Clues for Suspecting AEA

1. Bruises of the neck or recurrent syncopal episodes in a child or an adolescent should prompt the pediatrician to inquire about “choking games” or the more elaborate AEA syndrome. (Physicians may be unaware that choking may engender feelings of pleasure, erection, and even orgasm.)
2. Hesitant/tangential responses to a sexual history (in an adolescent) do not confirm AEA but may warrant additional inquiry (eg, “Do you ever play with death?” “Have you ever experienced giddiness or sexual stimulation if you are temporarily deprived of oxygen by choice or accident when roughhousing, inhaling a substance, or playing a choking game?” “Do you engage in risk-taking related to sexual stimulation or behavior?”).
3. Is there evidence in the physical examination that an orifice has been repeatedly subjected to foreign-body insertion?
4. Are there unusual, unexplained urogenital, vaginal, or anal injuries?
5. Does the child or adolescent express concerns about sexual matters?
6. Do abrasions found on limbs, wrists, ankles, or trunk suggest bondage or binding activities during masochistic practices? Is there ornamental piercing of intimate body parts?
7. Are there erythematous or ligature marks on the penis or base of the scrotum?
8. Do family members express concern about choking games that they have observed or heard about whether in their adolescent or their friends?