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PubMed1999

American Academy of Pediatrics. Committee on Adolescence. Contraception in adolescents.

The risks and negative consequences of adolescent sexual intercourse are of national concern, and promoting sexual abstinence is an important goal of the American Academy of Pediatrics. In previous publications, the American Academy of Pediatrics has addressed important issues of adolescent sexuality, pregnancy, sexually transmitted diseases, and contraception. The development of new contraceptive technologies mandates a revision of this policy statement, which provides the pediatrician with an updated review of adolescent sexuality and use of contraception by adolescents and presents current guidelines for counseling adolescents on sexual activity and contraceptive methods.

Adolescent↗
PubMed1996

The adolescent's right to confidential care when considering abortion. American Academy of Pediatrics. Committee on Adolescence.

In this statement, the American Academy of Pediatrics (AAP) reaffirms its position that the rights of adolescents to confidential care when considering abortion should be protected. The AAP supports the recommendations presented in the report on mandatory parental consent to abortion by the Council on Ethical and Judicial Affairs of the American Medical Association. Adolescents should be strongly encouraged to involve their parents and other trusted adults in decisions regarding pregnancy termination, and the majority of them voluntarily do so. Legislation mandating parental involvement does not achieve the intended benefit of promoting family communication, but it does increase the risk of harm to the adolescent by delaying access to appropriate medical care. The statement presents a summary of pertinent current information related to the benefits and risks of legislation requiring mandatory parental involvement in an adolescent's decision to obtain an abortion. The AAP acknowledges and respects the diversity of beliefs about abortion and affirms the value of voluntary parental involvement in decision making by adolescents.

Abortion, Induced↗
PubMed1997

Adolescent Multiphasic Personality Inventory and its utility in assessing suicidal and violent adolescents.

Adolescent Multiphasic Personality Inventory profiles of inpatient adolescents were examined to identify differences between suicidal (danger to self, n = 145) and violent (danger to others, n = 36) adolescents. Participants were 181 inpatients (12-17 years old, mean age, 14.7 years) admitted to an adolescent psychiatric unit of a southern California county hospital. Results indicate that the suicide group had significantly higher scores than the violent group on five scales (Hypochondriasis, Psychasthenia, Paranoia, Schizophrenia, and Social Introversion). This scales, singly or in combination, have been found to be indicative of psychotic process. This suggests the presence of psychotic process in suicidal, but not violent, adolescents.

Adolescent↗
PubMedDate not supplied

Lessons for prevention and intervention in adolescent pregnancy: a five-year comparison of outcomes of two programs for school-aged pregnant adolescents.

Adolescent fertility control has been linked with educational completion and long-term economic success. This study evaluated the effect of short-term prenatal intervention on selected maternal and child indexes with first-time pregnant adolescents. Birth patterns were examined over a 5-year period for three groups (N = 216) of adolescents who received varying amounts of prenatal intervention for the index birth. No significant differences between groups were found on number of subsequent births within 5 years, mean time between births, graduation from high school, gestational age, or mean birth weight of infants. Age at first birth was a predictor of the number of subsequent births and subsequent graduation from high school. Grade in school at first pregnancy and total number of births in 5-years were related to high school graduation. Findings support the need for continued intensive community-based collaborative intervention for adolescent mothers during the 5 years after the index birth, the peak childbearing years for these women.

Adolescent↗
PubMedDate not supplied

Factors associated with adolescent pregnancy- a sample of Taiwanese female adolescents.

This study was designed to explore the factors that differentiate sexually experienced teenagers who become pregnant from those who do not. The study examined the differences between pregnant and never-pregnant female adolescents in personal background characteristics, family characteristics, substance use, contraceptive attitude, contraceptive knowledge, contraceptive self-efficacy, sexual history, and effective contraceptive use. Sexually experienced but never-pregnant female adolescents were selected from two vocational high schools. Pregnant adolescents were recruited by convenience sampling from obstetric clinics and health stations in Tainan City, Taiwan. Multiple logistic regression analysis identified six factors associated with pregnancy: poor contraceptive knowledge, poor contraceptive self-efficacy, low socioeconomic status, low effective contraceptive use scores, more frequent sexual intercourse, and older age. The results of this study provide health professionals with information to develop more-effective prevention and intervention programs to reduce adolescent pregnancy. The results also could be used as a reference for related research and policy development in other countries.

Adolescent↗
PubMed1999

Mode of infant feeding and achieved growth in adolescence: early feeding patterns in relation to growth and body composition in adolescence.

OBJECTIVE: Feeding mode in infancy and differences in childhood growth have been studied in several longitudinal studies, but few studies have followed children up to adolescent age. There is evidence that formula-fed infants weigh more and are taller than their breast-fed counterparts, and indications that this difference may sustain. RESEARCH METHODS AND PROCEDURES: We have studied the relations between length of breast-feeding, growth, and body composition in a group of 781 representatively chosen adolescents. Data on feeding pattern in infancy and on weight and height from birth up to 18 years were collected. We studied the relation between high body mass index (BMI) (defined as < or =85th percentile) in adolescence and length of breast-feeding. RESULTS: Girls who were not breast-fed or breast-fed for less than 3 months had a significantly higher height curve than girls exclusively breast-fed for more then 3 months. There were tendencies towards higher values of adipose tissue measured by skinfolds in girls breast-fed for 3 months or less. Short duration of exclusive breast-feeding was associated with higher BMI (p<0.04). In a subgroup of 194 adolescents, body composition was measured with dual energy X-ray. Both boys and girls who were exclusively breast-fed for more than 3 months were leaner and showed a trend towards lower skinfold values. CONCLUSION: These results are important to include in the debate about optimal feeding in infancy. Regarding breast-feeding as a standard, our results imply that formula fed infants may be at risk for overfeeding, which might lead to overweight, even up to adolescent age.

Absorptiometry, Photon↗
PubMed1998

Adolescents who take overdoses: outcome in terms of changes in psychopathology and the adolescents' attitudes to care and to their overdose.

Adolescent self-poisoners were followed up 3 months after taking an overdose. High levels of psychopathology were found, with 72% (18/25) of the adolescents having a diagnosable psychiatric disorder and 48% (12/25) major depression. All the adolescents were offered follow-up treatment from health or social services. Compliance with treatment was very high. Seventy-two per cent of the adolescents found treatment useful to them. The adolscents received a generally sympathetic response from their significant others. Fifty-four per cent of the adolescents thought that their overdose had resulted overall in improvements to their lives but 44% would consider taking an overdose again in similar circumstances.

Adolescent↗
PubMed2006

Obesity, free testosterone, and cardiovascular risk factors in adolescents with polycystic ovary syndrome and regularly cycling adolescents.

Adolescent girls with polycystic ovary syndrome (PCOS) have increased levels of factors constituting the metabolic syndrome: centripetal obesity, hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), and hyperinsulinemia. Given the strong association reported between early, persistent obesity and development of metabolic syndrome 10 years later in girls, we speculated that if adolescent girls without PCOS had obesity measures similar to girls with PCOS, they would exhibit similar metabolic syndrome-cardiovascular disease risk factors. Within this context, we compared 37 adolescent girls with PCOS and 2 samples of normal, regularly cycling adolescent girls (controls) of similar ages, selected from the Cincinnati Clinic of the National Heart, Lung, and Blood Institute Growth and Health Study. The first sample included 157 controls selected using a stratified random sample based on age. As expected, girls with PCOS had higher body mass index (BMI), waist circumference, insulin, systolic blood pressure (SBP) and diastolic blood pressure, triglycerides (TGs), lower HDL-C, and higher low-density lipoprotein cholesterol (LDL-C) and free testosterone (FT) than controls. A second sample consisted of girls matched one to one with girls with PCOS for BMI and age. Comparisons of group differences were not significant for insulin, lipids, or blood pressure; girls with PCOS had a trend toward higher values for waist circumference (median, 92.7 vs 87.5 cm; P = .07) and much higher median FT (4.25 vs 1.42 ng/mL, P = .0001). After matching for BMI and age, by conditional regression analysis, we showed that the groups were not differentiated (P > .15) by insulin, HDL-C, LDL-C, TG, SBP, or diastolic blood pressure, but were differentiated by higher FT (P = .0024) and waist circumference (P = .0024) in PCOS than in controls. Prospective longitudinal analyses of NHGS controls showed that changes in BMI from ages 9 to 10 years to ages 15 to 16 years were positively associated with changes in waist circumference (P < .0001), LDL-C (P = .01), TG (P = .008), and SBP (P = .002). These findings suggest that if adolescent girls achieve adiposity equal to girls with PCOS, they then acquire major components of the metabolic syndrome, and excluding high FT and waist circumference, comparable increased cardiovascular disease risk.

Adolescent↗
PubMed1985

The Family Functioning in Adolescence Questionnaire: a measure of psychosocial family health during adolescence.

An instrument has been developed to assess psychosocial health of the family during the stage of having adolescent children, as perceived by the adolescent. The measure is based on a model integrating family systems research and the developmental tasks of adolescents. It examines six dimensions of family functioning: (1) Structure, (2) Affect, (3) Communication, (4) Behaviour control, (5) Value Transmission and (6) External Systems. A sample of 413 Year 10 students (means = 15.7 years) participated in the development of the instrument. Satisfactory levels of reliability and validity are reported. The Family Functioning in Adolescence Questionnaire (FFAQ) provides a means of assessment for researchers interested in family functioning during adolescence, and also for therapists and counsellors working with teenagers.

Adolescent↗
PubMed1997

Multiple maltreatment experiences and adolescent behavior problems: adolescents' perspectives.

By adolescence, appraisal of one's past life experience becomes critical to the stage-salient issue of identity formation. This study examined adolescents' perceptions of their maltreatment experiences. It scrutinized the combined and unique contribution of five maltreatment types (i.e., physical abuse, sexual abuse, psychological abuse, neglect, and exposure to family violence) to variance in adolescent adjustment. It was predicted that these maltreatment types would account for significant variance in adjustment when controlling for the context variables of age, sex, socioeconomic status, IQ, and stressful life events. Adolescents (N = 160, aged 11-17) were randomly selected from the open caseload of a child protection agency. Participants completed global severity ratings regarding their experiences of the five types of maltreatment, as well as a battery of measures assessing self- and caretaker-reported externalizing and internalizing symptomatology. The youths' maltreatment ratings significantly predicted self-reported adjustment, even when controlling for all context variables. Psychological maltreatment was the most predictively potent maltreatment type, and enhanced the predictive utility of other maltreatment types. Significant sex differences in the sequelae of perceived maltreatment were evident. Also, interactions between youths' ratings and those obtained from CPS files were detected. The findings were consistent with recent research in child maltreatment, and contribute to our understanding of developmental psychopathology among adolescents.

Adolescent↗
PubMed2002

Bony density in adolescents after surgical repair of tetralogy of fallot: a comparative study with healthy adolescents.

BACKGROUND: Adverse influences arising in fetal life or immediately after birth have a permanent effect on body structure, physiology and metabolism. Evidence is now accumulating that programming of bone growth might be an important contributor to the later risk of osteoporosis. Long-term morbidity and mortality associated with retralogy of Fallot is not completely known. The aim of the present study was to evaluate the state of the bones in adolescents after surgical repair of tetralogy of Fallot, so as to ascertain any possible repercussions of the disease on bone mineralization. MATERIAL AND METHODS: We studied 34 adolescents with repaired tetralogy of Fallot, between the ages of 11 and 18 years, to establish their nutritional status, in terms of height, weight, and skinfolds, their body composition using an anthropometric method, their sexual maturity according to Tanner, and their food-habits as based on 24-hour recall. Bone density was evaluated by lumbar dual-energy X-ray absorptiometry. We included 34 healthy eutrophic adolescents, matched for gender and age, as controls. RESULTS: No significant differences were observed between the patients and their controls concerning nutritional status, body composition, total energy intake and nutritional supply in macronutrients, calcium, phosphorus, magnesium and vitamin D. Bone mineral density, expressed in Z-score and g/cm2, was significantly higher in patients with tetralogy of Fallot (p < 0.01). The age at the time of the first surgical procedure, or at complete surgical repair, and the total number of surgical procedures, had no significant influence on nutritional status or bone mineralization. Gender, chronological age, sexual maturity and the index of body mass are the major determinants of bone density for both samples. Obese adolescents with repaired tetralogy of Fallot had a significantly higher bone density (p < 0.05) compared to undernourished or euthrophic patients. CONCLUSIONS: Being born with tetralogy of Fallot has no significant repercussion, by the stage of adolescence, on nutritional status, pubertal progression, and accretion of bone minerals subsequent to surgical repair. Nutritional status is the major influence on the accretion of bone mass.

Adolescent↗
PubMed1998

Peer influences and drug use among urban adolescents: family structure and parent-adolescent relationship as protective factors.

The moderating influences of family structure and parent-adolescent distress on the relationship between peer variables and drug use were examined in a predominantly African American sample of 630 10th graders at 9 urban high schools. Both peer pressure and peer drug use were significantly related to the reported frequency of drug use. The relationship between peer pressure and drug use was stronger among girls than boys, and also among adolescents in families without fathers or stepfathers. The association between peer pressure and drug use also increased as a function of the level of mother-adolescent distress among adolescents who were not living with fathers or stepfathers. Neither gender nor family structure moderated the relationship between peer drug models and drug use. However, the association between peer drug models and drug use increased as a function of the level of mother-adolescent distress.

Adolescent↗
PubMed2000

Relationship of CD4+ T cell counts and HIV type 1 viral loads in untreated, infected adolescents. Adolescent Medicine HIV/AIDS Research Network.

The REACH Project (Reaching for Excellence in Adolescent Care and Health) of the Adolescent Medicine HIV/AIDS Research Network was designed as a study of an adolescent cohort composed of HIV-1-infected and -uninfected subjects. The goal of the analysis presented was to examine the relationship of CD4+ T cell counts and HIV-1 plasma viral loads in adolescents. The CD4+ T cell counts of 84 HIV+ subjects who were 13 to 19 years of age were measured at the clinical sites, using ACTG standardized techniques. HIV-1 viral loads in frozen plasma were determined by the NASBA/NucliSens assay at a central laboratory. Past and current treatment with antiretroviral drugs was determined by medical record abstraction and interview data. The slope of the line generated by regressing log10 HIV-1 RNA (copies/ml) versus CD4+ T cell counts of REACH subjects who are antiretroviral drug naive was negative and significantly different than zero. A negative association has also been reported for antiretroviral drug-naive, adult males in the Pittsburgh Men's Study, a component of MACS (Pitt-MACS) (Mellors J, et al.: Science 1996;272:1167). These data show that in adolescents, as in adults, HIV-1 RNA concentrations are correlated with corresponding absolute CD4+ T cell count. The slopes of the lines generated with data from each cohort were different (p = 0.003). In addition to age, there are sex and racial differences in the makeup of the two cohorts. Any or all of these differences may affect the slopes of the lines.

Adolescent↗
PubMed1994

Psychosocial stressors more common in adolescent suicides with alcohol abuse compared with depressive adolescent suicides.

OBJECTIVE: Relationships between stressors and psychiatric diagnoses were studied among 13- to 19-year-old adolescent suicide victims with alcohol abuse/dependence (N = 14), depressive disorders (N = 18), and the remainder (N = 21). METHOD: The study included all adolescent suicides (N = 53) during a nationwide psychological autopsy study of suicides in Finland during a 12-month period (N = 1397). The data were collected through interviews with the victims' parents and health care personnel and from official records. RESULTS: Interpersonal separations and difficulties regarding discipline or the law were common recent stressors among the alcohol abuse victims, and interpersonal conflicts and somatic illness among those with depressive disorders. Compared with the depressive victims, an unstable earlier family history was more common among the alcohol abusers. The accumulation of stressors and weakened parental support during the previous year were also more frequently found in the alcohol abuse victims. CONCLUSIONS: The results indicate that specific psychosocial stressors may be critical for suicidal adolescents with different diagnoses. In the evaluation of suicidal adolescent substance abusers, particularly recent interpersonal separations and family support need to be carefully weighed. Disruptions in the adolescent's interpersonal relationships, excess accumulation of stress, and lacking support from the family may be warning signs of suicide potential and indications for additional social support, for more intensive treatment, or for a change in the treatment setting.

Adolescent↗
PubMed1979

Adjustment in diabetic adolescent girls: II. Adjustment, self-esteem, and depression in diabetic adolescent girls.

The Rosenberg Self-Esteem Scale, Beck Depression Inventory, and Sullivan Diabetic Adjustment Scale were administered to 105 adolescent girls with diabetes. Results indicate that levels of self-esteem and depression highly correlate with the level of adjustment as assessed on the Diabetic Adjustment Scale (DAS). That is, the adjustment of adolescent diabetic girls in peer and family relationships, dependence-independence conflicts, and attitudes toward diabetes is significantly related to self-esteem; and the level of depression is significantly related to all these adjustment factors as well as body image. The results point to the usefulness of the DAS as a potential screening device for low self-esteem and depression in adolescent girls who have diabetes. The importance of diabetes as a scapegoat for normal adolescent concerns is discussed. It was also hypothesized that depression in adolescents may be expressed through concerns about diabetes. The importance of exploring relationships with peers and fathers is emphasized.

Adolescent↗
PubMed2005

Prefrontal cortex, thalamus, and cerebellar volumes in adolescents and young adults with adolescent-onset alcohol use disorders and comorbid mental disorders.

BACKGROUND: In adults, prefrontal, thalamic, and cerebellar brain injury is associated with excessive ethanol intake. As these brain structures are actively maturing during adolescence, we hypothesized that subjects with adolescent-onset alcohol use disorders, compared with control subjects, would have smaller brain volumes in these areas. Thus, we compared prefrontal-thalamic-cerebellar measures of adolescents and young adults with adolescent-onset alcohol use disorders (AUD, defined as DSM-IV alcohol dependence or abuse) with those of sociodemographically similar control subjects. METHODS: Magnetic resonance imaging was used to measure prefrontal cortex, thalamic, and cerebellar volumes in 14 subjects (eight males, six females) with an AUD (mean age, 17.0+/-2.1 years) and 28 control subjects (16 males, 12 females; 16.9+/-2.3 years). All AUD subjects were recruited from substance abuse treatment programs and had comorbid mental disorders. RESULTS: Subjects with alcohol use disorders had smaller prefrontal cortex and prefrontal cortex white matter volumes compared with control subjects. Right, left, and total thalamic, pons/brainstem, right and left cerebellar hemispheric, total cerebellar, and cerebellar vermis volumes did not differ between groups. There was a significant sex-by-group effect, indicating that males with an adolescent-onset AUD compared with control males had smaller cerebellar volumes, whereas the two female groups did not differ in cerebellar volumes. Prefrontal cortex volume variables significantly correlated with measures of alcohol consumption. CONCLUSIONS: These findings suggest that a smaller prefrontal cortex is associated with early-onset drinking in individuals with comorbid mental disorders. Further studies are warranted to examine if a smaller prefrontal cortex represents a vulnerability to, or a consequence of, early-onset drinking.

Adolescent↗
PubMed2006

Adolescent Drug Abuse Diagnosis (ADAD) vs. Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA) in clinical outcome measurement.

BACKGROUND: The Adolescent Drug Abuse Diagnosis (ADAD) and Health of Nation Outcome Scales for Children and Adolescents (HoNOSCA) are both measures of outcome for adolescent mental health services. AIMS: To compare the ADAD with HoNOSCA; to examine their clinical usefulness. METHODS: Comparison of the ADAD and HoNOSCA outcome measures of 20 adolescents attending a psychiatric day care unit. RESULTS: ADAD change was positively correlated with HoNOSCA change. HoNOSCA assesses the clinic's day-care programme more positively than the ADAD. The ADAD detects a group for which the mean score remains unchanged whereas HoNOSCA does not. CONCLUSIONS: A good convergent validity emerges between the two assessment tools. The ADAD allows an evidence-based assessment and generally enables a better subject discrimination than HoNOSCA. HoNOSCA gives a less refined evaluation but is more economic in time and possibly more sensitive to change. Both assessment tools give useful information and enabled the Day-care Unit for Adolescents to rethink the process of care and of outcome, which benefited both the institution and the patients.

Adolescent↗
PubMed1978

Study of psychiatric illness in adolescence, psychiatric breakdown in adolescence: diagnosis and prognosis.

A discussion on the pitfalls of studying adolescent psychiatric breakdown emphasises two difficulties, firstly that of delineating the age of adolescence, and secondly the difficulty in applying adult diagnostic criteria. A study of 52 adolescents has been made to establish an initial, and a two year follow-up diagnostic formulation, and to attempt through a detailed survey of the adolescent's early history to identify prognostic indices. The difficulty of formal diagnoses is shown, but prognostic factors of relevance can be identified in the group which have helpful predictive value. Outcome in a group of 50 treated adolescents showed a satisfactory conclusion at two year follow-up, in 70% of cases.

Adjustment Disorders↗