Lecture VI: Approach to Adolescents Flashcards
Describe the cognitive components of adolescent development
Cognitive development
• Early 17: uses formal operational thought and abstract thinking. Can compromise and set limits. Can understand others’ feelings and thoughts.
• Assume adolescent is a concrete thinker and needs clear, specific questions; abstract thinking may be difficult for some
Developmental Tasks
- Emancipation from family of origin
- Acquisition of skills for future economic independence
- Development of a mature sexual self-concept
- Achievement of a realistic and positive self-image
- Does not correlate with physical maturity
Physical Development: Boys
Stage 1: Prepubertal
Stage 2: Enlargement of scrotum and testes; scrotum skin reddens and changes in texture
Stage 3: Enlargement of penis (length at first); further growth of testes
Stage 4: Increased size of penis with growth in breadth and development of glans; testes and scrotum larger,
scrotum skin darker
Stage 5: Adult genitalia
Physical Development: Girls- Breasts
Girls - breast development
Stage 1: Prepubertal
Stage 2: Breast bud stage with elevation of breast and papilla; enlargement of areola
Stage 3: Further enlargement of breast and areola; no separation of their contour
Stage 4: Areola and papilla form a secondary mound above level of breast
Stage 5: Mature stage: projection of papilla only, related to recession of areola
Physical Development: Pubic Hair
Boys and girls - pubic hair
Stage 1: Prepubertal (can see velus hair similar to abdominal wall)
Stage 2: Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia
Stage 3: Darker, coarser and more curled hair, spreading sparsely over junction of pubes
Stage 4: Hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs
Stage 5: Adult in type and quantity, with horizontal distribution (“feminine”)
Identify the importance of confidentiality in the medical interview with adolescents: when do you not need parental consent?
- Emergency
- Emancipated minor
- Sexual health/substance abuse
- “Mature Minor”
When must confidentiality be broken?
- Threat of imminent harm to self or others
- Suspected or threatened physical or sexual abuse of minors
- Suspected neglect
Components of an adolescent complete medical interview and how it applies to health promotion/disease prevention
- Confidentiality
- Set the agenda (chief complaint)
- Establish Trust and rapport
- Psychosocial history
HEEADSSS
Home Education Employment Activities Drugs Sex Suicide/Depression Safety
CRAFFT
C - Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A - Do you ever use alcohol or drugs while you are by yourself, or ALONE?
F - Do you ever FORGET things you did while using alcohol or drugs?
F - Do your family or FRIENDS ever tell you that you should cut down
on your drinking or drug use?
T - Have you ever gotten into TROUBLE while you were using alcohol or drugs?
Open-ended questions to illicit history from adolescent patients
See study guide for examples
Techniques to make adolescent more comfortable with the physical exam
- Discuss what is included beforehand
- Who would the patient like present?
- Wash hands in front of patient
- Ensure Privacy
- Talk through the exam while doing the exam
- Emphasize normalcy of the exam
- If sensitive issue comes up, discuss how you’ll explain it to the parents
- Multiple issues: follow-up may be needed
PHQ2/9
Screening for depression:
- last 2 weeks, how often have you been bothered by feeling down, depressed, or hopeless?
- In the last 2 weeks, how often have you had little interest/pleasure in doing things?
Anything other than “not at all” is a positive that requires a follow-up
