Adolescent Medicine Summary Page 2015

Abigail Donaldson MD, Arik Marcell MD/Ambulatory Curriculum/Johns Hopkins Hospital

Part 1: Tasks of Adolescence
Achieve independence from parents
Interpret peer codes and identify personally appropriate behaviors
Undergo remarkable physical transformation and learn to accept a new body image
Develop and establish sexual identity
Develop and establish moral and vocational identities

Part 2: Central Issues in Early, Middle, and Late Adolescence
VARIABLE EARLY ADOLESCENCE MIDDLE ADOLESCENCE LATE ADOLESCENCE
Age (yr) 10-13 14-16 17-20 and beyond
Sexual maturity rating* 1-2 3-5 5
Somatic Secondary sex characteristics
Beginning of rapid growth
Awkward appearance
Height growth peaks
Body shape & composition change
Acne and odor
Menarche/spermarche
Physically mature
Slower growth
Cognitive and moral Concrete operations
Unable to perceive long-term outcome of
current decision-making
Conventional morality
Emergence of abstract thought (formal operations)
May perceive future implications, but may not apply in
decision-making
Questioning mores
Future-oriented with sense of perspective
Idealism; absolutism
Able to think things through independently
Self-concept/identity
formation
Preoccupied with changing body
Self-consciousness about appearance &
attractiveness
Fantasy and present-oriented
Concern with attractiveness
Increasing introspection
"Stereotypical adolescent"
More stable body image
Attractiveness may still be of concern
Emancipation complete
Firmer identity
Family Increased need for privacy
Increased bid for independence
Conflicts over control & independence
Struggle for acceptance of greater autonomy
Emotional & physical separation from family
Increased autonomy
Peers Seeks same-sex peer affiliation to counter
instability
Intense peer group involvement
Preoccupation with peer culture
Peers provide behavioral example
Peer group & values recede in importance
Intimacy/possible commitment takes
precedence
Sexual Increased interest in sexual anatomy
Anxieties & questions about genital
changes, size
Limited dating & intimacy
Testing ability to attract partner
Initiation of relationships & sexual activity
Questions of sexual orientation
Consolidation of sexual identity
Focus on intimacy & formation of stable
relationships
Planning for future & commitment
Relationship to society Middle school adjustment Gauging skills & opportunities Career decisions (e.g., college, work)
Marcell AV. Chapter 12: Adolescence. Nelson Textbook of Pediatrics. Ed. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. 18
th
Edition. 2007, pg. 60.

Part 3: Legal issues
Minors are persons <18 years in all states except Mississippi and Washington DC (both 21 years) and Alabama and Nebraska (both 19 years).
In most states, emancipated minors include those who are married (or divorced), in the armed services, parents of a child, or who live
independently and are financially independent of their parents. For state-specific laws on emancipated minors, please refer to the Juvenile
Law Center at http://www.jlc.org/factsheets/4/
Most states allow confidential services for minors for the following health concerns: contraceptive services, STD/HIV services, treatment for
alcohol and substance abuse, and outpatient mental health services.
Confidentiality does have limits: in cases of risk of harm to self or others.
State laws and access to services vary widely by state. Providers should become familiar with the laws in your state; refer to Guttmacher
Institute (www.guttmacher.org/pubs/tgr/03/4/gr030404.pdf), The National Center for Youth Law (www.youthlaw.org), and The Center for
Adolescent Health and the Law (www.cahl.org/web).

Part 4: The adolescent interview
HEEADSSS: Home; Education/Employment; Eating; Activities; Drugs; Sexuality; Suicide; Safety. This mnemonic is used to ask about key issues
facing the adolescent and is a non-judgmental interview that can be key to a successful office visit.
CRAFFT: Mnemonic used to more specifically inquire about substance abuse: Ridden in Car with someone under influence; Used
drugs/alcohol to Relax/fit in/feel better or when you are Alone; Do you Forget things you did when using drugs/alcohol; Family/friends tell
you to cut down; Ever gotten in Trouble?

Part 5: Transition from Pediatric to Adult Medical Care
Encourage the young adult to assume increasing responsibility for his/her medical care management
Assure the young adult understands his/her health condition and medications.
Encourage the youth to ask questions during each office visit and to make his/her own appointments.
Provide parents with the opportunity to discuss their feelings about loss of control, concerns about the future and increasing the young
adults independence.
Encourage the youth to maintain a personal health record book to keep track of medical appointments, health information, history,
medications, treatments and medical care providers.
Assess the young adults and the familys readiness for transfer to an adult health care provider
Discuss concerns that the youth might have about transitioning to an ownership role in their health management
Facilitate communication between the youth and their family around transition concerns
Implement the transfer to an adult care provider
Ensure receipt of previous medical records
Discuss nuances of care with the pediatric provider.
Consider close patient follow up after the transfer.