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PubMed2002

Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents.

BACKGROUND: Primary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians' attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated. OBJECTIVES: To examine (1) physicians' attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents. METHODS: A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association's Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents. RESULTS: On average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented. CONCLUSIONS: Physician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians' attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.

Adolescent↗
PubMed2006

Malaria in adolescence: burden of disease, consequences, and opportunities for intervention.

The problem of malaria in adolescence has largely been overshadowed by the huge burden of disease in young children. A substantial number of adolescents are at risk from malaria infection, but the burden of disease and consequences of infection in this age-group have rarely been studied. Our understanding of specific risk factors and beneficial interventions for adolescents is also limited. Data show that, from an adolescent viewpoint, malaria is a common cause of clinical illness and a preventable cause of death, even in areas of stable malaria transmission. Younger adolescents might be at a higher risk than older adolescents, because of immunological and hormonal factors. There are limited data about the adverse consequences of malaria in non-pregnant adolescents. However, in pregnant adolescents, the consequences of malaria are of great concern and simple interventions might lead to a substantial benefit. Malaria infection in adolescents is an under-recognised problem, and the prevention, diagnosis, and treatment of malaria should have a high priority within adolescent health programmes.

Adolescent↗
PubMed2002

Risk of adverse pregnancy outcomes in young adolescent parturients in an inner-city hospital.

OBJECTIVE: Our purpose was to determine the relationship between adolescence and pregnancy-related outcomes. STUDY DESIGN: A retrospective cohort study was conducted in a population of adolescents delivered in a large inner-city hospital. The study population consisted of 14,718 adolescents and 11,830 nonadolescent controls. Pregnancy outcomes were compared in young adolescents (n = 2930) and mature adolescents (n = 11,788) versus controls. RESULTS: Adolescents were significantly more likely than controls to be African American, single, diagnosed with a sexually transmitted disease during pregnancy, and reside with others (P <.001). Adolescents were significantly more likely than controls to have eclampsia (relative risk [RR] 2.23, 95% CI 1.37-3.66) and preterm delivery (RR 1.12, 95% CI 1.04-1.21). Young adolescents were significantly more likely than controls to have preeclampsia (RR 1.33, 95% CI 1.15-1.54), eclampsia (RR 3.24, 95% CI 1.70-6.14), preterm delivery (RR 1.47, 95% CI 1.31-1.64), low-birth-weight delivery (RR 1.47, 95% CI 1.31-1.64), and very-low-birth-weight delivery (RR 1.25, 95% CI 1.01-1.56). Finally, mature adolescents were significantly more likely than controls to have eclampsia (RR 1.99, 95% CI 1.19-3.34). CONCLUSION: Young adolescents are at increased risk for adverse pregnancy outcomes.

Adolescent↗
PubMed2000

Growth of adolescents who were born at extremely low birth weight without major disability.

OBJECTIVE: To compare growth between adolescents who were born at extremely low birth weight (ELBW, </=1000 g) and adolescents who were born at normal birth weight (NBW, >/=2500 g). DESIGN/METHODS: Cross-sectional design. Fifty-three ELBW and 53 NBW adolescents without a major neurodevelopmental disability were matched by sex, race, age, and socioeconomic status. Anthropometrics (z scores), bone age, body composition (Lunar DPX-L densitometry), and sexual maturity were assessed. ELBW adolescents were classified as being born small for gestational age (SGA) or not (NSGA). RESULTS: Subjects were 58.5% female, 43.4% black, and 56.6% white. The mean birth weight for ELBW subjects was 849 g and 3355 g for NBW subjects. The mean age was 14.85 years. On average, ELBW adolescents were 4.8 cm shorter and 9.1 kg lighter than NBW adolescents. ELBW adolescents had lower mean z scores for height (P <.0001), weight (P <.0001), and head circumference (P <.0001) than NBW adolescents. ELBW/SGA subjects had lower mean z scores for height (P <.0001) and weight (P =.001) than NBW subjects. Head circumference z scores were lower for the ELBW/SGA group than the ELBW/NSGA group or the NBW group (P =. 003). Sexual maturity and relative body composition were similar between groups. Bone age, measured in SD units, was more advanced in the ELBW group (0.86 vs. 0.42, P =.039). CONCLUSIONS: ELBW adolescents who survive without a major neurodevelopmental disability attain lower growth measurements compared with NBW adolescents but have similar sexual maturation and relative body composition.

Adolescent↗
PubMed1986

An exploratory study of parent-child communication about sex and the sexual attitudes of early, middle, and late adolescents.

In an attempt to examine the relationship between parent-child communication about sex and parent-adolescent attitudes about sex, 12- to 20-year-olds (N = 141) and their parents completed sexual communication and attitude questionnaires. The correlation between parents' and children's attitudes were high for all the early adolescents and low for all the middle adolescents. Only among the late adolescents was there a significant difference in the correlations between the sexual attitudes of parents and their children as a function of family communication level, with the attitudes of adolescents and parents in the high communication group being highly correlated and the attitudes of adolescents and parents in the low communication group not being significantly correlated. Middle adolescents had significantly more permissive sexual attitudes than early and late adolescents. Gender variables were also studied, but conclusions were limited due to the small number of participating fathers. All findings must be tempered with the recognition of the possible sampling bias introduced by the use of a convenience sample. It is suggested that the more responsible sexuality seen in adolescents who can talk to their parents about sex may be a function of the similarity in sexual attitudes between these late adolescents and their parents.

Adolescent↗
PubMed2005

The quality of communication between parents and adolescent children in the case of parental cancer.

BACKGROUND: This study was designed to investigate: (i) parent-adolescent communication in families of cancer patients; (ii) relationships between parent-adolescent communication and posttraumatic stress symptoms (PTSS) in adolescent children; and (iii) associations between parents' illness characteristics and parent-adolescent communication. PATIENTS AND METHODS: A total of 212 adolescents completed the Impact of Event Scale and Parent-Adolescent Communication Scale. RESULTS: Adolescents communicated less openly with mothers with cancer than controls with mothers; this was the only significant difference with the reference group. Daughters communicated more openly with ill parents than with healthy parents. More open communication with healthy parents was related to fewer PTSS in daughters. More problem communication with both parents was related to more PTSS in both sons and daughters. Sons reported more problems in communication with ill parents in case of more intensive treatment or recurrent disease. Daughters experienced less open communication with both parents when ill parents received more intensive treatment. Time since diagnosis was not related to parent-adolescent communication. Multivariate analyses showed that communication patterns specifically affected PTSS of daughters. Problem communication with the healthy parent was the strongest predictor of intrusion while problem communication with the ill parents was the strongest predictor of avoidance. CONCLUSIONS: Parent-adolescent communication in families of cancer patients differs little from that in families not confronted with parental cancer. Problem communication outweighed lack of openness with respect to development of PTSS. Recurrent disease and intensive treatment regimens affected parent-adolescent communication negatively.

Adolescent↗
PubMed2002

Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents.

Food insufficiency has been shown to be associated with poor health, academic and psychosocial outcomes in American children, but the relationship between food insufficiency and depressive disorders in U.S. adolescents has not been studied. Further, there are no national estimates of the prevalence of depressive disorders for U.S. adolescents, nor investigation of associations with sociodemographic characteristics using national data. Therefore, we analyzed data for 15- and 16-y-old adolescents from the Third National Health and Nutrition Examination Survey (NHANES III). Depressive disorders and suicidal symptoms were assessed using the Diagnostic Interview Schedule. Adolescents were classified as "food insufficient" if a family respondent reported that the family sometimes or often did not have enough to eat. The prevalence of depression outcomes is reported by sociodemographic characteristics. Odds ratios for associations with food insufficiency are reported, adjusted for sociodemographic factors. Overall, lifetime prevalence of major depressive disorder was 6.3% and of dysthymia, 5.4%. Almost 5% of 15- to 16-y-old adolescents reported that they had ever attempted suicide and 38.8% reported at least one suicidal symptom. Female adolescents were significantly more likely than males to have had dysthymia, any depressive disorder and all symptoms of suicide. Low income adolescents were less likely to report suicide ideation than high income adolescents, but there were no other differences by family income. Food-insufficient adolescents were significantly more likely to have had dysthymia, thoughts of death, a desire to die and have attempted suicide. There is a strong association between food insufficiency and depressive disorder and suicidal symptoms in U.S. adolescents.

Adolescent↗
PubMed1999

Rates of U.S. physicians counseling adolescents about smoking.

BACKGROUND: The health care system provides an important opportunity for addressing tobacco use among youths, but there is little information about how frequently physicians discuss smoking with their adolescent patients. We analyzed data from the National Ambulatory Medical Care Surveys to assess the prevalence and the predictors of physicians' identification of smoking status and counseling about smoking at office visits by adolescents. METHODS: From 1991 through 1996, 5087 physicians recorded data on 16 648 visits by adolescents aged 11-21 years. We determined the proportion of office visits at which physicians identified an adolescent's smoking status and counseled about smoking and then identified predictors of these outcomes with logistic regression. Statistical tests were two-sided. RESULTS: In 1991, physicians identified an adolescent's smoking status at 72.4% of visits but provided smoking counseling at only 1.6% of all adolescent visits and 16.9% of visits by adolescents identified as smokers. These proportions did not increase from 1991 through 1996. Compared with specialists, primary care physicians were more likely to identify smoking status (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.53-1.89) and to counsel about smoking (OR = 3.43; 95% CI = 2.18-5.38). Patients with diagnoses of conditions potentially complicated by smoking were more likely to have their smoking status identified and to be counseled about smoking. Younger and nonwhite adolescents were less likely to be counseled about smoking than older and white teens. CONCLUSIONS: We found that physicians frequently identified adolescents' smoking status but rarely counseled them about smoking. Physicians' practices did not improve in the first half of the 1990s, despite a clear consensus about the importance of this activity and the publication of physician guidelines targeting this population. Physicians treating adolescents are missing opportunities to discourage tobacco use among teens.

Adolescent↗
PubMed1993

Cognitive social skills and social self-appraisal in depressed adolescents.

OBJECTIVE: This study was undertaken to determine whether the social cognitive skills and social self-appraisal of depressed adolescents differed from those of other adolescents with nonaffective psychiatric disorders or of adolescents free from disorder. METHOD: Within the age range of 15 to 19, 38 depressed adolescent outpatients (14 boys, 24 girls); 31 nondepressed adolescent outpatients (17 boys, 14 girls); and 34 normal high-school students (18 boys, 16 girls) were assessed using the following dependent measures: Interpersonal Negotiation Interview, Adolescent Social Problem Solving Measure, Adolescent Self Perception Profile, and Interpersonal Dependency Inventory. RESULTS: Depressed adolescents were found to have significantly more negative self-concepts and significantly less social self-confidence than either comparison group. They did not differ from the other adolescents in either social problem-solving ability or interpersonal understanding. CONCLUSIONS: These results indicate that depressed adolescents have unique deficits in social self-evaluation which contribute to ineffective social behavior and the maintenance of dysphoric affect. Treatment of social skill deficits should be based on a careful assessment of the patient's functioning in this area.

Adolescent↗
PubMed1995

A case-control family history study of depression in adolescents.

OBJECTIVE: To examine whether depression aggregates in the families of depressed adolescents and to determine whether clinical features and/or comorbid syndromes in the depressed adolescents change the risk of psychopathology in relatives. METHOD: Lifetime prevalence rates of psychopathology in the first-degree (n = 228) and second-degree (n = 736) relatives of 76 adolescents with major depressive disorder (MDD) and the first-degree (n = 107) and second-degree (n = 323) relatives of 34 normal control adolescents were assessed by the Family History-Research Diagnostic Criteria (FH-RDC) method using the parent/guardian as the family informant. RESULTS: Compared with the first-degree relatives of normal controls, the relatives of depressed adolescents had significantly higher lifetime rates of MDD (25% versus 13%) and "any" of the FH-RDC psychiatric disorders (53% versus 36%). The second-degree relatives of adolescents with MDD had significantly higher lifetime rates of FH-RDC "other" psychiatric disorder (12% versus 7%) and "any" of the FH-RDC psychiatric disorders (22% versus 15%) but not MDD (5% versus 6%) compared with the relatives of normal controls. The first-degree relatives of depressed adolescents who were also suicidal had increased lifetime rates of suicidal behavior which significantly cosegregated with MDD. Comorbid conduct disorder in the depressed adolescent was associated with increased rates of antisocial personality disorder in the first-degree relatives and also tended to cosegregate with MDD. CONCLUSIONS: The current study provides further evidence for the familial aggregation of depression in adolescent-onset MDD. This study also suggests that the familial aggregation of nonaffective psychiatric disorders depends on the clinical features and comorbid syndromes present in the depressed adolescent proband.

Adolescent↗
PubMed1997

Correspondence between adolescent report and parent report of psychiatric diagnostic data.

OBJECTIVE: To examine the degree of agreement between parent and adolescent report of major psychiatric disorders in the adolescent (14 to 18 years of age). METHOD: A total of 281 parent-adolescent pairs were interviewed separately regarding psychopathology in the adolescent. RESULTS: The kappa values for parent-adolescent agreement on the disorders ranged from .19 for alcohol abuse/dependence to .79 for conduct disorder, with an average kappa of .42. Excellent agreement was found for conduct disorder and the core symptom of anorexia; good agreement was found for separation anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, substance abuse/dependence, and the core symptom for bulimia; poor agreement was found for major depression, dysthymia, anxiety disorders other than separation anxiety, alcohol abuse/dependence, and the infrequent core symptoms of bipolar and obsessive-compulsive disorders. Parent-adolescent agreement was not influenced by gender, current adolescent age, parental education level, disorder onset age, or severity of disorder. CONCLUSIONS: For detecting cases of adolescent psychopathology, there are clear advantages to the current consensus position that combines adolescent and parent report, especially for externalizing disorders. However, if forced to choose one informant, assessing the adolescent will result in the detection of more diagnosed cases.

Adolescent↗
PubMed1997

Traumas and other adverse life events in adolescents with alcohol abuse and dependence.

OBJECTIVE: Clinical observation suggests that adolescents with alcohol use disorders often have complex histories that include childhood maltreatment and other traumas. The aim of this study was to determine the relationships among adolescent alcohol use disorders and a broad range of traumas and adverse life events. METHOD: The subjects were 132 adolescents with alcohol dependence, 51 adolescents with alcohol abuse, and 73 adolescents recruited from the community as a control group. Trauma history was assessed by a semistructured interview and other adverse life events by questionnaire. RESULTS: Traumatic events reflecting interpersonal violence had occurred in many of the adolescents with alcohol dependence and abuse and few of the control adolescents. Adolescents with alcohol abuse or dependence, compared with control subjects, were 6 to 12 times more likely to have a physical abuse history and 18 to 21 times more likely to have a sexual abuse history. Sexual abuse was more common in females, and victimization by other violent acts was more common in males. Many other adverse life events were also significantly more common in the alcohol use disorder groups than in the control group, including having a close friend die, arguments within the family, and legal difficulties. CONCLUSIONS: These results demonstrate that trauma and other adverse life events are strongly associated with alcohol use disorders in adolescents. Clinical screening of adolescents with alcohol use disorders for a range of traumatic events is recommended.

Adolescent↗
PubMed1999

Natural course of adolescent major depressive disorder: I. Continuity into young adulthood.

OBJECTIVE: To examine the course of adolescent major depressive disorder (MDD) by comparing rates of mood and non-mood disorders between age 19 and 24 years in participants with a history of adolescent MDD versus participants with adolescent adjustment disorder with depressed mood, nonaffective disorder, and no disorder. METHOD: Participants from a large community sample who had been interviewed twice during adolescence completed a third interview assessing Axis I psychopathology and antisocial and borderline personality disorders after their 24th birthday: 261 participants with MDD, 73 with adjustment disorder, 133 with nonaffective disorder, and 272 with no disorder through age 18. RESULTS: MDD in young adulthood was significantly more common in the adolescent MDD group than the nonaffective and no disorder groups (average annual rate of MDD = 9.0%, 5.6%, and 3.7%, respectively). Adolescents with MDD also had a high rate of nonaffective disorders in young adulthood (annual nonaffective disorder rate = 6.6%) but did not differ from adolescents with nonaffective disorder (7.2%). Prevalence rates of dysthymia and bipolar disorder were low (< 1%). Adolescents with adjustment disorder exhibited similar rates of MDD and nonaffective disorders in young adulthood as adolescents with MDD. CONCLUSIONS: This study documents the significant continuity of MDD from adolescence to young adulthood. Public health implications of the findings are discussed.

Adolescent↗
PubMed1998

Comparison of standing sagittal spinal alignment in asymptomatic adolescents and adults.

STUDY DESIGN: A retrospective examination of the spine radiographs of 88 asymptomatic adolescents was performed to analyze the indices of regional and segmental sagittal spinal alignment in relation to the sagittal vertical axis as determined by the C7 plumb line. OBJECTIVES: To determine the sagittal spinal alignment in asymptomatic adolescents and to correlate the sagittal vertical axis with the overall sagittal spinal balance and other indices of sagittal spinal alignment. In addition, to compare these results with previously established data for asymptomatic adults. SUMMARY OF BACKGROUND DATA: Previous studies of sagittal spinal alignment have included subjects encompassing a wide range of ages. A previous study at the authors' institution established normative data for sagittal spinal alignment in asymptomatic adults. No previous study has reported on the correlation between the sagittal vertical axis and other measurements of sagittal spinal alignment in asymptomatic adolescents. METHODS: Measurements obtained from the standing lateral spine radiographs of 88 asymptomatic adolescents (age range, 10-18 years) were collected and analyzed using statistical methods. These data were compared with previously established data for asymptomatic adults. RESULTS: There was a striking similarity in regional thoracic kyphosis and lumbar lordosis between adolescents and adults. Despite having similar regional and segmental sagittal alignments, adolescents had a significantly more negative sagittal vertical axis (mean, -5.6 cm) than adults (mean, -3.2 cm; P = 0.0001). Also, unlike that in adults, the sagittal vertical axis in adolescents was not significantly correlated with the distal segmental lumbar lordosis. The sagittal vertical axis in adolescents was significantly correlated with the level of thoracic kyphosis and the distances from the thoracic apex, lumbar apex, and T12 to the C7 plumb line. Sacral inclination, which is a determinant of hip extension and standing pelvic rotation, was correlated with the lumbar apex and the total and segmental lordosis, except at L5-S1. CONCLUSIONS: Asymptomatic adolescents tend to stand in greater negative sagittal spinal balance than asymptomatic adults, despite similar regional and segmental alignments in the thoracic and lumbar spine. The role of hip extension, spinopelvic axis rotation, and other sagittal alignment parameters in determining the sagittal vertical axis in adolescents warrants further study.

Adolescent↗
PubMed1999

Persistent osteopenia in adolescent idiopathic scoliosis. A longitudinal follow up study.

STUDY DESIGN: A follow-up study assessing the bone mineral dynamics in adolescent patients with idiopathic scoliosis and associated osteopenia. OBJECTIVES: To investigate whether osteopenia in patients with adolescent idiopathic scoliosis is a transient phenomenon or a persistent problem. SUMMARY OF BACKGROUND DATA: Investigators have suggested a significant correlation of osteopenia with adolescent idiopathic scoliosis. Because one half of the skeletal mass is acquired during the adolescent years, it is of importance to know whether the osteopenia is transient or persistent. METHODS: Using dual-energy x-ray absorptiometry, bone mineral density of bilateral proximal femurs was studied longitudinally in 70 healthy control subjects and 14 patients with adolescent idiopathic scoliosis with significant osteopenia more than 2 standard deviations below the mean normal value. RESULTS: The 14 girls with osteopenic adolescent idiopathic scoliosis who were followed up longitudinally for up to 3 years showed persistent and significantly lower bone mineral density when compared with normal age-, sex- and maturity-matched control subjects. CONCLUSIONS: Patients with adolescent idiopathic scoliosis are at increased risk of osteoporosis than are healthy adolescents. The lower rate of increase of bone mineral density in patients with adolescent idiopathic scoliosis who have low bone mineral density could predict a significantly lower peak bone mass in adulthood, with all the associated problems of osteoporosis. Further investigation is needed to define whether osteopenia-associated scoliosis has the same cause, pathogenetic mechanism, and risk of progression when compared with adolescent scoliosis without osteopenia.

Absorptiometry, Photon↗
PubMed2004

Obesity in adolescence and adulthood and the risk of adult mortality.

UNLABELLED: BACKGROUND There are few long-term follow-up data on the relation between body mass index (BMI) in adolescence and in adulthood, and between adolescent BMI and adult mortality. The present study explores these relations. METHODS: In Norwegian health surveys during 1963-1999, height and weight were measured for 128,121 persons in a standardized way both in adolescence (age 14-19 years) and 10 or more years later. Persons were followed for an average of 9.7 years after the adult measurement. Cox proportional hazard regression models were used to study the association between adolescent and adult BMI and mortality. RESULTS: The odds ratio of obesity (BMI >/=30) in adulthood increased steadily with BMI in adolescence, from 0.2 for low BMI up to 16 for very high BMI. Very high adolescent BMI was associated with 30-40% higher adult mortality compared with medium BMI. Adjusting for adult BMI explained most of the association of adolescent obesity and mortality, especially among men. Adjustment for smoking did not change the results. CONCLUSIONS: Obesity in adolescence tends to persist into adulthood. Adolescent obesity is also connected to excess mortality, but this excess seems to be explained mostly by obesity in adulthood. High BMI in adolescence seems to be predictive of both adult obesity and mortality.

Adolescent↗
PubMed2005

The treatment of adolescent depression in the era of the black box warning.

PURPOSE OF REVIEW: This paper reviews the epidemiology and sequelae of adolescent depression, recent studies of antidepressants and psychotherapeutic modalities for treatment of adolescent depression, and the black box warning from the United States Food and Drug Administration regarding the use of antidepressants in adolescents. RECENT FINDINGS: Over the past 4 years, four major randomized placebo-controlled trials of selective serotonin reuptake inhibitors in adolescents have been published. Although each of these published studies concluded that the drug under study was efficacious, the United States Food and Drug Administration and others have offered words of caution. Over the past 2 years, there has been increasing concern that antidepressants may increase suicidal thinking and behavior (not completed suicide) in depressed adolescents. The United States Food and Drug Administration has issued a black box warning asking providers to use caution when prescribing antidepressants in children under the age of 18. SUMMARY: Adolescent depression is common, socially and economically costly, and a potentially lethal disease. Recent studies of antidepressant use in adolescents have demonstrated variable efficacy and an increased risk of adverse events, including suicidality. The evidence is greatest to support the efficacy of fluoxetine, and thus it remains the only selective serotonin reuptake inhibitor approved by the United States Food and Drug Administration for the treatment of depression in children and adolescents. Psychotherapy is strongly encouraged in any patient for whom medication is prescribed. The risk of adverse events associated with antidepressant use requires caution when these medications are prescribed to adolescents. In an adolescent with depression, however, there is an inherent and greater risk to doing nothing.

Adolescent↗
PubMed2005

A structured communication adolescent guide (SCAG): assessment of reliability and validity.

PURPOSE: To assess the reliability and validity of a Structured Communication Adolescent Guide (SCAG) in an undergraduate medical education setting using trained adolescent raters. METHOD: The SCAG is a 49-item, 6-section (A-F), protocol derived from the Calgary Cambridge Observation Guide that incorporates adolescent psychosocial data collection with the physician's communication skills. Four trained female adolescents scored 42 videotaped adolescent clinical encounters using the SCAG; a trained psychologist's rating for each videotape was used as the gold standard. RESULTS: Agreement among adolescent raters was determined by calculating intraclass correlation coefficients (ICC). The individual SCAG item scores, combined with the global ratings for each section, resulted in an overall ICC value of 0.93, indicating very strong agreement among the 4 raters. The global rating scores for the sections ('initiating the session', 'initiating separation', 'once adolescent is alone--lifestyle' and 'closure') produced an ICC range of 0.58-0.93. However, the ICC values for the 2 remaining sections ('how was information collected' and 'gathering information') global rating scores were below 0.30, signifying low agreement. Overall agreement between the adolescent raters and the gold standard resulted in an ICC value of 0.78. This is evidence of the SCAG's criterion validity. CONCLUSION: The SCAG is a reasonably valid tool for use in guiding an encounter with an adolescent patient. However, 2 sections require modifications to improve their reliability and thus the SCAG's overall performance. Our results suggest that the SCAG shows promise as a potentially useful teaching resource in undergraduate medical education in adolescent medical interviewing.

Adolescent↗