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PubMed1998

Health status and service use. Comparison of adolescents at a school-based health clinic with homeless adolescents.

OBJECTIVE: To examine the health status, risk-taking behaviors, and access-to-care issues of shelter-based homeless adolescents compared with a domiciled adolescent population from the same large US city. SUBJECTS: The samples consisted of 109 youth (aged 12-17 years) in emergency shelters and 1010 youth using school-based inner-city clinics. INTERVENTIONS: Adolescents completed a health history, which was followed by a physical examination. RESULTS: Homeless youth began sexual activity at an earlier age (median, 12 vs 13 years for homeless vs school-based youth), were less likely to have used birth control at their first sexual experience, and were twice as likely to have ever been pregnant. Oral and anal sex, same-sex activities (boys only), multiple sex partners in the past 30 days, depression, and substance use behaviors were reported more often by the homeless sample. The homeless youth were twice as likely to have visited an emergency department in the past 12 months. After adjustment for other risk factors, homelessness was an independent predictor of depression (adjusted odds ratio [OR], 7.0; 95% confidence interval [CI], 3.9-12.6), emergency department use in the past 12 months (adjusted OR, 1.8; 95% CI, 1.2-2.7), and history of pregnancy (adjusted OR, 2.6; 95% CI, 1.3-5.2) in the final logistic regression models. CONCLUSION: This study confirms and extends past research indicating that homeless youth exhibit more risk-taking behaviors and suffer from poorer overall health than do nonhomeless youth.

Adolescent↗
PubMed2006

Depot medroxyprogesterone acetate and bone mineral density in adolescents--the Black Box Warning: a Position Paper of the Society for Adolescent Medicine.

The purpose of this Position Paper is to review the published Black Box Warning regarding depot medroxyprogesterone acetate (DMPA) and bone loss as it relates to adolescent girls. The scientific findings that prompted the Food and Drug Administration to issue the warning are reviewed and the following additional issues are considered: (1) likely low risk of fracture related to DMPA use, (2) evidence of at least partial recovery after discontinuation of the method, and (3) the need to balance the physical, social and economic cost of adolescent pregnancy versus the immediate and long-term impact of DMPA on bone. A list of clinical guidelines is included, the main recommendation of which is to continue prescription of DMPA, with counseling about the risks and benefits, in most of the adolescent population desiring to use this contraceptive method.

Adolescent↗
PubMed2001

Adolescents and human immunodeficiency virus infection: the role of the pediatrician in prevention and intervention. Committee on Pediatric AIDS and Committee on Adolescence.

Half of all new human immunodeficiency virus (HIV) infections in the United States occur among young people between the ages of 13 and 24. Sexual transmission accounts for most cases of HIV during adolescence. Pediatricians can play an important role in educating adolescents about HIV prevention, transmission, and testing, with an emphasis on risk reduction, and in advocating for the special needs of adolescents for access to information about HIV.

Adolescent↗
PubMed2005

Assessing post-traumatic stress disorder in South African adolescents: using the child and adolescent trauma survey (CATS) as a screening tool.

BACKGROUND: Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. METHODS: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. RESULTS: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cut-off value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. CONCLUSIONS: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD.

Journal Article↗
PubMed2005

Pain complaints in adolescent patients with affective disorders versus adolescent psychiatric controls.

OBJECTIVE: To ascertain the frequencies of 4 prospectively determined pain complaints among adolescents meeting the criteria for major depressive episode (MDE) relative to non-affectively ill controls. METHOD: In a community mental health clinic for the indigent situated on the border of the United States and Mexico (Rio Grande City, Tex.), adolescents (age range, 12-17 years) who consecutively presented to the clinic from August 2001 to November 2003 received structured psychiatric diagnostic screens for depression and mania using the modules from the DSM-IV. Subsequently, all subjects were asked whether they had had significant (distressing or bothersome) backache, abdominal pain, headaches, or myalgia in the last 7 days. We compared patients meeting the criteria for MDE with individuals without affective symptomatology. Significance of the differences between groups was assessed using the Fisher exact test and multivariate logistic regression analysis. The odds ratios were adjusted for age and sex. RESULTS: One hundred thirty-two subjects met the criteria for MDE. Forty-eight had non-affective disorders. Seventy-six percent of the subjects meeting the criteria for MDE had at least 1 pain complaint compared to 33% of the control subjects (p < .0001). Fifty percent of the subjects in the midst of a MDE had at least 2 pain complaints compared to 6% of the control subjects (p < .0001). Twenty-nine percent of the subjects in the midst of a MDE had at least 3 pain complaints compared to 2% of the control subjects (p < .0001). Fourteen percent of the subjects in the midst of a MDE had all 4 pain complaints compared to none of the control subjects (p = .002). The odds ratio of subjects with a MDE having a pain complaint relative to control subjects was 5.8 (p < .0001). CONCLUSION: That in excess of three fourths of clinically depressed adolescents had 1 or more pain complaints has important implications for adolescent psychiatry and primary care, as well as somatic medicine.

Journal Article↗
PubMedDate not supplied

[Adolescents' knowledge about adolescence, puberty and sexuality].

OBJECTIVE: The objective of this research was to evaluate the level of knowledge about adolescence, pubertal development and sexuality among adolescents from 10 to 14 years old at municipal public schools in Feira de Santana-Bahia, 2000. METHODS: Cross-sectional study, with a randomized and proportional sample out of a population of 6,419 students in the municipal Public System. The level of knowledge was analyzed according to age, sex and educational level. Data was collected by means of a specific confidential questionnaire, which was pre-tested. A scale of values (score--satisfactory, reasonable and unsatisfactory) was established according to the percentage and proportional number of right answers regarding general and specific topics. Statistical inference was calculated by chi-square with a significance of 5% as well as the bivariate and multivariate analysis, calculating the simple and adjusted prevalence, through stratified analysis. RESULTS: Adolescents showed unsatisfactory level of information about terms, particularly those at the age of 10 (69.2%) and 11 years (70.6%), female (61.7%) and the ones in the 4th (82.8%) and 5th (61.1%) grades. The level of knowledge according to sex, adjusted by age and educational level, showed that females are 1.3 and 1.27 times more likely to present an unsatisfactory level of knowledge than males. The level of knowledge according to educational level, adjusted by age, showed that those subjects between 4th and 5th grades are 2.32 times more likely to present an unsatisfactory level of knowledge if compared to students of 6th and 8th grades, with significant differences (p<0.05). CONCLUSIONS: The high prevalence of unsatisfactory level of knowledge with significant association between 4th and 5th grades and females points to the necessity of educative actions regarding health and sexuality in the beginning of adolescence at municipal public schools.

English Abstract↗
PubMed2004

Fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents With Depression Study (TADS) randomized controlled trial.

CONTEXT: Initial treatment of major depressive disorder in adolescents may include cognitive-behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI). However, little is known about their relative or combined effectiveness. OBJECTIVE: To evaluate the effectiveness of 4 treatments among adolescents with major depressive disorder. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial of a volunteer sample of 439 patients between the ages of 12 to 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of major depressive disorder. The trial was conducted at 13 US academic and community clinics between spring 2000 and summer 2003. INTERVENTIONS: Twelve weeks of (1) fluoxetine alone (10 to 40 mg/d), (2) CBT alone, (3) CBT with fluoxetine (10 to 40 mg/d), or (4) placebo (equivalent to 10 to 40 mg/d). Placebo and fluoxetine alone were administered double-blind; CBT alone and CBT with fluoxetine were administered unblinded. MAIN OUTCOME MEASURES: Children's Depression Rating Scale-Revised total score and, for responder analysis, a (dichotomized) Clinical Global Impressions improvement score. RESULTS: Compared with placebo, the combination of fluoxetine with CBT was statistically significant (P =.001) on the Children's Depression Rating Scale-Revised. Compared with fluoxetine alone (P =.02) and CBT alone (P =.01), treatment of fluoxetine with CBT was superior. Fluoxetine alone is a superior treatment to CBT alone (P =.01). Rates of response for fluoxetine with CBT were 71.0% (95% confidence interval [CI], 62%-80%); fluoxetine alone, 60.6% (95% CI, 51%-70%); CBT alone, 43.2% (95% CI, 34%-52%); and placebo, 34.8% (95% CI, 26%-44%). On the Clinical Global Impressions improvement responder analysis, the 2 fluoxetine-containing conditions were statistically superior to CBT and to placebo. Clinically significant suicidal thinking, which was present in 29% of the sample at baseline, improved significantly in all 4 treatment groups. Fluoxetine with CBT showed the greatest reduction (P =.02). Seven (1.6%) of 439 patients attempted suicide; there were no completed suicides. CONCLUSION: The combination of fluoxetine with CBT offered the most favorable tradeoff between benefit and risk for adolescents with major depressive disorder.

Adolescent↗
PubMed1992

Evaluation of state efforts to improve systems of care for children and adolescents with severe emotional disturbances: the CASSP (Child and Adolescent Service System Program) initial cohort study.

In 1984, the National Institute of Mental Health (NIMH) began funding its Child and Adolescent Service System Program (CASSP). In this paper, we present findings from a descriptive study of the experiences of the initial cohort of states to receive CASSP grants, conceived and conducted when the projects were approaching the end of their fifth and final year of NIMH funding. Detailed case studies were conducted of each of the 10 initial cohort projects, and the findings analyzed across projects. Data were collected from three major sources: (1) existing documentation about the projects, (2) site visits to each of the projects, and (3) information from relevant secondary sources. Findings suggest that the initial cohort projects utilized a variety of strategies and encountered a variety of barriers and facilitating factors. The projects generally implemented the intended CASSP program and did so by using a variety of strategies. The projects were judged by stakeholders in their states to have influenced the service systems in their states in the intended directions: toward a more comprehensive system of care that emphasizes community-based treatment; toward better integrated, more collaborative efforts among the state agencies involved; toward a more detailed understanding on the part of system stakeholders of the mental health problems of children and adolescents who have severe emotional disturbances, and of the influence of those problems on the lives of the children and their families; and toward increased involvement by parents and other family members in the care of these children and adolescents.

Adolescent↗
PubMed2005

Can we--and should we--have a Europsychiatry for Children and Adolescents? The work of the UEMS Section and Board for Child and Adolescent Psychiatry/Psychotherapy.

The Union of European Medical Specialists (UEMS) paves the way for harmonisation of training and free movement of medical doctors within the European Union. For more than 10 years, Child and Adolescent Psychiatry has been a distinct specialty at this European level--separate from Adult Psychiatry and Pediatrics. The article gives detailed information on the background of the section/board of Child and Adolescent Psychiatry/Psychotherapy (CAPP), training issues including the Training Log Book and the recent situation as well as future perspectives of Continuous Professional Development (CPD) in CAPP, all of which influence the corner stones of CAPP and its delineation from other medical and non-medical organisations. Child and Adolescent Psychiatry as the application of trained specialist medical practice to mental illnesses and psychological disorders in children and young people up to the age of about 18 years reflects more and more the growing research advances of the last years within the field with more progress to come. On the other hand, shortcomings of patient provision in Europe still have to be resolved and CAPP may help to do so.

Adolescent↗
PubMed2006

The mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use.

This study investigated the mediating role of adolescent self-efficacy in the relationship between parental practices and adolescent alcohol use. Resistance self-efficacy was a perfect mediator in the relationship between parental monitoring and lower alcohol use. Resistance self-efficacy may determine the effect of parental monitoring on deterring alcohol use in adolescents.

Adolescent↗
PubMed2003

Affiliation with deviant peers among children of substance dependent fathers from pre-adolescence into adolescence: associations with problem behaviors.

OBJECTIVE: Affiliation with delinquent peers has been shown to be a major risk factor for the development of antisocial and substance abuse behaviors in adolescence. However, little data are available concerning the developmental trajectories of deviant peer affiliation. METHOD: In this study, we have prospectively examined the density of deviant peers among the social networks of children of drug dependent fathers at age 10, and at 2 and 5 year follow-ups, and compared them with those of controls. Measures of internalizing and externalizing psychopathology were employed as time varying covariates, while socioeconomic status (SES) was used as a time invariant covariate. A pattern mixture analysis of missing data was conducted. RESULTS: Using mixed effects models, we found significant main effects of time, group, externalizing psychopathology, and to lesser extent, SES on the magnitude of affiliation with deviant peers. Greater deviant peer affiliation among the high-risk children was found at each time point. Externalizing psychopathology augmented the magnitude of deviant peer affiliation in both high-risk and comparison children. CONCLUSION: Offspring of drug dependent fathers have heightened affiliation with deviant peers from pre-adolescence through mid-adolescence. This social developmental process may be a component of the familial risk for substance abuse and antisocial behaviors.

Adolescent↗
PubMed2001

Relationship between adolescent-parental communication and initiation of first intercourse by adolescents.

OBJECTIVE: To examine the level of communication between parents and adolescents and correlate the findings with onset of sexual intercourse. METHODS: This was a 10-year longitudinal study. Subjects filled out questionnaires at the time of each health supervision visit. The data in this article were harvested at enrollment and at the 5-year point. Comparisons of adolescent-parental communication were first compared between the virginal and nonvirginal groups at the initiation of the study. The results were then confirmed by adding data from patients in the virginal group who converted over the first 5 years of the study to the nonvirginal group. Two hundred and three patients, aged 12-21 years, were studied from a pediatrician's practice panel in Middleton, Wisconsin. The questionnaires inquired about grades and activities school, relationship with siblings and parents at home, and risk-taking behaviors involving alcohol, drugs, and sex with peers. Statistical analysis included the Student's t-test to determine the mean difference between groups. Fisher's exact test was used to evaluate the association of variables to the status of patients' sexual activity at enrollment. Multiple logistic regression was conducted on the initial enrollment data to examine the association between the initial covariates and patients' sexual status. RESULTS: During the initial survey, 172 enrolled patients were in the virginal group and 31 in the nonvirginal group. The virginal group had a higher rating of communication with their parents after adjusting for age (p <.001). To verify these findings, we examined an additional 29 patients in the virginal group who converted to nonvirginal status during the first 5 years of the study. We then compared the level of adolescent-parental communication between the subgroup who converted to nonvirginal status with the level of communication of the subgroup who remained virgins. Even after correcting for age, communication with the mother was significantly better in patients who maintained their virginal status (p <.01). CONCLUSIONS: Teenagers who perceive that they have a better level of communication with their parents are less likely to engage in sexual intercourse.

Adolescent↗
PubMed2001

Serologic response to hepatitis B vaccine in HIV infected and high-risk HIV uninfected adolescents in the REACH cohort. Reaching for Excellence in Adolescent Care and Health.

PURPOSE: To evaluate hepatitis B (HBV) vaccine response rates in HIV infected and high-risk HIV uninfected youth and examine associations with responsiveness in the HIV infected group. METHODS: Cohorts within the Reaching for Excellence in Adolescent Care and Health (REACH) study population were defined based on receipt of HBV vaccine both retrospectively and prospectively. Sero-responsiveness was determined by HBsAb measurements. Testing was done for HBsAg, HBsAb, and HBcAb. For HBsAb, a value of > 10 International Units per liter was considered a positive response, and the data were collected as either positive or negative from each of the reporting laboratories. Covariates of responsiveness were explored in univariate and multivariate models for each cohort. RESULTS: Sixty-one subjects had received a three-dose vaccination course at the time of entry into REACH. HIV uninfected subjects had significantly higher rates of response by serology compared with HIV infected subjects (70% vs. 41.1%; chi(2) = .05; RR = .586, 95% CI: .36-.96). By the time of an annual visit 43 subjects had received three vaccinations with at least one occurring in the study period. The rates of response were similar for the HIV infected and uninfected groups (37.1% vs. 37.5%) in this cohort. Univariate and multivariate analysis in the prospective HIV infected group (N = 35) found an association between elevated CD8(+)/CD38(+)/HLA-DR(+) T cells and lack of HBV vaccine responsiveness (6.7% vs. 60%; chi(2) = .03; RR = .12, 95% CI: .02- .55). CONCLUSIONS: The poor HBV vaccine response rate in the HIV uninfected high-risk adolescents was unexpected and suggests that HBV vaccination doses have not been optimized for older adolescents. This is the first report of decreased responsiveness in HIV infected subjects being associated with elevated CD8(+)/CD38(+)/HLA(-)DR(+) T cells and suggests that ongoing viral replication and concomitant immune system activation decreases the ability of the immune system in HIV infected subjects to respond to vaccination.

ADP-ribosyl Cyclase↗
PubMed2002

The private adolescent: privacy needs of adolescents in hospitals.

This report is based on an interpretative study that explored the meaning of space to adolescents in the hospital environment. Through designing their own adolescent ward and discussing their designs in an interview, participants articulated their spatial needs in the ward environment. This paper addresses the private space issues of the adolescent patient in the ward environment. Issues that are discussed include the use of the telephone, the bathroom, and the bedroom, and additional facilities needed to enhance privacy in the ward.

Adolescent↗
PubMed1994

Guidelines for overweight in adolescent preventive services: recommendations from an expert committee. The Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Services.

An expert committee was convened to determine specific criteria for overweight to be integrated into routine preventive screening of adolescents. Body mass index (BMI) should be used routinely to screen for overweight adolescents. Youth with BMIs > or = 95th percentile for age and sex, or > 30 (in kg/m2) should be considered overweight and referred for indepth medical follow-up to determine underlying diagnoses. Adolescents with BMIs > or = 85th percentile but < 95th percentile or < or = 30, should be considered at risk of overweight, and should be referred to a second-level screen. The second-level screen includes family history, blood pressure, total cholesterol, large prior increment in BMI, and concern about weight. If youths are positive for any of the items on the second-level screen they should be referred for further medical assessment.

Adolescent↗
PubMed1998

Summary of the practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American Academy of Child and Adolescent Psychiatry.

This summary describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence regarding diagnosis and effective treatment as well as on the current state of clinical practice. Given the paucity of research on the treatment of substance use disorders in children and adolescents, many of the recommendations are drawn from the adult literature and current clinical practice. This summary considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.

Adolescent↗
PubMed1998

Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. American Academy of Child and Adolescent Psychiatry.

This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents with Depressive Disorders. Depressive disorders in children and adolescents are marked by core symptoms similar to those seen in adults, although symptom expression varies greatly with developmental stage. These disorders are common, chronic, and recurrent, and they are associated with comorbid psychiatric conditions and poor outcome that can be alleviated by early identification and treatment. Opinions differ regarding treatment planning and duration of treatment required. Development of a treatment relationship with the patient and family is crucial for a successful outcome. Psychotherapy is an appropriate treatment for all children and adolescents with depressive disorders. Antidepressants may prove useful in some cases and are especially recommended for patients with psychosis, bipolar depression, and severe depression. Continuation treatment is necessary in all patients after the acute phase; long-term maintenance is required in some. Early detection and intervention is effective in ameliorating the poor psychosocial outcome.

Adolescent↗
PubMed2000

Summary of the practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. American Adademy of Child and Adolescent Psychiatry.

This summary provides an overview of the assessment and treatment recommendations contained in the Practice Parameters for the Assessment and Treatment of Children and Adolescents Who are Sexually Abusive of Others. The parameters were written to aid clinicians in the assessment and treatment of children and adolescents with symptoms of sexually abusive behavior. The assessment and treatment of children and adolescents with sexually abusive behavior requires an understanding of normal sexual development. A multiplicity of biological and psychosocial factors determines the child's sexual development, gender role, sexual orientation, patterns of sexual arousal, sexual cognitions, sexual socialization, and the integration of sexual and aggressive patterns of behavior. The individual's sexuality evolves in concert and as a result of interaction with family, ethnic, social, and cultural influences. These parameters summarize what we know about the epidemiology and phenomenology of sexually abusive youths and provide guidelines for the assessment and the selection of treatment interventions for these youths. Essential considerations in the assessment and treatment of sexually abusive youths, as well as the different categories of sexually abusive youths which should be recognized and which influence treatment decisions, are presented. The spectrum of currently available psychosocial and biological treatments will be summarized.

Adolescent↗