Growth and Development: Adolescence

Question 1

Adolescence Stages

Answer 1

• Early adolescence: 11-14
• Middle Adolescence: 15-17
• Late adolescence: 18-21

Question 2

Adolescence General Considerations

Answer 2

• Adolescence: Refers to the physical, psychosocial, and emotional transition from childhood to adulthood
• Puberty: biologic process that leads to fertility
• Growth and maturation equivalent to that of infancy
• Entire hormonal regulatory system undergoes dramatic changes in the hypothalamus, pituitary, gonads, and adrenal glands
• Rapid growth in height, weight, secondary sex characteristics, onset of fertility
• NL is an “approximation”, timing is variable
• Sequence of development is orderly

Question 3

Approach to the Adolescent Assessment

Answer 3

• Should be evaluated independently of parents
• Include adolescents in decision making
• Maintain confidentiality

Question 4

Exceptions to Maintaining Confidentiality

Answer 4

• Threat of potential suicide/violence
• Drug/ETOH use
• Evidence of psychiatric/eating disorder
• Physical abuse
• Sexual abuse/rape
• Consent of the adolescent
• Sexual activity/pregnancy (parameters for when this is considered sexual abuse under any circumstance varies from state to state)
• If adolescent perceives confidentiality, they are more likely to disclose information
• When teens are privately informed that confidentiality cannot be maintained, they are more apt to understand and cooperate

Question 5

Adolescent Health History

Answer 5

*** Pay attention to changes in psychosocial, emotional, or cognitive development which are not adult-like

Question 6

Adolescent PE

Answer 6

• Continue to plot stats on chart and compare to NL for age

- GYN exam only at 21 yrs unless medically warranted (NEW guidelines)

Question 7

Male Gynecomastia

Answer 7

• Transient enlargement of breast in males
• Usually lasts 12-18mo and resolves by late puberty
• May be surgically corrected if it persists
• May affect body image

Question 8

Adolescent Development: Screening Tools

Answer 8

• GAPS: Guidelines for Adolescent Preventative Services
• HEEADSSS and CRAFFT
• PSC may also be used in this group

Question 9

Guidelines for Adolescent Preventative Services (GAPS)

Answer 9

• A tool developed by the American Medical Association as a thorough interview format for teens
• There is a screen for early, middle, and late adolescence completed by the patient
• There is also a parent questonionnaire if desired
• Items must be read, interpreted, and addressed by the provider; it is not scored

Question 10

HEEADSSS Assessment

Answer 10

• H ome Environment
• E ductaion/employment
• E ating
• A ctivities (peer related)
• D rugs/cigarettes/ETOH/steroids
• S exuality/STIs
• S uicide/depression
• S afety

Question 11

CRAFFT (Used with the D in HEEADSSS)

Answer 11

• C: Have you driven in a CAR withsomeone who is high?
• R: Have you used drugs to RELAX?
• A: Have you used drugs while ALONE?
• F: Do you FORGET things when using drugs?
• F: Do FRIENDS/FAMILY tell you not to use drugs?
• T: Have you gotten into TROUBLE due to drug use?

Question 12

Parameters of NL Early Adolescent Development

Answer 12

• Confused by physical/emotional changes
• Anti-adult: prefers peers
• Challenge parental authority wanting to negotiate rules
• Moody: may change mood in minutes
• Conscious of body: look in the mirror to check appearance
• Like clothes, hair style, clear skin, make-up, etc.
• Overly sensitive about appearance
• Frequently daydream: needed time for cognitive development
• Set goals that frequently change
• Desire privacy
• Start to develop a value system
• Onset of 2nd sex characteristics
• Tremendous concerns about menstruation, wet dreams, masturbation, same sex feelings
• Prefers group socialization

Question 13

Parameters of NL Middle Adolescent Development

Answer 13

• Parental conflict peaks
• Continues to negotiate for things (curfew, dating, parties)
• Less concern about body image: growth is nearly complete
• More interested in making themselves attractive to opposite sex
• Most common time for dieting or activities to build muscle mass
• Have periods of excess physical activity followed by periods of great fatigue
• Teen dress code, communication style, peer groups with same code of conduct preferred
• Emergence of sex drive
• Interested in 1-on-1 dating
• Physical urges precede emotional development
• Egocentric: do not understand that risks may come with harm
• Intellectual sophistication and creativity are quickly increasing
• No longer anti-adult, more non-adult

Question 14

Parameters of NL Late Adolescent Development

Answer 14

• Preparing for high school graduation, college, employment, military, marriage
• Adult-like family relationships are more of an adult-to-adult basis
• Look for family to support, but desire and obtain autonomy
• Can understand consequences of actions and desire to maintain health-well being
• Can make complex decisions about human relationships (although some adults never obtain this ability)
• Establish sexuality
• Have experienced relationships with one intimate partner based on individual preference and not peer group
• Adolescents that attend college have an “extended adolescence” that allows for more time to formulate identity
• Those that enter the military or workforce must face adult issues sooner
• May marry and start family

Question 15

Warning Signs of Abnormal Adolescent Growth and Development

Answer 15

• Loss of appetite
• No physical activity/difficulty with tasks
• Sleep disturbances
• Experimentation with high risk activities
• School fights/gangs/poor anger control
• No close friends
• Cruelty to animals/others/self
• Feelings of hopelessness, sad, negative about self-worth
• Excessively defiant
• Abusive dating relationships
• No life goals/future plans
• Drunk driving
• Poor grades/performance
• Weapon possession/use
• Teen parenthood
• Runaway attempts