The second day will give a global vision on the different means of information and prevention implemented in different countries, expounding on current and developing strategies, cooperative efforts leading to new and improved efficient actions of prevention on national and international platforms.

These speakers talk about prevention implemented
in their country .

Françoise Cochet, pharmaceutical chemist, worked in the research and dosage form department of Sanofi Laboratories, then as quality responsible in the veterinary department. She is a mother of three children.
In September 2000 her son, Nicolas (nearly 15) died doing the choking game, a practice she totally ignored.
She discovered that, unbeknownst to their parents, many kids and teenagers put themselves in danger, unconscious of neck compression consequences. She alerted the French media in October 2000.
A group of victims' parents, gathered for a common action, founded in June 2002 the association, APEAS, she presides.

Identification of various practices leading to fainting, syncope or asphyxia with more or less intensity according to the extension of the oxygen lack to the brain, whether as a result of compression of the larynx or restriction of the arterial and venous cerebral circulation.
The immediate consequences for the child can range from simple loss of consciousness to death through coma. If the intensity of the cerebral hypo-oxygenation was significant, while recover occurred on vital plane, different sequelae are observed and analyzed.

CPR paediatrician since 1973, he coordinates since 1979 the mobile emergency and resuscitation service of the Hospital Necker-Enfants Malades (SAMU de Paris). Specialized in pediatric emergencies and accidents of the child, Jean Lavaud has been involved in accident prevention for thirty years, contributing with many conferences on these topics and organizing continuous training of health and early childhood workers.
Author and co-author of a dozen books, half of them being on scientific matters related to pediatric emergencies and seriously ill or injured children's transportation and the other half, for families and public in general, concerning children accidents and prevention.

Objectives : To determine the prevalence of knowledge about and participation in asphyxial games ; and how to raise awareness of this risk taking behaviour and provide preventive education.
Design : A collaborative research model using a school-based questionnaire at 8 middle/high schools in Texas (USA) and Ontario (Canada).
Results : 2504 surveys (90.7%) were completed. 68% of children responding had heard about the “choking game” ; 45% knew somebody who played it ; 6.6% had tried it (93.9% with someone else). 40% of respondents perceived there to be no risk associated with participation in asphyxial games. The most respected source for a preventive education message was parents for pre-adolescents (43%) or victim/victim family (36%) for older adolescents.
Conclusions : Knowledge of and participation in self-asphyxial behaviour is not unusual amongst North American children. The age of the child likely determines who the most effective informant (parents or victims/victims' family) for delivering preventive education intended to modify behaviour.

Andrew Macnab is a pediatric critical care specialist with a reputation for interdisciplinary research studies who has received national and international awards for his scholarship. In the field of injury prevention he conducted the definitive research proving that children who wear a ski helmet have a significantly reduced risk of head injury, and are not at greater risk of neck injuries from helmet wear.
His original report of a survivor who played “the choking game” raised awareness of this form of risk-taking behavior; his subsequent work has influenced youth education, public policy and the practices of Coroners in Canada in this context ; and led to a documentary feature on asphyxial games by the Canadian Broadcasting Corporation.
Dr. Macnab has received over 10 million dollars in competitive research grant funding, published more than 160 peer reviewed papers and is the author of the best selling textbook “Care of the Critically Ill Child”. He is currently a Fellow at the Institute for Advanced Studies at Stellenbosch University, South Africa.

Asphyxial games, as played by young adolescents are not new phenomena. What appears to be different at present is an increase in lethality introduced by the increasing use of ligatures and “playing” the game alone. Presented are by two closely spaced, but unrelated deaths in young adolescent males. Closer investigation ultimately revealed this surprisingly widespread practice in New Hampshire youth. The deaths described led to review of other, similar deaths. Characteristics of victims of this practice that may help distinguish these deaths from suicidal asphyxia are discussed as well as media coverage of this issue. The presentation strives to emphasize the importance of a thorough death investigation in hangings among youth as well as the importance of raising awareness of the dangers of this behavior among children, their parents, teaches and other influential adults.

Dr. Andrew is Chief Medical Examiner for the State of New Hampshire. He is a graduate of the University of Dayton and the University of Cincinnati College of Medicine. He began his medical career as a pediatrician, and then returned to the University of Cincinnati for training in anatomic pathology, followed by a fellowship in forensic pathology with the Office of Chief Medical Examiner in New York City under the tutelage of Dr. Charles S. Hirsch. He remained on staff in New York until September, 1997 when he was named New Hampshire's Chief Medical Examiner.
Dr Andrew is board certified in pediatrics, anatomic pathology and forensic pathology, and has performed over 4000 autopsies investigating sudden, unexpected or violent death. He is an Associate Professor of Pathology at Dartmouth Medical School and a member of the National Association of Medical Examiners, the American Academy of Forensic Sciences, the American Academy of Pediatrics, the Association of SIDS and Infant Mortality Programs and the College of American Pathologists.

From the lack of prevention to choking game incitement. What practices Law must consider ?

The many situations which APEAS has had to, or is, facing, unavoidable raise the question of the role of the law in these dangerous practices. The main objective is not sanction, it is prevention: avoiding failure to take action as a result of ignorance and, above all, avoiding the dissemination, through any media (books, films, on line videos, blogs, etc...) of dangerous or inciting messages.
What do the rules say where there is no prevention or alert given and children are potentially in danger ? What do the rules say where discussion groups and videos on Internet show adolescents in imminent danger ? What legal means are available to protect children and adolescents ? The French approach, as well as the approach taken abroad, will through some light from a legal standpoint on this subject of international scale.

Fainting practices, which place for Law ?

What is the penal scenery in front of these practices ? What role can or must play the French Ministry of Justice in boosting an evolution of legislation in order to repress provocation to or facilitation of such acts ? Are there other judiciary ways (civil actions, etc...) ? What existing facilities provide an accurate picture of the number and characteristics of these practices (we do not have reliable statistical data allowing comprehensive assessment) ?
The wide diversity of approach of police and gendarmes has some implications on families of victims' feelings. The field reports start only now to discriminate between Choking Game, autolysis and attempted suicide. It is imperative to list the procedural treatments of the investigators to give these tragedies their true meaning.

Games involving asphyxiation and strangulation, widespread in child and adolescent groups for decades, is still an area largely neglected by public health policy. Adults and professionals dealing with children and adolescents are unaware of these experiments, or see them as something marginal involving only psychotic children or depressive teenagers destined to die young.
These views lead to a public debate overloaded with psychiatric opinions on these “new deviants”, when, in fact, our societies are living through a real social shift in their child and teenage cultural practices, where risk-taking and thrills are seen as caution of well-being and proof of maturity.
What prevention policies do public authorities need ? To what extent should professionals involve young people in raising awareness of pleasurable risks and dangerous games? What can be done to allow adults, whether parents or not, who would be prepared to take action and play their full part in prevention, but who are unable to do so because of the many constraints they face in their daily lives.

After completing her doctorate on adolescent risk behaviour and mental health in Alsace (2005), Hakima Ait el Cadi carried out post-doctoral studies on adolescent food-related behaviour and habits under the direction of Annie Hubert at the Marseilles Laboratory of bio-cultural anthropology (UMR/CNRS 6578).
Deputy mayor in Avignon for education/youth, she also leads the Adolescence delegation, a local innovation in France.
She contributed to a number of scientific works like the Youth and Adolescence Dictionary (to be published in 2010, Paris) and an issue of /Autrement/ on “Adolescent Cultures” (2008).

Play is governed by, inter alia, two imperatives for the human child : when conducted with others, it is part of the socialisation process ; but for oneself, it allows the child to discover and to discover who he/she is. Not all games, however, are innocent or help the child grow without danger. Dangerous games,in sometimes old, sometimes new forms, are to be found everywhere around school and extracurricular activities.
The choking game (and its many variations) is one of the most widespread. Dangerous games are unhealthy rituals. Ritual is essentially a call to life. Thus, in a ritualised form, games should have a worthy role to play. Abuses should descend into nonsense and end up fading away, even effectively disappearing. Ritualising is, first and foremost, for adults, providing guarantees. Ritual is here, then, prevention.

Thierry Goguel d'Allondans was a specialist educator for 20 years before becoming a social work trainer (IFCAAD - Alsace Regional Education and Social Work Association) and Doctor of Anthropology at the University of Strasbourg. His initial work focused on adolescent rites of passage.
Today Goguel d'Allondans is continuing his work, with the regular publication of articles and books on adolescence while, at the same time, conducting training for many players on the ground and continuing his work as an associate researcher at the University of Strasbourg Cultures et sociétés en Europe laboratory. He is also active in a number of associations in Alsace. He is the Chief Editor of the magazine Cultures & Sociétés.

The starting assumption is that strangulation activities can and must be assimilated with true addictive behaviours. In setting the framework and focusing on the period of adolescence, terminological information essential to understanding will be provided.
Then will be considered a particular psychopathological approach - at the borderline of psychoanalysis (this word should be used carefully), in order to try to establish a link between dependence, separation distress and reality.

Initiation into dangerous practices can occur in various contexts, not only social but in the family, at school, with friends… Yet as much in initiation than in the proceeding of these practices, an attempt to get close to the psychic process of the concerned children is important. Some children appear more exposed because of some psychopathological disorder : hyperactivity, oppositional trouble, behaviour disorder, anxiety and depression syndromes.
Apart from these specific psychopathological contexts, certain temperamental features constitute risk factors: search of novelty, sensation seeking and sensitivity to boredom… Without excluding precocious children, eager to experiment, who form also a very exposed population. The spotting of these psychological and psychopathological risk factors is here at stake.

MD specialized in child and adolescent psychiatry, she is a former Clinic Head Assistant in Lariboisière-Saint Louis Faculty (Paris). Marie-France Le Heuzey works currently as hospital practitioner at the Robert Debré Hospital (department of child and teenager psychopathology).
Author of several works on suicide, hyperactive children, anorexic children and school phobia, she recently published Dangerous games. When the child takes risks (Odile Jacob, 2009).
In relation to care and clinical research, she wrote articles on childhood, particularly in the fields of psychopharmacology, eating disorders, development disorders and learning disabilities.

“APEAS was the first to make the French public and childcare professionals aware of little known, dangerous practices. But what are these practices? It is better to know what they are to be able to take steps to prevent them.
8 years on, it is not quite so easy to say exactly what these practices are. Termininology will be clarified.
While awaiting the publication of forthcoming studies, some retrospective epidemiological data will be drawn from the association's database. From these, a developmental child psychiatric approach will be applied.”

Christophe Rathelot studied medicine in Aix-Marseille (Psychiatry, Child Psychiatry, Behavioural Therapy and Medicine, Ethology). He won the gold medal at the Dominique Franchi Trophy.
A former university hospital doctor and teacher, he currently works, after teenagers care, in medico-social homes for children with autism and learning difficulties. He has conducted a number of studies on childhood bereavement, pervasive development disorders, attachment disorders, substitute families, thrill-seeking behaviour and therapeutic meals.

Although in both cases the purpose is, reducing the oxygen supply to the brain (usually with a loop), to reach an (euphoric) altered state of consciousness, the relationship of the embarrassing auto-erotic hypoxiophilia and TCG (without obvious sexual component) is generally eluded.
Death shockingly surprises close friends and family, no sign pointing to it : no psychiatric records, no sexual disorders or suicidal depression, the victim was seen a few hours earlier in good health and mood and without apparent troubles. Besides any careful investigation uncovers a more or less complex safety device which failed.
Hence the correct interpretation of facts that are incomprehensible (almost no call for psychiatric help) and rather absent in literature is difficult. I'll review the state of knowledge and consider the features of these strange rituals under the lighting of myths.

Alain Boucherie, a qualified CID Officer, trainer with Gendarmerie anti-drugs team (FRAD) and holder of a university qualification in problem adolescents, joined the gendarmerie in 1983. In 2005, he was posted as Commander of the Juvenile Crime Squad in Caissargues (Gard). He has been involved in prevention initiatives since 1987, and organised a conference for professionals, in which APEAS took part, on “Deviant Behaviour Among Young People” in Nîmes in December 2008.

Scott Metheny has been a police officer in Upper Moreland Township (PA) since 1994. While teaching a DARE class in 2005, he learned of a deadly activity known as “The Choking Game” and put together a prevention presentation to educate children and adults.He has presented over 300 times in many States, appeared on numerous television shows (Today Show, Good Morning America...), is an executive trainer of GASP and colaborates with this association in providing educational materials. He was the 2008 Recipient of the Public Safety Injury Prevention Award from the National Emergency Nurses Association.

The attention paid for several years now by educational staff to prevent “dangerous games” has forced the ministers of National Education to recall the rules of vigilance and responsiveness concerning these phenomena. A series of articles, reports, documents, information in the form of brochures, booklets, websites, guides that I'll identify allowed to set up specific actions and arouse consideration, among the educational community, about these serious acts.
“prevention adapted to school environnement” continues to be a matter of reflexion. It has led to specific actions on certain territories where I was a witness. The National Education Health staff is a valuable support in conducting prevention actions : respective roles of the National Education physician and the Social Welfare and Health Promotion Department for students.

The different means of information and prevention implemented in different countries and strategies of opening new prospects for effective action at national and international

Summary biographies and presentations are to be found on the following pages.

In 1985, our family moved from Toronto, Ontario to a small town of Penetang, Ontario to raise our family in a safe environment. I have been blessed to be the mother of a beautiful 28-year-old daughter Kristen and 2 sons, Joshua age 11 and Jesse 12. I have learned first hand the meaning of loss and grieving. We lost our 12-year-old Jesse to the Choking Game in April of 2005. Life for our family has never been the same and never will.
We have taken from this tragedy the three most important things that we believe were meant for us.
1. Appreciate every minute of each day with your loved ones
2. Do something important for all children with the time there is left
3. Believe that our children were sent to us for such a very short time to learn and teach an important lesson and without a doubt we need to keep that memory of each and every one of them alive !

I am 28 years old and have been working full time as a Program Analyst for 8 years. I have 3 brothers Jesse, Beau and Josh and a sister Maddy. I also have 6 month old twin sons Evan & Ethan.
I lost my brother Jesse to the choking game when he was 12 on April 23, 2005. About 6 months after Jesse died my mom and I decided that there was not enough information warning children about the dangers of the Choking Game.
With the help of some great family and friends and other family members we have met, that have also lost a loved one to the Choking Game, we have put a website together.
The website started off as a way to get information out to the public about the choking game and a way for families affected by the choking game to communicate with each other. Quickly the website became well know across the world and we found ourselves overwhelmed with emails and phone calls from parents of children who had died, children who were still playing the game, schools who wanted to know more information, media contacts and many more.
We were approached by other families from across Canada and the United States and eventually founded GASP (Games Adolescents Shouldn’t Play)
I am one of the website administrators for GASPInfo.com (also known as deadlygameschildrenplay.com or stop-the-choking-game.com). I maintain the website and make changes when needed along with my mother Sharron Grant.
Our goal is to make sure other families don’t have to suffer the same pain that our family went through and to raise awareness of this game that is taking our friends, our children’s, our brothers and our sister’s lives !