PHYSICAL ASPECTS The teen years mark a second period of rapid growth, beginning at age 10 in girls and age 12 in boys. Secondary sexual development begins shortly after beginning the growth spurt, with menarche starting between 10 and 16 years in girls. Sexual activity and drug use are common during adolescence, and many teens are parents themselves, complicating both the differential diagnosis and issues of maturity and reliability in carrying out the follow-up plan.
NEUROLOGIC ASPECTS Abstract reasoning ability progressively develops during adolescence, paired with a self-centered worldview and self-consciousness regarding appearance. Feelings of immortality and denial of the consequences of risky behavior are common. Loss of autonomy is the greatest fear of an adolescent, and mistrust of and rebellion toward authority is normal. Previously well-controlled chronic disease frequently becomes unstable as a result of these developmental issues. Psychiatric disease and suicidal behavior are increasingly recognized in this age group. The parents of teenagers are frequently angered by these changes and may project these feelings on the emergency department staff.
AGE-SPECIFIC APPROACH The traditional history and physical examination with respect for modesty is effective in the assessment of adolescents. The examiner should communicate to the teenager that he or she will be treated "like an adult." Choices must be allowed, such as parental presence during the examination, with proper limit setting regarding cooperative behavior. The parent's concerns must be addressed individually and, if necessary, in private. Confidentiality should be stressed, particularly as the law requires with respect to pregnancy and sexually transmitted disease.
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