Editing Session 8: Life cycle 2 - adolescence

===Goals===
*This session will concentrate on the normal aspects of age and adolescent development.

===Objectives===
*Become familiar with normal school age and adolescent development.
*Appreciate the difference between early and late adolescence in cognitive and emotional development.
*Conceptualize adolescence as preparation for adult functioning.
*Discuss issues such as confidentiality in the context of a medical interview.
*Identify risk-taking behavior and associated decision making in adolescents; try utilizing the value matrix (description follows)
*Understand some of the stressful life events that adolescents experience and how they impact physical and emotional well being.

===Study Questions===
*Without attempting to memorize the specifics, how would you characterize the physiologic changes of puberty in relation to those associated with the psychosocial development of adolescence?
**Happening to them versus trying to gain control.

*More specifically, in what manner do the physical changes in development of sexual characteristics relate to the emotional and cognitive changes in teens as they develop over the course of adolescence?
**One of the things that strikes me is how both physical changes and psychological are a comparison and competition between the internal (self) and the external (society).

*Peers are said to play a major role in the adolescent period. What are some of those influences and how do you think they might affect the care of a teen in your practice?
**Drugs, sex and violence and rock'n roll.

*What is meant by "risk taking behavior"?  What is its relevance to medical care?  Give two examples from your experience with friends, classmates or family members.

*Be prepared to discuss the factors in the misuse or rejection of contraceptives and how they relate to adolescent development.

===Focus Questions===
*What are your favorite after school social activities?
*What do you do with your friends on the weekends?
*Identify and describe your favorite teacher. Why is he/she your favorite teacher / mentor?
*What kind of grades do you get in school?  Is school easy for you?  Why or why not?
*Do you feel safe in school?
*Have you ever tried drugs or alcohol?  Do other kids in your class use drugs or alcohol?  How frequently?
*Tell us about your family.  With whom do you live?  (If parents are divorced, ask how that has affected them, their grades, relationship, etc.)
*Do you have a job?  Tell me about it. Does it effect the time you spend studying?
*How important is religion in your life?
*What are your plans following high school graduation?
*What happens in your family if you or someone else gets sick?
*How often do you see a doctor?  What makes the visit a successful or “good” visit?
 
===Activities===
*Briefly interview a student to explore some or all of the focus questions as well as areas of adolescent life that interest you.  If there are too few students to go around interview in pairs.
*Use the value matrix to look at one fact of decision –making that comes up in your interview.
*Obtain the student’s Past Medical History, Social History, and Family History.
*Record your encounter on Angel in the Clinical Encounter Tracking section.

===Readings===

====The gist====
*Kids develop something like this: me and mom, me and my body, me and my parent of opposite gender, me and my brain, me and my changing body, me and my peers.
*Upon illness, regression occurs.
*The family is an important filter and developmental guidance tool; when it is broken, so is development.

====Life Event Checklist====
*Life stress is correlated with health problems including psychiatric and psychological problems.
*Seems to be true in children, too.
*The '''life events checklist''' for adults has been modified to the '''life experiences checklist''' for adolescents.
*The LEC is a list of events for review by a patient.
*The LEC helps assess what events have occurred and how they have affected the patient's life.
*The validity and reliability of the LEC have been demonstrated by correlation to many factors that indicate emotional and physical wellness.
**Positively correlated negative predictors: visits to the doctor, diagnosable illnesses, biochemical measures of diabetic control, visits to the school counselor, depression, anxiety, emotional 
maladjustment and external locus o f control.
**Positively correlated positive predictors: internal locus of control. 
*The LEC should be used:
**for a closer examination of recent life events,
**in preparation for talking with a caregiver about the patient's life events,
**when planning an intervention to recognize / decrease / deal with stress
***This could include addressing issues like emotional control, problem solving, and working on "maladaptive cognitions".
*The test is pretty self-explanatory.
*Scoring is completed by summing the positive and negative scores separately.
**None = 0; Some = 1; Moderate = 2, Great = 3
*A working "cutoff" for negative score to identify significant negative stress is 16-17.
**This is based on 4 "normal" samples.
*Some examples of questions include:
**Moving to a new home. 
**New brother or sister. 
**Changing to a new school. 
**Serious illness or injury of family member. 
**Parents divorced. 
**Increased number of arguments between parents. 
**Mother or father lost job. 
**Death o f a family member. 
**Parents separated. 
**Death o f a close friend. 
**Increased absence of parent from home. 
**Brother or sister leaving home. 
**Serious illness or injury of close friend. 
**Parent getting into trouble with the law.

====Adolescence and Adulthood====
*This would be a good exercise for the class:
**Have each person read a section.
**Read the case, have them answer if the patient is normal or not.

====Childhood and Adolescent Development====
*See this set of notes: [[Childhood and Adolescent Development]]