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Dr Shapiro completed his undergraduate education at UC San Diego earning a B S in Biochemistry and Cell Biology and a B A in Political Science He furthered his education at UCLA where he earned a Masters Degree in Public…
FAST FACTS
Just as caring for newborns and infants is a specialty in itself, the same can be said about approaching children who are nearing their adolescent years (from 11 years onward). And for those of you with children nearing that age range (or even those who have reached or surpassed it), I thought it might be helpful to give a little bit of insight as to how we approach what can be a very sensitive area of the Adolescent History and Physical...the psychosocial history. Such importance is placed upon this part of the visit as so many causes of adolescent morbidity and mortality are preventable and early indicators of potential problems (e.g. suicide risk, drug and alcohol use, risky sexual behavior) may be found during the psychosocial history of the exam.
So with thanks to Drs. Eric Cohen and John Goldenring in their original design of the Adolescent HEADSS Assessment (and from which modifications have been made over the years), I share with you how I approach this part of the adolescent visit:
After a general conversation with both the parent(s) and child, I ask for a period alone with the adolescent in order to create an environment and relationship built on trust and respect for the adolescent's privacy. I then continue on with the HEADSS Assessment:
H - Home: This focuses on who lives at home and of any recent developments in the household (parental discordance, running away, etc). It's a perfect opportunity for the adolescent to vent about his/her parents with the confidence in knowing it will not leave the room.
E - Education/Employment: This obviously includes grades and which subjects are being enjoyed, how things are going with the teachers, and, of course, any bullying that may be going on.
E - Eating/Exercise: You've heard me rant and rave about the obesity epidemic in the U.S...so this is where I focus in on appropriate dietary habits and routine exercise. But just as important, this is also where I concentrate on any potential eating disorders and body image concerns.
A - Activities: This includes sports, dance, music, video game/computer/TV time. And it is also very important to get a sense of who else is involved in these activities...both the peers and family.
D - Drugs/Cigarettes/Alcohol: I am very careful with this one as it is very easy for an adolescent to just deny or say "no" to any questions here. I really feel I have to gain the trust of the adolescent first or I won't get a straight reply. I should also note it is very easy for comments to be made first about friends and what they are doing before answering anything about oneself.
S - Sexuality: Again, very important to have the trust of the adolescent first before asking questions here. During this discussion, it also is crucial to ask about any history of being touched inappropriately...the sexual/physical abuse question. I also enjoy having questions being thrown my way as I feel it is an indicator the adolescent takes this topic seriously.
S - Suicide/Depression/Mood Screen: It is during this time I try to get a sense of how the child is feeling and ensure there is someone he/she can talk to. This is also where I explore any self-harm issues...the potential risk of suicide.
So for all the parents who have been asked (or will be asked) out of the room during their adolescent's physical exam, I hope this gives a bit of insight and understanding of what occurs as it serves as the best opportunity to assess your child's overall well-being and safety.
Dr. Jeremy
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I started showing signs of depression when I was 17 and a senior in high school. My parents were quick to take me to our family doctor. He ran many tests but I never was given a medical or psycholigical diagnosis. Just rest until I felt better, which I eventually did. The next episode was at the end of my freshman year in college. Same routine. I was not diagnosised with clinical depression until 16 years later and the real diagnosis of bipolar came another two years later.
If the family doctor who I saw at 17 had the tools you have, I think alot of my suffering could have been eased. I would have had issues in each of your groups you assess. Especially with my mother suffering from severe depression & anxiety all my life.
As I think of my three children, I am always on the look out for these signs with our strong family history of mental illness. My oldest son had drug issues and had bipolar that he denies. But was diagnosised my a pediatric psychiatrist when he was 14. I see depression on my 20 year old that I am having an impossible time reaching him.
My 14 year is now having some of the signs of depression the past 2-3 months and headaches and stomach problems which she is missing school because of.
I would be extremely grateful for a healthcare provider to take the time to look at these issues when they are in a doctors office as part of the visit.
As a parent, sometimes the only time the child is being evaluated is in these brief visits. Like my 20 year old, I can't force anything on him. I can only talk about the issues in his life and hope something I say is reaching him. And for his to know his parents are supportive of him.
KEEP UP THE GOOD AND IMPORTANT WORK FOR OUR CHILDRENS MENTAL HEALTH!!!
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Ella
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Ella
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