A group of young teen boys and girls gather downstairs in their parents' basement. One boy shoots each one of his seventh grade friends a glance. A thick, penetrating silence sweeps across the rec room. The boy whispers the dare to them all.
"Try it if you're brave enough."
A twelve-year-old boy steps forward, running one trembling hand through his overgrown, shaggy blonde hair, his bravado about as convincing as the peach fuzz barely covering the skin above his lip.
He knows too well this is not your typical game.
One boy presses the other up against the wall. His hand wraps around the neck of his friend, cutting off blood flow and therefore oxygen to the brain. The boy begins to feel faint, then high, and then loses consciousness as his friends lower him to the floor.
The choking pressure is released and blood rushes back into the boy's brain, which greedily soaks up oxygen, causing him to feel high once again -- but this time more euphoric. One girl looks on in anticipation: her turn is next.
Also called the American Dream, the Funky Chicken, and Space Monkey, as well as a plethora of other seemingly innocent pseudonyms, the choking game is well known to teenage and tween boys and girls across North America and the world. Scenes like the fictional one described above are played out every day, sometimes with deadly results.
Not much of a 'game'
A study by the Centers for Disease Control and Prevention identified 82 choking game related deaths among American children and adolescents between 1995 and 2007. Fatalities most often occurred among boys under 15 years of age. Clearly, this is a harmful behaviour.
"At this point, there is a need for public education," says Angela Boak, Research Coordinator and Analyst at the Centre for Addiction and Mental Health in Toronto. After studying this phenomenon, she believes "parents, physicians and educators should be aware of this game."
Unfortunately, many are not.
Recent surveys found close to one-third of physicians had not even heard of this potentially life-threatening activity, and almost half of the youths surveyed believed there was no risk associated with the game at all. And the risks are serious: the game has been fatal for some, while other complications include brain damage, loss of vision, and physical injuries from fainting.
While it is important for adolescents to understand the very real risks, this knowledge may not be enough to prevent an adolescent from playing the choking game.
The adolescent brain
One reason for this is that the adolescent brain has not reached the peak of its ability to assess risk. In fact, neuroscience shows that adolescents use a different area of the brain than adults when evaluating risk and making decisions.
Decision-making can be thought of as a competition between two areas of the brain, the socio-emotional control network and the cognitive control network. Depending on the decision, it can be a real battle of the emotional vs. the rational mind. In adults, the cognitive control network is often very good at rationalizing feelings and controlling impulsive behaviour. It helps a person exercise caution, allowing them to think, "wait a second: even though I feel curious and eager to play, this game could be very dangerous."
In adolescents, the cognitive control area of the brain is not fully developed, sometimes leading them to what psychologists call "sensation-seeking behaviour," behaviours which are often risky. Being scared or excited about an idea, like playing the choking game, stimulates the socio-emotional control network. This area of the brain is further stimulated by the idea of a social reward, like gaining approval from friends. With less regulation or cognitive control, these factors can make risky behaviour far more enticing. In this case, the obvious physical risks recognized by the cognitive control network are not adequately weighed when making a decision to participate or not.
"Students with high sensation-seeking scores are also more likely to have played the choking game," says Boak. This is perhaps not a surprise: high sensation seekers normally choose activities with higher levels of stimulation or thrill, like skydiving or contact sports. But thrill-seeking may not be the only reason an adolescent gets involved in a risky activity. "The question remains as to whether the choking game is simply a thrill-seeking activity or if participating in the game is also somehow related to emotional problems."
Boak cites data from the 2007 Ontario Student Drug Use and Health Survey, revealing that adolescents who reported higher levels of psychological distress and those who reported being bullied were significantly more likely to have participated in the choking game. "It is hard to say if those types of feelings necessarily cause children to play the game," she says, noting that a causal relationship was not determined in the study.
Regardless of whether a child is a sensation-seeking type or under psychological distress or not, all kids are susceptible to peer pressure. Adolescents in groups or even as individuals have always been faced with difficult choices. In some cases, playing the choking game may simply start as a social activity at a birthday party or in the locker room. Later a child may play alone, where the risk of death and brain injury is increased. "Education about risks is always a first step in prevention," says Boak.
Communicating with your child and paying attention to their physical and emotional health is probably the next step.
If you notice any of the following signs or symptoms in your child, contact your health care provider:
- mentioning the choking game
- marks on the neck
- wearing high-necked shirts, even in warm weather
- bloodshot eyes
- small red spots on the face, especially the eyelids or white part of the eye
- frequent severe headaches
- disorientation after spending time alone
- unusual need for privacy
- increased and uncharacteristic irritability or hostility
- unexplained presence of dog leashes, choke collars, bungee cords
- ropes, scarves, and belts tied to bedroom furniture or doorknobs, or found knotted on the floor
- wear marks on bedposts and closet rods
Children who are suffering from complications of the choking game may complain of the following:
- episodes of confusion and seizure-like events
- episodes of altered awareness
- acute vision changes or visual loss
If you find your child unconscious while he is playing the choking game, call the emergency department right away.