Adolescent medicine

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:

Sexually transmitted disease
Unintended pregnancy
Birth control
Substance abuse
• Menstrual disorders (such as amenorrhea, dysmenorrhea and dysfunctional uterine bleeding)
• Acne
Eating disorders

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, 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? Does the patient get routine reproductive health checks? 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?
• 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 on a yearly basis. Developmental progression, including an assessment of Tanner stage, should be noted, 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. The American Board of Pediatrics 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 Mount Sinai Medical Center (Manhattan)
• Adolescent clinic at Children's Hospital at Montefiore Medical Center (the Bronx)
The Door

Los Angeles

• Teenage and Young Adult Health Center at Children's Hospital Los Angeles

San Francisco area

• Adolescent Medicine Clinic at Lucile Packard Children's Hospital at Stanford
Adolescent Medicine Clinic at UCSF

Boston

• Division of Adolescent Medicine at Children's Hospital Boston

Philadelphia

• Adolescent Medicine Clinic at the Children's Hospital of Philadelphia
• Adolescent Medicine at St. Christopher's Hospital for Children
• Teen Health Center at Temple University Children's Medical Center
• 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 Children's Hospital at Westmead
• The Department of Adolescent Medicine at Westmead Hospital
• Youth Consultatncy & the Chill, at Royal Prince Alfred Hospital

Melbourne

• The Centre For Adolescent Health Royal Children's Hospital Melbourne

Professional Organizations

In addition to membership in the organizations for their various specialties, adolescent medicine providers often belong to The Society for Adolescent Medicineand/or The North American Society for Pediatric and Adolescent Gynecology. The Journal of Adolescent Healthand the Journal of Pediatric and Adolescent Gynecology are the publications of the two organizations, respectively.