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
Suicide. Among individuals 15 to 29 years of age, suicide is the second leading cause of death globally, with an annual incidence of 11 to 15 per 100,000.31 Suicide attempts are 10 to 20 times more common than completed suicide.31 Males are more likely than females to die by suicide,32 and boys with a history of attempted suicide have a 30-fold increased risk of subsequent successful suicide.31 Hanging, drug poisoning, and firearms (particularly for males) are the most common means of suicide in adolescents. More than half of adolescents dying by suicide have coexisting depression.31
Characteristics associated with suicidal behaviors in adolescents include impulsivity, poor problem-solving skills, and dichotomous thinking.31 There may be a genetic component as well. In 1 of 5 teenage suicides, a precipitating life event such as the break-up of a relationship, cyber-bullying, or peer rejection is felt to contribute.31
ADHD. The prevalence of ADHD is 7% to 9% in US school-aged children.33 Boys more commonly exhibit hyperactive behaviors, while girls have more inattention. Hyperactivity often diminishes in teens, but inattention and impulsivity persist. Sequelae of ADHD include high-risk sexual behaviors, motor vehicle accidents, incarceration, and substance abuse.34 Poor self-esteem, suicidal ideation, smoking, and obesity are also increased.34 ADHD often persists into adulthood, with implications for social relationships and job performance.34
Eating disorders. The distribution of eating disorders is now known to increasingly include more minorities and males, the latter representing 5% to 10% of cases.35 Eating disorders show a strong genetic tendency and appear to be accelerated by puberty. The most common eating disorder (diagnosed in 0.8%-14% of teens) is eating disorder not otherwise specified (NOS).35 Anorexia nervosa is diagnosed in 0.5% of adolescent girls, and bulimia nervosa in 1% to 2%—particularly among athletes and performers.35 Unanticipated loss of weight, amenorrhea, excessive concern about weight, and deceleration in height/weight curves are potential indicators of an eating disorder. When identified, eating disorders are best managed by a trusted family physician, acting as a coordinator of a multidisciplinary team.
Sexual health
Girls begin to menstruate at an average age of 12, and it takes about 4 years for them to reach reproductive maturity.36 Puberty has been documented to start at younger ages over the past 30 years, likely due to an increase in average body mass index and a decrease in levels of physical activity.37 Girls with early maturation are often insecure and self-conscious, with higher levels of psychological distress.38 In boys, the average age for spermarche (first ejaculation) is 13.39 Boys who mature early tend to be taller, be more confident, and express a good body image.40 Those who have early puberty are more likely to be sexually active or participate in high-risk behaviors.41
Continue to: Pregnancy and contraception
