the traumatic impact of this event.

• From the moment we are first conceived, to the day we die, we are constantly changing and developing.
• While some of the changes we undergo are as a result of chance incidents and personal choices, the vast majority of life changes and stages we pass through are due to our common biological and psychological heritage as human beings and are shared by all people.
• It\'s important to be aware of the stages that all people go through including birth, infancy, adolescence, adulthood, old age and finally death.
• Knowledge about how human lifespan development is supposed to unfold is important becuase it serves as the base upon which our life problems sit.
• Knowing something about how people typically develop themselves over time thus helps us to place our problems and illnesses into context, and also suggests ways that our problems can be fixed.

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• To be great leader today, a person must continuously pursue excellence in ten areas of expertise.
• A leader must look at the organization as a system, understand the importance of interdependencies and ensure that each unit properly contributes to the whole.
• Leaders who fail to recognize the importance of variation often leap to conclusions with too little data.
• Leading change is one of the biggest challenges for new leaders.
• Effective modern leaders use focused work teams to solve business problems and to make business processes more efficient.
• Leaders must carefully analyze performance problems in the context of the organizational system they occur in before attempting to remediate the problem.
• New leaders should cultivate a vision statement articulating what the organization should look like and how it should function in the future.
• Experts on leadership recognize four major decision-making approaches, all of which may lead to successful decision making in particular circumstances.
• Effective leaders need to cultivate emotional competency (also called emotional intelligence).
• The single best way leaders can improve their communication skills is for them to learn to listen actively.
• Leaders know that to a great extent, the world is what you make of it and that different people can and will interpret the same events in very different lights and still be 'right'.

• Complete personal and financial records will have most of the details you need to plan for any changes that might come up in the years ahead?such as retirement, a move, or a death in the family.
• Personal records are facts, dates, names, and documents that are part of your history. A personal records file should include the following information:
• Full legal name
• Social Security number
• Legal residence
• Date and place of birth
• Names and addresses of spouse and children (or location of death certificate if any are deceased)
• Location of ?living will? or other advance directive if one exists
• Location of birth certificate and certificates of marriage, divorce, and citizenship
• List of employers and dates of employment
• Education and military records
• Religious affiliation, name of church or synagogue, and names of clergy
• Memberships in organizations and awards received
• Names and addresses of close friends, relatives, doctors, and lawyers or financial advisors
• Requests, preferences, or prearrangements for burial.
• Financial Records should list information about insurance policies, bank accounts, deeds, investments, and other valuables. Here are some suggestions:
• Sources of income and assets (pension funds, IRA?s, 401K?s, interest income, etc.
• Social Security and Medicare information
• Investment income (stocks, bonds, property, and any brokers? names and addresses)
• Insurance information (life, health, and property) with policy numbers and agents? names
• Bank account numbers (checking, savings, and credit union)
• Location of safe deposit boxes
• Copy of most recent income tax return
• Liabilities ? what is owed to whom and when payments are due
• Mortgages and debts ? how and when paid
• Location of deed of trust and car title
• Credit card and charge account names and numbers
• Property taxes
• Location of all personal items such as jewelry or family treasures.

• A will is your chance to say who should receive the things you own. Another way to do that is a trust.
• A standard power of attorney or a durable power of attorney can give one person the right to handle personal or financial matters for another. A standard power of attorney is not useful, however, if the person being cared for cannot make their own decisions.
• A durable power of attorney may be a better choice because it is effective even if a person becomes unable to make decisions for himself.
• Another type of document, an advance directive, describes in writing what your wishes about health care are in case you become terminally ill.

• To become a first-time homebuyer, you need to know where and how to begin the homebuying process.
• Before buying a home, it is important to make a wish list of aspects that are important to you.
• Living in a common ownership community (condo, cooperative, or homeowners association property) is becoming increasingly common, but many people do not know just what it involves or how it is different from what they are used to.
• You may be able to save hundreds of dollars a year on homeowners' insurance by shopping around and being aware of your options.
• A mortgage - whether it?s a home purchase, a refinancing, or a home equity loan - is a product, just like a car, so the price and terms may be negotiable.
• You should be aware of certain rights before you enter into any mortgage loan agreement.
• If you?re thinking about selling your home, you may be considering using the services of a real estate broker or agent. Before you sign a listing agreement be informed about your choices.
• If you have a gain from the sale of your main home, you may qualify to exclude all or part of that gain from your income.
• For those that decide to lease an apartment or home instead of buying, the lease is a legally binding document that courts will generally uphold in legal proceedings, so it is important for you to know the exact terms of the agreement before you sign it.

• No matter how old or young you are, there are some basic things you can do to better manage and protect your money.
• Before you decide to file for personal bankruptcy, there is key information should know about the process and your rights.
• If you or someone you know is in financial hot water, consider these options: realistic budgeting, credit counseling from a reputable organization, debt consolidation, or bankruptcy.
• Credit laws protect your rights by requiring businesses to give all consumers a fair and equal opportunity to get credit and to resolve disputes over credit errors.
• The Fair Debt Collection Practices Act (FDCPA) prohibits debt collectors from using abusive, unfair, or deceptive practices to collect from you.
• Financial security in retirement doesn?t just happen. It takes planning and commitment and, yes, money.
• Learn the Internal Revenue Service?s top 10 tips to ensure a smooth income tax-filing process.
• When internet fraudsters impersonate a business to trick you into giving out your personal information, it?s called phishing.
• Take steps to limit the amount of spam you get, and treat spam offers the same way you would treat an uninvited telemarketing sales call.

• There are many different types of adoption and it is important to understand the various options and determine the best route to building your family through adoption.
• There are important legal steps a person needs to do when their name has changed, typically in the case of a marriage or divorce.
• Despite widespread familiarity with the effects of divorce, the details of the divorce process are less well known.
• There is no single correct answer for all families and/or individuals considering guardianship. Different individuals have different situations, needs, and available supports.
• A prenuptial agreement is a contract entered into by two people before their marriage where they decide how their property will be divided if they get a divorce, legal separation, or annulment, or when one of them dies.
• By law, schools must provide special help to eligible children with disabilities. This help is called special education and related services.

• Long-term care is a type of personal care you may need if you are unable to care for yourself because of a physical illness, a disability, or a cognitive impairment, such as Alzheimer?s disease.
• Long-term care can be expensive and depends on the amount and type of care you need, where you receive it, and what type of medical professional provides it.
• You should plan and think about long-term care before you need care or before a crisis occurs.
• Learn about key areas of concern, suggested questions to ask, and ways in which families might initiate conversations about these often difficult to discuss topics with their aging parents.
• There are important steps adults can take ahead of time to protect their rights when they are unable to make or communicate their decisions about health care or finances.
• A Power of Attorney for Health Care lets you choose another person to make health care decisions for you right away or when you are too ill to make decisions about your own care.
• A Guardianship or Conservatorship is generally only considered after other alternatives have been explored. The Probate Court makes the decision about whether it is needed and who the Guardian or Conservator should be.
• A Joint Bank Account is a common arrangement that people use to allow more than one person to access money in an account.
• The Durable Power of Attorney (DPOA) for Finances allows a trusted person to spend money on your behalf and manage your property.
• Under a typical Trust, one person allows someone else to control his property and to make it available for the benefit of himself or others.
• A Representative Payee is responsible for receiving the older person's check from a federal agency (usually Social Security or Veteran's Administration) and spending it on the elder's care and support.
• Medicare is health insurance for the following: 1) People 65 or older; 2) People under 65 with certain disabilities; and 3) People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant).
• It is important to be aware of the 4 parts of Medicare that cover different types of services, which include Part A (Hospital Insurance), Part B (Medical Insurance), Part C (also known as Medicare Advantage), and Part D (Medicare Prescription Drug Coverage).

• Identity theft occurs when someone uses your personally identifying information, like your name, Social Security number, or credit card number, without your permission, to commit fraud or other crimes.
• Deter identity thieves by safeguarding your identity and financial information.
• Detect suspicious activity by routinely monitoring your financial accounts and billing statements.
• If you are a victim of identity theft, take four steps as soon as possible, and keep a record with the details of your conversations and copies of all correspondence.

• All foreign workers must obtain permission to work legally in the United States and each employment category for admission has different requirements, conditions and authorized periods of stay.
• You may be eligible to apply for a green card (permanent residence) through your family, a job offer or employment, refugee or asylum status, or a number of other special provisions.
• There are important guidelines to follow for U.S. citizens wishing to bring a foreign national fiancé living abroad to the United States to marry.
• The most common path to U.S. citizenship allows a green card holder (permanent resident) of at least 5 years to apply for naturalization.
• As an employer, you may need to hire foreign labor when a U.S. citizen is not available. You will need to consider whether you wish to petition for permanent residence (a green card) for your prospective employee to work here permanently or whether you wish to petition for someone to come temporarily to the United States to fill an employment need.

• Small claims court is a special court where disputes are resolved quickly and inexpensively because the rules are simple and informal.
• In general, a natural person (an individual) cannot ask for more than $10,000 in a claim. Businesses and other entities (like government entities) cannot ask for more than $5,000.
• There are different kinds of cases you can file in small claims court.
• The deadline to file a lawsuit is called the statute of limitations and most lawsuits MUST be filed within a certain amount of time.
• The filing fee is based on the amount of your claim and the number of claims you have filed in the past 12 months.
• The judge may make a decision at your hearing or mail it to you later.
• You cannot appeal if you were the person who filed the claim. If someone else files a claim against you and you lose, you can appeal.
• Collecting a judgment can be one of the more difficult and frustrating parts of your small claims case.

• Parking tickets are not filed with the court, but instead shows the amount you must pay to the parking agency where the violation occurred.
• If the police stop you for driving too fast or running a red light, they can charge you with an infraction.
• The police can give you a ticket for a more serious crime, like driving without a license.
• When you get a traffic ticket, you must act before the due date on your "Notice to Appear" runs out.
• When you get a traffic ticket, you can take one of four actions including pleading guilty and paying the ticket, plead guilty and go to traffic school (if you are eligible), provide proof of correction if you got a traffic ticket for a "Correctable Violation", or ask for a trial if you believe you are not guilty.
• Whenever you?re in a vehicle, there?s a chance you?ll be involved in a traffic accident. Learn about some of the most frequently asked questions about automobile insurance claims.
• It is very important to be aware of the steps to follow after a car accident in order to file police reports and when you file for insurance compensation.

• Upon death, an estate plan legally protects and distributes property based on your wishes and the needs of your family and/or survivors with as little tax as possible.
• Advance directives are written documents that tell your doctors what kind of treatment you'll want if you become unable to make medical decisions (for example, if you're in a coma).
• A living will is one type of advance directive that comes into effect when a person is terminally ill.
• A will is the most practical first step in estate planning; it makes clear how you want your property to be distributed after you die.
• An executor is the person who is responsible for settling the estate after death.
• If you are active online you should consider creating a statement of how you would like your online identity to be handled, like a social media will.
• Probate is a legal process that usually involves filing a deceased person's will with the local probate court, taking an inventory and getting appraisals of the deceased's property, paying all legal debts, and eventually distributing the remaining assets and property.
• A trust is a legal arrangement where one person (the "grantor") gives control of his property to a trust, which is administered by a "trustee" for the "beneficiary's" benefit.
• A living trust, created while you're alive, lets you control the distribution of your estate. You transfer ownership of your property and your assets into the trust.

• Stress management in the workplace is about helping employees to cope with stressors that cannot be avoided, and about reducing opportunities for employee stress wherever possible.
• Leading by contingency means learning to flexibly use the set of leadership styles, skills and tools most appropriate to the circumstances the leader encounters.
• Creative managers and employees can help their companies to overcome rigid, traditional problem solving approaches.
• Teamwork requires all team members to be committed to achieving group goals, and to share in responsibility for team successes and failures.
• As an employee who may be a minority member in an organization because of age, gender, physical challenges, lifestyle choices or being from an ethnically different group from the majority of workers, you have several responsibilities in trying to make diversity work for the organization.
• Workplace Emotional Intelligence involves learning to identify and manage emotions for both personal and organizational effectiveness.
• Managed properly, by both leaders and by employees, conflict can become a positive force and actually result in improved performance of the group.
• Critical Incident Stress is what can result when one or more people experience a critical incident and become overwhelmed by that experience.
• Coaching usually takes place for one of two different primary reasons: to correct a performance gap, or to enhance professional growth and skills development.
• The competing demands work and family can place on your time and energy may be daunting, and may reduce your effectiveness both on and off the job.
• Harassment and discrimination can cause severe personal and financial consequences for employees, and supervisors and for the entire company as a whole.
• While having people of all ages in the workplace provides a wide range of talent, knowledge and experience, it can also lead to many conflicts between employees and supervisors from different generations.

• Stress management in the workplace is about helping employees to cope with stressors that cannot be avoided, and about reducing opportunities for employee stress wherever possible.
• Leading by contingency means learning to flexibly use the set of leadership styles, skills and tools most appropriate to the circumstances the leader encounters.
• Creative managers and employees can help their companies to overcome rigid, traditional problem solving approaches.
• Teamwork requires all team members to be committed to achieving group goals, and to share in responsibility for team successes and failures.
• Employees and leadership must be culturally sensitive and appreciate cultural differences.
• Workplace Emotional Intelligence involves learning to identify and manage emotions for both personal and organizational effectiveness.
• Once you, as a supervisor, become aware of a conflict it is essential that you meet with the people and attempt to define the facts of the situation.
• Critical Incident Stress is what can result when one or more people experience a critical incident and become overwhelmed by that experience.
• One of every supervisor's most basic responsibilities is to function as a coach for their employees.
• The competing demands work and family can place on your time and energy may be daunting, and may reduce your effectiveness both on and off the job.
• Harassment and discrimination can cause severe personal and financial consequences for employees, and supervisors and for the entire company as a whole.
• As a supervisor, you have a responsibility to manage the generational differences that exist both between your different employees, and between you and your employees.

• Emotional Intelligence can be defined as your ability to use your emotions intelligently and appropriately in different situations, combined with your ability to use emotions to make yourself more intelligent overall.
• Emotionally intelligent people intentionally use their thinking and behavior to guide their emotions rather than letting their emotions dictate their thinking and behavior.
• In order to become more emotionally intelligent, it is necessary to develop the following five skill domains:
• Self-awareness - involves your ability to recognize feelings while they are happening.
• Emotional management - involves your ability to control the feelings you express so that they remain appropriate to a given situation.
• Self-motivation - involves your ability to keep your actions goal-directed even when distracted by emotions.
• Empathy - involves your ability to notice and correctly interpret the needs and wants of other people.
• Relationship Management - involves your ability to anticipate, understand, and appropriately respond to the emotions of others.

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• You can begin the process of identifying emotions by asking yourself questions that will help you understand the ways that emotion has affected you. Good questions to ask include:
• What am I feeling now?
• What are my senses telling me?
• What is it that I want?
• What judgments or conclusions have I made (and are they accurate)?
• What is this emotion trying to tell me?
• The answers to these questions are key to using your emotions to move toward your life goals, rather than allowing your emotions to use you.
• Often, your body reactions suggest important clues to what you are feeling. For example, if your face begins to get warm while you are talking with someone, you may be embarrassed; if you have "butterflies" in your stomach, you may be nervous; and if your head pounds, your heart races, and you feel increasingly tense and hot, you are probably angry.
• You can also learn to identify emotions based on the way they make you feel, think and act. For example, maybe certain memories come to the surface of your mind when you are feeling sad that aren't there at other times.
• Consciously knowing what you are feeling and why may suggest steps you can take to help you change your feelings.
• Understanding your emotions makes it possible for you to manage them so that they work for rather than against you.
• If your sadness (or anger, or anxiety, etc.) would normally influence you to act in a way that might hurt yourself or someone else, becoming aware of that emotion can enable you to take steps to not act in that destructive way.

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• Like other emotions, anger is experienced in our bodies as well as in our minds.
• Anger is a fundamental emotion that everyone experiences from time to time.
• An anger problem exists when people become dependent on anger as a primary means of expressing themselves; when they inappropriately use anger or the threat of violence as a weapon to get their way. Inappropriate and uncontrolled anger is harmful for both targets of anger and the angry person as well.
• Inappropriate anger destroys relationships, makes it difficult to hold down a job, and takes a heavy toll on angry people's physical and emotional health.
• Help for anger problems exists in the form of anger management programs which are coordinated interventions designed to help angry people learn and practice methods of bringing their anger under control.
• Learning to control your anger will be an ongoing task as you will need to rethink your automatic responses towards people.

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• We can define stress by saying that it involves the "set of emotional, physical, and cognitive (i.e., thought) reactions to a change."
• How intensely stressed we feel in response to a particular event has to do with how much we need to accomplish in order to meet the demands of that situation.
• How vulnerable you are personally to becoming stressed out depends on a variety of factors, including your biological makeup; your perception of your ability to cope with challenges; characteristics of the stressful event (e.g., the "stressor") such as it's intensity, timing, and duration; and your command of stress management skills.
• Biofeedback techniques can be used to help people gain conscious control over their bodily stress processes, and cognitive techniques can be used to help people gain conscious control over their mental stress-inducing processes.
• That your thoughts determine your mood is a good thing, because while it is difficult to alter your feelings at any given moment, it is always possible to re-evaluate and change your thoughts.
• The cognitive theory of emotion suggests that our self-talk (our "automatic thoughts" and our beliefs) is influential in determining whether we will experience eustress or distress.

• Domestic violence is a variety of abuse that occurs within the home, between family members or couples.
• Destruction of property, psychological and emotional abuse, and physical and sexual assault are all common forms.
• On the milder but still quite serious side, perpetrators of domestic violence may threaten victims or use verbal put downs and bad name, attempt to publically humiliate them, or play manipulative mind games. Abusers may be act very jealously, and work to control victims' access to family and friends or employment.
• Rape is a crime involving forced sexual activity, usually including sexual penetration, against the will of the victim.
• In addition to the financial and social adjustment difficulties that are often associated with removing one's self from an ongoing abuse situation, survivors of domestic violence or rape can develop emotional and psychological concerns that last well after the physical injuries have healed.
• No matter what type of violence you may have experienced (or are experiencing) or variety of emotional difficulty you may have incurred from such trauma, it is important that you not blame yourself for having been victimized.
• Nobody deserves to be physically, sexually, emotionally, or spiritually abused as a child or as an adult.
• Abusive people are unable or unwilling to effectively control or cope with their own impulses and to respect human dignity and rights.

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• To have a disability means that one has fundamental difficulty accomplishing things that others take for granted.
• Disabilities can be physical in nature (an inability to walk due to amputation, or muscular or neurological dysfunction, for example), sensory (as in blindness, or deafness), cognitive (as in brain damage or mental retardation), behavioral (as in an inability to work), or even emotional.
• Physical and sensory disabilities can be major impediments to participating in normal society.
• Disabilities can take a severe psychological toll. It can also easily mean being more isolated from others than one would like to be. And because people are sometimes cruel and/or clueless, disabled persons are often made to feel ?different? by others.
• Grief and loss, a sense of being ?broken? or ?useless?, and self-pity can easily cascade into a diagnosable depression or related mental disorder.
• For this reason, it is important that persons with disabilities remember to take care of their mental health needs as well as their physical ones.

• These conditions involve a person being separated from reality or feeling separate from their own body, thoughts, and behaviors. These symptoms can affect every part of their life.
• Very mild forms are common in all people. This can include the feeling of 'spacing out' for a bit. Another example would be someone having the sensation of being separate from their thoughts as though they are an alien in their body.
• More severe forms often happen after very stressful events such as war, death, abuse and other traumatic situation.
• There are three conditions in this category including:
• Dissociative Amnesia - involves a loss of memory for personal information that happens because of traumatic events.
• Depersonalization/Derealization Disorder - involves either or both of the following: 1) ongoing experiences of feeling like you are separate from your thoughts, feelings or body. You may feel emotionally or physically numb or like things that you are experiencing are not quite real/happening. 2) ongoing experiences where other people or objects around you don't feel real, seem distorted, or like they are in a dream/foggy state.
• Dissociative Identity Disorder (often called multiple personality disorder in the past) - this condition often happens after traumatic events and/or abuse occurring as a child. The child separates themselves as a way of coping with the abuse or memories of it. This causes problems with the child's developing sense of self. Instead of a single self, it causes multiple personality pieces with different memories and identities.

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• Symptoms include:
  • Either one or both of the following happens:
    • Depersonalization - ongoing experiences of feeling like you are separate from your thoughts, feelings or body. You may feel emotionally or physically numb or like things that you are experiencing are not quite real/happening.
    • Derealization - ongoing experiences where other people or objects around you don't feel real, seem distorted, or like they are in a dream/foggy state.
  • During these episodes, the person knows who they are and where they are, but things just don't feel/seem quite right.
  • these issues cause stress in the person's life or trouble at work, in relationships with others, or other daily activities.
  • these issues aren't happening because of the effects of a substance (medication or drug of abuse).
  • there isn't another medical or mental health issue that explains the symptoms.
• Occasional episodes that occur for hours or even days are fairly common in the general population. As many as 50% of all adults have experienced one of these states at least once in their life. Only about 2% meet all the criteria for this condition though.
• People that try to avoid harm and have immature defenses, like acting out and not adapting well to stress or difficult situations are at risk for this condition.
• Also, those that had trauma as a child is also at risk. This could include physical or emotional abuse or neglect, growing up with someone that is seriously ill (physically or mentally), the unexpected death of a parent or close family member, or witnessing domestic violence in the home.
• The main treatment for this condition is psychotherapy. The therapist will help the person deal with what happened and understand the causes of the condition.
• Stress management techniques will also be used to help the person handle the situation and to better cope with stressful situations that they face in the future. Once the person has learned coping skills, the therapist may then begin working with the person on the traumatic memories and experiences that came before the condition.

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• This condition happens when someone is unable to recall important information that would normally be easily recalled, which is called amnesia. This includes information like name, home address, where they work or go to school, etc. This is not just simple forgetfulness.
• This is not a common condition with only 1 or 2% of people suffering from it.
• It has been seen in children, teens and adults. It is harder for a child to have the condition because their ability to remember information is not as good as in an adult, so figuring out if the condition is really the issue can be difficult.
• Risk factors include exposure to traumatic experiences, either a single time or ongoing. This can include witnessing violence, being in a terrible accident, physical or sexual abuse, or being the victim of violence.
• This can happen with other mental health conditions, including personality disorders.
• The main treatment for this condition is psychotherapy where the therapist will help the person come to terms with what happened and understand the causes of the condition.
• Stress management techniques will also be used to help the person handle the situation and to better cope with stressful situations that they face in the future.
• Medication can be also used to treat symptoms such as anxiety, depression or trouble sleeping, but does not cure the overall condition.

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• This condition used to be called multiple personality disorder.
• Symptoms include:
  • a person's identity has two or more different personalities that exist separate from each other.
  • the person displays differences in thoughts, behaviors, personality, memory, and even different body behaviors (walking differently). This may be noticed by other people or the person may feel that someone else has taken control of their mind and body.
  • gaps in memory of day-to-day activities, personal identity information, or other important events. The different personalities often have their own names, life histories, experiences, thoughts and feelings. They may be a different gender. They may also have different medical issues. For example, one may need to wear glasses or contacts when the main person doesn't normally. They can also sound and even walk differently.
  • not being related to a cultural or religious practice.
  • not being caused by a medical condition, a substance (medication or drug of abuse) and in children, cannot be explained by an imaginary friend or other pretend play.
• This condition only happens to about 1.5% of people. It can be seen at any age, including in children and teens.
• This condition occurs after traumatic events, especially physical or sexual abuse as a child. As many of 90% of those with this condition experienced child abuse or neglect.
• The main treatment for this condition is psychotherapy where the therapist will work with the person to united the various personalities into a single personality. This new single identity may keep parts that come from the others.
• Medication can be used to treat specific symptoms. There is no medication that cures the overall condition. But usually medication is not used because of the different personality states.
• There are also self-help support groups that have formed on the internet and within larger cities/areas.

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• In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness.
• Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels, or some combination of these and other factors.
• Only when a person has had two or more seizures is he or she considered to have epilepsy.
• A measurement of electrical activity in the brain and brain scans such as magnetic resonance imaging or computed tomography are common diagnostic tests for epilepsy.
• Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques.
• While epilepsy cannot be cured, for some people the seizures can be controlled with medication, diet, devices, and/or surgery.
• Scientists are studying the underlying causes of the epilepsies in children, adults, and the elderly, as well as seizures that occur following brain trauma, stroke, and brain tumors. Ongoing research is focused on developing new model systems that can be used to more quickly screen potential new treatments for the epilepsies.

• An unpredictable disease of the central nervous system, multiple sclerosis (MS) can range from relatively benign to somewhat disabling to devastating, as communication between the brain and other parts of the body is disrupted.
• Most people experience their first symptoms of MS between the ages of 20 and 40; the initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye.
• Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance. In the worst cases, MS can produce partial or complete paralysis.
• Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations. Some may also experience pain. Speech impediments, tremors, and dizziness are other frequent complaints.
• Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked.
• Depression is another common feature of MS.

• The ultimate cause of MS is damage to myelin, nerve fibers, and neurons in the brain and spinal cord, which together make up the central nervous system (CNS).
• Evidence appears to show that MS is a disease caused by genetic vulnerabilities combined with environmental factors.
• Although there is little doubt that the immune system contributes to the brain and spinal cord tissue destruction of MS, the exact target of the immune system attacks and which immune system cells cause the destruction isn't fully understood.
• There is no single test used to diagnose MS. Doctors use a number of tests to rule out or confirm the diagnosis. There are many other disorders that can mimic MS. Some of these other disorders can be cured, while others require different treatments than those used for MS. Therefore it is very important to perform a thorough investigation before making a diagnosis.
• In addition to a complete medical history, physical examination, and a detailed neurological examination, a doctor will order an MRI scan of the head and spine to look for the characteristic lesions of MS.
• Doctors may also order evoked potential tests, which use electrodes on the skin and painless electric signals to measure how quickly and accurately the nervous system responds to stimulation. In addition, they may request a lumbar puncture (sometimes called a "spinal tap") to obtain a sample of cerebrospinal fluid.
• The course of MS is different for each individual, which makes it difficult to predict. For most people, it starts with a first attack, usually (but not always) followed by a full to almost-full recovery. Weeks, months, or even years may pass before another attack occurs, followed again by a period of relief from symptoms. This characteristic pattern is called relapsing-remitting MS.
• Primary-progressive MS is characterized by a gradual physical decline with no noticeable remissions, although there may be temporary or minor relief from symptoms.
• Secondary-progressive MS begins with a relapsing-remitting course, followed by a later primary-progressive course.

• There is still no cure for MS, but there are treatments for initial attacks, medications and therapies to improve symptoms, and recently developed drugs to slow the worsening of the disease.
• These new drugs have been shown to reduce the number and severity of relapses and to delay the long term progression of MS.
• The usual treatment for an initial MS attack is to inject high doses of a steroid drug, such as methylprednisolone, intravenously (into a vein) over the course of 3 to 5 days.
• During the past 20 years, researchers have made major breakthroughs in MS treatment due to new knowledge about the immune system and the ability to use MRI to monitor MS in patients. As a result, a number of medical therapies have been found to reduce relapses in persons with relapsing-remitting MS.
• These drugs are called disease modulating drugs.
• MS causes a variety of symptoms that can interfere with daily activities but which can usually be treated or managed to reduce their impact. Many of these issues are best treated by neurologists who have advanced training in the treatment of MS and who can prescribe specific medications to treat the problems.
• Although researchers haven't been able to identify the cause of MS with any certainty, there has been excellent progress in other areas of MS research?especially in development of new treatments to prevent exacerbations of the disease. New discoveries are constantly changing treatment options for patients.

• The health care system in the United States has been radically transformed by the advent of managed care over the past 20 years.
• Conceived as a means of cost-cutting in the face of ever-increasing healthcare expenditures, managed care has successfully shifted the balance of power within the medical field; reigning in spending excesses, lowering payments for services, and standardizing on efficient best practice care standards when possible.
• Given the changes brought by managed care, it is important for healthcare patients to become advocates for their own best treatment.
• Learning as much as possible about how the current medical decision making and reimbursement systems work can be an important beginning step towards taking better control of your own medical treatment.

• The term Retirement is typically used to describe a time in people's lives when they definitively stop working to earn a living.
• Retirement is essentially a life transition; just one of many life transitions that people must make throughout the course of their lives.
• Retirement brings about significant changes to people's identity, income and way of life.
• The reality of retirement - the loss of work identity - can come as a shock to people who have not really understand just how deeply they have become identified with their work.
• Some people find the idea of retirement to be freeing and exciting. Other people, however, find that thoughts of retirement and the end of work lead to anxiety, depression and fear.
• There are several types of retirement that may occur and each retirement type carries with it different feelings and transition experiences. These include traditional retirement, partial retirement, and forced retirement.

• While each person will experience retirement and the period of retirement transition in different ways, there are common pathways and stages that most people will typically go through.
• Robert Atchley's six stage conceptualization, as described in, "Social Forces and Aging" offers a description of these stages.
• Stage #1 - Pre-Retirement - this preliminary stage involves undertaking the planning work necessary to support make retirement a realistic possibility.
• Stage #2 - Retirement - whether a person has experienced the luxury of pre-retirement contemplation or has been forced to retire by circumstance, a day ultimately comes when it is time to leave the workplace and not return. There are three different paths or styles that people typically take as they make this transition, which include Honeymooners, Routiners, and Relaxers.
• Stage #3 - Disenchantment - a period of disenchantment with retirement tends to follow the honeymoon, routine or relaxation phases characteristic of initial retirement.
• Stage #4 - Reorientation - after a period of rest and relaxation, honeymooning or disenchantment, it is common for retirees to review their retirement expectations and goals.
• Stage #5 - Retirement Routine - if all goes well during the reorientation phase of retirement, retirees are able to establish a new and rewarding retirement routine that will help guide their daily lives for some indefinite period of time.
• Stage #6 - End of Retirement - the way many retirees see it, their retirement ends when they do, with their death. However, retirement may end prior to personal death with the onset of a new life crisis (another life transition).

• The first, and the most important retirement topic involves your finances.  If you haven't done retirement planning at an earlier age, you may find that your finances don't allow you to retire!
• The second topic to consider is your identity and how it will almost certainly change with retirement. Just as you lose your association with work when you retire, you also lose those parts of work, which supported your sense of self and lifestyle, necessitating that you form a new identity for yourself.
• The third aspect of life affected by retirement is friendships. Many friendships are forged by proximity. As people leave the workplace and/or move to a new home with the onset of retirement, existing friendships can be lost, necessitating the formation of new friendships.
• The fourth aspect of your life affected by retirement decisions involves couple relationships, and your relationships with children.
• The fifth topic to think about is the daily schedule as many people find the loss of daily structure and routine provided by the necessity of working for a living to be difficult.
• The sixth area of life affected by retirement is insurance as the majority of people with insurance coverage have it through their employer.
• Legal issues constitute a seventh aspect to consider in your retirement planning. There are multiple legal issues you should explore.
• An eighth and final topic to consider when thinking about retirement involves your living situation, which includes where you will live, the type of housing you will occupy, and the level of assistance you may require in order to manage any illnesses or disabilities which may occur.

• Identifying your new path in life will help to ease your transition. It is now time for you to make choices and decisions, and to thoughtfully consider what your new retirement life routines will look like.
• Retirees who are at a loss for what to do with their lives should think about their strengths and interest areas as they consider their options.
• There are a wide variety of paths or directions that retirees may ultimately decide upon.
• In addition to increasing time spent traveling or visiting with family (particularly with adult children and grandchildren) , or simply spent relaxing in unstructured activity, retirees may choose to go back to school, start a new career, become an active volunteer in community organizations, and immerse themselves in hobbies or recreational activities. 

• Healthy partners communicate the positive feelings of trust and affection towards each other via words and gestures in a cyclical manner that breeds more positive communication.
• Knowing more about how to communicate clearly and with sensitivity can help you to avoid problems before they start.
• Learn to recognize the types of situations that trigger your anger, and the types of characteristic angry thoughts that tend to occur to you when you are faced with those triggers.
• There are a variety of ways that people can use to help clarify the emotional situation without getting into a quarrel.
• Relationship strengthening approaches help couples to strengthen the bonds that hold them together in spite of conflicts.
• Social skills involve actual skills, knowledge and beliefs about self and the world that come together to make people better able to manage relationships.
• Learning to communicate open and freely with your significant other in a relationship is the key to a happy relationship.
• Communication Disorders are problems of childhood that affect learning, language, and/or speech.

• Caregivers can help babies to safely explore their world by attending to and fixing aspects of babies' environments that may be dangerous for them.
• By law, all fifty United States require that infants and younger children must be restrained in a crash-tested child restraint seat while riding in a motor vehicle.
• Use the safety tips in this checklist to help keep young children safe.
• Caregivers can ensure a good night's sleep for their babies and themselves by following these tips to create a safe sleeping space for infants and toddlers.
• Kitchens can easily be either the center of a rich and busy family life or a dangerous place where young children are not allowed.
• Caregivers can make sure certain safety precautions have been taken as children and families go about their daily business.
• Caregivers should follow certain safety precautions to help ensure that everyone stays happy and healthy when playing outside and on a playground.
• There are several things that caregivers can do to reduce the possibility that their children will be harmed in a fire-related situation.
• Older people are also at special risk for death and injury from fires.
• Properly installed and maintained smoke alarms will provide an early warning alarm to your household.
• It's important to follow safety tips to maintain a fire safe home this winter.
• Adults also need to be vaccinated from time to time to protect themselves against serious infectious diseases.
• Each year thousands of older men and women are disabled, sometimes permanently, by falls that result in broken bones.

• When you are faced with a situation that provokes your anger, learn to stop and reflect before responding.
• Healthy partners communicate the positive feelings of trust and affection towards each other via words and gestures in a cyclical manner that breeds more positive communication.
• Compassionate, empathetic people are able to really listen to and understand the experiences that other people describe.
• Some problems caused by a lack of knowledge or skill are purely personal in nature and can be pursued independently by way of self-study.
• Making time to engage in activities that are enjoyable, either because they are absorbing and fun, or because they are relaxing is a very important, and yet frequently overlooked component of taking good care of yourself.
• Low self-esteem keeps you from enjoying life, doing the things you want to do, and working toward personal goals.
• Though relationships are a vital and necessary part of the human condition, it is frequently quite painful to need other people.
• Stress can be defined then as the reaction we have to difficult, demanding or challenging events.
• Many of us do know that when said with conviction, including the congruence between one's words and one's nonverbal communication, a clear "No" is a vital tool for being assertive and effective across an array of work and home battlefronts.
• If you would like to quit smoking, you should plan not only the method or methods you will use to assist you in quitting, but also how you are going to change your environment and your habits to help ward off cravings.
• A reducing diet should encourage sensible weight loss, and encourage healthy eating and exercise habits both during and after 'dieting' is complete.

• One of the biggest decisions parents have to make after choosing to have a child involves deciding who will care for that child, especially during the early developmental years.
• A nanny is a professional caregiver of any age and level of experience who will work in the parent?s home to care for the child.
• Another type of childcare is to have a relative, friend, or neighbor provide care.
• The following websites may be helpful during the process of choosing childcare.

• This guide offers you a range of suggestions to make caregiving easier and more successful, whether you are a caregiver or the person who ensures that your loved one receives the best possible care from others.
• Care decisions should be based on a solid and objective-as-possible assessment of each elder's actual care needs, rather than on emotionally driven desires to be helpful or guilt feelings.
• The following steps and suggestions can help to make the process of locating and evaluating eldercare options more manageable.
• Several kinds of services are available for caregivers of individuals with dementia.

• Healthcare includes areas such as health insurance, mental health advocacy, the mental health professions (psychiatry, psychology, social work, etc.), and various treatments and interventions (e.g., medications and psychotherapy).
• It is important to know as much about how the healthcare system works as possible if one is to get the best possible care for one?s self.
• Choosing a doctor is one of the most important decisions anyone can make and the best time to make that decision is while you are still healthy and have time to really think about all your choices.
• Deciding to have surgery can be difficult, but an informed decision may be easier to make once you know why surgery is necessary and whether there are other treatment choices.

• Memory problems are common and everyone's memory can fail them at one time or another.
• Memory occurs in the brain, but it is not limited by the brain. Many things around us influence our ability to make and retrieve memories.
• Through practice of mental and other activities, a variety of efforts can be made to lessen memory problems.
• In many cases, memory loss is just a normal part of the aging process, a side effect of medication or a symptom of a treatable disease.
• The term dementia describes a group of symptoms that are caused by changes in brain function.
• Damage to any part of the brain can cause a cognitive disorder, which is a "catch all" term used to describe impairment in any one (or all) of the thinking skills.

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• Tic Disorders are a type of Neurodevelopmental Disorders. Neurodevelopmental means that symptoms affect the body's nervous system.
• Tic disorders are a result of problems with the body's nerves which transmit signals to and from the brain.
• Typically, these disorders begin in early childhood (between ages 4 and 6 years of age) and affect the child's social, academic or occupational functioning in some way.
• All of the Tic Disorders share a common characteristic of having vocal or motor (physical) tics, which are sudden, rapid, recurring body movements or vocalizations (noises, words or phrases).
• Tic Disorders are diagnosed by the type of tics that are present and how long they have been present. These include:
  • Tourette's Disorder, (commonly referred to as Tourette's Syndrome) - includes multiple motor and one or more vocal tics that have been present for more than one year.
  • Persistent (Chronic) Motor or Vocal Tic Disorder - involves single or multiple motor tics or vocal tics that have been present for more than one year.
  • Provisional Tic Disorder - when single or multiple motor and/or vocal tics that have been present for less than one year.
  • Other Specified Tic Disorder - when symptoms are like those of a tic disorder and cause significant distress or impairment in social, occupational or other functioning, but do not meet the full criteria for any of the 3 disorders above. This category is used when the clinician specifies the reason that criteria are not met, such as "with onset after age 18 years."
  • Unspecified Tic Disorder - when symptoms are like those of a tic disorder and cause significant distress or impairment in social, occupational or other functioning, but do not meet the full criteria for any of the 3 disorders above. This category is used when the clinician chooses not to specify the reason that criteria are not met or when there is not enough information to make a more specific diagnosis.

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• Tourette's Disorder is more commonly referred to as Tourette's Syndrome. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition.
• The symptoms of this disorder include:
• both multiple motor (body) and one or more vocal tics that have been present at some point during the illness
• the tics may come and go, but have been experienced for more than one year since the first tic occurred
• the condition first appears while the person is under 18 years of age
• the symptoms are not the result of effects on the body from a substance (such as cocaine) or another medical condition
• It is estimated that 3 to 8 per 1,000 school-aged children have Tourette's disorder. Typically, it occurs more often in male children than females (from 2-4 times more likely).
• Research has found risk factors for this disorder that influence the tics being present and also cause them to be more severe. These include genetic factors, complications during pregnancy, older paternal (father's) age, lower birth weight, and a mother smoking during pregnancy.
• Because tic symptoms do not often cause the person's health to be worse or stop them from living their daily lives, most people will not need medication to stop the tics.
• There are also behavioral approaches that have been used, but none of these methods have been thoroughly tested and are not considered proven approaches for treating Tic Disorders at this time.

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• The symptoms of this disorder include:
• single or multiple motor or vocal tics that have been present at some point during the illness, but not both motor and vocal tics.
• the tics may come and go, but have been experienced for more than one year since the first tic occurred
• the condition first appears while the person is under 18 years of age
• the symptoms are not the result of effects on the body from a substance (such as cocaine) or another medical condition
• the criteria for Tourette's Disorder have not been met.
• Clinicians will also specify if the condition is:
  • With motor tics only
  • With vocal tics only
• Tic disorders are common in childhood, but are typically temporary. They generally occur more often in male children than female children (from 2-4 times more likely).
• Research has found risk factors for this disorder that influence the tics being present and also cause them to be more severe. These include genetic factors, complications during pregnancy, older paternal (father's) age, lower birth weight, and a mother smoking during pregnancy.
• Because tic symptoms do not often cause the person's health to be worse or stop them from living their daily lives, most people will not need medication to stop the tics.
• There are also behavioral approaches that have been used, but none of these methods have been thoroughly tested and are not considered proven approaches for treating Tic Disorders at this time.

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• The symptoms of this disorder include:
  • single or multiple motor and/or vocal tics
  • the tics have been present for less than one year since the first tic occurred
  • the condition first appears while the person is under 18 years of age
  • the symptoms are not the result of effects on the body from a substance (such as cocaine) or another medical condition
  • criteria for Tourette's Disorder or persistent (chronic) motor or vocal tic disorder have never been met.
• Tic disorders are common in childhood, but are typically temporary. They generally occur more often in male children than female children (from 2-4 times more likely).
• Research has found risk factors for this disorder that influence the tics being present and also cause them to be more severe. These include genetic factors, complications during pregnancy, older paternal (father's) age, lower birth weight, and a mother smoking during pregnancy.
• Because tic symptoms do not often cause the person's health to be worse or stop them from living their daily lives, most people will not need medication to stop the tics.
• There are also behavioral approaches that have been used, but none of these methods have been thoroughly tested and are not considered proven approaches for treating Tic Disorders at this time.

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• All Sleep Disorders involve daytime stress and trouble with work, school or daily activities because of sleep problems during the night.
• People with a sleep disorder often have depression, anxiety, trouble thinking, remembering or learning information that need to be treated along with the particular sleep problem.
• Ongoing sleep issues like insomnia (trouble falling asleep) or excessive (too much) sleeping can lead to other mental health problems, so getting help is important if you suffer from these conditions.
• There are 10 Sleep Disorders:
• Insomnia Disorder - having trouble falling asleep, staying asleep, or going back to sleep after waking up.
• Hypersomnolence Disorder - being really sleepy even though you slept at least 7 hours at a time
• Narcolepsy - being unable to resist going to sleep or taking a nap
• Breathing-Related Sleep Disorders - this includes 3 issues:
• Obstructive Sleep Apnea Hypopnea - the person takes involuntary pauses in breathing during sleep where air cannot flow in or out of their nose or mouth. This causes them to be very tired during the day.
• Central Sleep Apnea - when the brain doesn't send the right signals to start the breathing muscles during sleep, which causes the person to temporarily stop breathing.
• Sleep-Related Hypoventilation - the person has decreased breathing and leads to an increase in blood carbon dioxide (CO2) levels.
• Circadian Rhythm Sleep Disorder - disruptions in a person's cycle of sleeping and being awake. This often happens because of a work schedule (for example, working overnight and sleeping during the day) that results in being very tired and sleeping a lot, having trouble going to or staying asleep (insomnia) or both.
• Non-Rapid Eye Movement (NREM) Sleep Arousal Disorders - the person has either Sleepwalking or Sleep Terrors while sleeping.
• Nightmare Disorder - repeated and long dreams that usually involve trying to avoid threats to survival or physical safety.
• Rapid Eye Movement (REM) Sleep Behavior Disorder - repeated episodes of vocalization (loud talking, yelling or screaming) and/or complex motor behaviors (kicking, punching, jumping out of bed, etc.) while asleep.
• Restless Legs Syndrome - an urge to move the legs during rest or inactivity due to uncomfortable or unpleasant sensations in the legs (a "pins and needles" type of feeling or crawling, tingling, burning or itching sensations).
• Substance/Medication-Induced Sleep Disorder - severe problems with sleep that started during or soon after using too much of a substance or while trying to stop using it. This could include alcohol, caffeine, sedatives, opioids, stimulants, cocaine, tobacco, or other medications.

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• Follow a regular schedule - go to sleep and get up at the same time. Try not to nap too much during the day - you might be less sleepy at night.
• Try to exercise at regular times each day.
• Try to get some natural light in the afternoon each day.
• Be careful about what you eat. Don't drink beverages with caffeine late in the day. Caffeine is a stimulant and can keep you awake. Also, if you like a snack before bed, a warm beverage and a few crackers may help.
• Don't drink alcohol or smoke cigarettes to help you sleep. Even small amounts of alcohol can make it harder to stay asleep. Smoking is dangerous for many reasons including the hazard of falling asleep with a lit cigarette. The nicotine in cigarettes is also a stimulant.
• Create a safe and comfortable place to sleep. Make sure there are locks on all doors and smoke alarms on each floor. A lamp that's easy to turn on and a phone by your bed may be helpful. The room should be dark, well ventilated, and as quiet as possible.
• Develop a bedtime routine. Do the same things each night to tell your body that it's time to wind down. Some people watch the evening news, read a book, or soak in a warm bath.
• Use your bedroom only for sleeping. After turning off the light, give yourself about 15 minutes to fall asleep. If you are still awake and not drowsy, get out of bed. When you get sleepy, go back to bed.
• Try not to worry about your sleep. Some people find that playing mental games is helpful. For example, think black - a black cat on a black velvet pillow on a black corduroy sofa, etc.; or tell yourself it's 5 minutes before you have to get up and you're just trying to get a few extra winks.

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Speech problems are known as Communication Disorders. Speech problems are often caused by problems with the body's nervous system. The problems between the brain and the nervous system affect the use of language, speech or communication.

• Language is the words people speak, the signs they make, the words they write or pictures they use to share their thoughts and feelings with each other. These forms each have rules that allow people to share information in a way that makes sense to others that know that language. Language includes:
• What words mean (for example, friend is someone you get along with and are close to, and enemy is the opposite)
• How to make new words using different endings and beginnings (for example - help, helpful, unhelpful)
• How to put words together in the right order (for example, "Alex played a new game yesterday" not "Alex play game new yesterday)
• Speech is how a person makes the sounds that form words said out loud. This involves:
  • Learning to make the sounds of each letter. For example, children have to learn how to make the "r" sound (often a tricky one) so that they can say "rock" instead of "wock").
  • How to use your vocal cords and breath to make sounds
  • the correct rhythm of speech so that you don't pause or stutter in between or while saying words.
• Communication is the use of language and speech to share thoughts, ideas or feelings with someone else. Examples include:
  • someone speaking English or Spanish or using sign language to ask someone for directions
  • writing a letter to a family member or friend to discuss plans for something they are doing together
  • posting on the Internet to talk to friends about a hobby or interest that you all share.

Disorders in this category include:

• Language Disorder - involves problems with understanding or with putting words together to make sentences that share thoughts.
• Speech Sound Disorder - involves trouble making the sounds needed to speak to others.
• Childhood-Onset Fluency Disorder (better known as Stuttering) - involves problems in the timing of words that are said.
• Social (Pragmatic) Communication Disorder - involves problems communicating with others. This might include not knowing how to greet others or talk to them, not taking turns when talking to someone, or not asking questions to understand what someone has said.
• Unspecified Communication Disorders - the person has speech issues that cause them stress or that cause issues in school, work or relationships with others. But, their problems don't completely match any of the four speech and language disorders.

• Symptoms of this disorder include:
• ongoing trouble in learning or using language including speaking, writing or sign language. The person has trouble understanding what others say or in communicating with them. This includes:
• knowing words and how to use them - the child doesn't start first talking when expected or doesn't know as many words as they should for their age.
• trouble putting words together into sentences that follow rules - the child's sentences are shorter and have grammar issues, such as the wrong tense of a verb. For example, "I goed to the store" instead of "I went to the store.")
• problems in using words and sentences to say something or talk with someone else. Examples include trouble remembering words or numbers and then using "um" or "uh" while talking to cover it up. The child might have trouble telling a story that makes sense because they leave out, mix up or use the wrong words.
• the child may have problems with talking to others, understanding what others are telling them, or both.
• the child's language skills are a lot lower than what would be expected for their age and cause problems at school or in talking with others.
• the symptoms first showed up when the child was 2 to 4 years-old.
• the problems aren't because of hearing problems, intellectual disabilities, or other medical or brain conditions.
• Up to 1 out of every 20 children has symptoms of a language disorder.
• Those with a family member that have the disorder are much more likely to have it as well.
• If a parent is worried about how a child's talks, they should start with the child's doctor first. The doctor may suggest that the family talk to a person who is trained to test and treat people with speech or language disorders (a speech-language pathologist).

• Symptoms of this disorder include:
  • ongoing problems with being able to correctly make speech sounds (saying words correctly). These problems make it hard for others to understand them or stop them from being able to accurately share their thoughts.
  • these issues cause problems in school, in talking with others, or both.
  • the symptoms first showed up when the child was 2 to 4 years-old
  • the problems aren't because of conditions that have existed since they were born (congenital) or ones that they got after birth (acquired conditions), such as cerebral palsy, deafness or hearing loss, traumatic brain injury, or other medical or neurological (brain) conditions.
• By the time a child is 3 years old, most will be able to understood by others, even though some words may not be said correctly yet. By age 8, most will be able to say the harder sounds including l, r, s, z, th, ch, dzh, and zh. If a child is having trouble with more than one of these sounds, then they may be diagnosed with Speech Sound Disorder.
• With the assistance of speech therapy, most children will be able to overcome the issues and will not have the problems for their whole lives.
• If a parent is worried about how a child's talks, they should start with the child's doctor first. The doctor may suggest that the family talk to a person who is trained to test and treat people with speech or language disorders (a speech-language pathologist).

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• Symptoms of this disorder include:
• problems in the timing patterns of saying words that would not be expected based on the child's age. These issues continue over time and are characterized by:
• sound and syllable repetitions (the person sounds like they got stuck on a word or part of a word and are repeating it over and over such as "W-W-W-W-Where are we going today?")
• making consonants or vowels in words longer than they should be (saying "ssssstop" instead of "stop" with firm/single "s" at the beginning)
• broken words (pauses within a single word such as "st---op")
• using other words to avoid using one that they have trouble saying or inserting words like "um" or "uh" into the sentence in order to try to make the delay between words less noticeable.
• repeating single syllable whole words (for example, "I-I-I-I-I want to go to the store.")
• these issues cause problems in school, in talking with others, or both.
• the symptoms first showed up when the child was 2 to 4 years-old
• the problems are happening because of speech-motor disorder, conditions that affected the person's brain, such as a stroke, tumor or trauma, or any other medical condition.
• 80-90% of children that have problems with stuttering will have issues by the time they are 6 years old. The problems usually start between ages 2 and 7.
• Research has found that 65-85% of children who have stuttering problems can overcome the issue. If the child is still showing severe symptoms at about age 8, then problems could continue when they are a teen or adult.
• If a child has a parent, brother or sister with the disorder, they are 3 times more likely to have issues than other children.
• If a parent is worried about how a child's stuttering, they should start with the child's doctor first. The doctor may suggest that the family talk to a person who is trained to test and treat people with speech or language disorders (a speech-language pathologist).

• Symptoms of this disorder include:
• ongoing problems in the using verbal and nonverbal communication (words and actions) in social ways with others including:
• problems in greeting others (not knowing to wave to them to say hello or goodbye, pointing to others, etc.)
• having trouble adjusting how you talk to different people. For example, knowing that you should talk in a more formal way in a classroom to your teacher compared to outside on the playground with a friend.
• having problems following accepted rules for conversations like taking turns when talking or asking questions if you don't know what someone is trying to say.
• problems drawing conclusions from what someone said (understanding things that they don't actually say)
• not understanding with more descriptive phrases. For example, not knowing that someone saying "he is the apple of my eye" really means "he is special to me" or your friend saying "a penny for your thoughts" means she is asking what you are thinking.
• these issues cause problems in school, in talking with others, or both.
• the symptoms first showed up when the child was 2 to 4 years-old, but the problems may not become noticeable until later on when talking to others requires more advanced speaking skills.
• the problems are not happening because of another condition such as autism spectrum disorder, intellectual disabilities, global developmental delay, or any other medical or brain condition.
• By the time a child is 4 or 5 years old, they should be able to have conversations with other people. If they are having problems at this time, then they may be diagnosed with Social (Pragmatic) Communication Disorder.
• Some children with the condition are able to improve their communication skills, but others may continue to have issues as an adult. Those that do improve may still have some issues in relationships with others or with learning related skills, such as writing down their thoughts.
• Children with this disorder often also have autism spectrum disorder, specific learning disorder, and other communication disorders.
• If a parent is worried about how a child's talks, they should start with the child's doctor first. The doctor may suggest that the family talk to a person who is trained to test and treat people with speech or language disorders (a speech-language pathologist).

• You can retire at any age provided that you have saved enough money to sustain you for the remainder of your life.
• The good thing about saving and investing for retirement is that the earlier you begin saving and investing the more money you will have when you retire.
• The longer you actually live, the more money you will need to have available to you during retirement.
• Planning for health care needs during retirement is another important retirement consideration that is easy to miss when planning takes place during the prime of your life.
• It is not enough to simply save money for your retirement. You will likely need to invest it in tax-sheltered retirement accounts so as to take maximum advantage of compounding interest over time.
• 401(k) plans are employer sponsored retirement savings accounts that can be the primary vehicle for your retirement planning.
• The Roth IRA is very similar to the Traditional IRA except that the way taxes work with regard to the account is different.
• It is important to learn the facts about retirement plans including withdrawals, distributions, beneficiaries, and rollovers.
• If you have access to multiple retirement savings programs, it is in your best interest to fund them all, and as fully as you can afford.
• Periodically checking your estimated Social Security benefits helps you plan for retirement and allows you to check for and correct errors. 
• Making decisions and arrangements before they are needed simplifies caring for an older person or planning for your own old age.

• Make study a priority. You only have so much energy, and if you leave study for the last thing you do you will not have energy for it. Study during your "prime time" hours, when you are still energetic enough to engage. Do not study when you are tired or fatigued.
• Quiet your mind before you begin a period of study. Do what you can to put your other concerns and worries down for a time and allow yourself to focus exclusively on the material you need to learn.
• Schedule frequent and regular periods of study; every day if possible and roughly at the same time of day. It is better to study a little bit every day than a whole lot once per week. Studying frequently keeps material fresh in your mind and helps you to organize it. Scheduling your study period at a regular time helps you to make it a priority.
• Make notes as you listen to lectures or read. When you are done reading, take your notes and then re-write them so that they make more sense and restate what you've learned. It is a real "pain-in-the-butt" to do this rewriting, but it truly helps you retain and organize what you are learning. The more you "process" and organize the material you're learning, the more completely you will learn it.
• Work out the steps to any problems you need to calculate or reason through in order to solve. Most textbooks show only partial solutions to problems. If you accept what they offer you, you will have memorized the solution, but not understood why and how it works. Instead, work through the steps until they make sense to you. If they don\'t make sense to you despite your efforts, seek the aid of a more experienced student or teacher who can help you see what you are missing.
• Where and when you don't understand things, ask questions until you do.
• Don't allow yourself to procrastinate. Do your homework in advance of when it is due. Start papers and other assignments in advance of when they are due, especially when they aren't due for some time.
• If your teacher is a poor communicator, either fire your teacher and find a new one who is a better communicator, or hire some other teacher on the side to help you comprehend what you are learning.

• You will want to attend a school that has a good ranking and reputation within the field you are interested in pursuing.
• Don't assume that it is necessary or even wise to attend the "very best" school in order to secure your future. Well regarded schools that aren't at the very top of the heap are often the best values.
• Most students have to take out loans to pay for their education, which then have to be paid back. So, when you are considering the field you will choose and what school you will attend, be mindful of how the career and the school you choose will affect your ability to repay your loans.
• You can get information about financing your education from the schools and most universities will have a dedicated financial aid department.
• Once you have been admitted to your chosen school, the school will generate a financial aid package and send you an award letter, which will let you know how much financial aid is available for you at your chosen school.
• This aid may consist of loans, scholarships, grants, work-study, and other sources of funding.
• Students can also participate in other programs to secure funding, such as AmeriCorps, Learn and Serve America (Corporation for National Service), Military Service, and PeaceCorps. These are community service programs that allow students to give of their time in order to earn funding for higher education.
• If community service is not an option, parents may also get education loans.
• In addition to traditional funding sources, students may also seek corporate funding. Many companies and associations offer scholarships.

• First and foremost, credit cannot be repaired quickly.
• Unless there have been errors in reporting (which can typically be corrected within 60-90 days by alerting your bank and the credit reporting agencies), you will have to give yourself the necessary time (months or years in some cases) to fix any issues in your credit history.
• As a starting place, you will need to get a copy of your report to verify that all the information in it is accurate.
• Legislation entitles you to get one free credit report annually from each reporting agency.
• If you find incorrect information in your credit reports, notify the credit bureaus in writing with copies of any documentation you have that supports your claim.
• You should also contact the creditor associated with the mistaken information and ask them to notify the credit reporting company of the error.
• If the creditor asserts that the information it reported is correct, you can request that the matter be investigated again.
• Give yourself time - 6 months to a year or more - to improve your rating before you apply for credit.
• Address any delinquent (late, unpaid) accounts first. Get them current or make payment arrangements with your creditors so that you can get on the road to being current.

• Credit cards are the easiest form of credit to get.
• A credit card is a plastic card, issued by a financial institution, that allows you to make purchases or to get cash from ATMs.
• Credit cards are called revolving lines of credit because the balance fluctuates (up or down) according to how much you borrow, how much you pay, and how much interest is assessed each month, and because there is not a set number of payments to satisfy the debt.
• Lenders assess your creditworthiness largely on your past credit history.
• Credit card companies make their money by charging interest on the amount of money that you borrow at any given time, and by charging annual fees for the use of their credit card.
• Shop for a credit card by reviewing the key credit terms in each offer.
• Besides allowing cardholders to stretch payments for goods and service out over time, credit cards offer other advantages to consumers, including purchase and fraud protections and travel insurance.
• There are some important do's and don'ts that will help you maintain a good credit experience.
• Know your rights and obligations if you discover an error on your credit or debit card statement.
• It is key to learn how to limit your liability for unauthorized credit or debitcard charges.

• It's important to take steps to protect yourself, otherwise thieves can steal critical information about your name, address, telephone number, bank account or credit card numbers, and -- most dangerous -- Social Security number.
• If your identity is stolen, you could spend months or even years cleaning up the mess.
• Ensure that your personal information is safely secured, especially if you have roommates or employ outside help.
• At work, verify that your personnel records are maintained securely and that sensitive records are shredded during disposal.
• Keep your wallet (and your purse) in a safe place at work.
• When you are out in public, carry your wallet on your person at all times.
• Keep your Social Security card in a secure location, and give SSNs out only when absolutely required.
• Place passwords on your credit cards, bank, and telephone accounts and use passwords that are not easily guessed or found.
• If you get notice from a company that it had a data breach that may have affected your records, contact the company directly using contact information in your existing records to confirm that the letter was for real.
• Follow a checklist of the steps you need to take if you suspect your identity has been stolen.

• Prior to the release of the DSM-5, these disorders were called Somatoform Disorders and also commonly known as Conversion Disorders. They included Conversion Disorder, Hypochondriasis, and Somatization Disorder.
• Those with one of these conditions generally have bodily or physical symptoms, not mental health ones. They usually see a medical doctor first for treatment.
• This category now includes 5 major disorders including Somatic Symptom Disorder, Illness Anxiety Disorder, Conversion Disorder, Psychological Factors Affecting Other Medical Conditions, and Factitious Disorder. There is also a disorder called Other Specified Somatic Symptom and Related Disorder (for people that have some of the symptoms of the other disorders, but don't technically meet the criteria for any of them in full.)
• Those with these disorders aren't diagnosed by the symptoms that they are having. Instead, it is by the way that they are showing those symptoms and how they explain them.
• People used to think that someone with one of these disorders wasn't having "real" physical symptoms and that it was "all in their head."
• In all of the conditions, except Factitious Disorder, people are not faking their symptoms.
• It is not all in their head. The symptoms are causing a lot of stress and problems in their daily lives.

For more information

• Somatic Symptom Disorder is diagnosed when the following symptoms are ongoing and typically last more than 6 months: A - One or more somatic (bodily/physical) symptoms are distressing or result in significant disruption of daily life. These symptoms are either not related to any medical condition or if they are symptoms that could be expected, they are much worse than would normally be present in that condition. B - Excessive thoughts, feelings, or behaviors are related to the physical symptoms and include one of the following: 1) Excessive, unreasonable and ongoing thoughts about how serious the symptoms are; 2) Ongoing high levels of anxiety about personal health or symptoms; 3) Excessive time and energy spent focusing on health and symptoms.
• This condition can be diagnosed as "Somatic Symptom Disorder with predominant pain". This was previously known as pain disorder and this description is used when the physical symptoms are primarily involving pain in the body.
• The exact prevalence rate is not known, but is estimated to be in the range of 5-7% of the adult population.
• One of the highest risk factors is if the person has high levels of worry, anxiety, loneliness, or depression about life and the world around them.
• This condition commonly happens with depression or anxiety.  It can also happen with medical conditions that may be related to the symptoms, but aren't enough to cause how severe the symptoms being reported are.
• Having a doctor that the person trusts and can communicate with is very important for treatment.  The goal will be to improve daily living and functioning, not necessarily about managing the physical symptoms.

For more information

• The symptoms of this disorder include:
  • being preoccupied with having or getting a serious illness.
  • bodily symptoms are not present or, if present, are very mild.
  • the person having a high level of anxiety about health and being easily alarmed about the status of his/her health or illness in general.
  • performing excessive health-related behaviors, such as checking their body for signs of illness, constantly going to the doctor's office or requesting tests/procedures be done (known as the care-seeking type of illness anxiety disorder). Or the person may be avoiding health-related circumstances, such as not ever going to see the doctor or not entering a hospital, even though the person believes they have a serious medical condition (the care-avoidant type of illness anxiety disorder).
  • the obsession with illness has been present for at least 6 months. The illness the person is worrying about may change over that period, but the worry about illness in general has been present for at least that long.
• Current statistics are based on past estimates of hypochondriasis and are believed to be in the range of 1.3 to 10%.
• This condition can sometimes happen after a stressful event in a person's life.  It can also happen after the person has been ill with a mild or non-life threatening illness.  Childhood abuse or having a serious illness as a child may also be a risk for developing this condition.
• Having a doctor that the person trusts and can communicate with is very important for treatment.  The goal will be to improve daily living and functioning, and to reduce the level of worry and anxiety being experienced.

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• This condition is also called Functional Neurological Symptom Disorder.  It involves having physical symptoms that appear after stress or a traumatic event has taken place.
• The symptoms of this disorder include:
• one or more symptoms involving motor or sensory functions. These may include problems such as weakness or paralysis; tremors or seizures; loss of balance or walking oddly; having trouble swallowing; and being unresponsive, among many others.
• the symptoms being displayed could not be caused by a medical condition that the person has
• the symptoms or problems also can't be explained by any other medical condition
• the symptoms are causing significant distress or impairment in the person's social, occupational, or other areas of daily functioning.
• According to the DSM-5, persistent conversion disorder is found in 2 to 5 people out of 100,000 per year.
• Risk factors can include the person's general temperament or personality, as well as history of child abuse or neglect.  Having stressful life events happen or having a brain disease that causes similar symptoms can also be a risk.  For example, a person with epilepsy may then have non-epilepsy related seizures after a traumatic event has happened.
• Anxiety disorders, especially panic disorder, and depression are both common.
• Symptoms of conversion disorder often go away on their own.  If they don't, physical therapy can be used for symptoms such as having trouble walking or muscle weakness.
• Psychotherapy can be very helpful in order to look at and change the thoughts that may be affecting the person.  It can also reduce the levels of worry and anxiety, as well as any depression that the person may be having.
• Stress management techniques can be used to help deal with and treat the stress that may have caused the symptoms.

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• The symptoms of this disorder include:
• having a medical symptom or condition, other than a mental disorder
• having psychological or behavioral factors that negatively affect the medical condition - either by:
• making it worse or stopping recovery
• affecting the treatment of the condition
• having stress or showing unhealthy behaviors. This could include saying symptoms aren't happening or not doing what the doctor tells you to do.
• There is not currently clear research data on how common this disorder is. According to some insurance data, it appears to be more common than somatic symptom disorder. The disorder can occur at any age, including in children and the elderly.
• Treatment includes the person learning about the effects of their thoughts and behaviors on their medical condition.  It also includes psychotherapy to help the person deal with their condition and to follow treatment recommendations for the medical condition.

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• This condition used to be called Munchausen syndrome.  Symptoms include:
• pretending to have physical or psychological symptoms; causing the injury or disease yourself, or describing actually present symptoms as much, much worse than they really are
• telling other people that you are ill, impaired or injured when this is not the case
• there are no obvious external reasons for this lying or self-injury behavior
• the faking behavior is not better explained by another mental disorder
• The condition can be a single episode or can be ongoing.
• The condition can also be diagnosed as Factitious Disorder Imposed on Another.  This used to be called Factitious Disorder by Proxy).  In this situation, a person lies about illness or injury in another person.  For example, a parent might say their child is sick, or an adult child might lie about their elderly parent.
• Estimates are that 1% of those in the hospital may have this disorder.
• Treatment does not focus on the symptoms that the person says they have.  These symptoms are either not really there at all or are mild ones that don't require treatment.
• Instead psychotherapy, especially cognitive-behavioral therapy (CBT), is used to help the person look at and change the thoughts that may be leading to the deceptive and faking behavior.

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• Prior to the 2013 edition of the DSM, there were 3 separate disorders including Reading Disorder, Mathematics Disorder, and Disorder of Written Expression.
• Now, there is a single disorder, Specific Learning Disorder, which has multiple academic areas (reading, written expression, and mathematics) and then skills within each of those areas that can be impaired.
• There are also 3 levels of severity that can be diagnosed which guide the amount of assistance that will be needed to allow the student to compensate or function well within that area.
• It is important to remember that, regardless of the name of the learning disorder, it is a true clinical disorder that is likely founded in abnormal brain development.
• Special assistance and learning programs are often available through schools (both public and private) for students with learning disabilities.

For more information

• Specific Learning Disorder is diagnosed when there are difficulties learning and using academics skills for at least 6 months in one or more of the following areas:
• Inaccurate or slow word reading
• Difficulty understanding the meaning of what is read
• Difficulties with spelling
• Difficulties with written expression
• Difficulties mastering number sense, number facts or calculation
• Difficulties with mathematical reasoning
• In addition to one or more on the above areas being affected, a few other items are required for a diagnosis including:
• The affected skills must be substantially below those expected for the child\'s age.
• The issues need to cause significant problems with academic performance.
• The problems begin during the school-age years, but may not become fully noticeable until academic demands become high, such as taking timed tests, completing long reports that have short deadlines, or very heavy homework levels.
• The learning disabilities are not the result of other issues, such as intellectual disabilities, uncorrected visual or hearing problems, other mental or neurological disorders, or inadequate teaching in those academic areas.
• The academic areas and subskills that can be diagnosed as impaired include:
• Impairment in Reading - word reading accuracy; reading rate or fluency; reading comprehension.
• Impairment in Written Expression - spelling accuracy; grammar and punctuation accuracy; clarity or organization of written expression
• Impairment in Mathematics - number sense; memorization of arithmetic facts; accurate or fluent calculation; accurate math reasoning

For more information

• According to the DSM-5, the diagnosis of specific learning disorder generally occurs in elementary school as children are required to begin learning reading, writing and math skills.
• However, there can be signs that appear prior to that time.
• For example, preschool children may not show an interest in learning rhymes or playing games that involve repetition. They may also continue to use \"baby talk\" or have trouble identifying letters of the alphabet including those in their own name.
• Elementary school children typically display problems with spelling, reading aloud, and reading single syllable words.
• In math areas, they may have problems learning basic math facts and procedures for adding and subtracting.
• As they progress into middle school, problems with reading or math comprehension can begin to appear.
• Adolescents may continue to show these problems around comprehension, spelling and grammar rules, and be unable to master math facts.

For more information

• According to the DSM-5, "the prevalence of specific learning disorder across the academic domains of reading, writing, and mathematics is 5-15% among school-age children across different languages and cultures. Prevalence in adults is unknown, but appears to be approximately 4%."
• There are both environmental and genetic factors that have been identified for the development of specific learning disorder.
• Environmental factors include premature delivery, very low birth weight, and exposure to nicotine/smoking during prenatal development.
• Resesrch has found that a genetic component to specific learning disorder in that it tends to occur in families.
• The DSM-5 states that the risk of developing specific learning disorder in reading is 4-8 times higher and 5-10 times higher in math for those that have a first degree relative that has the disorder (parent or sibling).
• Parents who have literacy problems or dyslexia are much more likely to have a child that has similar problems, which seems to indicate a combination of environmental and genetic factors.
• Specific learning disorder has been found to commonly exist with several other disorders and conditions including ADHD, Communication Disorders, Developmental Coordination Disorder, Autism Spectrum Disorder, Anxiety Disorders, and Depressive and Bipolar Disorders.

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• People with learning disabilities and disorders can learn strategies for coping with their disabilities.
• If learning disabilities remain untreated, a child may begin to feel frustrated with schoolwork, which can lead to low self-esteem, depression, and other problems.
• Children diagnosed with learning and other disabilities in most states, territories and provinces can generally qualify for special educational services.
• For children that have specific language disorder with impairment in reading, interventions can include special teaching techniques, classroom modifications, and use of technology.
• For children that have specific language disorder with impairment in written expression, interventions can include special tools, use of technology, and other ways of reducing the need for writing.
• For children that have specific language disorder with impairment in mathmatics, interventions can include visual techniques, use of memory aids, and use of computers.
• A child with specific learning disorder may struggle with low self-esteem, frustration, and other problems. Mental health professionals, including school counselors or psychologists, can help the child understand these feelings, develop coping tools, and build healthy relationships.

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The 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders includes a category for Disruptive, Impulse-Control, and Conduct Disorders.

All of the disorders in this category involve problems controlling behavior and emotions. The disorders are typically seen in childhood or adolescence and are rarely first seen in adulthood.

The DSM-5 lists the following impulse control disorders:

• Intermittent Explosive Disorder (characterized by uncontrolled fits of extreme anger and violence)
• Pyromania (characterized by irresistible urges to set fires)
• Kleptomania (characterized by irresistible urges to steal various items from stores and homes)
• Conduct Disorder (characterized by repetitive and persistent behaviors that violate the basic rights of other people or that violate age-appropriate societal rules)

Several disorders were previously listed in this category, but have now been moved to other sections. These include:

• Exhibitionism (characterized by recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one's genitals to an unsuspecting stranger)
• Pathological Gambling (characterized by compulsive, uncontrollable gambling)
• Trichotillomania (characterized by uncontrollable hair twisting and pulling, often resulting in bald spots on an otherwise normal-haired person)

For more information 

• Intermittent Explosive Disorder is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
• The major symptom of this disorder can be either one of the following:
• Recurring behavioral outbursts or aggressive impulses that the person is not able to control. This can be verbal aggression (temper tantrums, verbal arguments, name-calling, etc.) or physical aggression toward people, animals, or property. The physical aggression does not result in damage to the property or physical injury to other people or animals. These outbursts must occur at least twice a week, on average, for at least 3 months in order for a diagnosis to be made.
• Three behavioral outbursts in a 12-month period that involve damage to property and/or causes physical injury to other people or animals.
• These outbursts are not planned or thought about ahead of time and are not designed to intimidate or get something from others. In the heat of the moment, the person is completely unable to control their angry or aggressive impulses and react toward others because of these feelings.
• The outbursts also cause either distress in the individual or impairment in their relationships with others, problems at school or work, and are typically associated with financial or legal consequences.
• The person must be at least 6 years old (or at an equivalent developmental level) in order to receive a diagnosis of Intermittent Explosive Disorder.
• According to research, approximately 2.7% of the United States population meets the criteria for this disorder. It is typically more common in younger individuals and in those with a high school education or less.
• Onset for the disorder is generally in late childhood or adolescence and is rarely seen for the first time in those over 40 years of age.
• Disorders that are most commonly seen with Intermittent Explosive Disorder include depressive disorders, anxiety disorders, substance use disorders, antisocial personality disorder, borderline personality disorder, and other disruptive behavior disorders (ADHD, conduct disorder, oppositional defiant disorder).
• There are two main treatments for this disorder, which are psychotherapy and medication.

For more information

• Pyromania is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
• The symptom of this disorder include:
• Deliberately and purposefully setting a fire more than one time.
• Tension or emotional arousal being present before the act of setting the fire.
• Having a fascination with, interest in, curiosity about, or attraction to fire and its uses and consequences. The person may be a "watcher" at neighborhood fires, set off false alarms, spend time at the local fire station and want to be associated with the department.
• Feeling pleasure, relief or gratification when setting fires or when seeing the damage causes by and aftermath of the fire.
• The fires are not set for monetary gain, to cover up criminal activity, to express anger or vengeance, in response to any hallucinations or delusions, or as a result of impaired judgment (from another disorder or substance).
• The fire setting is not better explained by conduct disorder, a manic disorder, or antisocial personality disorder.
• It is not currently known what how common pyromania is, but it appears to be very rare as a main diagnosis.
• Disorders that are most commonly seen with pyromania include substance use disorders, gambling disorder, depressive and bipolar disorders, and other disruptive, impulse-control, and conduct disorders.
• There are two main treatments for this disorder, which are psychotherapy and medication.

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• Kleptomania is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.
• The symptoms of this disorder include:
• compulsive stealing of items that are not needed for personal use or for their monetary or other value. The items stolen typically have very little value to the person and they often could have paid for it instead of taking it. After stealing the item, the person will often throw it away or give it to someone else, rather than keeping it, but sometimes will hoard the items or eventually return them in secret. The thefts are usually not planned ahead of time and do not involve the help of others, instead it is an impulse in the moment that is not resisted.
• feeling an increased level of tension before the stealing occurs.
• feeling pleasure, gratification or relief when committing the stealing.
• the stealing is not done to express anger or vengeance and isn't related to a delusion or hallucination.
• the stealing is not better explained by conduct disorder, a manic episode, or antisocial personality disorder.
• Research has found that 4-24% of individuals arrested for shoplifting have kleptomania. In the general population, it is very rare at about 0.3-0.6% and is found in females at three times higher a rate than in males.
• The DSM-5 reports that kleptomania is associated with compulsive buying, as well as depressive disorders, bipolar disorder, anxiety disorders, eating disorders (particularly bulimia nervosa), personality disorders, substance use disorders (especially alcohol use disorder), and other disruptive, impulse-control, and conduct disorders.
• Those with this disorder often feel a lot of shame at their inability to resist stealing and therefore, often do not seek treatment on their own. When they do finally enter treatment, there are two main treatments for this disorder, which are psychotherapy and medication.

For more information

• Conduct Disorder is one of the most frequently diagnosed mental disorders in children. A child with Conduct Disorder engages in repetitive and persistent behaviors that violate the basic rights of other people or that violate age-appropriate societal rules and norms for behavior with others.
• This behavior falls into four different categories including aggression to people and animals, destruction of property, deceitfulness or theft, and serious violations of rules.
• Symptoms of conduct disorder may include:
• Bullying, threatening, or intimidating behavior towards other children
• Frequent starting of physical fights
• Use of weapons or tools capable of causing serious physical harm to people or property (e.g., bricks, bats, broken bottles, knives, guns)
• Physical cruelty toward animals or people
• Stealing while confronting a victim (e.g., mugging, purse snatching, armed robbery)
• Physical violence towards others (in the form of rape, assault, homicide, etc.)
• Destruction of property (e.g., fire setting, breaking of windows, breaking into homes, buildings or cars)
• Frequent and manipulative telling of lies or breaking of promises in order to obtain goods, favors, or to avoid debts or obligations (e.g., "conning" people)
• Staying out at night despite parent's curfew rules (before the age of 13)
• Repeatedly running away from home, or running away from home for a lengthy period of time
• Use of alcohol or drugs
• Truancy (skipping school) before the age of 13
• Symptoms of conduct disorder vary with age, changing as children develop increased strength, cognitive abilities and sexual maturity. Less severe behaviors, such as lying and shoplifting, usually emerge first, while other, more severe behaviors, such as burglary or auto theft, usually emerge later.
• According to the DSM-5, the child/adolescent must display at least three of the identified 15 behaviors in the past 12 months from any of the four categories and at least one must have occurred in the last six months for a diagnosis to be made.
• The prevalence rate for Conduct Disorder ranges from 2-10% of the general population across various countries, races and ethnicities. The rates increase from childhood to adolescence, and are higher in males than females.
• Treatments for Conduct Disorder can include behavior therapy, cognitive-behavior therapy, parent management training, cognitive problem-solving skills training, functional family therapy, and medication.

For more information 

• Prior to the release of the DSM-5 in 2013, Exhibitionism was classified as another impulse control disorder.
• The symptoms of this disorder include a person having recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the exposure of one\'s genitals to an unsuspecting stranger over a period of at least 6 months. The person has either acted on these impulses with a nonconsenting person or the fantasies and sexual urges are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• In the DSM-5, this disorder has been reclassified to be a Paraphilic Disorder and renamed Exhibitionistic Disorder.
• A paraphilia involves intense and persistent sexual interest (recurrent fantasies, urges or behaviors of a sexual nature) that center around children, non-humans (animals, objects, materials), or harming others or one\'s self during sexual activity. Sometimes this sexual interest focuses on the person\'s own erotic/sexual activities while in other cases, it focuses on the target of the person\'s sexual interest.
• Please see our Sexual Disorders center for more information.

• Prior to the release of the DSM-5 in 2013, Pathological Gambling was classified as an impulse control disorder.
• This diagnosis is made when a person is unable to resist impulses to participate in gambling activities even though doing so has resulted in negative consequences.
• In the DSM-5, this disorder has been reclassified to be an Addiction Disorder. Gambling disorder was included in Addictions because it has been well researched and neurological similarities between gambling addiction and drug addiction have been found. There also appears to be a genetic basis as well with gambling disorder (APA, 2013).

• Prior to the release of the DSM-5 in 2013, Trichotillomania, also known as hair-pulling disorder, was classified as an impulse control disorder.
• This disorder involves the recurrent pulling (removal) of one\'s hair from any part of their body with the most common sites are the scalp, eyebrows, and eyelids. These behaviors are usually performed in private, are more common in women and often begin during the onset of puberty.
• Many people with trichotillomania try to stop the behavior but feel unable to do so. This sense of being unable to avoid performing a particular behavior is very similar to the compulsions in obsessive-compulsive disorder (OCD). While there are differences from OCD, the DSM-5 moves this disorder to the same classification family of Obsessive-Compulsive Disorder Spectrums.

• In this family of topic centers you will find information concerning various mental disorders including depression, generalized anxiety, panic, bipolar disorder, attention deficit and schizophrenia, to name but a few.
• There is always a question of whether a given disorder or issue would be better classified as a "mental" or a "medical-biological" disorder.
• To some degree or another, there is no really firm distinction between mental and medical disorders.
• Many so called 'mental' disorders like schizophrenia and bipolar disorder are now known to be primarily biologically based, while other 'medical' disorders have been shown to have a large 'psychological' component.
• Therefore, many, including this site have decided to follow the lead set out by the authors of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard reference used by psychiatrists, psychologists and social workers in classifying and describing mental disorders.

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• Mental Health treatment in the 21st century generally involves a coordination amongst several healthcare professionals drawn from different disciplines.
• While medical doctors still run the show (in the form of Psychiatrists), their role has typically diminished to that of diagnostician and prescriber of medication (and the occasional assessment and/or ECT).
• Clinical Psychologists are often called upon to handle assessment work (psychological and cognitive testing), as well as psychotherapy.
• Social workers increasingly offer psychotherapy services as well.
• A host of related professionals, (licensed counselors specializing in substance abuse, marital and family therapy, etc.) now exist as well and handle many psychotherapy tasks.
• Psychiatric nurses are still around too, handling much of the hands-on work involved in inpatient hospital care.
• Whether you are looking to understand your therapists' credentials better, or are wondering about a career in mental health treatment, this information is helpful to know about.

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• In this topic area, we deal broadly with modes of treatment, leaving more specific treatment descriptions (tailored to specific disorders) to specific disorder topic areas.
• Treatment stratagies may be sorted into two gross categories: physical interventions (including medicine/drugs/herbs, surgery, and other 'hands-on' treatments such as massage), and mental interventions (including psychotherapy and hypnosis).

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• Electroconvulsive therapy, also known as electroshock or ECT, is a type of psychiatric shock therapy involving the induction of an artificial seizure in a patient by passing electricity through the brain.
• ECT was first introduced as a treatment for schizophrenia in the 1930s, and quickly became adopted as a common treatment method for mood disorders?and as a dreaded mechanism for disciplining unruly psychiatric inpatients.
• Currently, in most countries, electroshock is administered under anaesthesia and muscle relaxants and continues to be used for the treatment of several, typically severe, psychiatric conditions, occupying a narrow but important niche in modern psychiatry.
• Currently ECT is mainly used to treat severe depression, particularly if complicated by psychosis. It is also used in cases of severe depression where antidepressant medication, psychotherapy, or both have proven ineffective. Or when medication cannot be taken, or when other treatments would be too slow (for example, in a person with delusional depression and intense, unremitting suicidal tendencies).
• It is also sometimes used to treat the manic phase of bipolar disorder and in the uncommon condition of catatonia.
• ECT should be administered under controlled conditions, with appropriate personnel (Rudorfer et al., 1997) and some mental health laws mandate this.
• The most common adverse effects are confusion and memory loss for events surrounding the period of ECT treatment. Some of the confusion and disorientation seen upon awakening after ECT clear soon after electroshock, although many patients report ongoing and debilitating problems.

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• Transcranial magnetic stimulation (TMS) is the use of powerful rapidly changing magnetic fields to induce electric fields in the brain by electromagnetic induction without the need for surgery or external electrodes.
• TMS was designed as a brain mapping tool in the 1980s to be used combined with MRI and EEG.
• One reason TMS is important in neuroscience is that it can demonstrate causality. A noninvasive mapping technique such as fMRI allows researchers to see what regions of the brain are activated when a subject performs a certain task, but this is not proof that those regions are actually used for the task; it merely shows that the a region is associated with a task.
• TMS is currently under study as a treatment for severe depression, auditory hallucinations, migraine headaches and tinnitus.
• It is particularly interesting as it may provide a viable treatment to certain aspects of drug resistant mental illness, particularly as an alternative to electroconvulsive therapy.
• TMS is also under investigation for the treatment of drug-resistant epilepsy.

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• As used in this website, the term 'medication' refers to a drug or other chemical compound that is administered into the body and which effects the body in a beneficial way, typically by relieving symptoms, or acting to remove or reduce causes of illness.
• There are lots of chemicals and drugs in existence, but not all of them are medications.
• People have been using medications to help cure disorders and illnesses for thousands of years.
• Originally, medications were derived from natural (typically plant) sources. Modern medications (as used by physicians) are almost exclusively synthesized in laboratories, however.
• The manufacture and use of medications is governed by law in most countries (if not all).
• With some exceptions (e.g., over the counter varieties), medicines must be prescribed by a licensed physician, and purchased from a licensed pharmacy before people can have access to them.
• Physicians (and members of several other health professions such as nurse-practitioners, physician's assistants, dentists, etc.) are trained in the use (and cross-use) of a variety of medicines. It is this training that allows these professionals to safely prescribe medicines to treat illness.
• Medicines are typically categorized into classes of related compounds and chemicals that produce particular effects on the body.
• Different class categorizations are in use, with some schemes categorizing medicines on the basis of how they affect the body and brain at a chemical and molecular level, and other schemes grouping them by the types of effects they have on the body and brain.
• You can use online databases to look up medicines you have questions about.

• It is important for you to be well informed about medications you may need. You should know what medications you take and the dosage, and learn everything you can about them.
• Medications for mental illnesses were first introduced in the early 1950s and have changed the lives of people with these disorders for the better.
• Psychotherapeutic medications also may make other kinds of treatment more effective.
• Medications do not cure mental illness, but in many cases, they can help a person function despite some continuing mental pain and difficulty coping with problems.
• How long someone must take a psychotherapeutic medication depends on the individual and the disorder.
• Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some have side effects, and others do not.
• You and your family can help your doctor find the right medications for you. The doctor needs to know your medical history, other medications being taken, and life plans such as hoping to have a baby.
• Medications for mental disorders are divided into four large categories - antipsychotic, antimanic, antidepressant, and antianxiety medications.
• Children, the elderly, and pregnant and nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned.

• People age 65 and older consume more prescription and over-the-counter (OTC) medicines than any other age group. Older people tend to have more long-term, chronic illnesses than do younger people.
• Because they may have a number of diseases or disabilities at the same time, it is common for older people to take many different drugs.
• Medicines may act differently in older people than in younger people. This may be because of normal changes in the body that happen with age.
• Keep in mind that "drugs" can mean both medicines prescribed by your doctor and over-the-counter (OTC) medicines, which you buy without a doctor?s prescription. OTC?s can include vitamins and minerals, herbal and dietary supplements, laxatives, cold medicines, and antacids.
• Be sure your doctor knows what medicines you are taking and assures you that it is safe for you to take your medicines together.
• Also ask about taking your medicines with food.
• Herbal supplements also should be taken with care.
• You and your family should learn about the medicines that you take and their possible side effects.
• Review your medicine record with the doctor or nurse at every visit and whenever your doctor prescribes new medicine. Your doctor may have new information about your medicines that might be important to you.
• Keep a daily checklist of all the medicines you take. Include both prescription and OTC medicines. Note the name of each medicine, the doctor who prescribed it, the amount you take, and the times of day you take it. Keep a copy in your medicine cabinet and one in your wallet or pocketbook.
• Make sure you can read and understand the medicine name and the directions on the container. If the label is hard to read, ask your pharmacist to use larger type. Let your pharmacist know if you have trouble opening the medicine bottle.

• Millions of companion animals in shelters across America are just waiting for a special home like yours.
• When you're looking to add a pet to your life, consider adopting a homeless animal from your local shelter or rescue group.
• Whether you want a puppy or a more mature dog, a purebred or a one-of-a-kind mixed breed, even a rabbit or hamster, your shelter has the best selection of animals anywhere?all screened for good health and behavior.
• Most shelters will even help you with spaying and neutering.

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• Here are five reasons to adopt your new best friend.
• You'll save a life. Sadly, around 2.7 million dogs and cats are euthanized each year in the United States simply because too many people give up their pets, and too few people adopt from shelters.
• You'll get a healthy pet. Animal shelters are brimming with happy, healthy animals just waiting for someone to take them home. Most shelters examine and give vaccinations to animals when they arrive, and many spay or neuter them before being adopted.
• You'll save money. Adopting a pet from an animal shelter is much less expensive than buying a pet at a pet store or through other sources.
• You'll feel better. Not only do animals give you unconditional love, but they have been shown to be psychologically, emotionally, and physically beneficial.
• You won't be supporting puppy mills and pet stores. Puppy mills are "factory style" dog-breeding facilities that put profit above the welfare of dogs.

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• There have always been people who were unable to restrict their use of mind and body altering substances to culturally prescribed limits, and who have fallen into the trap we know today as addiction.
• Addiction usually does not happen overnight. Rather, people who become addicted to drugs (such as alcohol, cocaine, heroin, marijuana, etc.) are gradually introduced and desensitized to them over a period of time.
• Some people are able to keep using drugs on an occasional basis, but many other people are not so lucky.
• For these unlucky others, their use of drugs begins (gradually in some cases, abruptly in others) to increase, and the amount of attention they spend thinking about getting high, purchasing drugs, preparing drugs and taking drugs increases until it becomes the center of their lives.
• As dependence increases, tolerance to the drugs increases as well - meaning that it takes more and more of the drug to get the same 'high' or 'buzz' effect. As most drugs (with the exception of alcohol) are illegal, they may become increasingly involved in criminal activities (buying drugs is a criminal activity, as is driving while intoxicated).
• No one knows exactly why some people get addicted to drugs while others do not. However, some contributing factors are clear.
• There is likely a strong genetic component to some forms of addiction (meaning that vulnerability to becoming an addict can run in families, and be inherited from your parents and grandparents).
• There is also much evidence suggesting that whether or not people develop addiction problems has a lot to do with experiences they have in childhood and as they are growing up.
• Help for addiction is available. For all the many people out there who are actively using drugs and alcohol, there are many others who have struggled with addiction and won a personal victory, on a day by day temporary basis to be sure, but a victory never the less.
• Help is available in the form of medical attention, medications, psychotherapy, self help groups, and spirituality.

• The diagnosis of a substance use problem (abuse or dependence) is important because it helps justify getting an addicted person into treatment.
• People with drug and alcohol problems are often secretive about their use, or blind to the idea that a problem exists.
• It is helpful then to have a list of behaviors that one can look for that, when present, may suggest that someone has a substance use problem.
• Behaviors to look for include:
• A repeating failure to meet social, occupational or familial duties
• Repeated lateness or absence
• Poor work performance
• Neglect of children, etc.
• Bizarre or lame excuses for social, occupational or family failures
• Borrowing (or stealing) money without good reasons.
• Uncharacteristic mood or personality changes.
• Physical signs may include:
• Puncture marks, or long thin lines along the arms or legs (IV drug use such as heroin)
• Skin Infections
• Nose and throat problems (snorted drugs such as cocaine)
• Bloody nose
• Nasal and/or sinus infections
• Coughing
• Loss of the sense of smell
• Drowsiness, or loss of coordination (depressant drugs such as alcohol)
• 'Pinned' (tiny, constricted) pupils in the eye (secondary to opioid abuse)
• Red or bloodshot eyes (secondary to smoking marijuana)
• Drug-related smells on clothing (drugs that are smoked)
• Drug-related paraphernalia (pipes, 'works', pill bottles, small plastic bags or vials, lighters, etc.)

• Drugs and medications of abuse can be grouped together into categories based on similarities between how they work and what effects they will produce in the human body and brain.
• Central Nervous System Depressants - Alcohol, Barbiturates ['ludes, sleepers, downers, tranquilizers] and Benzodiazepines (Valium, Ativan, Librium, Xanax) [sleepers, downers, tranquilizers].
• Central Nervous System Stimulants - Cocaine (Crack, Blow, Nose, Snow, Toot, White, Rock, Flake), Amphetamine & Methamphetamine (Ritalin, Meth, Uppers, Bennies, Crank, Crystal), Caffeine (Coffee), and Nicotine (Cigarettes, Chew).
• Opiates - Heroin (Horse, Junk, Smack, Snow, "H", Brown, Black), Morphine, Codeine (OxyContin, Tylenol with Codeine), and Methadone, LAAM
• Cannabinols - Marijuana (Marinol, Pot, Grass, Weed, Brick, Joint, Thai Stick, Mary Jane) and Hashish (Hash, Ganja, Rope)
• Hallucinogens - LSD (Acid), Mescaline (Cactus), Psilocybin, ('Shrooms, Mushrooms) and MDMA (Love Drug, "X", Esctacy)
• Solvents - Aerosol sprays, Glues, Paint Thinner and Gasoline
• Other Drugs of Abuse - PCP (Angel Dust)

• Treatment of Substance Abuse and Dependence disorders is a complex endeavor that usually involves the piecing together of medical, psychological and social treatment components.
• Components Of Substance Abuse Treatment include the following:
• Medical and Biological Treatments:
• Detoxification - before any actual drug treatment can occur, it is necessary that drug dependent people be 'detoxified' (meaning that all drugs they are addicted to get physically removed from their bodies). 
• Diet and Nutrition Concerns - it is not uncommon to find that people presenting for drug or alcohol treatment are moderately to severely undernourished and lacking in the proper vitamins and nutrients.
• Medication (Symptom Reduction) - recovering drug or alcohol dependent persons often complain of mood and anxiety problems. 
• Medication (Relapse Reduction) - there are several medications that physicians can prescribe for their recovering patients which can help to minimize their chances of relapsing. 
• Drug Screening - drug testing is helpful (even indispensable) as a way of motivating drug and alcohol dependent people to remain clean and sober.
• Psycho-Social Treatments:
• Psychotherapy - a variety of psychological and social (psychosocial) strategies for treating drug and alcohol dependence have been developed, each offering a different level and type of support to persons recovering from drug or alcohol dependence
• Relapse Prevention is a type of coping-focused psychotherapy or psycho-education that strives to teach drug or alcohol dependent persons coping skills to help them avoid relapsing back to using drugs and/or alcohol.
• 12 Step Programs - most all drug or alcohol dependent persons who enter treatment are referred to what are known as "Twelve Step" groups.
• Levels of Care Available (from most intensive to least intensive):
• Hospital Care
• Substance Abuse Rehabilitation Programs
• Partial Hospitalization/Intensive Outpatient Programs
• Residential Centers And Halfway Houses
• Putting It All Together - an idealized treatment program for someone who is alcohol dependent might look something like this.
• Substance-Specific Concerns:
• Alcohol and CNS Depressant Drugs
• Cocaine and CNS Stimulants
• Cannabis
• Opioids