3.11 Anticipatory guidance: Adolescents

Question 1

What is harm reduction

Answer 1

a strategy to reduce harm assocaited with certain behaviours

Question 2

What is important in terms of the layout of visits with adolescents

Answer 2

spend part of visit seeing without parent

Question 3

What topics of anticipatory guidance should the provider focus on with adolescents

5

Answer 3

• growth/development
• sexuality
• physical activity
• nutrition
• safety (vaping, cannabis, risk-taking behaviours)

Question 4

What screening tool can be helpful in addressing concerns of adolescents

Answer 4

HEADSS questionnaire

Question 5

When should primary vs seconday prevention strategies for risky behaviour be used in adolescents

Answer 5

primary- for those who have not yet engaged in the activity
secondary- for those who have already engaged in the activity

Question 6

What is the primary prevention for risky behaviour for adolescents

Answer 6

Discouraging behaviour

example delaying sexual activity

Question 7

What is the secondary prevention for risky behaviour for adolescents

2

Answer 7

• encouraging to reduce behaviour
• provide education on safey around behaviour (condom use, STI testing)

Question 8

What is the AMPS program

Answer 8

school program for grade 5/6 to educate on harms of alcohol abuse, social pressure etc.

Question 9

What is the SHAHRP program

Answer 9

similar to AMPS program but includes active learning/skills training and alcohol education

Question 10

What type of interviewing technique should be used in adolescents

Answer 10

motivational interviewing

Question 11

Who and when should screening for risky behaviours occur in primary care

Answer 11

all preadolescent and adolescent patients at regular health care visits

Question 12

What messages should be given about risky behavs for those not already engaging in the behav

Answer 12

• encourage delay of starting behav (primary prevention)

also provide risk reduction strategies for if they choose to engage

Question 13

What messages should be given about risky behavs for those who are already engaging in the behav

Answer 13

promote risk-reduction strategies (secondary prevention)

Question 14

info about sexual development of kids if needed for exam based on hint sheet

Question 15

table 13.1

Question 16

The transition from adolescence to adulthood is ___ and generally ___

Answer 16

continuous and generally smooth

Question 17

FYI

Adolescent Survival Guide for Parents
* Start with clear rules and expectations before children are teenagers.
Work on good communication with children early and continue through
adolescence. State expectations and future consequences before
trouble occurs (e.g., identify curfew expectations before the dance, not
when the teen comes home late).
* Be firm and consistent with follow through.
* Be flexible and allow teenagers to negotiate nonsafety-related rules.
Discussing principles and negotiating solutions are valuable life skills for
the future. Do not negotiate rules that are nonnegotiable.
* Fighting and arguing are typical, often used by teens as they practice
their developing reasoning skills. Often teens are engaged more
recreationally than emotionally. Therefore, when the parent is tired,
they should disengage and walk away. Try not to take what they say
personally.
* Teenagers want parents to be involved, concerned, and ask questions.
They just may not know it or know how to express their desire.
* Know who their friends are and call those parents from time to time.
Compare household rules if possible.
* Be involved at their school as much as possible. Try to meet their
teachers and stay in contact with them.
* Continue to involve teenagers in family activities, even when they no
longer want to. Bringing friends along helps.
* Keep promises made to teens. This builds trust and respect and makes
you a role model.
* Model good behavior. Adolescents recognize the hypocrisy of saying one
thing and doing another.
* Don’t forget that teenagers still need adult supervision at times.
* Keep communication lines open and don’t be afraid to start
conversations. Adolescents sometimes

Question 18

The biologic, cognitive, and emotional changes experienced by adolescents require a ____

Answer 18

reworking of family relationships

Some degree of adolescent-parent conflict
is expected because of this, but disruptive family conflict is not the norm.

Question 19

What is essential to navigating the mundane, everyday issues (such as, which clothes to wear,
hairstyles, household chores, curfew, and friends) that are the usual
sources of parent-adolescent conflict?

Answer 19

negotiation

negotiate on rules that arent important- do not negotiate on rules that are non-negotiable

Question 20

If families are experiencing one crisis after another with their teen this is ___

Answer 20

a cause for concern

When true turmoil exists, it usually represents psychopathology and will not be simply “outgrown.”

Behavior that results in negative consequences is
especially worrisome. For example, fights over hair color may not be worthwhile because hair color will grow out, but behavior that results in school and/or work difficulties should be addressed.

Question 21

The adolescent milestone of developing formal operational thinking describes the change in what?

Answer 21

the ability to reason using verbal manipulation rather than thinking in terms of only concrete objects

In early adolescence, thinking tends to be very concrete.

The classic example is an adolescent who when asked, “Are you sexually active?” responds, “No, I just lie
there,”

or when asked, “What brought you here to see me today?” answers, “The bus.”

Question 22

For teens who are reluctant to discuss sensitive issues what can be used

Answer 22

checklist or questionnaire

Question 23

What measurements should be coleted besides vital signs at each visit of teens

Answer 23

SMR- sexual maturity rating scale number

prepubertal (SMR 1) to adult (SMR 5)

Question 24

table 13.2 is anticipatory guidance

Question 25

Is it normal for teens to experiment with same sex/ different relationships

Answer 25

yes- strong friendship bonds can lead to experiementation

Question 26

Should people have PAP smears who are not sexually active

Answer 26

yes- starting at age 21

Question 27

HEEADSSS assessment (more in depth than HEADSS) includes what

Answer 27

Home
Education/employment
Eating
Actvitites
Drugs
Sex
Suicide/depression
Safety

Question 28

Are tattoos or piercings considered high risk behaviours of youth

Answer 28

no

Question 29

table 13.3

Question 30

what are primary and seconday prevention methods for teens and smoking

Answer 30

primary- provide education, recommend avoiding

secondary- ID barriers to quitting, provide support for quitting

recall - primary is before starting behaviour

secondary is for after they’ve started

Question 31

What is nonsuicidal self-injury

Answer 31

a group of repetitive behaviors
with the intent of purposefully causing physical harm to oneself
but not with the intent of ending one’s own life

doesn’t include piercings and tattoos - seen as socially acceptable.

Symptoms must have occurred at least five times within the past year and be associated with at least two of the following:
* Previous negative emotions
* Preoccupation with and a repetitive desire to engage in the activity
* Feelings of relief from negative emotions or a sensation of positive feelings with activity
* Impaired interpersonal relationships

NSSI behaviors:
cutting (the most common mechanism), scraping, hitting, burning or ripping of skin, subdermal
tissue, or hair, hindering wound healing (does not include scab picking), and head banging

Question 32

Why do teens engage in nonsuicidal self injury

Answer 32

coping strategy to relieve distress, anger, stress and create sense of calm

These are NOT suicide attempts

Question 33

Are those who engage in nonsuiidal self injury more likey to have an eating disorder

Answer 33

yes

also more like to have HO trauma, mood disroder, psychological distress

Question 34

What should those who engage in nonsuicidal self injury be screened for

Answer 34

suicide risk

Question 35

Nonsuicidal self injury is a common feature of what MH disorder

Answer 35

BPD

Question 36

What is good management for nonsuicidal self injury behavs

Answer 36

CBT/DBT/family therapy

• Prompt referral to a mental health professional is needed if symptoms of psychosis or suicide ideation are present.
• Not all adolescents who use NSSI need psychiatric referral.
• Those who have no other signs of mental illness and who are experimenting with self-injury, or who
  have engaged in NSSI because of peer pressure may not require immediate intervention but should have close follow-up.