Be on the lookout for a disorder called "female athlete triad" in young women who are competitive athletes. According to a recent article in American Family Physician, female athlete triad has three major components: eating disorders, lack of menstruation (amenorrhea) and osteoporosis or brittle bone disease.

The risk factors for female athlete triad include being a competitive athlete, playing sports that require youth to check their weight often, not having time to spend with friends because of sports activities, exercising more than is necessary for a sport and being pushed by coaches or parents to win at all costs.

Some signs of female athlete triad are weight loss, absent or irregular periods, fatigue and stress fractures. Hormone replacement therapy may be needed to prevent loss of bone density. Recognizing and preventing the disorder requires a collaborative effort among coaches, athletic trainers, parents, athletes and physicians. Young female athletes should be encouraged to eat nutritious, well-balanced meals, exercise in moderate amounts, and to tell their doctors about any changes in their periods.

(American Family Physician, June 1, 2000, pp. 3357-3367. For more information, go to: www.aafp.org/afp/20000601/contents.html)

As schools across the country reopen for a new academic year, they find themselves between the proverbial rock and a hard place when it comes to youth violence. Clearly, violence involving children and adolescents, including violence within schools, is on the increase, and schools need to respond. Yet the educational system's main mission, the expertise of teachers and even the structure of the school itself makes violence prevention of relatively low priority and a difficult undertaking.

Recent statistics document the increasing prevalence of youth violence. Gunshot wounds to children ages 16 and under have increased 300 percent in major urban areas since 1986. The Children's Defense Fund reported that everyday in the U.S. 16 children and adolescents are killed by firearms. In 1996, according to FBI reports, 2,900 juveniles were arrested for murder. When all violent crimes in the country are considered, over 123,000 children are arrested each year.

Far from being a sheltered haven for learning, schools themselves are experiencing threats and actual violence. The Parents Resource Institute for Drug Education estimated that nearly one million U.S. students took guns to school during 1998. Three years ago 10 percent of all public schools reported at least one serious violent crime to police or law enforcement, and there is no evidence that that number has decreased substantially.

Highly publicized school shootings by disturbed students, such as the Columbine incident a year and a half ago, convey a sense of lurking danger to worried parents, students and staff. Schools are expected to respond in ways that both guarantee security and promote learning, and most are trying diligently to do so.

Unfortunately, however, many school districts are finding the task daunting and frustrating. As Dr. Rappaport's article in this issue points out, mental health professionals can identify risk factors but precise identification of which adolescents will actually commit serious violence is still not possible. Given that, thankfully, school shootings are extremely rare events, school personnel are left trying to pick the violent needle out of a haystack of adolescents at risk. Too often, they have no on-site mental health consultation to help in the process. This fact is reflected in the rate of psychiatric referrals to pediatric emergency rooms almost doubling in the past two years.

Effective security in schools is expensive, especially so since most schools were designed and built with education and social development in mind rather than weapons detection. Violence prevention is only the latest task (after drug awareness, suicide prevention, sex education, etc.) that society has delegated to the schools. Frequently, neither the budget, nor the staffing nor the specific expertise of the educators is increased commensurate with the school's expanded responsibilities. And woe be to the school whose SAT scores fall in the midst of these pressures.

True, in many ways it makes sense to utilize schools for preventive efforts: that's where the kids are. Without reasonable security and structure, no education can take place. However, we must be realistic about what we expect of our teachers and schools, whose primary task is to educate our children in an increasingly complex world. Mental health and school professionals must work together to apply our limited knowledge to the current situation while invigorated research efforts pursue a real understanding of youth violence.