21 Adolescent health

See also  pp.575–576, 1034, 1038. The primary goal of any consultation with an adolescent, regardless of the presenting complaint, is to establish a relationship of trust. This calls for effective and efficient communication. However, achieving this is often difficult and challenging, particularly when faced with a personality who is undergoing rapid psychological and social change, and who does not have an adult’s perspective of health issues and society. Young people may be seen by themselves, as well as with their parents. Parents should not be excluded, but it is important to emphasize that the adolescent is the centre of the consultation. Communication of information should be in a manner appropriate for development.

Have a style of communication that is:

A positive regard and respect for any differing values and practices should be exhibited. At all times there must be reassurances about confidentiality.

The HEADSS protocol (Box 21.1) is a psychosocial history toolkit specifically designed for adolescent health-related consultations.¹

Adolescence is the transition period before adulthood. A number of physical and psychological objectives are achieved.

Adolescence is therefore filled with major changes that need to be taken into account when caring for adolescents with health-related problems.

Appreciation of adolescent-relevant issues, e.g. sex/drugs/smoking.

All those working with adolescents need to acquire the appropriate skills to manage and communicate effectively with young people.

Adolescence marks the beginning of the development of more complex thinking processes. These include:

During adolescence, young people acquire the ability to think systematically about all logical relationships within a problem. The transition from concrete thinking to formal logical conclusions occurs over time. Each adolescent progresses at varying rates in developing his/her ability to think in more complex ways. Some adolescents may be able to apply logical operations to school work long before they are able to apply them to personal dilemmas. When emotional issues arise, they often interfere with an adolescent’s ability to think in more complex ways. The ability to consider possibilities, as well as facts, may influence decision-making, in either +ve or −ve ways. The interactions that occur between puberty and psychological development are important, esp. in the context of developing self-esteem and a sense of sexuality and body image.

Adolescence marks the period of time during which there is a gradual shift in the balance between dependence on others to position of independence. The timing of this process is variable and will depend on the social and cultural environment.

Psychological and social changes occur against a background of physical changes of puberty.

The WHO defines adolescence as the period between 10 and 19yrs of age and, in most developed countries, this accounts for 13–15% of the population. In the UK adolescent health problems are increasing. This is thought to be a reflection of poor investment in health care delivery to young people, and also of the increasing proportion of adolescents who are of low socioeconomic status and who belong to ethnic minority groups.

The improvement in mortality rate observed in other age groups over recent decades has not been mirrored in adolescents. The most common cause of death in this age group is traumatic injury (particularly road traffic accidents) and poisoning. Suicide among late teenage males has doubled in the last 3 decades.

The pattern of adolescent illness is distinct. Some of the most common concerns that we see in adolescents are summarized in the Box 21.2.

An increasing trend has been observed in the following adolescent health problems in recent years:

Misuse of alcohol, tobacco, and illicit drugs is becoming common amongst adolescents, and causes health problems in this age. Alcohol and tobacco are the most commonly used substances, and are thought to account for 95% of the morbidity and mortality in this age range. Most adolescents who use alcohol or tobacco do not progress to using illicit substances. However, most users of illicit drugs will have used alcohol and tobacco.

See also  pp.576, 1002. Sexual health is a priority for adolescent care. The median age of first sexual experience in the UK is around 16yrs of age.

Experience of sex at an early age is often associated with unsafe sex practice. This may be due to lack of knowledge, or access to contraception, being under the influence of drugs, or inability to resist peer pressure. Unsafe sex practices may lead to unwanted pregnancies and STIs.

The UK has one of the highest rates of teenage pregnancy in Europe (approx 20–25 per 1000 women aged 15–19yrs). Many such pregnancies occur within marriage. Most unwanted teenage pregnancies occur in the context of poverty, low educational achievement, and adverse social factors (e.g. mental health problems, sexual abuse, and crime). Infants of teenage mothers are at increased risk of being low birth weight (SGA). Prevention of teenage pregnancies is a high priority. Health promotion and sex education are successful in this area.

Rates of STIs in UK 16–19yr olds in the UK are increasing. The highest rates of infection occur in Afro-Caribbeans and Africans. 30–40% of sexually active girls in high-risk groups may be infected with Chlamydia.

Clinical symptoms and signs similar to adults.

A chronic illness is defined as a condition lasting at least 6mths. The number of young children surviving into young adulthood with a congenital or chronic health problem is increasing. In addition, the prevalence of certain chronic lifelong conditions (e.g. type 1 diabetes) is increasing. It is estimated that 20–30% of young people may have a chronic illness.

Teenagers with a chronic illness are disadvantaged compared with their healthy peers. Their illness can impact on physical, psychological, emotional, and social development and well-being:

Constitutional delay in growth and pubertal development (  p.468).

Chronic illness can adversely impact on the adolescent’s family. Parents have to provide additional time for care and support of the teenager with a chronic illness, often with financial consequences. Parents may experience guilt, frustration, and anxiety, and the frequency of mental health problems is increased. Siblings are also disadvantaged, often missing out on parental time and attention. The support of specific agencies and child and adolescent psychology services is often required and may be helpful.

Young people are usually more concerned about the ‘here and now’ issues of adolescence, and less interested in the long-term consequences of their treatment and their behaviour towards it. This often leads to a conflict of priorities between health professionals (and parents) and the adolescent, and may lead to problems with compliance. Improving compliance may be helped by the following:

Adolescents requiring ongoing specialist hospital care will eventually need transfer to ‘adult’ health care services. This transition requires more than a ‘simple’ transfer of medical records from one service to another. There are many different models of transition of care (e.g. direct paediatric to adult service or indirect via an intermediary ‘adolescent’ or young adult service). Transition should be carefully planned and the adolescent patient, and their family, should be given plenty of time to consider and prepare. Transition should not take place at a fixed, predetermined age, but rather at a point when the adolescent is ready and has the necessary coping skills to deal with the adult clinic. Personalized transition plans are needed for each patient and careful communication, co-ordination, and organization are required between the paediatric and adult teams.