From Health and Fitness

Is My Adult Son Too Old for House Rules?

We will be hosting our son, daughter-in-law and 3-year-old grandchild at our winter home for 10 days. My daughter-in-law is extremely lazy: She takes frequent naps and spends hours scrolling on her phone. My son is better, but he lays around in bed a lot, too. At their home, dishes go unwashed; clothes lie on the floor, etc. What can I say to them, when they are in our home, about napping and phone use, particularly when our granddaughter is awake? They try to get her to nap with them, often to no avail. (I have to say something to prevent myself from going crazy!)

ANONYMOUS

I have heard this tale many times, occasionally from the perspective of the adult children. Their version often goes like this: “We were fried from work and taking care of our toddler, so we visited my parents for a week. Hello, catch-up sleep and free child care! But they hounded us from the minute we walked in the door.”

Here’s the disconnect: You are thinking of your son and his wife as houseguests, while they may see you as the source of a free vacation (with maid service and a nanny included). Clear up any confusion by setting reasonable limits. No good will come from antagonizing them, especially if you want to keep seeing your son and grandchild.

Don’t try to boss them around over naps and phones as if they were kids. But if their clothes or dirty dishes litter public areas, ask them nicely to tidy up. Also, decide how much you are willing to watch your granddaughter (whether her parents are busy napping or solving national crises) and convey your wishes clearly.

A final thought: If you can afford it (and your “winter home” suggests that’s possible), consider putting them up, perhaps for a shorter stay, at a nearby hotel. You may enjoy your family time more by seeing them less: for dinners and afternoons by the pool, instead of living on top of each other for 10 solid days.

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Credit…Christoph Niemann

Not Even a ‘Thanks’?

At work, we have an office assistant who helps with errands. Since I joined the company, I have watched my colleagues order him around rudely. They rarely say “please” or “thank you.” Unfortunately, the office environment is not one where colleagues can offer each other suggestions without offense being taken. But this really bothers me. Help!

ANONYMOUS

You can dislike the mistreatment of the assistant all you want, but if you aren’t willing to put anything on the line to stop it, you are complicit in the unkindness. It’s hard to imagine anyone taking offense if you stood up at the next staff meeting and said: “I think we should treat the assistant more respectfully.”

Or talk to the boss or someone in human resources. But perhaps the most generous thing to do here is to spend some time with the assistant himself. Let him know you appreciate his help. Tell him you wish your co-workers treated him more professionally. And issue a standing invitation to your office when he needs to vent.

Surprise Renovation

Fifty years ago, while my uncle and aunt (and their five children) were on vacation, my father (now deceased) had their home painted and plastered without discussing it with them first. My father even built them sorely needed bookshelves. My uncle and aunt, busy with work and children, didn’t prioritize their home. But they were quite put out when they returned. My uncle (now 96) told me he had been “furious,” and my aunt found my father’s behavior “presumptuous.” I am ambivalent. My father clearly meddled. But the improvements were badly needed. Shouldn’t he have been thanked?

ELLEN

No. (But congratulations on your memory!) For your ambivalence, you have earned the designation of “loyal daughter.” But almost anyone who respects our system of private property would find your father’s behavior appalling. Who was he to decide unilaterally to alter their home?

Still, I also get that it frequently falls to loving children to find the positive in complicated stories about their parents, especially after they have died. Undoubtedly, there were seeds of brotherly love in your father’s domineering behavior. So, your ambivalence is hereby sanctioned. Just don’t pull the same stunt yourself, OK?

It’s Called Self-Care, Look It Up

I told a friend that I didn’t want to go out two nights in a row because when there’s too much excitement, I don’t sleep well. Her response: “Don’t be an old lady.” I’m 70; she’s 60. I didn’t say anything, but her remark put me off. Thoughts?

ELIZABETH

Your friend tried to bully you by using an ageist epithet. I totally get why that upset you. And I can’t imagine this tactic is very effective for her. If the incident is still bothering you when you next see her, refresh her memory.

Say: “I’d be careful generalizing about a demographic that many would say you are speedily approaching.” And by the way: Well done on knowing what works for you and taking care of yourself!


For help with your awkward situation, send a question to SocialQ@nytimes.com, to Philip Galanes on Facebook or @SocialQPhilip on Twitter.

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First Edition: February 27, 2020

Your School Assignment For The Day: Spelling And Specs

DELANO, Calif. — Daisy Leon struggles to sit still and read the letters on the eye chart. Her responses tumble out in a quiet, confused garble.

“You know your letters?” asks optometrist Jolly Mamauag-Camat. “Umm, ya,” says Daisy, almost inaudibly.

The 6-year-old kindergartner had her eyes examined for the first time on a recent Thursday morning. Although she hadn’t complained about headaches or blurry vision, her grandmother noticed she’d been inching closer to watch television.

After Daisy’s failed attempts at reading the eye chart, Mamauag-Camat inspects the little girl’s eyes through a phoropter and writes her a prescription for glasses.

At least 20% of school-age children in the U.S. have vision problems. But according to the Centers for Disease Control and Prevention, fewer than 15% of children get an eye exam before entering kindergarten. Because vision problems tend to worsen the longer they go undetected, many children suffer even though there are often simple, relatively inexpensive solutions such as prescription glasses.

Half of the states plus the District of Columbia require screenings or exams for preschoolers, according to the National Center for Children’s Vision & Eye Health. But California has no such requirement, said Xuejuan Jiang, an assistant professor of research ophthalmology at Keck School of Medicine of USC. California does require them for older children.

“The system in California is not as good as it can be,” Jiang said.

In much of California’s Central Valley, where roughly 1 in 5 people live in poverty, two school districts are working with two nonprofits, the Advanced Center for Eyecare and OneSight, to provide vision care to Kern County’s underserved and uninsured children.

Many of the neediest are the children of farmworkers.

“We are an agriculture-based community,” said Linda Hinojosa, coordinator of health services for the Delano Union School District. “Most of our families harvest table grapes 12 hours a day, with very limited time to take their children in for an eye exam.”

The program, funded by the nonprofits and the school districts, operates five school-based clinics in Bakersfield and Delano. Students receive comprehensive eye exams and glasses, along with free transportation. And breakfast.

Most of the children who visit the clinics have coverage through Medi-Cal, California’s Medicaid program for low-income people. There is no out-of-pocket cost for the eye exams and glasses for them, or for children who are uninsured, said Alexander Zahn, chief business development officer for the Advanced Center for Eyecare.

Almost half of the students examined need glasses.

“The need was very apparent” in the Central Valley, Zahn said. “Sixty dollars for an eye exam and $80 for glasses might be the difference between eating dinner a couple days a week.”

Daisy was among 12 students who were bused to the Delano Union School District Vision Center, adjacent to Pioneer School, an elementary school with about 1,000 students. Almost all the students at Pioneer are Hispanic and about three-quarters qualify for free lunches.

Students from throughout the Delano Union Elementary School District visit the clinic. Since it opened in 2018, the clinic has performed 961 eye exams and prescribed 517 pairs of glasses.

For Daisy, whose parents are farmworkers, the clinic has been a tremendous help.

“They prune out in the fields,” said Guadalupe Leon, Daisy’s grandmother. “They can’t afford to take days off.”

The Delano Union School District Vision Center is funded by multiple sources: OneSight, a nonprofit organization dedicated to increasing access to vision care in underserved communities around the world, donated the ophthalmic equipment and provided grant funding for the first year of operation. The Advanced Center for Eyecare provides staff and supplies. And the school district provides the facility, furnishings and transportation. (Heidi de Marco/KHN)

Twelve students from Nueva Vista Language Academy and Fremont Elementary School arrive by bus for their eye exams and follow-ups. Linda Hinojosa, a registered nurse for 20 years, says lack of transportation is a major barrier to vision care. “Parents a lot of times don’t have a car, or it can be a one-vehicle family,” she says. (Heidi de Marco/KHN)

Students are offered breakfast before their appointments with optometrist Jolly Mamauag-Camat. About three-quarters of students in the district are eligible for free/reduced-price meals. (Heidi de Marco/KHN)

Daisy Leon, a kindergartner at Nueva Vista Language Academy, takes a test to check for color blindness. Before beginning, the optical technician asks Daisy if she understands English. Because of the region’s large Spanish-speaking population, clinic staff members often act as interpreters. (Heidi de Marco/KHN)

Daisy looks into an auto refractor as part of her eye exam. (Heidi de Marco/KHN)

Daisy and Jonathon Castro watch a movie as they wait for their eyes to dilate. This is the first eye exam for both of them. (Heidi de Marco/KHN)

Daisy sits on her knees to see through a phoropter, a device to help determine eyeglass prescriptions. Mamauag-Camat says children often can’t tell if they have vision problems because they don’t know any differently. “They can fall through the cracks,” she says. “They don’t know the difference between what’s clear and not clear.” (Heidi de Marco/KHN)

About 45% of Kern County’s population is on Medi-Cal. Medi-Cal covers vision care, including an eye exam and glasses every two years, but in communities like Delano, access is a problem. “We live in an area with a big shortage of providers, particularly specialty care providers like optometrists and ophthalmologists,” says Alexander Zahn, of the Advanced Center for Eyecare. (Heidi de Marco/KHN)

Daisy picks out glasses right after her exam, a pink pair that she had been admiring all morning. “We need to go where students are,” says Hinojosa. “Vision is absolutely vital.” (Heidi de Marco/KHN)

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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They Fell In Love Helping Drug Users. But Fear Kept Him From Helping Himself.

She was in medical school. He was just out of prison.

Sarah Ziegenhorn and Andy Beeler’s romance grew out of a shared passion to do more about the country’s drug overdose crisis.

Ziegenhorn moved back to her home state of Iowa when she was 26. She had been working in Washington, D.C., where she also volunteered at a needle exchange — where drug users can get clean needles. She was ambitious and driven to help those in her community who were overdosing and dying, including people she had grown up with.

“Many people were just missing because they were dead,” said Ziegenhorn, now 31. “I couldn’t believe more wasn’t being done.”

She started doing addiction advocacy in Iowa City while in medical school — lobbying local officials and others to support drug users with social services.

Beeler had the same conviction, born from his personal experience.

“He had been a drug user for about half of his life — primarily a longtime opiate user,” Ziegenhorn said.

Beeler spent years in and out of the criminal justice system for a variety of drug-related crimes, such as burglary and possession. In early 2018, he was released from prison. He was on parole and looking for ways to help drug users in his hometown.

He found his way to advocacy work and, through that work, found Ziegenhorn. Soon they were dating.

“He was just this really sweet, no-nonsense person who was committed to justice and equity,” she said. “Even though he was suffering in many ways, he had a very calming presence.”

People close to Beeler describe him as a “blue-collar guy” who liked motorcycles and home carpentry, someone who was gentle and endlessly curious. Those qualities could sometimes hide his struggle with anxiety and depression. Over the next year, Beeler’s other struggle, with opioid addiction, would flicker around the edges of their life together.

Eventually, it killed him.

People on parole and under supervision of the corrections system can face barriers to receiving appropriate treatment for opioid addiction. Ziegenhorn said she believes Beeler’s death is linked to the many obstacles to medical care he experienced while on parole.

About 4.5 million people are on parole or probation in the U.S., and research shows that those under community supervision are much more likely to have a history of substance use disorder than the general population. Yet rules and practices guiding these agencies can preclude parolees and people on probation from getting evidence-based treatment for their addiction.

A Shared Passion For Reducing Harm

From their first meeting, Ziegenhorn said, she and Beeler were in sync, partners and passionate about their work in harm reduction — public health strategies designed to reduce risky behaviors that can hurt health.

After she moved to Iowa, Ziegenhorn founded a small nonprofit called the Iowa Harm Reduction Coalition. The group distributes the opioid-overdose reversal drug naloxone and other free supplies to drug users, with the goal of keeping them safe from illness and overdose. The group also works to reduce the stigma that can dehumanize and isolate drug users. Beeler served as the group’s coordinator of harm reduction services.

“In Iowa, there was a feeling that this kind of work was really radical,” Ziegenhorn said. “Andy was just so excited to find out someone was doing it.”

Meanwhile, Ziegenhorn was busy with medical school. Beeler helped her study. She recalled how they used to take her practice tests together.

“Andy had a really sophisticated knowledge of science and medicine,” she said. “Most of the time he’d been in prison and jails, he’d spent his time reading and learning.”

Beeler was trying to stay away from opioids, but Ziegenhorn said he still used heroin sometimes. Twice she was there to save his life when he overdosed. During one episode, a bystander called the police, which led to his parole officer finding out.

“That was really a period of a lot of terror for him,” Ziegenhorn said.

Beeler was constantly afraid the next slip — another overdose or a failed drug test — would send him back to prison.

An Injury, A Search For Relief

A year into their relationship, a series of events suddenly brought Beeler’s history of opioid use into painful focus.

It began with a fall on the winter ice. Beeler dislocated his shoulder — the same one he’d had surgery on as a teenager.

“At the emergency room, they put his shoulder back into place for him,” Ziegenhorn said. “The next day it came out again.”

She said doctors wouldn’t prescribe him prescription opioids for the pain because Beeler had a history of illegal drug use. His shoulder would dislocate often, sometimes more than once a day.

“He was living with this daily, really severe constant pain — he started using heroin very regularly,” Ziegenhorn said.

Beeler knew what precautions to take when using opioids: Keep naloxone on hand, test the drugs first and never use alone. Still, his use was escalating quickly.

A Painful Dilemma 

The couple discussed the future and their hope of having a baby together, and eventually Ziegenhorn and Beeler agreed: He had to stop using heroin.

They thought his best chance was to start on a Food and Drug Administration-approved medication for opioid addiction, such as methadone or buprenorphine. Methadone is an opioid, and buprenorphine engages many of the same opioid receptors in the brain; both drugs can curb opioid cravings and stabilize patients. Studies show daily maintenance therapy with such treatment reduces the risks of overdose and improves health outcomes.

But Beeler was on parole, and his parole officer drug-tested him for opioids and buprenorphine specifically. Beeler worried that if a test came back positive, the officer might see that as a signal that Beeler had been using drugs illegally.

Ziegenhorn said Beeler felt trapped: “He could go back to prison or continue trying to obtain opioids off the street and slowly detox himself.”

He worried that a failed drug test — even if it was for a medication to treat his addiction — would land him in prison. Beeler decided against the medication.

A few days later, Ziegenhorn woke up early for school. Beeler had worked late and fallen asleep in the living room. Ziegenhorn gave him a kiss and headed out the door. Later that day, she texted him. No reply.

She started to worry and asked a friend to check on him. Not long afterward, Beeler was found dead, slumped in his chair at his desk. He’d overdosed.

“He was my partner in thought, and in life and in love,” Ziegenhorn said.

It’s hard for her not to rewind what happened that day and wonder how it could have been different. But mostly she’s angry that he didn’t have better choices.

“Andy died because he was too afraid to get treatment,” she said.

Beeler was services coordinator for the Iowa Harm Reduction Coalition, a group that works to help keep drug users safe. A tribute in Iowa City after his death began, “He died of an overdose, but he’ll be remembered for helping others avoid a similar fate.”(Courtesy of Sarah Ziegenhorn)

How Does Parole Handle Relapse? It Depends

It’s not clear that Beeler would have gone back to prison for admitting he’d relapsed and was taking treatment. His parole officer did not agree to an interview.

But Ken Kolthoff, who oversees the parole program that supervised Beeler in Iowa’s First Judicial District Department of Correctional Services, said generally he and his colleagues would not punish someone who sought out treatment because of a relapse.

“We would see that that would be an example of somebody actually taking an active role in their treatment and getting the help they needed,” said Kolthoff.

The department doesn’t have rules prohibiting any form of medication for opioid addiction, he said, as long as it’s prescribed by a doctor.

“We have people relapse every single day under our supervision. And are they being sent to prison? No. Are they being sent to jail? No,” Kolthoff said.

But Dr. Andrea Weber, an addiction psychiatrist with the University of Iowa, said Beeler’s reluctance to start treatment is not unusual.

“I think a majority of my patients would tell me they wouldn’t necessarily trust going to their [parole officer],” said Weber, assistant director of addiction medicine at the University of Iowa’s Carver College of Medicine. “The punishment is so high. The consequences can be so great.”

Weber finds probation and parole officers have “inconsistent” attitudes toward her patients who are on medication-assisted treatment.

“Treatment providers, especially in our area, are still very much ingrained in an abstinence-only, 12-step mentality, which traditionally has meant no medications,” Weber said. “That perception then invades the entire system.”

Attitudes And Policies Vary Widely

Experts say it’s difficult to draw any comprehensive picture about the availability of medication for opioid addiction in the parole and probation system. The limited amount of research suggests that medication-assisted treatment is significantly underused.

“It’s hard to quantify because there are such a large number of individuals under community supervision in different jurisdictions,” said Michael Gordon, a senior research scientist at the Friends Research Institute, based in Baltimore.

A national survey published in 2013 found that about half of drug courts did not allow methadone or other evidence-based medications used to treat opioid use disorder.

A more recent study of probation and parole agencies in Illinois reported that about a third had regulations preventing the use of medications for opioid use disorder. Researchers found the most common barrier for those on probation or parole “was lack of experience by medical personnel.”

Faye Taxman, a criminology professor at George Mason University, said decisions about how to handle a client’s treatment often boil down to the individual officer’s judgment.

“We have a long way to go,” she said. “Given that these agencies don’t typically have access to medical care for clients, they are often fumbling in terms of trying to think of the best policies and practices.”

Increasingly, there is a push to make opioid addiction treatment available within prisons and jails. In 2016, the Rhode Island Department of Corrections started allowing all three FDA-approved medications for opioid addiction. That led to a dramatic decrease in fatal opioid overdoses among those who had been recently incarcerated.

Massachusetts has taken similar steps. Such efforts have only indirectly affected parole and probation.

“When you are incarcerated in prison or jail, the institution has a constitutional responsibility to provide medical services,” Taxman said. “In community corrections, that same standard does not exist.”

Taxman said agencies may be reluctant to offer these medications because it’s one more thing to monitor. Those under supervision are often left to figure out on their own what’s allowed.

“They don’t want to raise too many issues because their freedom and liberties are attached to the response,” she said.

Richard Hahn, a researcher at New York University’s Marron Institute of Urban Management who consults on crime and drug policy, said some agencies are shifting their approach.

“There is a lot of pressure on probation and parole agencies not to violate people just on a dirty urine or for an overdose” said Hahn, who is executive director of the institute’s Crime & Justice Program.

The federal government’s Substance Abuse and Mental Health Services Administration calls medication-assisted treatment the “gold standard” for treating opioid addiction when used alongside “other psychosocial support.”

Addiction is considered a disability under the Americans with Disabilities Act, said Sally Friedman, vice president of legal advocacy for the Legal Action Center, a nonprofit law firm based in New York City.

She said disability protections extend to the millions of people on parole or probation. But people under community supervision, Friedman said, often don’t have an attorney who can use this legal argument to advocate for them when they need treatment.

“Prohibiting people with that disability from taking medication that can keep them alive and well violates the ADA,” she said.

This story is part of a partnership between NPR and Kaiser Health News.

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Raising a Glass to Chronic Disease

Bunched on the kitchen counter, the bananas glowered. “Eat me, drink me, suck my juices,” they taunted, like the tempting fruit in Christina Rossetti’s kinky poem “Goblin Market.” I was flummoxed since I loathe the mushy texture of bananas. (Sorry, Chiquita!) But how else could I ingest more of the magnesium I need in order to not get thrown out of my cancer clinical trial?

Quite a few years ago, I had to undergo a series of lengthy infusions because chemotherapy produced mineral deficiencies. Now, it appeared that the experimental drug I take in the trial was leaching magnesium from my body. Although I have been swallowing a 500-milligram magnesium pill nightly, at my last blood test the level was so low that my research nurse, Alesha, panicked. Insisting on another test in a month, she recommended spinach, almonds, black beans, avocado, brussels sprouts.

“Alesha,” I said, “you are my guardian angel, but remember the ileostomy!” With a compromised digestive system, it is impossible to eat a sufficient portion of the foods she listed without suffering some sort of ghastly bowel blockage.

“Ah, yes,” she nodded. “Maybe peanut butter … or bananas!”

Bananas, neatly packed in their lined coats, are a portable source of nourishment — for those who can stomach them. I’m wondering if they lose their virtue if they are baked into banana bread, when a late-night email pops up from my friend Nancy K. Miller. A cancer patient, she just learned that a nodule in her lung is growing. She must choose surgery, radiation or ablation, all far worse prospects than gagging down a banana.

“It’s not that I didn’t know it would spread,” Nancy writes and then asks, “Do you ever think that one day the drug you take will stop working?”

“Sure,” I type back, after gulping some red wine and then moving the glass away from my laptop, since last year I had spilled wine on the keys, destroying the motherboard. “My med will either stop working or it will give me a secondary cancer, probably leukemia.”

“And we live like this,” Nancy responds.

“The alternative is not good,” I shoot back.

The next day, as the bananas were mottling, a brainstorm hit. I Googled alcohol and magnesium. Wine, it turns out, flushes minerals out of the body. It may be the pinot noir rather than the trial drug that is responsible for my magnesium deficiency. The seductive “eat me, drink me, suck my juices” refrain of fermented grapes had produced accidents in the past and could produce worse accidents in the future. Why had I succumbed?

Maybe the stress of living “like this” — with a sword of Damocles dangling overhead — accounts for the steady escalation in my drinking. While relinquishing my teaching profession, an intact body, physical vitality, hair and a sense of a secure future, had I anesthetized myself with increasing doses of vino? Am I mitigating my sobering condition with the levity the first sips convey and, yes, the oblivion later mouthfuls deliver?

This side effect of prolonged treatment has not shown up in my reading probably because drinking problems often remain hidden, unspoken or unspeakable. For the same reason, doctors and nurses may not suspect what is going on. But an overreliance on alcohol surely poses a threat to older as well as younger people dealing with all sorts of chronic diseases, not just cancer.

Living with chronic disease daily can be a drag; living with chronic disease nightly can become unbearably depressing … without the buzz conferred by aptly named spirits. At that moment, the thought of renouncing the consolation of getting tipsy seemed unendurable. My drinking may have accelerated recently, but alcohol had played a rousing role in my life long before diagnosis.

Still, what if imbibing too much wine prevents my body from retaining magnesium, no matter how many bananas I put into the blender for smoothies? The bananas were blackening, as was my mood, by the time I determined to talk with my husband, Don, about an evolving resolve.

“Magnesium is a great reason to limit your intake,” he said. “Not moral, just physical.” Then he added, “but don’t try to go cold turkey.”

What a boon to be accepted, even with errant foibles, by a loving companion! Abstinence would set me up for a harder fall than any banana peel could produce. “How about a glass or two with dinner,” Don suggested and then he laughed, telling me about the two-bottles-a-day squires in the 18th century, though they probably guzzled port.

Two glasses of wine a night is double the recommended allowance of alcohol for women; however, that would be a reduction for me. Until the next blood test, I determined, I would forgo bananas but decrease wine consumption … to try to elevate the magnesium in my body.

When Nancy’s next email arrived, her attachment cracked me up. She had found a drawing she had made of an aging physician warning his patient, “Consider the alternative.” The figure reminded her of the misogynist Professor von X in Virginia Woolf’s “A Room of One’s Own.”

Image
Credit…Nancy K. Miller

Neither Nancy nor I would follow the dictates of a paternalistic authority hectoring us to do whatever it takes to win the so-called fight against cancer. A point will surely come when we consider the alternative of dying and refuse medical interventions. But that moment has not yet arrived. And anyway, no one was ordering me to limit my alcohol consumption. The idea came from me; Don’s input helped by making it a provisional and pragmatic resolution, not an eternal or ethical fiat.

Gazing at the sketch, I felt bathed in love for my husband and also for Nancy, who never surrenders her wry perspective and quirky values while grappling with disease. Thoughts of her returned me to the conclusion of Christina Rossetti’s insights into addiction and intoxication: “there is no friend like a sister / In calm or stormy weather; / To cheer one on the tedious way, / To fetch one if one goes astray, / To lift one if one totters down, / To strengthen whilst one stands.”

Not sanguine about my perseverance in the days to come, I only hope that I don’t go bananas.

Susan Gubar, who has been dealing with ovarian cancer since 2008, is distinguished emerita professor of English at Indiana University. Her latest book is “Late-Life Love.”

When the Police Stop a Teenager With Special Needs

A man in his mid-20s regularly roams the streets of my small town in the middle of the night. He looks angry and doesn’t communicate clearly.

Not everyone living in the area knows him. But the police do.

“His father reached out to us,” said Sgt. Adrian Acevedo of the South Orange, N.J., police department, “to tell us his son is blowing off steam, has special needs, and won’t make eye contact or listen to us. If we didn’t have this information, we could mistakenly take him for a burglar.”

All of South Orange’s police officers are aware of this man’s disability. His name, his parent’s phone numbers, and brief details about his special needs are on file at the South Orange Police Office.

“It’s a smart move,” said Gary Weitzen, executive director of Parents of Autistic Children, a nonprofit based in New Jersey that provides training for parents and educators on how to teach children with autism to respond to people in uniform. The group also hosts workshops for police officers and other officials on how to interact with people with special needs. To date, they’ve trained more than 70,000 police officers, firefighters and ambulance squads in New Jersey.

When Mr. Weitzen’s son Christopher, who has autism, was young, Mr. Weitzen always held his hand when out in public. If he didn’t, Christopher would bolt. “Our friends called our house Fort Weitzen,” he said. “I couldn’t let Christopher out of my sight.”

Today Christopher is 25 and goes out on his own. “It was a lot of training on my part,” Mr. Weitzen said.

Whenever they were out as a family at a community gathering and the police were nearby, Mr. Weitzen would introduce Christopher to the officers. “I want them to know him and for him to feel comfortable around them,” Mr. Weitzen said.

Many people of color talk to their children about ways to interact with the police. While the circumstances are different, parents of children with special needs often need to educate their children about ways to behave if they’re stopped by the police.

Indeed, in 2016, North Miami police officers shot a behavioral therapist, Charles Kinsey, who was trying to calm down a young man with autism who was holding a toy truck that the officers mistook for a weapon.

The tendency of many people on the autism spectrum to wander can lead to encounters with the police, but Wendy Fournier, president of the National Autism Association, said there are two distinct categories, wandering and elopement, though they are often used interchangeably.

Wandering, she said, is more purposeful and usually happens between ages 4 and 7. “That child will have it in his head that he wants to go swimming or to the park,” she said. “It’s what he wants to do regardless of the safety issues, which can be crossing a busy street without looking so he can get to his destination. It’s hard to stop him.”

In elopement, a child may bolt because of an overwhelming situation such as being around large crowds.

The association has two free downloadable programs with tools to address these issues. The Big Red Safety Box covers wandering and elopement, and the Meet the Police program teaches parents of children on the autism spectrum and children with autism how to interact with the police.

According to a 2017 study from the A.J. Drexel Autism Institute at Drexel University, an estimated one in five teenagers with autism was stopped and questioned by the police before age 21, and 5 percent were arrested. And according to research at the Children’s Hospital of Philadelphia, people with disabilities, including those on the autism spectrum, are five times more likely to be incarcerated than people in the general population, and “civilian injuries and fatalities during police interactions are disproportionately common among this population.”

“The police are not the bad guys,” Mr. Weitzen said. “They need to meet our children and should understand why they may not be able to make eye contact or that they’ll run when ordered to stay put.”

He said that people with autism “may keep their hands in their pockets because it’s a coping mechanism. They may repeat a word because it helps them focus. Not all uniformed personnel understand these behaviors.”

When a friend of mine whose son has both autism and oppositional defiant disorder moved to a new neighborhood about six years ago, she called the local police to let them know about his behavior. The officer on duty invited them to come in so they could meet.

“At the station, the officers treated him with respect,” said my friend, who did not want her name published to protect her son’s privacy. “I told them about his violent temper ahead of the visit, and we discussed it with the police officers. All of the officers know him. They have our information on file at the precinct. It will help keep him safe in the event of a meltdown. They even know his coping words.”

Recently, when her son began attending a program for students on the autism spectrum in New Jersey, she asked the school to host a seminar with the local police.

“When I met the officer, I was a bit scared,” said her son, who is now 19. “But I listened and he seemed friendly. I was able to talk to him, and I know that most police officers are good and are here to protect us.”

In the Weitzens’ neighborhood, the police officers know that it can help Christopher if they mention John Deere tractors and “Thomas the Tank Engine” characters. They also know what triggers him.

“Most people with autism have some form of anxiety,” Mr. Weitzen explained. “The cops know Christopher won’t look them in the eye. Something little like that can escalate and make a bad situation worse.”

Mr. Weitzen believes children with autism should carry an ID card. It should have their name, their diagnoses, a parent’s or caretaker’s name and phone numbers, and any other information that could be helpful to the police.

“Your child should never reach into his pocket” if confronted by police, he said. “Instead, he needs to tell the officer that his ID is in his pocket and ask if he can take it out.”

Sgt. Acevedo said, “If we have information about your child, we have an idea of what to expect. We need to know the people in the neighborhood, the signs to look for, and it helps if they know us. Some parents share information and others don’t.”

“We even have a file of elderly people with Alzheimer’s and dementia,” he said. “We’ve had a few elderly people with dementia wandering the streets looking lost. Knowing about someone’s autism, Alzheimer’s or special needs saves lives.”

“Police officers don’t want children to be afraid of us,” Sgt. Acevedo said. “In a tense situation, where we don’t know what to expect, we make split-second decisions. Knowing your child and having your child know us completely changes that situation.”

The Difference Between Worry, Stress and Anxiety

You probably experience worry, stress or anxiety at least once on any given day. Nearly 40 million people in the U.S. suffer from an anxiety disorder, according to the Anxiety and Depression Association of America. Three out of four Americans reported feeling stressed in the last month, a 2017 study found. But in one of these moments, if asked which you were experiencing — worry, stress or anxiety — would you know the difference?

I reached out to two experts to help us identify — and cope with — all three.

What is worry?

Worry is what happens when your mind dwells on negative thoughts, uncertain outcomes or things that could go wrong. “Worry tends to be repetitive, obsessive thoughts,” said Melanie Greenberg, a clinical psychologist in Mill Valley, Calif., and the author of “The Stress-Proof Brain” (2017). “It’s the cognitive component of anxiety.” Simply put, worry happens only in your mind, not in your body.

How does worry work?

Worry actually has an important function in our lives, according to Luana Marques, an associate professor of psychiatry at Harvard Medical School and the president of the Anxiety and Depression Association of America. When we think about an uncertain or unpleasant situation — such as being unable to pay the rent, or doing badly on an exam — our brains become stimulated. When we worry, it calms our brains down. Worry is also likely to cause us to problem-solve or take action, both of which are positive things. “Worry is a way for your brain to handle problems in order to keep you safe,” Dr. Marques explained. “It’s only when we get stuck thinking about a problem that worry stops being functional.”

Three things to help your worries:

  • Give yourself a worry “budget,” an amount of time in which you allow yourself to worry about a problem. When that time is up (start with 20 minutes), consciously redirect your thoughts.

  • When you notice that you’re worried about something, push yourself to come up with a next step or to take action.

  • Write your worries down. Research has shown that just eight to 10 minutes of writing can help calm obsessive thoughts.

Remember: Worry is helpful only if it leads to change, not if it turns into obsessive thoughts.

What is stress?

Stress is a physiological response connected to an external event. In order for the cycle of stress to begin, there must be a stressor. This is usually some kind of external circumstance, like a work deadline or a scary medical test. “Stress is defined as a reaction to environmental changes or forces that exceed the individual’s resources,” Dr. Greenberg said.

How does stress work?

In prehistoric times, stress was a natural response to a threat, like hearing a predator in the bushes. Today, it still prompts a behavioral response, firing up your limbic system and releasing adrenaline and cortisol, which help activate your brain and body to deal with the threat, Dr. Greenberg explained. Symptoms of stress include a rapid heart rate, clammy palms and shallow breath. Stress might feel good at first, as the adrenaline and cortisol flood your body, Dr. Marques said. You might have experienced the benefits of stress as you raced through traffic to get to an appointment, or pulled together an important assignment in the final hour. That’s called “acute stress,” and the rush wore off when the situation was resolved (i.e. you turned in your assignment).

Chronic stress, on the other hand, is when your body stays in this fight-or-flight mode continuously (usually because the situation doesn’t resolve, as with financial stressors or a challenging boss). Chronic stress is linked to health concerns such as digestive issues, an increased risk of heart disease and a weakening of the immune system.

Three things to help your stress

  • Get exercise. This is a way for your body to recover from the increase of adrenaline and cortisol.

  • Get clear on what you can and can’t control. Then focus your energy on what you can control and accept what you can’t.

  • Don’t compare your stress with anyone else’s stress. Different people respond differently to stressful situations.

Remember: Stress is a biological response that is a normal part of our lives.

What is anxiety?

If stress and worry are the symptoms, anxiety is the culmination. Anxiety has a cognitive element (worry) and a physiological response (stress), which means that we experience anxiety in both our mind and our body. “In some ways,” Dr. Marques said, “anxiety is what happens when you’re dealing with a lot of worry and a lot of stress.”

How does anxiety work?

Remember how stress is a natural response to a threat? Well, anxiety is the same thing … except there is no threat.

“Anxiety in some ways is a response to a false alarm,” said Dr. Marques, describing a situation, for example, in which you show up at work and somebody gives you an off look. You start to have all the physiology of a stress response because you’re telling yourself that your boss is upset with you, or that your job might be at risk. The blood is flowing, the adrenaline is pumping, your body is in a state of fight or flight — but there is no predator in the bushes.

There is also a difference between feeling anxious (which can be a normal part of everyday life) and having an anxiety disorder. An anxiety disorder is a serious medical condition that may include stress or worry.

Three things to help your anxiety

  • Limit your sugar, alcohol and caffeine intake. Because anxiety is physiological, stimulants may have a significant impact.

  • Check in with your toes. How do they feel? Wiggle them. This kind of refocusing can calm you and break the anxiety loop.

  • When you’re in the middle of an anxiety episode, talking or thinking about it will not help you. Try to distract yourself with your senses: Listen to music, jump rope for five minutes, or rub a piece of Velcro or velvet.

Remember: Anxiety happens in your mind and your body so trying to think your way out of it won’t help.

Too worried, stressed or anxious to read the whole article?

Here’s the takeaway: Worry happens in your mind, stress happens in your body, and anxiety happens in your mind and your body. In small doses, worry, stress and anxiety can be positive forces in our lives. But research shows that most of us are too worried, too stressed and too anxious. The good news, according to Dr. Marques, is that there are simple (not easy) first steps to help regulate your symptoms: Get enough sleep; eat regular, nutritious meals; and move your body.

Watch: One Father’s Fight Against ‘Predatory’ Drug Price

Dr. Sudeep Taksali tells “CBS This Morning” about his efforts to get a cheaper version of a drug commonly known as a hormone blocker for his daughter, who has central precocious puberty. The report is the latest collaboration between CBS, NPR and Kaiser Health News on the “Bill of the Month” crowdsourced investigative series.

KHN Editor-in-Chief Elisabeth Rosenthal described how one active ingredient is sold by Endo Pharmaceuticals as two different drugs — the one for children has a price tag of $37,300, while one used in adults goes for $4,400.

Taksali said the discrepancy signals a type of “predation on parents who have that sense of vulnerability, who will do anything within their means to help their children.”

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