How Stress Affects Child Development

free anxiety workshop on childhood anxietyStress surrounds us on a daily basis. From traffic delays to work projects, worries about finances or health, and news reports of world events, the demands of our everyday lives produce both positive and negative stress. Stressors (which are the things that cause your stress) can be physical, emotional, theoretical, or environmental. Even positive events like weddings and job promotions cause stress.

Whether negative or positive, one thing is certain – stress raises the body’s anxiety levels. When we’re under stress, the “fight or flight” response kicks in, raising blood pressure and heart rate, and sometimes causing you to lose sleep or feel like you can’t breathe. While this response usually subsides after the stressor is removed, a prolonged or permanent stress response can develop in someone who is under constant stress. It’s called toxic stress, and children can be affected by it just the same as adults.

What are the Effects of Stress on Kids?

The incidence of obesity, diabetes and heart problems, cancer and other diseases goes up when a child lives with toxic stress. Additionally, their chances of depression, substance abuse and dependence, smoking, teen pregnancy and/or sexually transmitted disease, suicide and domestic violence greatly increase. So does their tendency to be more violent or to become a victim of violence.

Studies done by the Centers for Disease Control and Prevention (CDC) have shown that when a child is subjected to frequent or continual stress from thing like neglect, abuse, dysfunctional families or domestic abuse, and they lack adequate support from adults, their brain architecture is actually altered and their organ systems become weakened. As a result, these kids risk lifelong health and social problems.

Of the 17,000 people who took part in the CDC study, two thirds had an Adverse Childhood Experiences (ACE) score of 1 or higher. 87% of those people had more than one ACE. By measuring and scoring ten types of trauma ranging from childhood sexual abuse to neglect or bullying and even divorce, researchers were able to assess the chronic disease risk for the study’s mostly white, middle class participants. Their results show that the problem of toxic stress isn’t limited to children who face poverty or to those who come from certain ethnic groups – children from all walks of life can have high ACE scores.

If you are interested in finding out your ACE score and what it might mean for you, go here.

Signs of stress

Children who are exposed to toxic stress exhibit:

  • Poorly developed executive functioning skills
  • Lack of self-regulation and self-reflection
  • Reduced impulse control
  • Maladaptive coping skills
  • Poor stress management

Research on children who face continued toxic stress shows they have:

  • More trouble learning in school
  • More difficulty trusting adults and forming healthy relationships and an increased chance of divorce as an adult
  • Higher incidence of unhealthy behaviors such as substance abuse, sexual experimentation and unsafe sexual practices, engaging in high-risk sports, smoking and alcohol abuse
  • Higher incidence of depressive disorder, post-traumatic stress disorders (PTSD), behavioral disorders, and even psychosis
  • Poor health outcomes such as obesity, heart disease, diabetes, cancer, and a higher suicide risk

Help for Toxic Stress

Awareness is key to preventing and reducing toxic stress in kids. Now that we know about the effects of ACEs, many states have conducted their own research. Some cities have set up task forces and others are working with schools, pediatricians, daycare centers and the justice system to set up screening programs that can turn lives around.

Protecting children from toxic stress involves a multi-faceted approach that targets both the caretaker and the child in order to strengthen family stability. Treatment includes intervention and implementation of methods that decrease stressors and strengthen the individual’s response to stress.

As more programs are enacted, researchers are finding that children benefit even when the solutions are solely focused on their caregiver and not on the child. This is likely because the caregiver’s altered interaction with the child makes the child feel safer. Parenting classes, family-based programs, access to social resources for parents, telephone support and peer support are beneficial, as are cognitive behavioral therapy and relaxation methods like yoga and mindfulness. Additionally, community-based programs like Head Start have been shown to be effective.

Do you have Questions?

For more information about toxic stress and its effects on child development, talk to the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida. Contact us or call us today at 561-496-1094.


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Gambling Addiction

We’d all like to be rich. Playing the lottery or making an occasional trip to Las Vegas or some nearby casino allows us to indulge in the dream of being wealthy someday. Bright lights lure us in and sporadic gaming payouts tempt us into believing we might just hit it big. But, while it’s generally fine for most people to wager on games of chance once in a while, for those at risk of a gambling addiction, giving into the temptation may trigger a slide into a gambling problem.

Why do People Gamble?

People don’t usually gamble for one single reason, although the underlying motivation for gambling is typically profit based. The thought of seeing coins flowing out of a slot machine like an endless silver waterfall or the Hollywood movie scene of a casino piling stacks of money in front of a winner can move almost anyone to take a chance on gambling.

Aside from profit, however, people often gamble for:

  • Excitement – think about the thrill of the flashing lights and bells that go off when someone wins on a slot machine
  • Pleasure and the euphoria of winning every so often
  • Escape from troubles
  • Social valuation – even if they lose a lot of money, a person may feel that the act of gambling shows they are successful enough to be able to afford to lose it (even if that isn’t really true)
  • Pride – if someone wins a few hands of poker, they feel smart and invincible
  • The chance you could change your life with very little effort
  • Social acceptance – this applies to many games, ranging from playing bingo at church to joining in football pools with friends on Game Day

Pathological Gambling Risk Factors

Around 1 to 3 percent of people in the United States are impacted by a gambling problem. As with other addictions, gambling disorders tend to run in families. Those who suffer from this impulse-control disorder also tend to have issues with anxiety and depression and/or problems with substance abuse or alcoholism. The disorder symptoms may come and go, but without treatment, the problem will return.

A gambling addiction usually starts between the ages of 20 and 40 in females and in early adolescence in males, however it can happen at any stage of life. While it can affect anyone, the risk of compulsive gambling increases in those who are highly competitive, are workaholics, have a friend or family member with a gambling compulsion, or in those who have bipolar disorder, obsessive-compulsive disorder (OCD), or attention-deficit/hyperactive disorder (ADHD).

Symptoms of a Gambling Addiction

In the same way as alcohol or drugs, gambling stimulates the brain’s reward center. Just like with any addiction, a person with a gambling disorder can’t resist gambling even if they don’t have the money to lose. They hide their need to gamble from family and friends and vehemently deny they have a problem. They feel compelled to keep playing in order to recover their losses. They also become tense and anxious when they can’t satisfy their urge to gamble and will feel relief when they finally get their “fix.”

The American Psychiatric Association (APA) defines a gambling disorder as involving “repeated problematic gambling behavior that causes significant problems or distress. It is also called gambling addiction or compulsive gambling.”

If family, friends, or coworkers have talked to you about your gambling, you may have a gambling problem. To help clarify if you may be a compulsive gambler, this list from the APA can help you decide:

A diagnosis of gambling disorder requires at least four of the following during the past year (Note: this questionnaire is not intended to replace professional diagnosis):

  1. Need to gamble with increasing amount of money to achieve the desired excitement
  2. Restless or irritable when trying to cut down or stop gambling
  3. Repeated unsuccessful efforts to control, cut back on or stop gambling
  4. Frequent thoughts about gambling (such as reliving past gambling experiences, planning the next gambling venture, thinking of ways to get money to gamble)
  5. Often gambling when feeling distressed
  6. After losing money gambling, often returning to get even (referred to as “chasing” one’s losses)
  7. Lying to conceal gambling activity
  8. Jeopardizing or losing a significant relationship, job or educational/career opportunity because of gambling
  9. Relying on others to help with money problems caused by gambling

Add up your score:

  • 4 to 5: Shows a mild gambling problem
  • 6 to 7: Points to a moderate gambling problem
  • 8 to 9: Indicates a severe gambling problem

Self-Help for Gambling Addiction

The biggest step toward recovery is acknowledging that you have a gambling problem. While it is difficult to quit gambling, many people have done so and were able to rebuild their lives. The path is easier when you have support.

Some self-help tips are:

  • Find a support group, like Gamblers Anonymous or get support from a mental health professional
  • Seek treatment for any underlying mood disorders, such as anxiety or depression, which can trigger a gambling problem
  • Reach out to family and friends for help
  • Practice relaxation techniques, such as yoga or mindfulness
  • Distract yourself by starting an exercise program or taking up a sport.
  • Spend time with non-gambling friends or take up a hobby. Be certain not to isolate yourself
  • Visualize what will happen if you gamble. How will you feel if you disappoint everyone again or if you lose all your money again?
  • If you are the family member or friend of a gambler, don’t pay off their debts. You run the very real risk of enabling them to gamble again.

Help for Gambling Addiction

If you or a loved one need help to stop compulsive gambling, the mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can help. For more information, contact us or call us today at 561-496-1094.

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7 Tips for Dealing with the Trauma of School Violence

The nation has been horrified to hear about another mass shooting this week. For many in South Florida, however, the trauma surrounding school violence has hit particularly hard because it happened right in our own backyard. Many people likely know someone or know of a family with a child who attends the Marjory Stoneman Douglas High School in Parkland, FL. Because of this, you might find it challenging to deal with your feelings about the event.

Keep in mind that it is normal to experience strong emotions, such as anger, fear, sadness, grief, and shock – even if you don’t know someone who is personally connected to the shooting. You might also have trouble sleeping or concentrating and you may even feel numb when discussing the incident with others. All of these reactions are typical responses of trauma psychology.

Tips for Overcoming Trauma after School Violence

It will take a while to move past this heartbreaking tragedy, but we have some tips for managing your emotions during this horrific time. Following these guidelines can help you build resilience – the inner strength that you can draw on when you’re exposed to trauma or adversity.

  • Don’t suppress your feelings. Everyone processes a stressful situation in different ways. Give yourself time to mourn the tragedy and remember that working through grief takes a long time. Don’t try to rush it. If you have a more intense reaction than you feel you should, talk to others or to a mental health professional.
  • Take care of yourself. It’s harder to work through strong emotions when you are tired or not eating well. Try to eat a balanced diet and get plenty of rest. Set aside some time during the day to get some physical exercise, which has been proven to reduce stress. Also, try to avoid using alcohol or drugs to deal with your reactions – studies show they intensify negative emotions and can suppress your feelings, making it tougher for you to deal with your emotional pain.
  • Turn off the news coverage of the event. Overexposing yourself to the anxiety and raw emotions of this community violence by watching endless replays on the news or by reading numerous reports on the internet can increase your stress. In particular, images of the school violence can trigger new anxiety or prolong episodes of distress about the event. Try to focus on something positive to help raise your optimism, which will, in turn, help you feel more encouraged.
  • Maintain a routine. Patterns can provide a sense of comfort and security when your world has upended.
  • Talk about it with others. By doing so, you give yourself permission to mourn. Additionally, sharing your shock and distress makes you feel more supported, less alone, and less overwhelmed.
  • Help others. Being of service to someone distracts you from your own problems, plus it boosts serotonin levels, which will help you feel more positive.
  • If you and your family or friends have been directly impacted by this mass shooting, you will experience some form of grief. You may experience survivor’s guilt because you have lived and your loved one did not. You may feel alone and want to avoid others. Grief is unpredictable – it can seem to lessen, then reappear when you least expect it. Milestones, such as birthday or holidays, will often trigger a fresh round of mourning. Understand that this is part of grief and grieving is a long process.

If you find you can’t move past this school violence or another traumatic event that has happened in your life, it may be beneficial to seek out a support group or turn to a qualified, licensed mental health professional in order to move forward. It is especially important to do so if you are unable to carry out the daily tasks of living, such as sleeping, eating, and other functions.

Our Trauma Professionals Can Help

The Center for Anxiety and Mood Disorder’s Trauma Center has specially trained clinicians on staff to help those who are grieving or who have gone through traumatic situations. For more information, contact us or call us today at 561-496-1094.

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Can Using Medical Marijuana Increase Anxiety and Depression?

As of this writing, 30 states, Guam, the District of Columbia, and Puerto Rico all have approved the broad use of medical marijuana. Additionally, other states allow limited medical use and 8 states (and the District of Columbia) allow recreational use of the drug. Even though the use of pot and weed is becoming more acceptable, the Drug Enforcement Administration (DEA) still considers marijuana to be a Schedule I substance, meaning it is likely to be abused and it completely lacks medical value. This classification also means there hasn’t been much research into the efficacy of the drug for medical conditions and, in particular, we lack long-term studies that would tell us whether it is safe and/or effective when used over a long period of time.

What we do know is that, in clinical practice – both in our practice and in discussions with colleagues in other practices – mental health professionals are seeing an increase in the number of incidents of anxiety, panic attacks, depression, and even psychotic reactions now that marijuana use has become more mainstream.

Did you know that:

  • THC, the primary chemical in marijuana, is believed to stimulate areas of the brain responsible for feelings of fear.
  • According to available scientific literature, people who use weed have higher levels of depression and depressive symptoms than those who do not use cannabis.
  • Frequent or heavy use in adolescence can be a predictor of depression or anxiety later on in life – especially for girls.
  • Even if using cannabis seems to alleviate symptoms in the short-term for some users, it can lead to delay in getting appropriate treatment.
  • Scientific evidence suggests cannabis use can trigger the onset of schizophrenia and other psychoses in those already at risk of developing it.
  • A 2015 study found that university-aged young adults are more likely to have a higher risk of developing depression from heavy marijuana use.
  • Numerous research studies show that marijuana is an addictive substance. The more you use it, the more you need to use in order to get the same “high.”

Medical Marijuana vs. Recreational Marijuana

Whether it’s used recreationally or medicinally, both forms of pot are the same product. The medical version contains cannabinoids just like recreational marijuana. Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main chemicals found in the medical form.

Although medical marijuana is used for many conditions (among them: multiple sclerosis (MS), cancer, seizure disorders, and glaucoma), its efficacy hasn’t been proven. “The greatest amount of evidence for the therapeutic effects of cannabis relate to its ability to reduce chronic pain, nausea and vomiting due to chemotherapy, and spasticity [tight or stiff muscles] from MS,” says Marcel Bonn-Miller, PhD, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine.

Mental Illness and Psychoactive Substances

As noted above, there aren’t many studies on the relationship between marijuana use and mental illnesses, such as anxiety, depression and bipolar disorder yet. However, research done in 2017, examined marijuana use in conjunction with the depression and anxiety symptoms of 307 psychiatry outpatients who had depression (Bahorik et al., 2017). This study found that “marijuana use worsened depression and anxiety symptoms; marijuana use led to poorer mental health functioning.” In addition, the study determined that medical marijuana was associated with reduced physical health functioning.

Part of the problem with using marijuana either recreationally or medically is that there is no way to regulate the amount of THC you’re getting, because the Food and Drug Administration (FDA) doesn’t oversee the product. This means not only the ingredients, but the strength of them can differ quite a lot. “We did a study last year [2016] in which we purchased labeled edible products, like brownies and lollipops, in California and Washington. Then we sent them to the lab,” Bonn-Miller says. “Few of the products contained anywhere near what they said they did. That’s a problem.”

Another area of concern is that, as we know from regulated psychiatric medications, one dose may affect you differently than it affects your sibling or a friend. People are unique – each person’s reaction to a medication will vary, which is why psychiatric medications are monitored by the prescribing doctor so that the dosage can be adjusted for your specific needs.

Be Careful with Marijuana Use

In summary, if you choose to use marijuana either medically or recreationally, be careful. Talk to the doctor who authorized it, or speak with a mental health professional if you find yourself experiencing the symptoms of depression or anxiety, or if you have panic attacks that begin or worsen while you are using pot. Additionally, be sure your doctor knows your psychiatric history before they authorize medical marijuana for you, especially if you have been diagnosed with anxiety, depression, panic attacks, bipolar disorder, or psychosis.

Do You Have Questions?

We can help! The mental health professionals at The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida can answer your questions about how medical or recreational marijuana use can affect your anxiety, depression, or other condition. For more information, contact us or call us today at 561-496-1094.

Resource:  Bahorik, Amber L.; Leibowitz, Amy; Sterling, Stacy A.; Travis, Adam; Weisner, Constance; Satre, Derek D. (2017). Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. Journal of Affective Disorders, 213, 168-171.

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Meet Dr. Andrew Rosen

Our very own Dr. Rosen was recently interviewed by VoyageMIA! See the full interview here.

Dr. Rosen, let’s start with your story. We’d love to hear how you got started and how the journey has been so far.

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How A Psychological Assessment Can Benefit Your Child

Children's Center Now OpenChildren are referred for a psychological assessment for many reasons. They may have attention or behavior problems at home or in school, be subjected to bullying, be depressed or anxious, or have a learning disorder. Often when kids are struggling in school or seem to be behind their peers developmentally, a counselor or teacher will suggest the child undergo a psychological assessment.

The findings from this type of evaluation will let us know where the child excels and which areas he or she might need to address (for example: an undiagnosed learning disability).  Dr. Ryan Seidman, the Clinical Director at our Children’s Center notes that, “Having your child evaluated can promote improvement in academic and emotional functioning.”

Who Performs a Psychological Assessment?

Psychological assessments are done by highly trained child psychologists who are specialists in their fields. These mental health professionals evaluate the child’s strengths and weaknesses, then work with parents and teachers to come up with an approach that will help the child progress.

How is a Child Psychology Test Done?

These assessments aren’t like “actual” tests can be and they aren’t something the child can study for. In fact, it is best if the child is relaxed during the evaluation, so the assessment isn’t a “pass or fail” test.

During a psychological assessment, the psychologist will:

  • Talk with the child (and later with their parents) to learn more about their behaviors and emotional skills. They will also look at the child’s neurological functioning in areas such as spatial processing. In some cases, they may also talk to the child’s teachers or others who know the child well.
  • Observe the child during the evaluation. Depending on the reason for the assessment, the child psychologist may also visit the child at home or at school to further gauge their interactions with others.
  • Have the child complete a standardized test. These tests have been taken by many different people and will allow the psychologist to compare your child’s results with those of others in order to evaluate a range of abilities. The psychologists want to know how the child functions in areas such as movement (dexterity) or behavior and in subjects like reading, writing and math.
  • May review school records, medical records, or test interview or the child’s parents or teachers in order to learn more about the child.

Psychological testing isn’t a quick assessment. The evaluation will likely takes several hours to complete and often involves more than one session to be certain the psychologist has all the details about a child. By putting this information together, the child psychologist comes to an understanding of where a child needs assistance and can develop strategies to help them reach their full potential.

The Results of a Psychological Assessment

When the testing is complete, the child psychologist will go over the results with the child’s parents. Keep in mind that the outcomes do not reveal everything about a child’s potential, abilities or skills. Rather, the evaluation is used as a way to learn about their “present functioning level” emotionally, in their school and home environments, how they learn, and their strengths and weaknesses.

The child psychologist will discuss areas in which the child does well and offer suggestions to help them improve in areas that need to be addressed. If the child is diagnosed with a learning disability, or a behavioral or emotional issue, recommendations will be made for ways to help the child manage that specific concern or problem.

By evaluating and understanding where the child has issues, child psychologists can provide positive coping strategies, reduce the child’s stress and enrich their competence and well being.

Learn More about Children’s Psychological Assessment

For more information about how our child psychologists can help your child with a psychological assessment, contact The Center for Treatment of Anxiety and Mood Disorders in Delray Beach, Florida or call us today at 561-496-1094.

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Help your Child Defend against School Bullying

October is National Bullying Prevention month. Organizations and schools use this month to raise awareness of school bullying, while working to prevent its impact on children.

School bullying is defined as the use of power to control another person. Bullying always intends to harm the targeted child – usually psychologically, but sometimes physically, as well. Additionally, bullying is carried out by the same person or the same group of people who repeatedly go after the same child. A child who is being bullied might be either unable to fight back against attacks or might have a hard time defending themselves.

The kids most at risk of being bullied are those who:

  • Are less popular than others
  • Have few friends
  • Are depressed or anxious
  • Have low self-esteem

Bullies typically:

  • Like to dominate others
  • Have social power
  • Are aggressive and often act impulsively
  • Are concerned about their popularity
  • Often also have issues with low self-esteem
  • Are easily pressured by their peers

About 1 in 4 children report having been verbally or socially bullied at school and most bullying happens in middle school, although it can occur at any grade level.

Types of Bullying

While bullying can be verbal (teasing, name-calling, threatening someone) or physical (for example: hitting, fighting, or forcing a person to do something they don’t want to do), today’s children also face social bullying:

  • Cyber bullying – Kids practically live on social media, but this has created an environment in which the bully can be anonymous. Since they don’t have to face their target or witness the effects of their bullying, they have little empathy for the pain they cause. Texting and social media allows the bully free reign to post embarrassing pictures, make rude comments, or post humiliating videos almost instantly and without recourse.
  • Slut shaming – censuring a female’s character in sexual terms in order to embarrass, humiliate, or intimidate her for actions that are a normal part of female sexuality. For example: a male teen may be praised for his sexual experimentation, however a girl may be bullied and called a slut. This scenario has been explored in Netflix’s 13 Reasons Why show (you can read our Children’s Center article about it here ). In the show, the girl who is slut-shamed ends up committing suicide.
  • Social Alienation – In social bullying, the idea is to damage someone’s reputation, get them excluded from social activities, and to get others to avoid them. This can often be accomplished by cyber bullying.

What are the Effects of School Bullying?

The symptoms of school bullying can be both physical and emotional. Your child may experience:

  • School refusal
  • Headaches, stomachaches or other aches or pains throughout their body
  • Weight loss
  • Nightmares and/or sleeplessness

A child who is bullied may avoid situations and interactions with others that could actually be positive for them. The effects of school bullying can create depression and anxiety disorders in the child who is being attacked. Often this depression and anxiety will stay with the youth and follow them into adulthood. In fact, someone who was bullied in school is more likely to be the target of workplace harassment as an adult.

Fight Back against Bullying

In all cases of school bullying, it’s important to seek help and report the incident as soon as possible. Ignoring the issue often makes it worse because the bully begins to think it is okay to continue hurting others. Additionally, the targeted child sometimes begins to believe what is being said about them. offers the following suggestions to help stop school bullying. They say:

  • Look at the kid bullying you and tell him or her to stop in a calm, clear voice. You can also try to laugh it off. This works best if joking is easy for you. It could catch the kid bullying you off guard.
  • If speaking up seems too hard or not safe, walk away and stay away. Don’t fight back. Find an adult to stop the bullying on the spot. also lists things your child can do to stay safe in the future:

  • Talk to an adult you trust. Don’t keep your feelings inside. Telling someone can help you feel less alone. They can help you make a plan to stop the bullying.
  • Stay away from places where bullying happens.
  • Stay near adults and other kids. Most bullying happens when adults aren’t around.
  • Stand up for others When you see bullying, there are safe things you can do to make it stop.
  • Talk to a parent, teacher, or another adult you trust. Adults need to know when bad things happen so they can help.
  • Be kind to the kid being bullied. Show them that you care by trying to include them. Sit with them at lunch or on the bus, talk to them at school, or invite them to do something. Just hanging out with them will help them know they aren’t alone.

Additionally, child psychologists, such as the professionals here at The Anxiety Center, can work with your child to develop coping techniques that will teach them how to react in particular situations. Child psychologists can also help bullying victims rebuild their self-esteem and confidence so that future harassment can be avoided.

We Can Help

For more information about how we can help your child learn to defend against school bullying, contact the Center for Treatment of Anxiety and Mood Disorders in Delray Beach, or call us today at 561-496-1094.

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Resilience and Optimism Can Predict Trauma Response

How much of a part does resilience play when it comes to dealing with emotional or psychological trauma? As it turns out, quite a lot. Resilience is the inner strength that allows you to adapt when you’ve been exposed to trauma or adversity. This characteristic is strengthened by optimism, which is the extent to which people feel positive and encouraged about their future. Studies have shown that those who are resilient and optimistic feel a higher degree of psychological well-being and are able to recover more quickly from disturbing events. These individuals are able to process stressful situations without becoming overwhelmed and can move through them without turning to unhealthy coping mechanisms, such as substance abuse.

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