This is the final growth and developmental stage in childhood. It is a complex stage of development for several reasons. For the second time in a child’s life, growth is occurring rapidly. They are also experiencing changes in hormones leading to the development of secondary sexual characteristics which sometimes give them the appearance of an adult, but still very immature emotionally. Adolescents have the feeling of being invincible or omnipotent which often leads to risk-taking behaviors. This is truly a challenging period for both the child and the parent.
The American Academy of Pediatrics defines the adolescent period as starting between 11 and 12 years of age and ending at 21 years of age. The definition of adolescence is not the same with every source. Healthy People 2020 is a great example, it defines adolescents as 10-17 years and young adults as 18-25 years. Regardless of the definition, adolescents should visit their HCP once a year. If they are playing sports or attending camp they are often seen because they need preparticipation physicals.
Performing Preventive Services: A Bright Futures Handbook contains information from screening topics to coding. Also included on the Bright Futures website are tools for adolescence, including previsit and supplemental questionnaires, documentation forms, and parent/patient handouts. The handouts are available in English and Spanish. The questionnaires contain questions regarding the topics that are important for each age group. These questionnaires are useful for the parents and teens to complete before seeing the provider.
Principles for the Order of Interview
Rapport building with the teen, using areas of interest
Start with the chief complaint or most pressing concern
In general, move from less sensitive to more sensitive questions
Tailor Interview to Youth’s Developmental Stages
There are several components to keep in mind while eliciting history. The first is the need to establish rapport with the teen, especially if this is the first time you are seeing him in your office. The second is to develop trust. Without trust, you will not obtain all of the necessary information when you begin discussing risk-taking during the history taking. Remember the majority of the information will be coming from the teen. The caregiver is primarily in the room for moral support.
When you are assessing the home environment, ask about relationships between parents, siblings, and this teenager, also relationships among friends in the neighborhood. When discussing employment, ask the teen how many hours they are working. What are the hours they are working? Are they doing okay in school? What kinds of grades are they making? Are they failing? Are they not doing well. Is work interfering with school performance? What are their plans after high school? That’s also another key important point because it gives you an idea of whether or not the teen is forward-thinking and looking at the future.
Vary interviews depending on the teen’s developmental stage:
Early adolescent (11-14 years)
Middle adolescent (15-17 years)
Late adolescent (18-21 years)
Use more concrete language for early adolescents
Be sensitive to varying exposure to risky behavior
For younger teens, start with “do you know anyone who…..?
For older teens or those with a history of risky behaviors, use a more direct approach
Questioning Technique
Use a combination of open-ended and closed questions.
Gender-neutral, avoid assumptions about family structure & sexual orientation of teen.
Try to use teen terminology, without trying to sound like an adolescent.
Warn exceptions to confidentiality before raising sensitive issues.
Ascertain who will be present
Ensure privacy
May need to do part of the interview without parents present
Avoid too much distance
Write as little as possible during the interview
Watch teens and your body language, and eye contact
Remember: The adolescent is identity seeking, may be rebellious, and often inflexible. He is trying to become independent and is in the process of refining sex-role & sexuality. Parents may appreciate resources about adolescents — such as the CDC’s Positive Parenting Tips.
