Adolescent medicine is a medical subspecialty that focuses on care of patients who are in the
adolescent period of development. Patients have generally entered
puberty, which typically begins between the ages of 9 to 11 for girls, and 11 to 14 for boys. A
primary care subspecialty, adolescent medicine incorporates aspects of
gynecology,
endocrinology,
sports medicine,
nutrition,
dermatology and
psychology. Adolescent medicine is an important specialty of
Family Practice,
Internal Medicine,
Pediatrics and
Youth Health.
Issues with a high prevalence during adolescence are frequently addressed by providers. These include:
- Certain mental illnesses (especially personality disorders, anxiety disorders, major depression and suicide, bipolar disorder, and certain types of schizophrenia)
- Delayed or precocious puberty
Scope of care
Providers of care for adolescents generally take a holistic approach to the patient, and attempt to obtain information pertinent to the patient's well-being in a variety of different domains. This approach, similar to the
biopsychosocial model, is encapsulated in the
HEADSS assessment,
[Goldenring, JM and Rosen DS (2004) Getting into adolescent heads: An essential update. Contemporary Pediatrics, Vol 21, No. 1, pp. 64-90.] which is a screening acronym for adolescent patients. It includes:
- Home -- how is the adolescent's home life? How are his/her relationships with family members? Where and with whom does the patient live? Is his/her living situation stable?
- Education (or Employment) -- how is the adolescent's school performance? Is he/she well-behaved, or are there discipline problems at school? If he/she is working, is he/she making a living wage? Are they financially secure? *Eating (incorporates body image) -- does the patient have a balanced diet? Is there adequate calcium intake? Is the adolescent trying to lose weight, and (if so), is it in a healthy manner? How does he/she feel about his/her body? Has there been significant weight gain/loss recently?
- Activities -- how does the patient spend his/her time? Are they engaging in dangerous or risky behavior? Are they supervised during their free time? With whom do they spend most of their time? Do they have a supportive peer group?
- Drugs (including alcohol and tobacco) -- does the patient drink caffeinated beverages (including energy drinks)? Does the patient smoke? Does the patient drink? Has the patient used illegal drugs? If there is any substance use, to what degree, and for how long?
- Sex -- is the patient sexually active? If so, what form of contraception (if any) is used? How many partners has the patient had? Has the patient ever been pregnant/fathered a child? Do the patient and their partners get routine reproductive health and STD checks and physical examinations? Are there any symptoms of a sexually transmitted infection? Does the patient identify as heterosexual, homosexual, or unsure? Does the patient feel safe discussing sexuality issues with parents or other caregivers?
- Suicidality (including general mood assessment) -- what is the patient's mood from day to day? Has he/she thought about/attempted suicide? In broader terms, is their mental and emotional state so dysfunctional that the activities of daily living are largely impaired or they present a risk to themselves or others?
- Some providers favor the addition of Strengths to the list, in an effort to avoid focusing on issues of risk or concern, and reframe the patient interaction in a manner that highlights resilience.
In addition to a detailed history, adolescents should have a comprehensive physical exam (including a developmental and neurological assessment, STI testing, and a reproductive system exam) and mental health status exam on at least a yearly basis, in addition to yearly dental and ocular exams. Developmental progression, including an assessment of
Tanner stage, should be noted at every yearly visit, and appropriate endocrinological work-ups undertaken for patients that fail to develop in an anticipated manner. Young women and young men should be taught how to examine their
breast tissue for signs of
breast cancer, and young men should be taught how to examine their testicles and penis for cancer and STDs. Screening lab tests, including a
complete blood count to screen for anemia, and either a spot
cholesterol check or (ideally) a
fasting lipid profile to screen for
hyperlipidemia, should be obtained at least once during adolescence. For patients who are sexually active, particularly in areas of high prevalence or with patients participating in higher-risk behaviors, screening tests for
sexually transmitted diseases should be performed, including an
RPR or
VDRL for
syphilis, screening for
gonorrhea and
chlamydia, and
HIV. Sexually active females should have a
pelvic exam (including a
Pap smear to screen for early signs of
cervical cancer), though the timing of the initial exam following first intercourse and how aggressively abnormal Pap smears must be followed up are subjects of controversy within the field. Needed immunizations include: a tetanus vaccination or booster shot, a meningitis vaccination, the Gardasil vaccine against HPV (primarily for sexually active young women), and a yearly influenza vaccination.
Young peoples' access to health care
In addition, issues of
medical ethics, particularly related to
confidentiality and the right to
consent for medical care, are pertinent to the practice of adolescent medicine.
Training
Adolescent medicine providers are generally drawn from the specialties of
pediatrics,
internal medicine or
family medicine. The
certifying boards for these different specialties have varying requirements for certification, though all require successful completion of a
fellowship (a comprehensive list of which is available through the
Society for Adolescent Medicine) and a passing score on a certifying exam. requires evidence of scholarly achievement by candidates for subspecialty certification, usually in the form of an original research study.
Adolescent Health centers in the United States
Many subspecialists practice as part of general specialty clinics or practices. In addition, many major metropolitan areas have clinics that offer adolescent-specific care. A partial list includes:
New York City- The Adolescent Health Center at (Manhattan)
- Adolescent clinic at (the Bronx)
Los Angeles- Teenage and Young Adult Health Center at
San Francisco area- Adolescent Medicine Clinic at at Stanford
Boston- Division of Adolescent Medicine at
Philadelphia- Adolescent Medicine Clinic at
- Teen Health Center at Albert Einstein Medical Center
Adolescent Medicine in Australia
These hospitals offer adolescent-specific care:
Sydney- The Department of Adolescent Medicine at
- The Department of Adolescent Medicine at
- Youth Consultatncy & the Chill, at
Melbourne- The Centre For Adolescent Health
Professional Organizations
In addition to membership in the organizations for their various specialties, adolescent medicine providers often belong to and/or . and the are the publications of the two organizations, respectively.
Founded in 1987, the (IAAH) is a multidisciplinary, non-government organization with a broad focus on youth health.
See also
