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 13 for boys. A primary care subspecialty, adolescent medicine incorporates aspects of psychiatry, endocrinology, sports medicine, nutrition and gynecology. Adolescent medicine is an important specialty within Youth Health and Adolescent Health.

Issues with a high prevalence during adolescence are frequently addressed by providers. These include:

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

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.

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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 HEADS assessment (for information on the development of this tool, see Wikipedia article on HEADSS), 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 assessment of Tanner stage, should be noted, and appropriate endocrinological work-up undertaken for patients that fail to develop in an anticipated manner. 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.

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.

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 Boston Children's Hospital

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

Professional Organizations

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