Choking Game

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    "My daughter hung herself! Please God no!"

    Greer Shannon dialed 911 from her Grapevine home after finding her teenage daughter Stephanie Shannon hanged on a Wednesday evening two years ago. The date was Dec. 7, 2005 &- only five days after her daughter's 15th birthday. The medical examiner's report listed the death as a hanging/suicide. And the family had no reason to believe otherwise.

    A blogger matching the name of Stephanie's sister stated: "After my sister's funeral, my mom found out that one of the ladies she works with daughter confessed to her that she had been playing this "game' and had played it alone several times." Stephanie may have been a victim of auto asphyxiation.

    The Shannons did not consent to an interview.

    Using ropes, belts and other ligatures, "gaspers squeeze their necks, restricting the flow of oxygen to the brain. Just before they blackout, the players release the pressure and the blood once again begins to flow. They catch a legal high.

    Others may have partners choke them to achieve euphoria or hyperventilate until friends apply pressure to their chests or abdomens, causing them to pass out.

    The risk is death.

    This is the "choking game."

    "A lot of kids are doing this to get a buzz, to get high, to alter their consciousness," said Stephen Wallace, chief executive of Students Against Destructive Decisions, a non-profit organization based in Marlborough, Mass. "And some are doing this for autoerotic reasons &- sexual gratification.

    "Unfortunately, we live in a society today where people will do almost anything to get high, including alcohol or other drugs or sucking on aerosol cans," Wallace said. "They're smashing their heads against walls or choking themselves and others."

    At least 82 children and adolescents have died as a result of the choking game since 1995, according to the Centers for Disease Control and Prevention's first official report, which was released in February 2008.

    Players can lose consciousness in seconds, and within three minutes of strangulation, memory, balance and the central nervous system begins to fail, according to the CDC. Even those who survive the game can experience the loss of brain cells, concussions or broken bones, hemorrhages of the eyes, comas or seizures, according to the CDC.

    According to the Dylan Blake Foundation, founded by a mother who lost her 11-year-old son to the game in 2005, at least 80 deaths and injuries were a result of the choking game in 2007.

    Kate Leonardi, founder of the Florida-based group, has been compiling statistics from parents and communities who have 70 percent auto asphyxiation and 30 percent autoerotic asphyxiation &- she doesn't know if the issue is a growing trend or if people are just more aware of the issue.

    "There might be an increase in incidences because kids are looking for a drug-free high or rush," she said. "They're aware of how bad drugs are so they see this as legal and safe."

    But asphyxiation is neither legal nor safe. Lt. Todd Dearing of the Grapevine Police Department said assisting in a suicide &-whether intentional or not &- is illegal.

    "Auto asphyxiation would probably be a reckless act," he said. "It would be a second-degree felony, which would be two to 20 years and up to a $10,000 fine. But it's kind of hard to say unless you have a totality of circumstances. I don't want to say if someone caused another one's death during the choking game it would always be a reckless act. It's kind of hard to say because you have to look at each one differently.

    "Anybody under the age of 17 goes to juvenile court," Dearing said, "and it's a different system in a juvenile court. They're charged with delinquent conduct/manslaughter."

    But Dearing said different rules apply in a juvenile court, so an adolescent wouldn't actually receive two to 20 years in prison. Travis Bailey, a senior entrepreneurial management major, said he remembers a couple of kids playing it in eighth grade gym class at St. Patrick Catholic School in Dallas.

    "They heard you'd pass out if you did it after physical exertion," he said. "They were just messing around. (But) the school flipped out and parents got involved." Wallace said parents and loved ones should look for the warning signs of the game: red eyes, marks and bruises around the neck, isolation or locking bedroom doors.

    And Leonardi said frequent, severe headaches and unexplained falls are also warning signs.

    "Dylan, a week before he had died, came home with contusions and bruises on his head and the front of his hands and we couldn't figure out why," she said. "He said, "Oh, you know, I fell off my bike.' It didn't match up. Looking back, it does match up with him and a friend or more playing the game. He passed out and they couldn't catch him."

    Gallagher said children who participate in auto asphyxiation might be depressed or anxious and have low self-esteem, allowing themselves to participate. Or others might feel they need the risk of auto asphyxiation to feel stimulated, she said.

    "A child would want to get high to escape something," she said. "It temporarily numbs you or masks the problems you're going through. It's a temporary escape of whatever the perceived problem is.

    "If you're looking at children or adolescents," Gallagher said, "they really don't have the understanding that, "I could die. Others could die and old people can die but, surely, that wouldn't happen to me.'"

    Leonardi said the sexual version of the game, autoerotic asphyxiation, is usually an issue among adolescents and adults, 16 and older. She said people must be aware of their sexual beings before they can incorporate autoerotic asphyxiation. Welsh said autoerotic asphyxiation is mostly a male behavior "associated with attempting to restrict the flow of oxygen to the brain in an attempt to heighten the effect of the sexual climax."

    "Unfortunately, it can go awry and people can accidentally hang themselves," he said. "It's such an odd and unusual phenomenon."

    TCU Police Sgt. Kelly Ham said he remembers two cases involving autoerotic asphyxiation in 1978 and 1979, when he was with the Granbury Police Department. However, he said, he has not seen a case at TCU in the 22 years he has been with TCU Police.

    Leonardi said even with almost 400 reported cases of asphyxiation worldwide &-nity mobilization agency.

    "With autoerotic asphyxiation, sometimes things are reported differently on the medical examiner's report because there's either some confusion about what happened or there is still a lot of shame and stigma in regards to sexual issues," said Haenes, who has studied
    sex therapy and sex issues. "So, often times, people just report it as an accidental death."

    Therefore, current statistics depend on online surveys, e-mails and deaths reported by the media, Leonardi said. And, until February, the CDC did not have statistics either.
    The Texas Department of State Health Services compiles death statistics each year.

    However, asphyxiation is not documented.

    "Statistics aren't compiled on auto asphyxiation because the people filling out the death certificates have no idea what was going on in the mind of the person who died, such as if they were playing the choking game," said Gene Willard, medical research specialist with the
    DSHS Center for Health Statistics.

    The Texas Department of State Health Services does collect data on deaths by suicide, hanging, strangulation and suffocation.According to provisional data from 2006, 65 deaths fit this category among the ages of 10 to 19. 

    Still, Doug McBride, DSHS press officer, said, "Data captured does not allow us to determine
    how many, if any, of these deaths were the result of the so-called "choking game.'"

    David Welsh, a psychologist in Fort Worth, said adolescents have always been fascinated by mood-altering experiences.

    "Adolescents are risk-takers and kind of herd creature, whereas if someone picks up a trend or idea or activity, others want to sample it," he said.

    Because they're adolescents, their judgment is not very solid and their impulse control is not very good," Welsh said. "Their common sense is sort of woefully lacking. They imitate adult behaviors and they mess it up."

    TCU alumna Sheree Gallagher is a clinical psychologist at the Fort Worth Psychological Center. She speculated that auto asphyxiation might fall under a couple of categories related to self-destructive behavior Lost children to the game since Dylan's death. She said about 75 percent of the children she has talked to are aware of the choking game. But only about 25 percent of parents are familiar with the term, she said.

    "It is worldwide," she said. "The only defining factor is it's typically 9 to 16-year-old boys. But there's no barrier &- no ethnic barrier, no socioeconomic barrier. It's across the board."

    About 87 percent of victims are boys, according to the CDC. And most girls who play the choking game are between the ages of 13 and 16, Leonardi said.

    In 2006, SADD surveyed 2,829 teens in high schools and middle schools across the U.S, according to SADD. More than one in 10 teens who were surveyed said they had engaged in self-asphyxiation, Wallace said, and more than half said they were aware of the game.

    Asphyxiation cases are often reported as suicides because it is difficult to determine if the game was the cause of death, meaning the facts may be skewed, said John Haenes, chief operating officer of Tarrant County Challenge, a grassroots commu-though the intent may not be there, thebehavior may unintentionally end someone's life."

    And Robin Davis, the Safe & Drug-Free Schools coordinator for Grapevine ISD, said though the district has not had an asphyxiation death that she is aware of, many parents are aware of the issue. 

    Last year, Davis said, parents were getting awareness e-mails and contacted the school resource officer. She said parents were seeking additional information from
    the school counselors. And as a result, Grapevine ISD put an awareness video in the school library, Davis said.

    The video, called "Choking Game" by Human Relations Media, plays a clip from a tragic 911 call from a 13-year-old boy who finds his brother hanging from a bunk bed.

    "I think we need to give kids a little more credit," Davis said. "If we give them accurate information and what the consequences are, I think they can make the right choice."

    Wallace said another problem is what he calls the "reality gap."

    "There's a disconnect between the real world kids live in and what I refer to as the make believe world adults think that they live in," he said.

    Leonardi said the Dylan Blake Foundation conducts presentations for parents on the dangers of the choking game. And, she said, the foundation is attempting to implement asphyxiation awareness into the Drug Abuse Resistance Education program or health programs in schools.

    Games Adolescents Shouldn't Play is also working to include awareness into the
    DARE program. Supporters can fill out a petition on the Web site at www.DeadlyGamesChildrenPlay.com.

    John Lindsay, regional director for DARE America, Miami, said DARE would encourage local DARE officers to address the issue.

    "But it has not risen to a level where the advisory board or parents and communities have brought it to our attention as a national issue," he said.

    Matt Petrie, DARE officer of Grapevine, said though asphyxiation awareness is not officially part of the program, it's always discussed.

    Welsh speculated that children engaging in asphyxiation are trying to say something through the behavior. First, he would perform a clinical assessment, he said.

    "Are we looking at someone who actively or even passively suicidal? Or are we looking at some knuckleheaded adolescent who has just engaged in risk-taking behavior because he wants to catch a buzz? The rule of thumb is anytime a child is exhibiting behaviors that are
    problematic … the first thing you have to do is figure out what the behavior means," he said.

    Some school districts are not aware of an asphyxiation issue with the districts, including Fort Worth ISD and Grapevine ISD.

    Linda Wolszon, director of Mental Health Services at TCU, said she has never treated or seen an asphyxiation issue in her counseling career. 

    Unfortunately, it takes death or near death before people know it's a problem, said Kathryn Everest, program coordinator of guidance and counseling for Fort Worth ISD.

    Monica Kintigh, a licensed professional counselor for the Health Center, said TCU offers programs that focus on the warning signs that can lead to suicidal behaviors.

    "We look at all the behaviors that might lead to suicide or death," she said. "Even

    When we're teaching DARE, this alwayscomes up," he said. "The kids bring it up. And if they don't, I bring it up. What DARE's about is making good decisions.

    "They always say, "I had a friend that did it.' But when they're sharing stories, I can tell if they've done it," Petrie said.

    "Sometimes you can tell by the look on their face that they're the one who has experimented with it. You can hear it in their voice. A lot of times it comes up when we're talking about inhalants (because) you get the same effects."

    Wallace and Leonardi agree that education is the best form of prevention.

    Leonardi said with prevention being a part of the picture, the future of asphyxiation
    education looks promising.

    "Minus a prevention and education piece, I think it's going to get worse as kids teach other kids how to do it," she said.

    According to SADD's research, Wallacesaid, young people whose parents take the
    time to talk about issues such as drinking and drug use, set expectations and enforce consequences for misbehavior are less likely to engage in these behaviors.

    "So my hypothesis would be that the same would hold true for self-asphyxiation behaviors,"
    he said.

    Leonardi said she thinks her son, Dylan, may have been playing the choking game for only the first or second time when he died.

    "I really don't think that he saw any danger in it," she said. "All he had to do was stand up. His knees were an inch off the floor. So I think his thought process was, "Once I get that floaty feeling, that dreamy feeling, I'll just stand up.' But they don't realize how fast that happens.

    "What happened? This kid had just finished a book report, he was packing it in his school bag for school the next day, we had plans for later on in the month," Leonardi said. "I was the single parent of an only child. He and I were the everything in the world."

    Leonardi said the chances are that children already know about the choking game and not discussing the issue with them allows them to continue thinking it's a safe game.

    "Having the information and not talking about it, you run the risk of ending up in my shoes," she said.

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