Come, follow me. Prevention S3

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PREVENTION SKILL: Repeating Positive Actions

Mindful Minutes “Square Breathing” Activity.

Use anytime you need to reduce stress, manage anxiety, improve focus, promote relaxation, such as before important events, or as part of your daily routine. Helps calm the nervous system by regulating your breath and lowering your heart rate.

Step 1: Sit comfortably and close your eyes. Slowly inhale through your nose while counting to four. Imagine drawing the first side of a square as you breathe in.

Step 2: Hold your breath for a count of four. Visualize drawing the second side of the square during this pause.

Step 3: Slowly exhale through your mouth while counting to four. Picture drawing the third side of the square as you breathe out.

Step 4: Hold your breath again for a count of four. Complete the square by imagining drawing the fourth side during this pause.

Step 5: Repeat Steps 1 through 4 for two minutes.

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GROUP SHARING Section – Maximum time 20 minutes

Let’s check in and share how your week went. This is a safe, supportive space where we can encourage each other and focus on positive steps forward. You’re invited to share for 3 to 5 minutes about anything you’re working on with your children. Feel free to talk about:

·      Any challenges you faced, and how you handled them,

·      What experience did you have practicing CRAFTConnect principles and skills?

·      How did your Family Chat go? What did you learn?

·      What did you do to purposefully take care of yourself and show self-compassion?

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LEARN SECTION – Maximum time 30 minutes

1. Today, let’s talk about a simple and kind way to help shape your child’s behavior—rewards. These rewards may seem small and they can lead to big changes over time. Jesus said: “Give, and it will be given to you… For with the measure you use, it will be measured to you.”—Luke 6:38. This verse reminds us that when we give kindness and love, we often receive it back. Using rewards is one way to give encouragement.

2. Take a look at your “Reinforcement Matrix Handout.” A reward is something that makes your child feel good and makes them want to do the same thing again. Think about what your child already enjoys—simple things like a hug, a high-five, kind words, or time together. These rewards can be free or very low cost, and they work best when you give them right after the good behavior. Jesus said: “Whoever can be trusted with very little can also be trusted with much.” —Luke 16:10. When we notice the small good things our children do, we help build trust and confidence.

Wanted Behavior Activity

Step 1: Describe a small specific good or wanted behavior your child used to do, but doesn’t do as much now.

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Step 2: Think of possible rewards that might encourage this behavior. Write down as many as you can think of. If you are unsure, ask your child what they think might be a good reward.

Reward                                                                                                          Rating

  ———————————————————————————————————————————————-

                                                       

Step 2 Step 3: Rate each reward from 1 to 5 based on how much your child would like it. Write their rating by each reward.

1----------------------2-----------------------3---------------------------4-------------------------5

Very little impact                                Moderate impact                                    Tremendous impact

Step 4: Decide what you will tell your child about why they are getting the reward. Use P-I-U-S statements.

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Talk About It: Share a few of your ideas with the group.

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3. You can help your child change by removing a reward they are getting when that behavior happens. This doesn’t mean yelling or punishing—it means removing something they like until the unwanted behavior stops. For example: Your child continues using a tablet past the agreed screen time. You might remove the tablet for the next day and explain calmly why. Jesus taught: “Let your ‘Yes’ be ‘Yes,’ and your ‘No,’ ‘No.’” —Matthew 5:37. He teaches us to be clear and follow through with what we say. Make sure the reward you remove is one your child notices, but also make sure it’s safe and fair. Always explain what is happening and why. Choose a reward they value and are likely to miss and value when it is reintroduced. Use this approach when you’re ready to handle potential reactions. If there’s a risk of harm, opt for a different reward to remove. Keeping track of how you removed the reward and how your child one responded at every point in that process will help you be better prepared for the next time.

4. As you read through these examples of common unwanted behaviors in school age children think about changes you would like to see your child make. Choose one behavior from this list (or one from your life) to focus on in the activity below.

·      Rolling eyes when asked to do something

·      Whining when asked to share

·      Staying on screens too long

·      Saying “No!” to a simple request

·      Leaving messes

·      Lying about homework

·      Calling others mean names

Remove Reinforcer Activity

Step 1: Describe a small specific unwanted behavior that you would like to help your child change. Make sure that the behavior happens on a daily or regular daily basis.

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Step 2: What has been your past responses. How have those responses affected the behavior?

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Step 3: What reinforcers (object, activity, or behavior) are they getting right now that would be appropriate to withdraw to get them to do less of that behavior?

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Step 4: Are there any potential negative effects or complications for you or child that could come from removing these reinforcers?

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Talk About It: Share what you learned from this activity.

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5. It can be hard to let your kids face the natural results or consequences of their actions-- and sometimes, that’s the best teacher. If your child forgets their lunch, they may feel hungry. That’s a real consequence. If you rush to fix it every time, they may not learn responsibility. Jesus said: “A tree is known by its fruit.” —Matthew 12:33. This means that actions lead to results—and learning from those results helps us grow. Letting kids experience consequences (as long as it’s safe) helps them take responsibility. And it gives you a break, too.

Talk About It: Have you ever let your child face a natural consequence? How did it help them? How did it help you?

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6. Punishment may stop behavior for a little while—and it doesn’t teach anything new. Kids need help learning what to do instead. That’s why rewards and clear, calm communication are more helpful than yelling or sudden punishments. Jesus said: “In everything, do to others what you would have them do to you.” —Matthew 7:12. This is the Golden Rule and is found in Judaism, Islam, Hinduism, Buddhism, Confucianism and many other faith traditions around the world. It means to speak to your children the way you want to be spoken to. When you need to talk to your child about a consequence, don’t use blame or shame. Use a P-I-U-S statement instead.

Less Helpful "You" Statement: You didn’t do your homework again! I’m sick of this. No games for a week!”

More Helpful P-I-U-S Statement: “I noticed your homework isn’t done, and I’m feeling frustrated because we agreed that homework comes first. I enjoy seeing you do well in school, and it’s important for you to keep your promises. Let’s figure out a way to get it done now, and then you can have some game time.”

Talk About It: What made the second statement more helpful? How can this kind of response build trust with your child?

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 7. As parents, we are not perfect—we are learning and growing with our children. Jesus shows us the power of kindness, truth, and calm guidance. When we reward the good, remove what’s unhelpful, and speak with care, we help our children grow stronger and wiser. “Fathers (and mothers), do not provoke your children to anger, but bring them up in the discipline and instruction of the Lord.” —Ephesians 6:4 Let’s keep doing our best—with love, truth, and patience.

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MY COMMITMENTS Section

These are our group commitments. We will start the next CRAFT Connect session by reporting on them. This week I will:

A. Hold the “Family Chat: Rapid Rewards” session or alternative ““Making Bath Time Fun” Family Chat for younger children.

·      Everyone creates their own Point Chart using the “Sample Point Chart Handout”.

B. Do the in-between session assignments.

·      Complete the “Natural Consequences Worksheet”.

·      Use rewards to encourage a wanted behavior from your child.

C. Show kindness to myself by having self-compassion and taking care of myself.

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 FAMILY CHAT FOR OLDER CHILDREN: Rapid Rewards

Mindful Minutes Activity. Use this whenever you need to feel calmer, stay focused, or relax—like before a big event or just as part of your daily routine. It helps you feel better by slowing down your breathing and calming your heart.

Step 1: Sit comfortably and close your eyes. Slowly inhale through your nose while counting to four. Imagine drawing the first side of a square as you breathe in.

Step 2: Hold your breath for a count of four. Visualize drawing the second side of the square during this pause.

Step 3: Slowly exhale through your mouth while counting to four. Picture drawing the third side of the square as you breathe out.

Step 4: Hold your breath again for a count of four. Complete the square by imagining drawing the fourth side during this pause.

Step 5: Repeat Steps 1 through 4 for two minutes.

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Read: Today, we're going to talk about how we can encourage positive actions in our family by using rewards to help one another make better choices. A positive reinforcer or reward is something we enjoy like smiles, hugs, kind words, or fun activities. When someone does a good action, giving something positive makes them want to do that action again. Let’s get started with a story.

Ethan was having trouble with his homework, often choosing to play video games instead. To help him, the family decided to create a rewards system that included everyone, even the parents! They gathered around the kitchen table and decided that for small, specific and observable daily tasks—like putting dirty dishes in the sink, getting up on time, making your bed —each family member could earn points. These points could be traded for privileges and rewards like movie nights, trips to the arcade, or even a special dessert night. Excited about the idea, Ethan and his siblings, Lily and Max, agreed to join in. As the weeks went by, the system for rewarding wanted behaviors made a big difference. Lily, did well in school, enjoyed helping Ethan with his homework and earned points for tutoring. Max, the middle child, started doing extra chores to earn even points for a family camping trip he really wanted. The parents participated too, earning points for doing the same things the kids did. The house was filled with encouragement, and everyone reminded each other about the points they could earn. The Thompsons not only helped each other make better choices but also grew closer as a family, turning challenges into joyful moments filled with teamwork and fun.

Talk About It: What did you learn from that story? (Chose three discussion questions to encourage children to reflect on and apply the story’s lessons to their own experience.)

·      How did helping Ethan with his homework make Lily feel, and how can we help each other more?

·      What jobs do you think are important to include in our rewards system, and why?

·      What rewards do you want to earn, and how can we make sure everyone gets to enjoy them?

·      What are some friendly ways we can remind each other about earning points without being annoying?

·      How can we celebrate our successes as a family, no matter how small they are?

·      Why is it important to encourage others when they do something well?

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ACTIVITY

Materials: Paper, pens or pencils.

Preparation: Print out “Sample Points Chart Handout” for all group members to refer to during this activity.

Instruction: Every player creates their own Point Chart listing positive behaviors and points they will earn by doing that behavior. The Group decides on rewards for that behavior and the points needed to redeem each reward. Post everyone’s chart in an area that is visible to the whole family. Update points regularly to keep everyone motivated.

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Read: The Thompson’s used positive reinforcers to help their family feel good about making good choices. Think about actions you would like to see more often in our family. What are some rewards we can give one another when we do these things? This week we will try to look for ways every day to reward one positive action.

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FAMILY CHAT FOR YOUNGER CHILDREN: Making Bath Time Fun with “Winnie-the-Pooh”

Read: Today, we're going to talk about how we can encourage positive actions in our family by using rewards like kind words or fun activities to help them make better choices. Let’s get started with a story inspired by A.A. Milne’s Winnie-the-Pooh characters.

Once upon a time in the Hundred Acre Wood, there lived a young kangaroo named Roo with his mother Kanga. One day, Kanga decided it was time for Roo to learn the importance of taking a bath every day. She led Roo to a peaceful spot near their cozy home. There, she filled a large tin tub with water from the nearby stream. Roo, initially reluctant and unsure, stood hesitantly at the edge. Kanga thought carefully about how to encourage him. With gentle words and the promise of his favorite honey treat afterward, she persuaded Roo to step cautiously into the tub. At first, Roo nervously sat still, unsure of this new experience. Sensing his discomfort, Kanga spoke soothingly and praised every small effort Roo made to relax in the water. "Good job, Roo!" she said softly. Roo, starting to understand that bath time could be enjoyable, gradually relaxed. At the bath’s end he was confidently splashing around. After he dried off Kanga gave Roo his treat. As the days passed, Roo began to look forward to bath time. With each bath, Kanga continued to encourage Roo, making the experience positive and rewarding. Just as Roo reveled in their daily adventures around the Wood, he now cherished the calming moments of a bath with Kanga by the water's edge.

Talk About It: What did you learn from that story? (Chose three discussion questions to encourage children to reflect on and apply the story’s lessons to their own experience.)

·      How did it make you feel when you did something good because you knew you would get a reward?

·      Have you ever learned something new with someone's help, like Roo did with Kanga? How did it make you feel, and what did you learn from the experience?

·      A positive reinforcer or reward is something we enjoy like smiles, hugs, compliments, or fun activities. When someone does a good action we give them something positive that makes them want to do that action again.

·      Rewards don’t have to be big or expensive. Simple things like saying, 'I love spending time with you when you help out,' can be powerful.

·      Like Kanga did with Roo make sure to give the reward right after the good action happens so people know why they are getting it.

·      Why is it important to encourage others when they do something well?

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ACTIVITY

Instructions: Each player describes a good action they want to see more of in the family. Example: “Doing homework without being asked”. Everyone suggests rewards that this player would enjoy for doing that action. Example: “Extra screen time”, “Choosing a family movie”, “Getting to pick dinner”, etc. Decide what you will say when you give them a reward. Example: "I really appreciate how you started your homework without being asked. Great job!"

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Read: Kanga used positive reinforcers to help Roo feel good about making good choices. Think about actions you would like to see more often in our family. What are some rewards we can give one another when we do these things? Kanga used positive reinforcers to help Roo feel good about making good choices. It’s important to be clear and kind when giving rewards. This week we will try to look for ways every day to reward one positive action.

Let’s repeat together the Winnie-the-Pooh cheer -- “Always remember, you’re braver than you believe, stronger than you seem, smarter than you think, and more loved than you know.”

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SAMPLE POINTS CHART HANDOUT

Modify as needed to fit your family’s needs and circumstances.  

Name:_______________________________  Week of:_________________________________

Point System. Family member earn points for positive behaviors during the week.

Behavior                                              Points Earned

Helping with chores                            5 points

Being kind to siblings                          3 points

Completing homework on time         4 points

Sharing toys or games                        3 points

Saying “please” and “thank you”       2 points

Listening without interrupting           4 points

Following family rules                         5 points

Helping without being asked              6 points

_______________________              _______

Reward System. Points earned by family members can be redeemed for rewards at the end of the week. (Please modify as needed to fit your family’s needs and circumstances.)

Points Needed                                    Reward

10 points                                             Choose a movie night

15 points                                             Extra playtime (30 minutes)

20 points                                             Favorite treat

25 points                                             Family game night

30 points                                             Choose special activity with parent

35 points                                             Craft or DIY project

40 points                                             Outdoor adventure day

50 points                                             Sleep over with a friend

________                                            _____________________________

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 REINFORCEMENT MATRIX HANDOUT

Wanted behavior is increased by consequences that your child wants, likes or will work to get (a reward) or that stops or reduces an unpleasant painful condition. Unwanted behavior is decreased by consequences that your child dislikes or will work to avoid or when something your child wants is withheld until the unwanted behavior is corrected. Natural consequences are outcomes that occur as a direct result of a your child’s actions, providing life lessons independent of your intervention. All reinforcers, pleasant and unpleasant, increase the likelihood of your child’s wanted or unwanted behaviors continuing.

 

INCREASE                    DECREASE CHILD’S

            CHILD’S WANTED      UNWANTED              

BEHAVIOR                   BEHAVIOR

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ADD REINFORCER                    Child wants, likes Child dislikes                                            

Will work to get     Will work to avoid _____________________________________________________________________________

NATURAL CONSEQUENCES   Let it be                       Let it be

WORK BEST                               Don’t undo it Don’t add reinforcer

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REMOVE REINFORCER            Child dislikes               Child wants, likes

Will work to avoid       Will work to get

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 NATURAL CONSEQUENCES WORKSHEET

Natural consequences are outcomes that occur as a direct result of your child’s actions, providing life lessons independent of your intervention. As you review these examples of unwanted behaviors and natural consequences think about those that are relevant to your child’s experience.

Step1: Describe a time in the last month when you could have let your child face the natural consequences of an action, see examples below. Be as specific as possible.

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Step 2: What happened because you didn’t let your child face those consequences?

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Step 3: List some “If they…” things that might have happened if you had let your child experience the natural consequences.

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Step 4: Decide what consequences you will allow next time a similar situation happens.

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ACTION                                   NATURAL CONSEQUENCES

 

Not Studying for a Test         If they don’t study, they might not do well on the test.

Homework                              If they don’t do their homework, they might get a lower grade.

Late for Curfew                       If they come home late, they might miss out on activities with                                                        friends.

Not following Safety Rules   If they ride a bike without a helmet, they risk getting hurt if they                                                    fall.

Skipping Breakfast:                 If they skip breakfast, they might feel hungry and have less energy                                                 during school.

Not Taking Care of a Pet         If they don’t feed their pet, the pet may be hungry or upset.

Not Charging a Phone             If they forget to charge their phone, they may not be able to use it                                                when they want to.

Ignoring a Friend:                   If they ignore a friend, that friend might feel hurt and not want to                                                  hang out anymore.

Impulsive Spending                 If they spend all their allowance, they won’t have money for                                                          something special

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‘LILY’ (13) CASE STUDY

Step 1: Describe the Behavior, something that happens on a fairly regular basis or has an observable pattern. Be as complete and specific about what it is, how often it happens, and how long it lasts. Lily regularly isolates herself in her room, spending hours alone instead of engaging with her family or friends. This behavior has become more frequent since the start of the school year, with episodes occurring daily and lasting several hours. During these times, she avoids family interactions and shows little interest in activities she once

enjoyed. 

Step 2: Identify External (outside) Triggers. What people, places or things might make this behavior happen?

Who is usually around when it happens?  Lily is usually by herself when this behavior begins, although her parents are nearby in the house.

Where does this behavior usually take place? The behavior typically starts in her bedroom, a space where she feels most comfortable but also isolated.

When does it usually begin? The behavior usually begins after school, particularly during the late afternoon and early evening.

Step 3: Identify Internal (inside) Triggers. Make your best guess about what could be the thoughts and feelings right before the behavior happens (Thoughts refer to our perceptions of a situation, while feelings reflect our emotional responses. Typically, we think before we feel.)

 Thought? She may be thinking thoughts like "I don't belong," "I’m not good enough," or "I’m scared to reach out."

Feelings? Lily likely feels sadness, loneliness, and anxiety about social interactions and fitting in.

Step 4: Recognize Warning Signs. Assuming that in some way you have witnessed the behavior, what are the physical and emotional signs that it is about to happen?

Physical signs? Slumped shoulders, lack of eye contact, and a withdrawn posture when she returns home from school.

Changes in feelings? Increased sadness, frustration, and anxiety when discussing school or friends.                                                                

Last thing usually said before the behavior starts? Lily often says, “I just want to be alone,” or simply walks away without engaging when asked about her day.

Step 5: Identify Positive Outcomes. What is enjoyable about this behavior?

Pleasant thoughts while doing behavior?  While isolating, Lily might think, "At least I don’t have to deal with the stress of school," or "I can create my own world here."

Pleasant feelings while doing behavior? She likely feels a temporary sense of safety, comfort, and relief from social pressures.

Step 6: Identify Negative Outcomes. What problems can happen because of this behavior?

What negative effects come from this behavior? Think about effects on interpersonal, emotional, physical, emotional, school/work, mental health areas of life. Note with a * any negative results that person engaging in behavior would agree with.

The negative results include:

*Interpersonal: Strained relationships with family and potential loss of friendships.

*Emotional: Increased feelings of loneliness and sadness over time.

Physical: Lack of physical activity leading to possible health issues due to prolonged isolation.

School/Work: Struggles due to disengagement and lack of social interaction.

Mental Health: Risk of developing anxiety or depression.

*Lily would likely agree that her isolation negatively affects her relationships and emotional well-being.

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 WHY WE DO WHAT WE DO WORKSHEET

Use this worksheet to think about unwanted behavior, an action that is done often, that we would like to change. Take your time and answer each question honestly. After you finish take a moment to think about what you wrote. Look for any patterns and think about if you want to add anything. It’s okay to ask for help if you need it!

Step 1: Describe the Behavior, something that happens on a fairly regular basis or has an observable pattern. Be as complete and specific about what it is, how often it happens, and how long it lasts.

What is the behavior?

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How often does it happen?

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How long does it usually last?

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Step 2: Identify External (outside) Triggers. What people, places or things might make this behavior happen?

Who is usually around when this happens?

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Where does this behavior usually take place?

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When does it usually happen?

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Step 3: Identify Internal (inside) Triggers. Make your best guess about what could be the thoughts and feelings right before the behavior happens (Thoughts refer to our perceptions of a situation, while feelings reflect our emotional responses. Typically, we think before we feel.)

Thoughts?

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Feelings?

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Step 4: Recognize Warning Signs. Assuming that in some way you have witnessed the behavior what are the physical and emotional signs that it is about to happen?

Physical signs?

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Changes in feelings?

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Last thing usually said before the behavior starts?

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Step 5: Identify Positive Outcomes. What is enjoyable about this behavior?

Pleasant thoughts while doing behavior?

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Pleasant feelings while doing behavior?

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Step 6: Identify Negative Outcomes. What problems can happen because of this behavior?

What negative effects come from this behavior? Think about effects on interpersonal, emotional, physical, emotional, school/work, mental health areas of life. Note with a * any negative results that a person engaging in behavior would agree with.

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Note: If the person engaging in a behavior is taking prescription drugs you need to separate the side effects of those drugs from their behavior. If you are not sure of the side effects one of these government websites will help https://dailymed.nlm.nih.gov/dailymed/,

https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm.)

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 COMMON UNWANTED BEHAVIORS HANDOUT 

SUBSTANCE USE DISORDERS

Figuring out if your child is using drugs or alcohol can be challenging. Many of the signs and symptoms are, at times, typical teen or young adult “unwanted” behavior. Many are also symptoms of mental health issues, including depression or anxiety disorders which appear to be under our child’s control, but are not (https://drugfree.org/article/look-for-warning-signs/):

Behavioral Changes

●      Has changed relationships with family members or friends

●      Uses chewing gum or mints to cover up breath

●      Often uses over-the-counter preparations to reduce eye reddening or nasal irritation

●      Frequently breaks curfew

●      Has cash flow problems

●      Drives recklessly, and has car accidents or unexplained dents in the car

●      Avoids eye contact

●      Locks doors

●      Goes out every night

●      Makes secretive phone calls

●      Makes endless excuses

●      Has the “munchies” or sudden appetite

●      Exhibits uncharacteristically loud, obnoxious behavior

●      Laughs at nothing

●      Has become unusually clumsy: stumbling, lacking coordination, poor balance

●      Disappears for long periods of time

●      Has periods of sleeplessness or high energy, followed by long periods of “catch up” sleep

Mood & Personality Shifts

●      Exhibits mood changes or emotional instability

●      Sullen, withdrawn, depressed

●      Shows loss of inhibitions

●      Silent, uncommunicative

●      Hostile, angry, uncooperative

●      Deceitful or secretive

●      Less motivated

●      Unable to focus

●      Hyperactive

●      Unusually elated

Hygiene & Appearance Problems

●      Smell of smoke or other unusual smells on breath or on clothes

●      Messy appearance

●      Poor hygiene

●      Red, flushed cheeks or face

●      Track marks on arms or legs (or long sleeves in warm weather to hide marks)

●      Burns or soot on fingers or lips (from “joints” or “roaches” burning down)

Health Issues

●      Unusually tired

●      Lethargic movement

●      Unable to speak intelligibly, slurred speech, or rapid-fire speech

●      Nosebleeds

●      Runny nose, not caused by allergies or a cold

●      Frequent sickness

●      Sores, spots around mouth

●      Seizures

●      Vomiting

●      Wetting lips or excessive thirst (known as “cotton mouth”)

●      Sudden or dramatic weight loss or gain

●      Skin abrasions/bruises

●      Accidents or injuries

●      Depression

●      Headaches

●      Sweatiness

School and Work Concerns

●      Absenteeism or loss of interest

●      Loss of interest in extracurricular activities, hobbies, or sports

●      Failure to fulfill responsibilities at school or work

●      Complaints from teachers or supervisors

●      Reports of intoxication at school or work

At Home and in the Car

●      Disappearance of prescription or over-the-counter pills

●      Missing alcohol or cigarettes

●      Disappearance of money or valuables

●      Receiving unusual packages in the mail

●      Smell in the car or bottles, pipes or bongs on floor or in glove box

●      Appearance of unusual containers or wrappers, or seeds left on surfaces used to clean marijuana

●      Appearance of unusual drug apparatuses, including pipes, rolling papers, small medicine bottles, eye drops, butane lighters, or makeshift smoking devices, like bongs made out of toilet paper rolls and aluminum foil

●      Hidden stashes of alcohol

MENTAL HEALTH DISORDERS

Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn't always easy. There's no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness. Because they are disorders of the brain, many symptoms of mental illness are expressed as complex behaviors. Although each illness has its own symptoms common behaviors of mental illness in adults and adolescents can include the following (https://www.nami.org/learn-more/know-the-warning-signs):

●      Excessive worrying or fear

●      Feeling excessively sad or low

●      Confused thinking or problems concentrating and learning

●      Extreme mood changes, including uncontrollable “highs” or feelings of euphoria

●      Prolonged or strong feelings of irritability or anger

●      Avoiding friends and social activities

●      Difficulties understanding or relating to other people

●      Changes in sleeping habits or feeling tired and low energy

●      Changes in eating habits such as increased hunger or lack of appetite

●      Changes in sex drive

●      Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality)

●      Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia)

●      Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”)

●      Thinking about suicide

●      Inability to carry out daily activities or handle daily problems and stress

●      An intense fear of weight gain or concern with appearance

●      Abuse of substances like alcohol or drugs

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