Anticipating the care adolescents will need
The HEADSS approach is one way to begin discussing key clinical and social topics and to guide further screening or intervention.
PRACTICE RECOMMENDATIONS
› Consider using a 2-question screening tool for adolescents that asks about personal use of alcohol and use of alcohol by friends; this resource offers a risk assessment with recommendations. C
› Consider using the American Academy of Pediatrics Family Media Plan to provide age-specific guidelines to help parents or caregivers establish rules for online activities. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Obesity and physical activity
The percentage of overweight and obese adolescents in the United States has more than tripled over the past 40 years,23 and 1 in 5 US adolescents is obese.23 Obese teens are at higher risk for multiple chronic diseases, including type 2 diabetes, sleep apnea, and heart disease.24 They are also more likely to be bullied and to have poor self-esteem.25 Only 1 in 5 American high school students engages in 60 or more minutes of moderate-to-vigorous physical activity on 5 or more days per week.26
Regular physical activity is, of course, beneficial for cardiorespiratory fitness, bone health, weight control, and improved indices of behavioral health.26 Adolescents who are physically active consistently demonstrate better school attendance and grades.17 Higher levels of physical fitness are also associated with improved overall cognitive performance.24
General recommendations. The Department of Health and Human Services recommends that adolescents get at least 60 minutes of mostly moderate physical activity every day.26 Encourage adolescents to engage in vigorous physical activity (heavy breathing, sweating) at least 3 days a week. As part of their physical activity patterns, adolescents should also engage in muscle-strengthening and bone-strengthening activities on at least 3 days per week.
Behavioral health
As young people develop their sense of personal identity, they also strive for independence. It can be difficult, at times, to differentiate normal adolescent rebellion from true mental illness. An estimated 17% to 19% of adolescents meet criteria for mental illness, and about 7% have a severe psychiatric disorder.27 Only one-third of adolescents with mental illness receive any mental health services.28
Depression. The 1-year incidence of major depression in adolescents is 3% to 4%, and the lifetime prevalence of depressive symptoms is 25% in all high school students.27 Risk factors include ethnic minority status, poor self-esteem, poor health, recent personal crisis, insomnia, and alcohol/substance abuse. Depression in adolescent girls is correlated with becoming sexually active at a younger age, failure to use contraception, having an STI, and suicide attempts. Depressed boys are more likely to have unprotected intercourse and participate in physical fights.29 Depressed teens have a 2- to 3-fold greater risk for behavioral disorders, anxiety, and attention-deficit/hyperactivity disorder (ADHD).30
Continue to: Suicide
