The "Choking Game"; you've probably heard about it since it has been around in one form or another for decades. It may also be known as the Pass Out Game, the Scarf Game, Purple Haze, or Space Monkey, among others.
It's a dangerous game involving what is medically termed "voluntary asphyxia". The player breathes in and out rapidly for a few minutes and then another player places pressure on each side of the neck, or hooks an arm around the neck or pushes on the chest to cut off circulation to the brain. The lack of oxygen to the brain causes the player to faint. This results in brain cell death which releases chemicals resulting in a "high". As the blood resumes circulation to the brain and regains oxygen there is a reported tingling sensation for a brief few seconds. 
Participants in this activity may believe that it is a "drug-free" high with little risk of legal or parental consequences. Information about the game is spread through social media and YouTube videos, often taken and posted by observers of the game. Many think it is harmless because they have not been educated on the risks of injury due to falls when fainting, as well as seizures, stroke and brain damage ranging from minor cognitive impairment to persistent vegetative state.
Tweens and teens between the ages of 11-16 are at the highest risk. It starts often in middle school when a few friends gather at a home, in a locker room or restroom. The activity may become addictive for some teens who then may attempt to achieve the high when alone. This is when the "game" can become deadly. A teen may use a belt, a scarf, a dog leash or other ligature to cut off the circulation of blood to the brain. If he or she passes out before the ligature is loosened the teen's oxygen to the brain will not be restored and he/she will perish in a matter of minutes. There are varying statistics on the number of teens who have died playing this game because many teen deaths may be misclassified as suicide. One report suggests that between 250-1000 teens have died per year in the US and Canada due to voluntary asphyxiation. Reports of death go back as far as 1934 according to the Academy of Pediatrics. The majority of the deaths - 87% - were male.
Teens who have played the game most commonly report they had not heard about the dangers from anyone. Schools tread a fine line between educating students about the dangers of the game versus giving information that could lead to experimentation.
Warning signs that a teen may be involved in this type of activity include: bloodshot eyes, marks on the neck, wearing high-neck shirts during warm weather, complaints of headache, unexplained presence of dog leashes, bungee cords, or other rope-like items, belts or scarves found around a bed post or closet rod, a teen who acts disoriented after spending time alone, locking doors to bedroom or bathroom and development of a raspy voice.
Parents can become educated about this behavior and learn how to approach a discussion with their child whether or not the activity is suspected. A website with educational materials and graphic video is available from G.A.S.P.- Games Adolescents Shouldn't Play. Website: www.gaspinfo.com
