It's obvious that adolescence spans the transition from childhood to adulthood and accepted as a time when teens establish their identities by testing boundaries and trying on different adult behavior patterns. Yet they're still kids, one researcher told the annual meeting of the American Academy of Family Physicians in San Francisco.
    "It's easy to realize that three-year old needs adult guidance and supervision," said Alison Warford, MD, medical director for Face to Face Clinic in St. Paul, Minn.
    "It's just as easy to forget that a 6'2", 180 lb teen's brain is going through the most rapid transformation since the very first year of life," she said. "Brain development has a tremendous impact on adolescent thought, behavior, and outcome. They may look adult, but they don't think or act adult."
    Not surprisingly, most health issues during the adolescent years involve risk taking or poor choices. Teens have behavioral, not biomedical, risks. Three-quarters of adolescent deaths are behavior-related: accidents (51.7%), assaults (13.7%), and suicide (11.0%). Biomedical problems such as obesity, diabetes, and hypertension are also related to behaviors such as poor dietary choices or drug/alcohol/tobacco use.
    "Working with teens is a model for family medicine's holistic mission," Dr. Warford said. "Because the adolescent health problems we most often encounter deal with behaviors, we ask about the whole person, their environment, their family, their emotions."
    Every visit is a vital opportunity to screen for potentially risky behaviors and intervene. Adolescents with repeat office visits are more likely to be at risk. At the same time, many teens are reluctant to enter a physician's office.
    "There might be a reason kids keep coming back to see you," Dr. Warford explained. "You need to find out. We don't generally do a very good job of screening teens for the risks they face."
    Every visit should include screening questions on home, family, school, activities, drugs, safety, sex, and suicide or depression. Since patient contact time is limited, it helps to structure visits and use a checklist to be sure to touch on all important topics.
    It is vital to focus the visit on the teen, not on his or her parent. That means shaking hands with the teen first and talking to him or her even if the parent tries to control the conversation.
    At least part of every visit should be spent with the teen under a promise of confidentiality, Dr. Warford added. Anything said in confidence must remain in confidence unless it represents a clear and immediate danger, she added.
    "This is not going to be a 15-minute exam, especially in the early years," she cautioned. "You have to watch scheduling."