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Adolescence, the transition between childhood and adult life, is one of the most dynamic stages of human development. Adolescence is accompanied by dramatic physical, cognitive, social, and emotional changes that present both opportunities and challenges for adolescents, families, health professionals, teachers, and communities. While prior life experiences form the foundation of adolescence, current experiences continuously contribute to the maturation and differentiation of the young person. The health professional must also be sensitive to the changes that must occur in the health supervision relationship as the adolescent becomes increasingly capable of making autonomous decisions about health.
Adolescence is generally a period characterized by good health. For millions of adolescents, however, these years are accompanied by considerable preventable morbidity, mortality, and poor health habits. Unintentional injuries, homicide, and suicide are leading causes of death, while sexually transmitted diseases, substance abuse, adolescent pregnancy, antisocial behavior, and school dropout are important causes of physical, emotional, and social morbidity.
Adolescence is a time when childhood health disorders either resolve or persist into adulthood, new issues emerge, and risks for some long-term adult problems become detectable. Thus, this pivotal developmental period offers special opportunities for preventive and health-promoting services. A major role of health supervision is the periodic assessment and support of the adolescent's adaptation to new roles and risks that accompany growth and development. Providing adolescents with a sense of self-assurance, knowledge of what to do, and the belief that they can do it, and encouraging and reinforcing healthy choices, helps them develop the social competence and self-responsibility needed for personal health, school achievement, and job performance.
The most noticeable physical changes during adolescence are those of somatic and sexual growth and development, including the appearance of secondary sexual characteristics and the capacity to reproduce. Young adolescents in particular are preoccupied with these physical changes and how they are perceived by others. Anticipatory guidance can help prepare adolescents and their parents for these changes. For example, many families are reassured to learn about the variability in the onset of these changes.
The changes in cognitive development during adolescence are, in their own way, as dramatic as those in the physical domain. During this period, the adolescent may advance from concrete operational to formal operational thinking. What initially was a primary focus on the present should mature into an ability to consider the future implications of current actions. This shift obviously has enormous implications for health supervision; for the first time, adolescents may begin to have the cognitive capacity to comprehend the impact of their present behaviors on their future health. It is important to note, however, that this emerging way of thinking is still limited and occurs erratically throughout much of adolescence.
The limited capacity to see beyond simple solutions to complex problems evolves into a tolerance for ambiguity and the growing recognition that many issues have multiple causes and interrelationships. These psychological developments help account for the frequent questions posed by adolescents, their sometimes argumentative behavior, and their recurring challenges to parental authority.
Peer relationships during adolescence play a major role in the adolescent's emotional separation and individuation. Research suggests that adolescents often seek out peers whose beliefs, values, and even behaviors are similar to those of their families. While peer and other social influences often reinforce familial values, some influences may expose the adolescent to values that differ significantly from the family's. Thus the need to balance peer pressure and family expectations creates both new challenges and family tensions as adolescents begin to make independent decisions. In their struggle to gain autonomy while retaining interdependence, they may be understandably ambivalent about replacing their familiar comfort with and dependence on their parents with the uncertainty of relationships with others. The health professional is in a key position to offer guidance and support for families as they adapt to these changes.
The ability to integrate emotional and physical intimacy in a love relationship is an important developmental task for the older adolescent. Health supervision must address the sexual experimentation and concomitant risks that accompany this aspect of development.
Adolescence is a time of trying out all sorts of new behaviors. While this experimentation is essential for development, it may also lead to an increase in risky behaviors. The potential negative health consequences are likely to be underestimated by the adolescent. For example, nontraditional eating patterns, such as fad diets, may be adopted. Continued, periodic health supervision during adolescence is imperative in order to provide anticipatory guidance, support health-promoting behaviors, and help the adolescent apply increasingly sophisticated thinking in evaluating the consequences of new behaviors and roles.
The dramatic changes that have occurred in the American family are particularly significant for adolescents. The decrease in the time that many parents, extended family members, and neighbors are able to spend with children leads to less communication with, support from, and supervision by adults at a crucial period in development. At the very time when they are most likely to experiment with behaviors that can have serious health consequences, adolescents have more unsupervised time concurrent with less parental involvement. Parents should maintain a regular interest in their adolescents' daily activities and concerns. Adolescents are more likely to become successful young adults if their families remain actively involved with them, providing authoritative parenting in a democratic fashion. As the nature of family relationships changes, the health professional plays an important role in helping families negotiate the most useful balance between supervision and promotion of the adolescent's growing independence. Continued parental involvement is enhanced when families receive useful information about the physical, cognitive, social, and emotional changes that occur in adolescence. Health professionals should emphasize that families serve as the major ethical and behavioral role models for adolescents and should communicate their expectations to them. The adolescent also needs the family's praise, support, availability, and unconditional positive regard.
Success in school contributes greatly to an adolescent's self-esteem and progress toward becoming a socially competent adult. Health promotion programs in schools can foster the establishment of good health habits and the avoidance of those that may lead to morbidity and mortality. Health promotion curricula can include family life education and social skills training, and information on pregnancy prevention, abstinence, conflict resolution, healthy nutritional practices, and avoidance of unhealthy habits such as smoking, drinking, and substance abuse. On-site integrated health services in the schools--with referrals to primary care physicians and community agencies (including mental health centers) for supplementary services--are evolving as an effective way to deliver adolescent health care in medically underserved areas.
Community recreational programs and facilities are important resources for adolescents. Opportunities for meaningful work experiences, community service, and participation in local governmental activities relating to adolescence contribute to an adolescent's sense of being included and valued. Community regulations and legislation that control the sale of alcohol, cigarettes, and guns and mandate seat belt/helmet use are important health supervision measures, as is the availability of contraceptives and family planning services.
Health supervision efforts are most likely to succeed when they foster the joint participation and shared responsibility of adolescents, parents, health professionals, teachers, and others who have a personal, professional, or supervisory relationship with adolescents. Requirements for success in health supervision include a respect for individual differences, support of the adolescent's emerging autonomy, a developmental approach, and a focus on the adolescent's strengths. The health professional should have an ability to establish a therapeutic alliance, an expertise in health matters that the adolescent can respect and trust, and an enjoyment of the rewards that come from helping adolescents achieve their full potential.
Adolescents may need special efforts to help them engage in regular health supervision. They are often more comfortable with health professionals who have the special training and experience to deal with their particular issues. Different types of settings, such as community or school health clinics, may also be more successful in encouraging adolescents to participate in regular health supervision.
The Adolescence Periodicity Schedule shows the recommended health supervision visits for adolescents judged not to be at undue risk. This primary schedule is based on an assessment of the needs of adolescents and families, and of the ability of health professionals to introduce effective interventions.
An augmented schedule is recommended for adolescents with school problems; those who live in poverty; those in dysfunctional families; those with insecure, isolated, or single parents; those with chronic illness or disability; those in foster care; those at risk for abuse and/or neglect; those experiencing emotional problems; and those at environmental risk. If major changes such as divorce, remarriage, death, or parental illness occur in the family between regularly scheduled visits, additional health supervision visits should be arranged.
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Last updated 8/21/96