Lisa A. Dado, MD

• Valley Anesthesiology Consultant
• Phoenix Children? Hospital
• Phoenix, Arizona

Have children take turns tossing the block onto the Stretch Chart to see which stretch it lands on medicine 003 order mentat ds syrup toronto. Help children Materials: understand that medicine emoji 100ml mentat ds syrup amex, like a car treatment zygomycetes buy generic mentat ds syrup 100ml on-line, Food cards (copy page 34 and cut along lines) Scissors we need fuel to go treatment centers in mn buy generic mentat ds syrup 100 ml online. Turn the volume down gradually, and tell children to slow their movements to match the music. Ask children to take turns putting their masks up to their faces to show how they are feeling. Send the masks home with children so they can help their families understand how they are feeling. In the program, * children have been: Your child is learning to listen to what Listening to their bodies, his body may be saying, like: stretching and dancing as they explore energy and the ?I?m tired. By fueling their bodies this way, children don?t become too hungry, which can lead to overeating. Providers are encouraged to reproduce pages as desired from this booklet for use in their own clinical practice. There was no pharmaceutical industry or commercial funding for preparing this booklet. It is a digestion of current knowledge into focused points practical for the primary care physician. Robert Hilt is the primary author, this guide has utilized peer review from a variety of mental health experts and the helpful input and guidance from state agencies. Hilt is the primary author of this guide, and peer For Care Principles Guide version 2. An additional for inclusion in the guide was selected based on the section on Autism care was added, for which Dr. Additional editing the process of formulating the care recommendations has been provided by Dr. Regarding medications, Ovid Medline modifed by a panel of state experts in each of the searches were performed looking back at least 10 years applicable felds to refect current and regionally with limits set to include only child studies. Medline searches were supplemented by reviewing recent conference presentations of drug treatment studies, and reviewing bibliographies of the published studies that were found. For instance early oppositionality may situation is safe to wait another week or so, and then evolve into depression or anxiety, and early schedule a second visit to fnish your assessment. Strongly consider use of a general screening difcult to get it exactly right on the frst visit. Seek to interview the child alone, especially if an of the game if you can recognize with certainty the internalizing problem like depression or anxiety general category of problem, such as some type of is suspected, to obtain a more thorough history. Young children open up better after inquiring a full social/family picture may explain things better about low risk topics like their name, birthday, or than multiple mental health diagnoses. Contained in this genuine interest in them, such as asking about their care guide are numerous state and county programs, interests, hobbies. If a patient looks like they don?t like the Partnership Access Line, that are designed to want to be there, comment on this and show them assist you and your patient. You could leave the room to see another patient, then return and review rating scale results. Rating scales can help confrm diagnoses, and they provide an objective measure for following treatment responses. For instance if a child is psychiatrists would like to talk about any tricky having screaming tantrums, hitting other children, is situations with you, and are available Monday sleeping poorly and sometimes appears anxious, one through Friday, 9am to 6pm. In that case, review the steps of our disruptive rating scale can help you learn how likely or severe behavior and aggression decision tree. Very high rating scale therapists, other relatives, and foster care case scores might similarly indicate that referral to managers will likely be able to give you information specialty care is appropriate. A good therapist can help you refne your diagnosis that it takes time to gather this additional information, over time. If you identify the child has a general which can be done by phone calls, record requests, problem for which a therapist referral is appropriate or by sending out questionnaires or rating scales. These will help you narrow down what diagnosis is still uncertain, be very clear what the area to investigate and can quantify the likelihood target symptom is you are treating, and monitor of fnding diferent types of diagnoses. If that target symptom does Options include: not improve, then that medicine needs to be stopped. Engagement can be enhanced through educating your families about what Evidence based care is a relative concept, not an to expect. Evidence for treatment varies in its have a philosophy emphasizing engagement and shared reliability: randomized controlled trials carry a diferent setting of treatment goals, and can be a further asset evidence weighting than individual provider experiences. As more information emerges, what is considered the most evidence based treatment is expected to evolve. A common theme typically emerges in both clinical experience and in the results of formal research trials: that a combination of medical treatment and social/ behavioral care often ensures the best of outcomes. Peer reviewed care guidelines from a professional association American Academy of Pediatrics, Clinical Practice Guidelines pediatrics. Modifed Checklist for Autism in Toddlers accessed at the website links provided. The established measures including the Child Behavior Questionnaire asses seven social-emotional areas Checklist. The sensitivity is 85% and the specifcity (self-regulation, compliance, communication, is 83%. It can help primary care providers assess the likelihood of fnding any mental health disorder in their patient. These comparison statistics are summarized below, with positive and negative predictive values shown based on diferent presumed prevalence (5 or 15%) of the disorders. Providers should notice that despite its good performance relative to longer such measures, it is not a foolproof diagnostic aid. If signifcant concern for cognitive impairment, get neuropsychological/learning disability testing. Each rating should be considered in the context of what is appropriate for the age of the child. Does not pay attention to details or makes 0 1 2 3 careless mistakes, such as in homework 2. Does not follow through on instruction and fails to 0 1 2 3 fnish schoolwork (not due to oppositional behavior or failure to understand) 5. Avoids, dislikes, or is reluctant to engage in tasks 0 1 2 3 that require sustained mental efort 7. Interrupts or intrudes in on others (butts into 0 1 2 3 conversations or games) 19. Lies to obtain goods for favors or to avoid obligations 0 1 2 3 (?cons others) 26. Feels lonely, unwanted, or unloved; complains 0 1 2 3 that ?no one loves him/her 35. Each rating should be considered in the context of what is appropriate for the age of your child. Does not pay attention to details or makes careless 0 1 2 3 mistakes, such as in homework 2. Does not follow through on instruction and fails to fnish schoolwork (not due to oppositional behavior or 0 1 2 3 failure to understand) 5. Avoids, dislikes, or is reluctant to engage in tasks that 0 1 2 3 require sustained mental efort 7. Loses things necessary for tasks or activities 0 1 2 3 (school assignments, pencils, or books) 8. Interrupts or intrudes in on others 0 1 2 3 (butts into conversations or games) 19. Lies to obtain goods for favors or to avoid obligations 0 1 2 3 (?cons others) 30. Has used a weapon that can cause serious harm 0 1 2 3 (bat, knife, brick, gun) 35. Feels lonely, unwanted, or unloved; complains 0 1 2 3 that ?no one loves him/her 46. Symptom items 1-47 are noted to be signifcantly present if the parent or teacher records the symptom as ?often or very often present (a 2 or 3 on the scale). The ?performance items at the end are felt to be signifcant if the parent or teacher records either a 1 or 2 on each item.

Pharmacists for children who take prescription medica zation status according to the nationally recommended tion on a regular basis or have emergency medications schedule to avoid potential exposure of other children for specifc conditions symptoms zinc deficiency adults buy 100ml mentat ds syrup fast delivery. The California Childcare Health Program has developed a Terapies and treatments need to meet the criteria for form to help facilitate the exchange of information between evidenced based practices medicine for diarrhea discount 100 ml mentat ds syrup visa. The medical home medications given for bipolar disorder generic mentat ds syrup 100ml online, access to care symptoms of anemia mentat ds syrup 100 ml low price, and insurance: Appendix O: Care Plan for Children With Special Health A review of evidence. Families should be asked to share information about family health (such as chronic diseases) that might afect 9. Families should be guaranteed that all Information Sharing on Therapies and information will be kept confdential. The consent form should the expiration date of the medication, and a list of include: warnings and possible side efects; 1. The date(s) and times the medication is to be given; authorization indicates the purpose of the medication 4. The dose or amount of medication to be given; and time intervals of administration, and if the medi 5. Long-term medications that are administered daily teachers trained to give them; for children with chronic health conditions that are 2. Storing and preparing distribution in a quiet area conditions that may become life-threatening such completely out of access to children; as asthma, diabetes, and severe allergies; 7. The circumstances under which the facility will not kept at the facility overnight. Checking the written consent form; medications will be administered to this population. Adhering to the ?six rights of safe medication child may have a negative reaction to a medication that administration (child, medication, time/date, dose, was given at home or to one administered while attending route, and documentation) (1); child care. They should know the names of the the medication; medication(s), when each was given, who prescribed them, 6. Documenting and reporting whether the child and what the known reactions or side efects may be in vomited or spit up the medication. Even common drugs such administered and the amount being returned to as acetaminophen and ibuprofen can result in signifcant the family; toxicity for infants and small children. When disposing of unused medication, the remain from the use of inaccurate measuring tools can result in der of a medication, including controlled substances. Tese products are not safe for infants on an ongoing basis by designated staf and should include and young children and were withdrawn by the Consumer the following: Healthcare Products Association for children less than two a. Specifc, signed parental/guardian consent for the care years of age in 2007 (4-6,8). The medication and possible side efects; errors log can be reviewed and will point out what kind of d. Written documentation of administration of medication intervention, if any, will be helpful in reducing the number and any side efects; of medication errors. Based on the information, the are ?controlled substances, meaning that the medication facility should develop and implement a plan regarding is regulated by the federal government due to potential for medication administration training (9). A prescribing health professional may Administering medication requires skill, knowledge need proper accounting for these types of medications to and careful attention to detail. Parents/guardians and assure that requests for reflls are because the medication prescribing health professionals must give a caregiver/ was given to the patient and not used/abused by adults. An example of when medication cannot be cies and procedures for the following items: returned is when a parent/guardian has removed the child a. Maintaining equipment used for hand hygiene, toilet from care and the facility cannot reach the parent/guardian use, and toilet learning/training in a sanitary condition; to return the medication. Managing animals in a safe and sanitary manner; home, the caregiver/teacher should be aware of their use. Con Administer Medication tamination of hands, toys, and other equipment in the 9. Policy the amount of bacterial contamination) can be easily for statement: Guidance for the administration of medication in school. Cough and cold procedures can reduce the occurrence of illness in the medication use by U. Touching a contaminated object; and cold medicines announce voluntary withdrawal of oral infant. State policies regarding Since many infected people carry communicable diseases nursing delegation and medication administration in child care setttings: A case study. Food and Drug Appendix K: Routine Schedule for Cleaning, Sanitizing, Administration Food Sanitation Standards, and Disinfecting State and Local Rules References 4. Hand-washing and diapering equipment reduces disease among children in out-of-home child care 4. Menu and meal planning; the input and approval from the nutritionist/registered. Determination of the kind and amount of commercially guardians; prepared formula to be prepared for infants as h. Eating behaviors of young child: Prenatal and the facility; postnatal infuences on healthy eating, 59-93. Use of sippy cups and bottles only at mealtimes during the day, not at naptimes; 9. Prohibition of serving sweetened food products; Plans for Evening and Nighttime Child Care g. Early identifcation of tooth decay; sleeping children and the management and maintenance of i. Tooth brushing and activities at home may not for daytime child care with the exception of sleep routines. Clinical guideline on needs, transitional objects, lighting preferences, and periodicity of examination, preventive dental services, anticipatory bedtime routines. Family child care homes should Policies should include that all of these substances are pro be kept smoke-free at all times to prevent exposure of the hibited inside the facility, on facility grounds, and in any children who are cared for in these spaces. Policies should In states that permit recreational and/or medicinal use of specify that smoking and vaping is prohibited at all times marijuana, special care is needed to store edible marijuana and in all areas (indoor and outdoor) of the program. Department of Health and Human Services, Centers for that young children can get on their hands and ingest, espe Disease Control and Prevention, Coordinating Center for Health Promotion, cially if they?re crawling or playing on the foor. Beliefs about the health efects of ?thirdhand smoke dination, judgment, and response time is prohibited. Health efects of second prohibited, but these items should be stored safely at hand smoke. The efects of cannabis and alcohol on simulated arterial driving: Infuences of Health Policies driving experience and task demand. Child care health consultants roles that if frearms and other weapons are present, they should: and responsibilities: Focus group fndings. Have child protective devices; of child care health consultation services for child care providers in New b. For large and small family homes the policy should include that ammunition and ammunition supplies should be: a. Parents/guardians should be notifed that frearms and other weapons are on the premises. Policy for scheduled reviews of staf members ability to occurrence that is threatening to the health, safety, or wel perform frst aid for averting the need for emergency fare of the children, staf, or volunteers. The facility should medical services; also include procedures of staf training on this plan. Injuries to children requiring medical or dental care; performance and opportunities for improvement should. Health and safety emergencies involving parents/ vention and control is necessary to ensure that a safe guardians and visitors to the program; environment is provided to children in child care. Routine restocking of frst aid kits is necessary to ensure The following procedures, at a minimum, should be supplies are available at the time of an emergency. Staf addressed in the plan for urgent care: should be trained in the use of standard precautions during the response to any situation in which exposure to bodily a. Management within the frst hour or to a source of urgent care and remain with the child so following a dental injury may save a tooth. Provision for the caregiver/teacher to provide the medi have occurred, some involved violence resulting in injury cal care personnel with an authorization form signed by and death.

Additionally medicine ball abs cheap mentat ds syrup 100 ml amex, stigma surveys tend dementia and to understand how stigma affects people to focus on knowledge and/or awareness treatment tinnitus discount 100ml mentat ds syrup fast delivery, assuming living with dementia medications causing dry mouth order 100ml mentat ds syrup mastercard. The consequences of stigma are that these are linked with discrimination; however medicine januvia proven mentat ds syrup 100ml, it is often described as being as important as the condition essential that we assess true behaviour and experiences itself. At the individual level, stigma can undermine life from the perspective of people living with dementia in goals, reduce participation in meaningful life activities order to validate these links2. At the prominence to the voices and reported experiences of societal level, structural stigma and discrimination can people living with dementia so that we can understand infuence levels of funding allocated to care and support. A better understanding of knowledge, attitudes and behaviour towards people Behaviour with dementia and how these link with consequences for people living with dementia could help us to understand Experiences among people living with where we might focus our efforts to reduce stigma in order to improve the lives of people living with dementia dementia and their families. We wanted to understand the stigma and discrimination (ii) experienced by people living with dementia, in particular Almost 70,000 people from 155 countries and territories what kinds of treatment they felt were unfair and the engaged with the survey and this chapter summarises outcomes associated with these negative experiences. Some survey that individuals experiencing greater levels of stigma and questions were asked among all respondents while discrimination might have worse outcomes. This enabled us to compare fndings across groups but also understand the specifc experiences of Unfair treatment experienced by people certain groups. In addition, we provide a break-down by others because of a diagnosis of dementia. We of selected questions by countries with more than 100 present the reported prevalence of unfair treatment by respondents. Domains of unfair treatment experienced by people living with dementia by World Bank income category (% of respondents) 13. Having responsibilities taken away unfairly Half of the respondents living with dementia from Being avoided or shunned lower-middle income countries reported that they A further 42. For example, one respondent said greatest experience of avoidance or shunning was in the their “spouse wants to do most of the work around the Region of the Americas (40. For example, one respondent said, “I yourself know my health records have been shared without my consent” (60 year old female from Australia). Another When asked about whether people do things for you respondent spoke of a lack privacy across many different that you could do yourself because they know you situations: “I have 3 caretakers. One of them will open have dementia, respondents living with dementia in packages I get in the mail, even after I have asked her upper-middle income countries (75%) reported higher not to . It is impossible for me to have a private phone call rates of others doing things for them, in comparison and privacy with visitors. It may be possible that in some cultures doing things that people can do for themselves When respondents living with dementia were asked corresponds to a wish to show deference, particularly have you been treated unfairly in housing? To the question, Because of your dementia have some Treated unfairly by children or family people not taken your opinions seriously? Respondents reported being by children or family members was greatest in the told “but you have dementia, so what would you know” Western Pacifc region (41. Told I was attention seeking” (66 year old commonly reported by people living in low/lower-middle female from Australia). The it all up” (60 year old female from Canada) and “My highest prevalence being in the Africa region (33. Respondents have reported diffculties and negative experiences while dating: “As soon as I mention I have dementia, they presume the worst. Making or keeping friends When asked about being treated unfairly in making or keeping friends because of dementia, respondents from upper-middle (57. Respondents living with dementia in the Americas reported the highest prevalence of unfair treatment when making or keeping friends (55. Respondent examples of being treated unfairly in social life because of dementia, categorised by theme Themes Respondent examples Accessibility I rely on people to get me places, they often forget me or they are too busy – 59, female, United Kingdom They control what they think I can do. They say they will take me for a drive and then make excuses that they can’t – 57, female, United Kingdom Having to always use a walker (rollator type) causes me to miss out on socialising and attending events. Just recently missed out on attending a good concert which my son and daughter-in law attended. That hurt me – 75, female, United States I was not able to attend an event because I didn’t have a caregiver to accompany me. I live by myself and don’t need one yet – 65, female, United States Sometimes I am not included. Also because of physical disabilities (as an effect of the dementia) accessibility at a given venue makes it impossible for me to attend – 56, female, United Kingdom ‘Feel I can no longer Feel I can no longer contribute – 68, female, Europe contribute’ To a family reunion because there are people who get annoyed or feel uncomfortable – 46, female, Panama I exclude myself, because I can’t keep up – 58, male, the Netherlands Loss of contact Some work colleagues do not contact me any longer – 63, female, Finland Fewer people call to socialize – 58, female, United States After going to a social function with friends, those friends have all but disappeared – 56, female, United States Old friends do not call – 72, male, United States Not being invited Sometimes friends don’t ask me to shindigs as often as they used to , because I don’t drive anymore. That hurt to start with, not so much now – 49, female, United Kingdom Except for a couple of very close friends I no longer get invited to anything – 57, female, United States I’m no longer invited to do things with my friends. I am no longer allowed visitation with my fve year old grandson who were her most of the time from birth to three and a half. The new girlfriend is in charge – 64, female, United States Not invited to family birthdays which hurt. Slowly changing but both my husband and I weren’t on the invitations anymore – 66, female, Australia I am excluded from social get-togethers with in-laws or friends – 57, female, Suriname ‘You are ostracized’ People treated me like a freak in our church meals. Neighbours avoid me – 69, female, United States Kicked out of book club – 69, female, United States I used to be active in a club, but now I am a non person – male, United States I used to volunteer in helping immigrants learn English until they found out I had dementia – 60, female, Canada First time at new resident clubhouse lunch function, after being accepted previously at their board meeting, they shunned my effort to help volunteer to prepare & serve the meal as they previously stated I would be helping – 77, female, United States They treat me like I don’t exist. Themes based on textual responses of people living with dementia when asked ‘Have you been treated unfairly in your social life? Themes based on textual responses of people living with dementia when asked ‘Have you been treated unfairly health or medical staff? When I had to stroke, the attending nurse said “We ‘After the diagnosis, no longer does spend an extended period in hospital, are going to send you home as soon my primary doctor conduct many I was expected to be submissive and as possible because we do not like tests. Respondent examples of being treated unfairly in healthcare because of dementia, categorised by theme Themes Respondent examples About me. They sometimes talk to my wife about things like I’m not even there, but I’m sitting right there – 58, male, United States My neurologist ignored my presence when my diagnosis was discussed with my husband – 59, female, South Africa Being talked about not being talked too I sometimes feel invisible in a room I think a lot of health care offcials need to retrain in dementia awareness skills – 56, male, United Kingdom Case manager who just wants to arrange things instead of talking about the diffculties I’m dealing with – 68, female, Netherlands Dismissive and I was advised I should no longer scuba dive without any reason other than I have dementia. Not any specifc impatient symptom to drive this decision and I am in very early stage of disease – 57, female, United States One medical provider advised me to stop my social engagements because I am old – 70, male, Canada Doctor advised me not to cook anymore, not to drive. And some doctors totally ignored me and talked to my daughter in law only – 76, male, Malaysia My doctor told me that I shouldn’t be able to continue with my voluntary activities – female, Australia Primary care doctor said to my face, “too bad that euthanasia is illegal here” – 65, female, United States Neurologist diagnosed me with Alzheimer’s at 56, telling me to go home and get my fnal affairs in order and to wait until my premature death – 60, male, United States Lack of People including health professional ignoring what I am saying – 86, male, Zambia Understanding When admitted to hospital for a stroke, the attending nurse said, “We are going to send you home as soon as possible because we do not like dealing with night terrors”, a common symptom of Lewy Body dementia which I have – 66, male, United States People look at me just as a dementia patient not as person living with dementia – 62, male, Japan the bluntness of the frst neurologist and his diagnosis without any additional examination – 78, male, Netherlands Not spending enough time, only showing me once how to use a gadget to read diabetes readings. I need shown a few times for me to remember how to use it – 73, female, New Zealand ‘Suggested I was While I was in hospital a nurse was moaning about a noisy patient with dementia made me feel like what are faking it’ they saying about me – 70, female, United Kingdom A primary care doctor told me that I wanted to be sick! But, also, they then talk over me, about me, and never to me, if an inpatient, due to me having dementia. When I had to spend an extended period in hospital I was expected to be submissive and not to question anyone or to stand up for my rights. They treated me as a “diffcult” patient – 56, female, United Kingdom I am fnding that health care professionals do not listen to me, or know how to ask the questions that I can answer. Examples of unfair treatment reported by people living with dementia according to life domain Domain of unfair Quote from respondents living with dementia treatment People doing things for My partner has taken over all our fnances I think I could manage some of the – 63, female, South Africa you that you could do yourself because they Sometime people try to speak for me, but I insist I am still able to do this – 56, female, United Kingdom know you have dementia People mean well, but I am not an invalid. If I offer to help when I go to their house they don’t often let me – 49, female, United Kingdom Giving a shower to the persons with dementia instead of assist and let them shower themselves because they don’t have time and have to go to work – 50, female, Thailand Spouse reminds me of things that I can remember on my own, i. All in voice that sounds like she is reminding a child – 57, female, United States A close friend sometimes fnishes my sentence as I take time to fnd my words. I am in very early stage and aphasia is my major problem – 75, female, United States A lot of things I feel I may still be able to do others do for me in the name of helping – 62, female, United States Always volunteering to do stuff not wanted by me. Tiresome – 60, female, Malaysia I was excluded from the rotating duty of the neighbourhood association – 87, female, Japan Not taking your opinion Sometimes in open conversations in groups of friends, I feel my opinion is “sidelined” – 63, female, South seriously because of Africa your dementia They simply think I am dumb. Especially since I look 10+ years younger than my age – 48, female, Uganda Some people have the impression that should be less vocal in my opinions. When speaking to carers (of others) in order to spread awareness of the dementia experience I have been shouted down and told I don’t understand the situation, even though I have also been a carer for a family member with dementia – 56, female, United Kingdom It’s as if invisible, if I ask my husband to do something, he totally ignores it causing arguments all the time – 57, female, United Kingdom I love a good debate. That is the dementia talking – 61, male, Canada People just don’t listen when I talk – 69, female, United States I have even been told, “but you have dementia, so what would you know! I was also denied access to an Alzheimer’s seminar because I have the disease and when insisted and raised the Americans with Disabilities Act, was allowed to attend but only if I didn’t tell anyone I had dementia. This was a well-known hospital providing this seminar – 57, female, United States Taking away carrying credit cards, cash – 81, male, United States I still live on my own. Asking people not to joke about us, always means they take offense, rather than accept they may be offending or upsetting us – 60, female, Australia My child said that I looked like an alpaca when I dribbled saliva – 53, female, Japan People said that I did not look like someone with dementia – 58, male, Japan Treated unfairly in They tend to visit less often avoid visits – 74, female, South Africa making or keeping friends because of your Forgetting their names or when to meet. I am not always included in the plans of friends I have kept and I put this down to my diagnosis – 56, female, United Kingdom My siblings don’t talk to me or ask how I am anymore – 62, male, United Kingdom Barred from my Sister’s house because they said I have used abusive and obscene language – 70, male, Canada People tend to run when they learn you have dementia – 60, male, United States When I make statements that are out of character some friends and family have taken it personally and stopped talking to me – 58, female, United States I feel isolated – 65, female, Argentina Many have told me they are not at all interested in “the dementia journey” – 60, female, Australia Some friends don’t like to talk to me because I repeat – 87, female, Singapore I have a few people say don’t talk to her she has no idea what she is talking about – 65, female, New Zealand Some people cannot cope with the different me – 69, male, Australia Avoided or shunned by Because they think that they cannot cope up to their standard of thinking – 55, female, Zambia people who know that you have dementia They avoid socialize – 74, female, South Africa Close friend doesn’t call at all anymore – 60, male, United states In my faith community, avoiding me – 66, male, United States No one comes to my house but one neighbour (who wants my furniture when I am moved away) and my adult children visit rarely when they come they avoid me most of the time and go out to have fun. I stopped attending family gatherings for the last 9 years since diagnosis – 70, male, Canada Too much expected of me sometimes. Irritation that I don’t remember things – 70, female, United States Family frustrated, angry, and in denial themselves – 69, female, Canada Children sometimes seem to dismiss my decisions regarding my future – 79 female, United States [being told] “You’re a crazy mother” – 52, female, Brazil Excluded by over half of them. It was easier to believe the wrong diagnosis of hypomanic depression late onset bi/ polar schizophrenia.

Perpetrators who committed assaults for sexual gratification or intimacy were more likely to have had prior social interactions or interpersonal relationships with their victim (Hodge and Canter symptoms during pregnancy buy mentat ds syrup overnight, 1998) medicine journal impact factor order 100 ml mentat ds syrup visa. While more research is needed to gain a better understanding of the full range of male perpetrators who sexually assault male victims medicine for runny nose purchase mentat ds syrup 100 ml free shipping, these studies indicate that medicine 94 purchase mentat ds syrup with paypal, similar to other types of sexual assault perpetrators, the motivations, characteristics, and behaviors of these perpetrators are complex and likely vary between perpetrators. Characteristics of Male Perpetrators Who Sexually Assault Male Victims Because the study of male-on-male sexual assault is still an emerging area of research, we know very little about the characteristics of male perpetrators who sexually assault other men. These studies have often drawn on relatively small samples of individuals from specific populations, such as emergency rooms or psychiatric facilities. In addition, most studies have not examined the association between perpetrators and the types of characteristics often found to be related to other types of sexual assault. Ongoing research has examined sexual assault victimization among active-duty members of the armed forces (Morral et al. Approximately 70 percent of victimized men responding to questions regarding the most serious offense they had experienced in the past year indicated that their offenders were men or a mixture of men and women. In addition, 34 percent of victimized men indicated that the incident was a form of hazing. Additional research is needed to more thoroughly consider the extent to which hazing may provide a context for male-on-male 7 sexual violence. More research is also needed on the characteristics of various types of male perpetrators who sexually assault other men. It found that homosexual men who reported engaging in sexually aggressive acts were more likely to report experiencing abuse as a child (physical, sexual, or emotional), to have previously accepted money for sex or paying money for sex, to have their first homosexual experience at a younger age, and to report that they would rape a man if they would not be caught or 44 Behaviors of Male Perpetrators Who Sexually Assault Male Victims Studies on the behavior of male perpetrators who assault other men have drawn samples from different populations?for example, sexual assaults reported to police, emergency-room visits, or other clinical samples. In addition, some studies have focused exclusively on sexual assaults in which the victims and/or perpetrators are homosexual, and others have not differentiated their sample by sexual orientation. For example, some research found that most perpetrators know their victims and rarely use weapons during the attack, while other studies, using samples of victims who visited emergency rooms, reported high numbers of male-on-male sexual assaults perpetrated by a stranger who employed a weapon during the attack (Frazier, 1993, and Isely and Gehrenbeck-Shim, 1997). Studies have also varied in the reported proportion of assaults in which the perpetrator uses enough force to cause injury to the victim, ranging from 25 to 60 percent of assaults (Frazier, 1993, and Stermac et al. In addition, assaults committed by a stranger were more likely to be reported by the police. These findings point to the need for research that considers both the source of data and male-on-male perpetration type. Conclusions the study of male perpetrators who sexually assault other men is still emerging. Existing studies do indicate that the motivations behind this type of sexual assault can vary. More research that considers differences among various types of male perpetrators who sexually assault other men is needed. In addition, most existing studies are largely descriptive in nature and/or are limited to particular samples. Therefore, more rigorous research examining the characteristics and behaviors among this diverse group of offenders is also needed. Multiple-Perpetrator Sexual Assault Multiple-perpetrator sexual assault involves a sexual assault in which more than one individual conducts the offense (Horvath and Kelly, 2009). The frequency of multiple-perpetrator sexual assault remains unclear, in part due to numerous issues in reporting and recording of sexual assault in general (Koss, 1993). Estimates for the United States suggest that the proportion of sexual assaults that involve multiple perpetrators ranges from 2 to 33 percent (da Silva, Woodhams, and Harkins, 2013, and Horvath and Kelly, 2009). The percentage of male service-member victims who were assaulted by multiple offenders was not reportable because fewer than 15 respondents reported this experience or because the relative standard error was high. Research on multiple-perpetrator sexual assault is limited and typically involves analysis of a select number of case descriptions, which are obtained through law enforcement or news reports (Porter and Alison, 2006). These reports are only available for reported cases, so the generalizability of information from these reports to unreported incidents is unclear. In addition, inconsistencies can be seen across studies, depending on the cases selected for inclusion in particular studies (Harkins and Dixon, 2010). Further, data from these reports often focus on victim statements (Chambers, Horvath, and Kelly, 2010), so there is little information on the interpersonal or intergroup dynamics of the offenders. With these limitations in mind, this chapter focuses on reviewing the past research and literature on multiple-perpetrator sexual assault, which may assist with preventing multiple-perpetrator sexual assault among those in the Air Force. Descriptive Characteristics of Multiple-Perpetrator Sexual Assault Descriptive research on multiple-perpetrator sexual assault suggests that most involve between two and four male offenders and that the victims tend to be women (Chambers, Horvath, and Kelly, 2010; Harkins and Dixon, 2010; Woodhams and Cooke, 2013). Incidents involving up to 22 offenders during a single multiple-perpetrator sexual assault have been recorded (Morgan, Brittain, and Welch, 2012). Although research on the characteristics of multiple-perpetrator sexual assaults is mixed (Harkins and Dixon, 2010), studies tend to show that multiple perpetrator sexual assaults commonly begin with an offender approaching the victim at an outdoor location, then using a vehicle to move the victim to a private dwelling, with some research showing this occurring in more than 40 percent of reviewed assaults (Horvath and Kelly, 2009; Morgan, Brittain, and Welch, 2012; Porter and Alison, 2006; Ullman, 1999b). When approaching the victim, perpetrators tend to talk with and trick the victim into temporarily 47 trusting them (da Silva et al. Thus, the initial encounter between one of the offenders and the victim is often friendly, then the victim is lured to a location, where the other offenders are located (Chambers, Horvath, and Kelly, 2010, and Morgan, Brittain, and Welch, 2012). Of note, surprise attacks also occur with frequency in multiple-perpetrator sexual assaults. Although some research suggests that there may be differences between multiple-perpetrator sexual assaults involving two offenders and those involving three or more offenders (da Silva, Woodhams, and Harkins, 2013), theory and research generally suggest that a leader, or one offender, tends to direct the actions of the other or group of others during multiple-perpetrator sexual assaults (Porter, 2013; Porter and Alison, 2001; Woodhams et al. During the offense, use of violence appears to be somewhat more common in multiple-perpetrator sexual assaults than in lone-perpetrator sexual assaults (Morgan, Brittain, and Welch, 2012, and Porter and Alison, 2006). The results of research on use of weapons during multiple-perpetrator sexual assaults are mixed, however, such that some studies have shown greater use of weapons in multiple-perpetrator sexual assaults than in lone-perpetrator sexual assaults (Hauffe and Porter, 2009, and Porter and Alison, 2006) and others have not (Morgan, Brittain, and Welch, 2012). Completed vaginal rape is common in all multiple-perpetrator sexual assaults, and it is more common in multiple-perpetrator sexual assaults than in lone-perpetrator sexual assaults (Morgan, Brittain, and Welch, 2012, and Ullman, 1999b). Limited research suggests that, following the multiple-perpetrator sexual assault, approximately half of the victims may be released by the offenders, but approximately one-fifth of the victims are killed (Porter and Alison, 2006). The outcomes in the remainder of cases include victim escape (11 percent), victim rescue (8 percent), or unsuccessful attempts to kill the victim (3 percent). Of those released, approximately one-fourth are abandoned at the scene of the crime, and approximately one-fifth are transported elsewhere and then abandoned (Porter and Alison, 2006). Characteristics of Multiple-Perpetrator Sexual Assault Offenders Multiple-perpetrator sexual assault offenders tend to be either strangers or casual acquaintances of the victim (Morgan, Brittain, and Welch, 2012), so the victim is unlikely to have a close relationship with any of the multiple-perpetrator sexual assault offenders. On average, multiple perpetrator sexual assault offenders are younger than lone offenders. Their average age tends to be approximately 21 to 22 years (Hauffe and Porter, 2009, and Ullman, 1999b), and they tend to choose victims who are approximately their same age or slightly younger (Porter and Alison, 2006). In addition, multiple-perpetrator sexual assault offenders are significantly more likely than lone-perpetrator sexual assault offenders to have a history of drug or alcohol abuse (Hauffe and Porter, 2009). A culture or subculture that encourages sexual inequalities and violence may influence sexual perceptions and behaviors. Fraternities, gangs, and military groups have been analyzed in the context of promoting a culture of hypermasculinity, male dominance, and male bonding (Bourgois, 1996; Franklin, 2013; Harkins and Dixon, 2010; Lilly, 2007). This culture, coupled with other group components, including group loyalty and protection, may contribute to a greater likelihood of multiple-perpetrator sexual assault (Martin and Hummer, 1989). Sexual assault of group members against other same-sex members in a group that encourages bonding and loyalty, such as during hazing activities, is also possible, but the frequency of this and factors that contribute to this are under-researched (Kirby and Wintrup, 2002). For example, multiple-perpetrator sexual assault or rape against a group initiate may occur in an effort to force the initiate to demonstrate their obedience and commitment to the group (Anderson, McCormack, and Lee, 2012). Due to the unwillingness of perpetrators and victims to report these acts, however, little research is available on this topic. Social Psychological Processes in Multiple-Perpetrator Sexual Assault Due to the involvement of more than one offender, perpetration in multiple-perpetrator sexual assault may be considered in the context of research on social processes. Interpersonal and group involvement appears to result, in part, from individual needs to belong and form bonds with others (Baumeister and Leary, 1995). In an effort to belong, a person may evaluate their own beliefs and actions against the beliefs and actions of others, including those of the group they wish to gain or maintain membership in (Festinger, 1954). If there is correspondence between the individual and group beliefs or behaviors, beliefs or behaviors may become more extreme (Myers, 1978). This would suggest that correspondence between mildly sexually violent thoughts and actions among those in a group may contribute to the performance of more extreme behaviors, including multiple-perpetrator sexual assault. Other theories support a related notion of group polarization through conformity to group norms. If there is no correspondence between the individual and the group, the group may pressure or threaten the individual to conform, and thus, an individual may be pressured into engaging in multiple perpetrator sexual assault (Harkins and Dixon, 2010). Another social-psychological process often attributed to offender participation in multiple perpetrator sexual assault is that of deindividuation (Harkins and Dixon, 2010).

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