details of pubertal changes, adolescensce with smr staging in detail, common adolescence behavioural, sexual problems,

1. Adolescence
MedicineBy Dr. Sonali Paradhi Mhatre

2. Epidemiology
• More than 2.6 million young people aged 10 to 24 die each year, mostly due
to preventable causes.
• About 16 million girls aged 15 to 19 give birth every year.
• Young people, 15 to 24 years old, accounted for 40% of all new HIV
infections among adults in 2009.
• In any given year, about 20% of adolescents will experience a mental
health problem, most commonly depression or anxiety.
• An estimated 150 million young people use tobacco.
• Approximately 430 young people aged 10 to 24 die every day through
interpersonal violence.
• Road traffic injuries cause an estimated 700 young people to die every day.

3. Definitions
• Adolescence – Period of development . This
includes physical, social and psychological
changes.
• Puberty – Biologic pr ocess in which a child
becomes an adult . I t includes gr owt h t o adult
size, appear ance of secondar y sexual char act er s,
and development of r eproduct ive capacit y.

5. Tanner Staging - males
Pubic
hair
Penis Testes
1 None Preadolesce
nt
Preadolesce
nt
2 Scanty, long Min
enlargement
Enlarged
scrotum
3 Dark, curling
start, small
amount
Lengthens Larger
4 Curly, adult
type
Larger.
Breadth
increases
Darker
scrotum.larg
er
5 Adult
distribution
Adult size Adult size

6. Tanner Staging - females
Pubic hair Breast
1 None Preadolescent
2 Scanty, straight,
medial border of
labia.
Brease papilla
elevated as a
mound.
Areola diameter
increased.
3 Dark, curling start,
small amount
Enlarged.
No contour
seperation.
4 Curly, adult type.
Abundant
Areola and papilla
form secondary
mound.
5 Adult distribution
at feminine
triangle.
Spread to medial
thigh.
Mature.
Nipples projects.
Breast contour
formed.

7. Male
growth
spurts

8. Female
growth
spurts

9. Early adolescence Mid adolescence Late adolescence
SMR 1 - 2 3 - 5 5
Biologic
development
Growth acceleration
begins.
Asymmetric growth spurt
begins distally.
Rapid enlargement of
larynx, pharynx, lungs –
voice change, voice
cracking.
Dental changes.
Height growth peak
veocity.
Increased lean body
mass.Hormonal body
changes.
Increase in heart size
and vital capacity,
hematocrit, BP, bld
volume.
Acne, body odor.
Menarche / spermache.
Growth is slower.
Final stages of genital
development.
Minor changes in hair
distribution.
Acne common.
Cognition Concrete thinking more
than logical thinking.
Emotions affect cognition.
Long term outcomes not
considered.
Black and white thinking.
Formal thoughts start.
Questioning and
analyzing is extensive.
Flexibility of thought.
Understand moral and
legal contexts.
Less self-centred
thoughts.
Idealistic thinking
Future oriented,
thougths of long term,
gratification,
compromise,
independence.
Career decisions
begin.

10. Early adolescence Mid adolescence Late adolescence
Self
concept
Self conscious
Self awareness based on
exteral appearance.
Girls - Body image issues.
Boys – self doubt, insecurity,
misconceptions about
masculinity.
Introspective
More accepting to body
changes.
Experimentations occur.
Stable body image.
Firm identity.
Attractiveness
mportant.
Sexuality Increased interest in
anatomy.
Anxieties and questions
regarding genitals.
Initiation of relationships.
Trying to attract partner.
Sexual orientation issues.
Focus on stable
relationships and
intimacy.
Planning future and
commitments
Family Need for privacy.
Want of independance
Conflicts over control,
independence and
acceptance.
Autonomy.
Peers Same sex peers appeals
more
Peer pressures.
Peers as role models,
behavioural examples.
Importance recedes.
Commitment and
logical thinking take
over.

13. DRUG GROUP DRUG STREET NAME USING METHOD
Depressants
Alcohol Booze, juice, hooch Swallowed in liquid form.
Barbiturates,
methaqualone,
benzodiazepines
Downers, ludes Consumed in capsules,
tablet, or pill form; mixed
into drinks; or injected.
Hallucinogens
Lysergic acid diethylamide Acid, LSD Swallowed in tablet or
capsule form, or placed
into thin squares of gelatin,
paper, sugar cubes, gum,
candy, or crackers.
Mescaline Peyote, cactus, mesc Chewed, swallowed in
capsule or pill form, or
ground and infused in hot
water and consumed as
tea.
Psilocybin/Psilocyn Mushrooms, shrooms Chewed, smoked, or
ground and infused in hot
water and consumed as
tea.
Phencyclidine Angel dust, crystal, PCP Snorted, injected, applied
to leafy material and
smoked, or swallowed in
liquid, capsule, tablet, or
pill form.
SUBSTANCE ABUSE

14. Drug Group Drug Street Names Method of Use
DRUG GROUP DRUG STREET NAME USING METHOD
Cannabinoids
Hashish Hash
Smoked in hand-rolled
cigarettes, pipes, or water
pipes (i.e., "bongs").
Marijuana Grass, pot, weed
Club Drugs
Gamma hydroxy butyrate GHB, "G" Mixed into drinks or injected.
Ketamine Special K, "K," Kit Kat,
vitamin K
Mixed into drinks, injected,
added to smokable
materials, snorted, or
consumed in pill form.
MDMA (3,4-methylenedioxy
methamphetamine)
Ecstasy, X, XTC, E Consumed in pill form, mixed
into drinks, or injected.
Flunitrazepan Rohypnol (commercial
name), roofies
Mixed into drinks or injected.
Yaba Crazy medicine, Nazi speed Consumed in pill form,
inhaled (by melting tablets
and inhaling vapors),
snorted, or injected.

15. DRUG GROUP DRUG STREET NAME USING METHOD
Inhalants
Airplane glue, aerosol
sprays, gasoline, paint
thinner
Air blast, highball Inhaled or sniffed,
sometimes using a paper
bag, rag, gauze, or
ampoule.
Cyclohexyl, amyl nitrate, or
butyl nitrate
Poppers, snappers
Nitrous oxide (N20) Whippets
Opioids and
narcotic pain
relievers
Heroin Smack, junk Injected, snorted, or
smoked.
Morphine M, monkey, white stuff Injected, snorted, or
smoked.
Opium Black stuff, block, gum, hop Swallowed or smoked.
Oxycodone Oxycontin (commercial
name), O.C
Swallowed, injected, or
snorted.
Hydrocodone Vicodin (commercial name) Swallowed.
Stimulants
Amphetamines Speed, uppers Swallowed in capsule,
tablet, or pill form; injected;
smoked; or snorted.
Cocaine Coke, blow, Connie Snorted or injected.
Crack cocaine Crack, rock Smoked.
Methamphetamine Meth, crystal, crystal meth,
Tina, T, crank, speed
Snorted, injected, smoked,
or swallowed.

17. Table 1: DSMIV-TR Criteria for Substance Abuse for Dependency
Criteria for Substance Abuse
A pattern of substance use leading to significant impairment or distress, as manifested by one or more of the following during in the past 12 month period:
1.Failure to fulfill major role obligations at work, school, home such as repeated absences or poor work performance related to substance use; substance-related
absences, suspensions, or expulsions from school; neglect of children or household
2.Frequent use of substances in situation in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
3.Frequent legal problems (e.g. arrests, disorderly conduct) for substance abuse
4.Continued use despite having persistent or recurrent social or interpersonal problems (e.g., arguments with spouse about consequences of intoxication, physical
fights)
Criteria for Substance Dependence
Dependence or significant impairment or distress, as manifested by 3 or more of the following during a 12 month period:
1.Tolerance or markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the
same amount of substance
2.Withdrawal symptoms or the use of certain substances to avoid withdrawal symptoms
3.Use of a substance in larger amounts or over a longer period than was intended
4.persistent desire or unsuccessful efforts to cut down or control substance use
5.Involvement in chronic behavior to obtain the substance, use the substance, or recover from its effects
6.Reduction or abandonment of social, occupational or recreational activities because of substance use
7.Use of substances even though there is a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the
substance

18. In puberty,
I felt like my body
was betraying me

19. Gender identity
disorder
• Gender identity disorder is a conflict
between a person's physical gender and
the gender he or she identifies as.

20. Symptoms:
• Children:
• Are disgusted by their own genitals
• Are rejected by their peers, feel alone
• Believe that they will grow up to become the opposite sex
• Have depression or anxiety
• Say that they want to be the opposite sex
• Adults:
• Dress like the opposite sex
• Feel alone
• Have depression or anxiety
• Want to live as a person of the opposite sex
• Wish to be rid of their own genitals
• Either adults or children:
• Cross-dress, show habits typical of the opposite sex
• Withdraw from social interaction

21. MANAGEMENT
• Individual and family counseling usually is recommended to treat
children with gender identity disorder.
• Counseling focuses on treating the associated problems of
depression and anxiety and on improving self-esteem.
• Therapy also aims at helping the individual function as well as
possible within his or her biological gender.
• Hormonal therapy as needed.
• The surgical alteration of a person's sex is called gender
reassignment surgery (sometimes referred to as a "sex change"
operation).

22. Adolescent Screening
•Interviewing
•Audiometry
•Visual testing
•Vitals measurement
•Breast examination
•Genitals examination
•Laboratory investigations

23. Short Form
BODY
Do you get some exercise at least 3 times a week? Do you feel you are
the right weight for your height? Do you ever throw-up or use laxatives
after eating?
HOME How are things at home? Who lives at home? How do you get along with
the other people in your house?
EDUCATION How are things at school? What classes do you like best? Least? Grades?
ACTIVITY How many good friends do you have? What do you do together? What do
your parents/guardian think of your friends?
DRUGS Do any of your friends smoke? Drink alcohol? Do you? Have you tried
other drugs?
SEXUALITY
Are you attracted to boys? Girls? Do you have a boyfriend or girlfriend?
How long? Do you get along well? Do you have sex? Does it go OK? Do
you know how to say "no"? Do you know how to protect yourself from STIs
and pregnancy?
SUICIDE/
DEPRESSION
Do you ever feel really depressed? How long does it last? Have you ever
thought of hurting yourself or suicide?
SAFETY Do you ever feel unsafe? When? At school? At home? In your
neighborhood? Have you ever been hurt by someone?
H-E-A-D-S QUESTIONAIRRE

24. • HEALTH EDUCATION
• SKILL BASED HEALTH EDUCATION
• LIFE SKILL EDUCATION
• FAMILY LIFE DUCATION
• COUNSELLING FOE EMOTIONAL STRESS
• NUTRITIONAL COUNSELLING
• EARLY DIAGNOSIS & MANAGEMENT OF MEDICAL &
• BEHAVIOURAL PROBLEM
PREVENTIVE STRATEGIES

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