ADOLESCENT

MEDICINE
Lerrie Diane D. Ibana
Department of Pediatrics
Cagayan Valley Medical Center
 ADOLESCENT

▰10-19 years old

▰Biophysical process
▰Before the onset of puberty and lasts
well beyond the termination growth
 3 PHASES OF ADOLESCENCE

▰ EARLY-10- 13 years old

▰ MIDDLE- 14-17 years old
▰ LATE- 17-21 years old
MILESTONE IN ADOLESCENT DEVELOPMENT
A. PHYSICAL DEVELOPMENT

▰ PUBERTY- biologic transition

from childhood to adulthood
include the appearance of the
secondary sexual characteristics,
increase in height, change in body
composition, and development of
reproductive capacity 
A. PHYSICAL DEVELOPMENT

▰ SEXUAL DEVELOPMENT
▻ progression of the development of
the secondary sex characteristics
may be described using the Sexual
maturity rating (SMR) scale
(ranging from 1, preadolescence, to
5, sexual maturity), or Tanner
stages.
TANNER STAGING
TANNER STAGING
TANNER STAGING
 MALES

▰ The first visible sign of puberty

and the hallmark of SMR 2 is
testicular enlargement beginning
as early as 9.5 yr, followed by the
development of pubic hair.
FEMALES

▰ The first visible sign of puberty

and the hallmark of SMR 2 is
the appearance of breast buds
(thelarche), between 8 and 12 yr
of age.
NEUROLOGIC AND COGNITIVE DEVELOMENT
▰ develop and refine their ability to use formal operational
thought processes
▰ Middle and late adolescents develop the ability to consider
multiple options and to assess the long term consequences
of their actions
▰ capacity for verbal expression is enhanced
▰ Early adolescence also is characterized by egocentricity,
the adolescent’s belief that they are the center of everyone’s
attention.
 NEUROLOGIC AND COGNITIVE
DEVELOPMENT
▰ ASYNCHRONOUS BRAIN MATURATION
▻ earlier maturation of the amygdala and
other limbic structures, which are involved in the
experience of fear and emotion, relative to the frontal
executive function systems  adolescents are more
likely to make poor decisions in highly emotionally
charged situations  risk taking, desire for immediate
gratification, and increased sensation and novelty
seeking
 MORAL DEVELOPMENT
▰ Preadolescents ▰ Middle and late
• concrete and adolescents
individualistic, follow • may establish a sense of
rules in order to please morality driven by their desire
authority figures and to be seen as a good person, to
avoid punishment behave in a manner according
to their perceived place in
society, or by their sense of
obligation to care for others.
▰ Late adolescents
• may develop a rational
conscience and an
independent system of values,
though these often are
ultimately consistent with
parental values.
B. PSYCHOSOCIAL DEVELOPMENT

▰ EMERGING ADULTHOOD- a period

where some late adolescents move immediately
from high school into marriage, childbearing,
working, and financial independence; others
remain dependent on the parents while pursuing
their own education for several more years
B. PSYCHOSOCIAL DEVELOPMENT

▰ OVERRIDING THEME: concept of

identity formation and consolidation as the
adolescent moves away from the nurturing
protection of the family, develops an
increased affiliation with the peer group(s),
and ultimately defines himself or herself as
an individual.
B. PSYCHOSOCIAL DEVELOPMENT

1. Separation from the parents

2. Increasing importance of the
peer group
3. Increased sexual awareness and
interest
4. Body image
GENDER AND SEXUAL IDENTITY

▰  TERMS AND DEFINITIONS

SEX- multifaceted, with at least 9 components

• chromosomal sex • external morphologic sex (external
• gonadal sex genitalia)
• fetal hormonal sex (prenatal hormones produced • hypothalamic sex (sex of the brain)
by the gonads) • sex of assignment and rearing
• pubertal hormonal sex
• internal morphologic sex (internal genitalia) • and gender identity and role
 SEXUAL IDENTITY
▰ self-perceived identification distilled from any
or all aspects of sexuality, and has at least 4
components
1. SEX ASSIGNED AT BIRTH-
newborn is assigned a sex before
(typically through ultrasound) or at the
time of birth based on the external
genitalia (natal sex)
SEXUAL IDENTITY

2. GENDER TERMS
▻ Gender identity- person’s basic sense of being a
boy/man, girl/ woman, or other gender (e.g.,
transgender)
▻ Gender roles- refers to one’s role in society, typically
either the male or female role
SEXUAL IDENTITY

3. SOCIAL SEX ROLES

 aka gender expression, which refers to
characteristics in personality,
appearance, and behavior that are, in a
given culture and time, considered
masculine or feminine
SEXUAL IDENTITY
4. SEXUAL
ORIENTATION
 refers to attractions,
behaviors, fantasies, and
emotional attachments
toward men, women, or
both.
SEXUAL IDENTITY

▰ SEXUAL BEHAVIOUR- any sensual activity to

pleasure oneself or another person sexually

▰ GENDER VARIANT- refers to any gender identity or

role that varies from what is typically associated with
one’s sex assigned at birth
 SEXUAL IDENTITY

▰ TRANSGENDER- synonymous to gender variant identity which is used

to refer to variation in gender identity, people are a diverse group of
individuals who cross or transcend culturally defined categories of gender
▻ Transsexuals
▻ Cross dressers or transverstites
▻ Drag queens and kings
▻ Bigender
▻ Genderqueer
SEXUAL IDENTITY DEVELOPMENT

▰ XRY chromosome- located on the Y chromosome induced the

development of testes
▰ Gender identity develops early in life and is typically fixed by
2-3 yr of age
▰ Children first learn to identify their own and others’ sex
(gender labeling), then learn that gender is stable over time
(gender constancy), and finally learn that gender is
permanent (gender consistency)
STIGMA, STIGMA MANAGEMENT, AND
ADVOCACY

▰ Children with gender variance are subject to ostracism

and bullying from peers, which may negatively impact
their psychosocial adjustment  to social isolation,
loneliness, low self-esteem, depression, suicide, and
behavioral problems
STIGMA, STIGMA MANAGEMENT, AND
ADVOCACY
1. The health professional and family can assist the
child or adolescent to find others with similar
interests (within and beyond the gender-related
interests) to strengthen positive peer support
2. Interventions in school and society to raise
awareness and promote accepting and positive
attitudes, take a stand against bullying and abuse,
and implement antibullying policies
TRANSGENDER IDENTITY DEVELOPMENT

 PRE COMING OUT STAGE

▻ the individual is aware that their gender identity is
different from that of most boys and girls
▻ some of these children are also gender-role
nonconforming while others are not
▻ Those who are also gender-role nonconforming
cannot hide their transgender identity, are noticed for
who they are, and may face teasing, ridicule, abuse,
and rejection
TRANSGENDER IDENTITY DEVELOPMENT

 COMING OUT STAGE

▻ acknowledging one’s transgender identity to self
and others (parents, other caregivers, trusted health
providers, peers)
▻ open and accepting attitude is essential; rejection
can perpetuate stigma and its negative emotional
consequences
TRANSGENDER IDENTITY DEVELOPMENT

 INTIMACY STAGE
▻ Once gender dysphoria has been
alleviated, the individual can proceed
with other human development tasks,
including dating and relationships
TRANSGENDER IDENTITY DEVELOPMENT

 INTEGRATION STAGE
▻ transgender is no longer the most
important signifier of identity but one of
several important parts of overall
identity
GENDER DYSPHORIA
SUBSTANCE ABUSE
SUBSTANCE ABUSE

▰ a substantial proportion of adolescents will

engage in use of a wide range of substances such
as alcohol, tobacco, or marijuana
▰ consequences of these exposures are influenced
by a complex interaction between biologic and
psychosocial development, environmental
messages, and societal attitudes
SUBSTANCE ABUSE
▰ The first use of the most commonly used drugs occurs
before age 18 yr, with 88% of people reporting age of first
alcohol use at <21 year old
▰ Inhalants have been identified as a popular first drug for
youth in grade 8
▰ Recognizing those drugs with the greatest harm, and at
times focusing on harm reduction with or without
abstinence, is an important modern approach to adolescent
substance abuse
ETIOLOGY

▰ biopsychosocially determined
▰ Biologic factors, including genetic predisposition, are
established contributors
▰ Behaviors such as rebelliousness, poor school
performance, delinquency, and criminal activity and
personality traits
▰ Conduct disorders and antisocial personality disorders
 EPIDEMIOLOGY
▰ Alcohol, cigarettes, and marijuana are the
most commonly reported substances used
among U.S. teens
▰ Males have higher rates of both licit and illicit drug use
than females
▰ Prescription drug abuse, or nonmedical use of a
prescription drug or an over-the counter (OTC) medicine
has gained popularity among teens in
the last 3 yr
MOST COMMONLY ABUSED PRESCRIPTION DRUGS
CLINICAL MANIFESTATION

▰ frequently detected in adolescents who experience trauma such as motor

vehicle crashes, bicycle injuries, or violence
▰ associated with the route of use
▻ intravenous drug use is associated with venous “tracks” and needle
marks
▻ nasal mucosal injuries are associated with nasal insufflation of drugs
▰ Seizures can be a direct effect of drugs such as cocaine and
amphetamines or an effect of drug withdrawal in the case of barbiturates
or tranquilizers
SCREENING FOR SUBSTANCE
ABUSE DISORDERS

▰ CRAFFT mnemonic is specifically designed to screen for

adolescents’ substance use in the primary setting
 URINE DRUG SCREENING
▻ psychiatric symptoms to rule out comorbidity or
dual diagnoses,
▻ significant changes in school performance or other daily
behaviors,
▻ frequently occurring accidents,
▻ frequently occurring episodes of respiratory problems,
▻ evaluation of serious motor vehicular or other injuries, and
▻ as a monitoring procedure for a recovery program
ASSESSSING SERIOUSNESS OF
ADOLESCENT DRUG USE
 DIAGNOSIS

▰ substance use disorder is defined by a cluster of

cognitive, behavioral, and physiologic symptoms that
indicate that an adolescent is using a substance even
though there is evidence that the substance is harming the
adolescent
 COMPLICATIONS
▰ associated with comorbidities and acts of juvenile
delinquency
▰ high-risk behaviors such as robbery, burglary,
drug dealing, or prostitution for the purpose of
acquiring the money necessary to buy drugs or
alcohol
▰ diminishes judgment
▰ Use of injected substances involves the risk of
hepatitides B and C viruses as well as HIV
TREATMENTS

▰ accessibility to treatment; utilizing a

multidisciplinary approach; employing
individual or group counselling;
offering mental health services;
monitoring of drug use while in
treatment; and understanding that
recovery from drug abuse/addiction
may involve multiple relapses
PROGNOSIS

▰ For adolescent substance abusers who have been

referred to a drug treatment program, positive
outcomes are directly related to regular attendance in
posttreatment groups
▰ Poorer outcome for males with learning problems or
conduct disorder
▰ Relapse in patient with chronic of a substance use
disorder
 PREVENTION
▰ prevention efforts aimed at the
INDIVIDUAL, FAMILY, SCHOOL, AND
COMMUNITY levels
 PREVENTION
▰ Essential principles of successful prevention Programs
▻ enhance protective factors (parent support) and reduce risk
factors (poor self-control)
▻ should address all forms of drug abuse (legal and illegal)
▻ should address the specific type(s) of drug abuse within an
identified community;
▻ should be culturally competent to improve effectiveness
PREVENTION

▰ HIGHEST RISK PERIODS FOR SUBSTANCE ABUSE

▻ transitions such as the move from elementary school to
middle school
▻ or from middle school to high school
 Prevention programs need to target these emotionally
and socially intense times for teens in order to
adequately anticipate potential substance use or abuse
▰THANK YOU
FOR LISTENING
AND HAVE A
GOOD DAY!