Adolescent Screenings and Evaluations

iStock-488712310

What are Adolescent Screenings?

Why are adolescent screenings so important? How do they help children heal and stay well?

Adolescent screenings are used by health professionals to assess the overall health of a child and to pinpoint problems to treat.

Why are Screenings Important?

Some of the most serious problems that adolescent screenings highlight are obesity, depression, risky sexual activity and STIs, gender issues, substance abuse, and environmental violence. We will discuss all those issues in this article.

How Adolescent Screenings Help Children Heal?

Once problems are found during screenings appropriate treatment plans can be made and healing can begin. The screening allows health professionals to zero in on the most important issues and make sure those are treated first.

Video: Talking about health with your child

HEEADSSS Screening Tools

Doctors and mental health professionals use a series of questions they call "tools" to gather a patient's psychosocial history. One popular assessment tool is the HEEADSSS assessment.1

This screening method has gone through several updates over the years. Doctors used to call it HEADSS, but greater awareness for social issues that affect adolescents have meant doctors have added new letters to the term.1

HEEADSSS stands for:

Home environment

Education and employment

Eating

Peer-related activities

Drugs

Sexuality

Suicide/depression

Safety from injury/violence

Doctors will usually use this tool, which includes lots of questions in each category, in a quiet environment.1

Example Questions

Examples of some of the questions a doctor may ask include:

H: What are your relationships like at home? Have you ever run away?
E: Is your school a safe place? Have you ever felt bullied at school?
E Have you had any recent changes in your weight? What would you feel like if you gained or lost 10 pounds?

A: What do you do for fun? How often do you use the Internet?
D: Do any of your friends or family members use alcohol or drugs? Do you use tobacco or drugs?
S: Have you ever been in a romantic relationship? Are you interested in girls or boys, or are you not yet sure?

S:Do you find you are feeling more stressed or anxious than you usually do?
S: Have you ever met or plan to meet up with a person you met online? Is there a lot of violence in your home or school?

Usually, a parent is not present as their presence could affect how honestly and comfortably the child answers. Trust and confidentiality are very important to an adolescent, and most doctors will make many efforts to provide this to their young patients.

Screening for Childhood Obesity

Childhood obesity is defined as a body mass index at or above the 95th percentile. This percentile depends upon a young person's age and sex.

Statistics on the Adolescent Obesity Problem

According to the Centers for Disease Control and Prevention (CDC), the number of adolescents and children who are obese has tripled over the past 50 years.2 Nearly 20 percent of all young people ages 6 to 19 years old is obese.

Risks and Complications

Some of the known risk factors for childhood obesity include the following:2

Family history of obesity

Metabolism, which is the amount of calories a person burns in their daily life

Neighborhood safety

Physical activity

Short sleep duration

Childhood obesity can affect a young person's health as well as their overall sense of well-being as an adolescent.

Management and Prevention

Managing adolescent obesity often requires a coordinated effort among the adolescent, parents, and teachers. Sometimes, their pediatrician may also be involved.

Both management and prevention involve teaching young people to adopt healthier habits at as young an age as possible. Examples of these habits include:2

Eating a variety of fruits and vegetables

Avoiding beverages and foods that are higher in sugars and solid fats

Getting 30 minutes to an hour of physical activity most days a week

Ideally, there is easy access to healthy foods and safe places to exercise and get physical activity. However, this is not always the case for all young people.

More About Childhood Obesity

Coming Soon

Screening for Depression

Identifying young people at risk for depression is important to intervening early to help prevent self-harm.

Statistics on Adolescent Depression

The number of adolescents who experience depression and anxiety has consistently increased over time, according to the CDC.3 Doctors have diagnosed an estimated 8.4 percent of adolescents with depression and anxiety.

Suicide and Self-Harm Risks

Sadly, suicide is one of the top three causes of death for those in their adolescent years, according to an article in the journal Contemporary Pediatrics. If you or someone you know experiences thoughts of suicide, you can

  1. Call the National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255)
  2. Text the Crisis Text Line by texting "HOME" to 741741

Video: Adolescent Depression

00:01 >> KATHRYN DELONGA: Hi, my name is Dr. Kathryn DeLonga. I am a licensed clinical psychologist and director of the psychological treatment program with the Mood Brain and Development Unit. Our lab is located within the Emotion and Development Branch of the National Institute of Mental Health at the National Institutes of Health in Bethesda, Maryland. I have nothing to disclose. All the opinions I am presenting are my own and they not intended as a substitute for medical or psychological diagnosis or treatment. And all this work is supported by the National Institute of Mental Health Intramural Research Program. 00:30 The Mood, Brain and Development Unit is a lab that studies adolescent depression and is led by Dr. Argyris Stringaris. We work to improve understanding and treatment of adolescent depression. In this short webinar, I�ll be talking a little bit about major depression�what it is, how frequently we see it in young people, signs and symptoms, and next steps if you think someone you care about may be experiencing depression. Major depression is an illness of brain circuitry and chemistry that causes and results from 01:00 changes in mood, thinking, motivation and behavior. The core symptoms of mood changes are irritability or sadness and difficulty feeling pleasure. And all these symptoms can be clustered into these groups. Some so changes in thinking, some changes in mood, and some physical symptoms. And sadness is something we all experience. It's a normal reaction to a loss or a setback but then passes with time. Depression is different. There is a range of symptoms that might start sticking around, more days than not, for multiple 01:33 weeks at a time. Symptoms include: Feeling sad, anxious, or empty, feeling irritable much of the time, loss of interest or pleasure, feeling worthless, helpless, guilty, withdrawing from friends and family, grades dropping, risky behaviors, thoughts of death, suicide, or self-harm, difficulty concentrating, remembering information, or making decisions, eating or sleeping more or less than usual, feeling loss of energy, constantly tired, feeling restless, having 02:00 trouble sitting still, and aches, pains, headaches, stomach problems. And you might not experience all these symptoms or may not even have multiple ones at the same time, but for more days than not, for multiple weeks, you might experience a range of some of these things. Major depression is among the world's leading causes of illness and disability. It's one of the most common mental disorders in the United States. What we know is that it rises during adolescence. 02:30 In 2016, just under 13% of the US population ages 12-17 experienced at least one major depressive episode. In childhood, rates of depression are generally low, with equal numbers across boys and girls. In adolescence, a time of vast physical, brain, and social changes, there is a sharp rise in the rates of depression, particularly among girls. And while race or sexual orientation are not predictors of depression, social isolation, bullying and a persistent fear of being targeted or not feeling supported or accepted for one's 03:01 race, gender identity or sexual orientation are. When we think about what causes major depression, we know that it's a brain disorder that affects circuits and chemistry. We know that depression can be genetic - it often runs in families - but that it is a combination of genes and environment that contribute to a first major depressive episode, and that sometimes if parent or another family member in a household is depressed, a teen may be more vulnerable to depression. Stressful life experiences, such as abuse or being bullied or an injury can be factors 03:32 that lead to depression, and additionally medical or psychological factors--endocrine disorders, substance abuse, underlying anxiety or learning issues can all lead to major depression. Without treatment, recurrence is likely. We often think of adults with major depression as having an onset during the teenage years. Depression is something that can wax and wane but often does come back without treatment. 04:05 So what are some of the treatments. Treatment may include psychological or "talk" therapy - such as cognitive behavioral therapy, which addresses thoughts and behaviors or interpersonal therapy that addresses relationships, social skills, grief, and role transitions in life, or attachment-based family therapy. Additionally, for moderate or severe depression, sometimes medications can be helpful. 04:31 The strongest evidence currently in treating depression in adolescents is for the selective serotonin reuptake inhibitors or SSRIs such as fluoxetine or sertraline, and medication may be effective when paired with psychological therapy such as cognitive behavioral therapy or CBT as this has been shown to be protective against possible side effects of medication-alone. For things to consider when choosing a mental health professional, see: https://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml 05:01 So what are the steps if you are interested in getting help. First is to talk with your parent or guardian, or trusted adult, OR text the word "safe" and your current location to 4HELP (44357) to be connected with a live mental health professional. Step 2 is to make an appointment with your doctor for an evaluation to ensure there is 05:30 no medical or safety issues that need to be addressed and to talk about what you are experiencing and ask for a referral to a mental health professional. If you are considering harming yourself or if you are in a crisis right now talk to your parents or a trusted adult. Reach out to trained counselors through these free, confidential resources, available 24 hours/day, 7 days/week: Call this toll-free number for the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). The service is available to everyone - if you are in crisis yourself or concerned about someone else. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential. 06:00 You can also visit the Lifeline's website at www.suicdepreventionlifeline.org. The Crisis Text Line is another free, confidential resource available 24 hours a day, 7 days a week. Text "Connect" to 741741 and a trained crisis counselor will respond to you with support and information over text message. Visit www.crisistextline.org. The Trevor Project has a 24/7 national crisis intervention and suicide prevention lifeline for LGBTQ young people at 1-866-488-7386. Or you can call 911 or go to your nearest emergency room if you have concerns for your safety. And if you know someone who you are worried about who might be in crisis right now. 06:31 Be there. Listen carefully to what the person is thinking and feeling. If you have concerns about their safety, ask, "Are you thinking of killing yourself?" Research has shown that asking at-risk individuals does not increase suicides or suicidal thoughts. Inquire about a plan. Remove access to lethal means such as making sure guns are locked away and making sure medications are locked away. 07:04 Help them connect to a crisis line counselor, health professional or trusted adult. Stay connected and follow-up. If you are someone watching right now who is experiencing depression, we encourage you to reach out for support. Depressive disorder is one of the most common mental disorders in the United States. 07:30 You are not alone. Sometimes living with depression can seem overwhelming, so build a support system for yourself. Talk to family members, friends, and your doctor. Reach out for help. And please feel free to visit us for more information and to learn more about some of our studies and treatment programs that we are offering for teenagers experiencing depression. Thank you for your time.

Signs of Depression

Depression is different from just feeling sad from time to time. Someone with depression may experience the following symptoms:4

These are just some of the steps that a prevention program may include to help prevent sexual violence.

Feeling sad and often anxious most of the time

Experiencing feelings of helplessness or hopelessness

Feeling worthless

Changes in grades, friendships, or enjoyment in activities

Sleeping more than usual, yet still feeling tired

Unfortunately, some adolescents who struggle with depression may also experience suicidal thoughts or thought of self-harm.

Treatment Options

Treatments for adolescent depression include therapy, especially cognitive-behavioral therapy. A doctor may also prescribe antidepressants. However, doctors don't usually prescribe certain types of antidepressants (especially tricyclic antidepressants) to adolescents.

More About Adolescent Depression

Sexual Education

According to Planned Parenthood, sexual education in adolescence can help young people avoid early effects of sexual activity.5 This includes pregnancy and sexually transmitted diseases.

What Does it Mean to be Sexually Active?

Being sexually active means more than having sexual intercourse (although it means that too). A sexually active person engages in several forms of sexual stimulation. These can include oral sex, dry humping, fingering, handjobs, or other sexual stimulation forms.

The Benefits of Comprehensive Sexual Education

Sexual education from parents, teachers, healthcare providers, and other trusted authority figures can help to prevent risky behaviors whenever possible. Examples of health goals include:

STD prevention

Pregnancy prevention

Education on how to prevent HIV transmission

Early Childhood and Continuing Sexual Education

Using age-appropriate terms and education for sexual education, even at an early age, can help a young person develop a healthier sense of their sexual health and well-being.

Addressing Sexual Violence

Working to prevent sexual violence whenever possible requires addressing all the potential factors that can lead to sexual violence. Examples include:

Don't use drugs or alcohol to get someone to have sex or to agree to have sex

Avoid objectifying men and women or stereotyping them

Recognize that silence does not mean a person is consenting to mis-treatment, abuse, or violence

Stay with friends

Refrain from accepting a drink from an unknown person or putting your drink down

These are just some of the steps that a prevention program may include to help prevent sexual violence.

Screening for STIs

Doctors will usually recommend that all sexually active individuals be screened for STIs, including HIV, gonorrhea, and chlamydia.

Why Adolescents are Responsible for 50% of All New STIs

Adolescence is a time of significant physical exploration -- and this includes sexual exploration and experimentation. Because adolescents may not have access or education about the effects of sexual experimentation, they face higher risks for pregnancy and sexually transmitted infections (STIs).

Strategies for STI prevention

STI prevention strategies include using condoms when engaging in sexual activity. Also, emphasizing monogamy and regular testing can help treat and prevent STIs.

Educating adolescents about where they can receive free STI testing is important. Examples include local health departments and many non-profit community health resources.

More About Child Sexual Activity

Screening for Gender Issues

Issues facing Transgender Children

An estimated 0.17 to 1.3 percent of adolescents identify themselves as transgendered, according to an article in the journal Adolescent Health, Medicine, and Therapeutics. 6 Experiencing early gender issues can affect the ability to form identity. Without support, a young person can face issues that include anxiety, depression, and fear.

Mental Impact of Gender Dysphoria

According to an article in the journal Adolescent Health, Medicine, and Therapeutics, higher numbers of adolescents are seeking treatment for gender dysphoria in the United States.6 Those with gender dysphoria may experience some of the following thoughts and emotions:

Feel they are not the same gender assigned at birth

Wish to live their lives as another gender

Wish to be rid of their sexual characteristics

Those thoughts and emotions are troubling to many children and require proper treatment to avoid problems stemming from gender issues. The most important thing is to have open and honest discussions so that the child can explore their gender identity is a safe environment. Medical professionals can then help the entire family through the challenges caused by gender dysphoria.

Puberty Blockers

Puberty blockers can suppress puberty by using medications that may prevent the development of characteristics that are decidedly either male or female. The idea behind taking these medications is that a young person can have more time to explore their gender dysphoria.

Puberty blockers, such as testosterone or estrogen blockers, are not a permanent solution to gender identity concerns. Instead, a child can take these medications for one to two years as they undergo treatments, such as therapy.

More About Gender Issues

Screening for Environmental Violence

Environmental violence puts an adolescent at greater risk for injuries, accidents, and self-harm. However, some adolescents may fear disclosing their experiences at home for fear of harming a parent or sibling.

Understanding Violence

Violence involves physical force that can mentally or physically harm a person. Beyond the immediate effects, violence can have long-lasting impacts on a person's life.

There are a number of types of violence that may impact an adolescent. These include:

Fighting

Threats

Attempting to harm others

Cruelty toward animals

Destruction of another person's personal property

Impact of Abuse from Parents

Childhood abuse can create significant instability and uncertainty in a young person's life. They may never feel safe, and this can affect their ability to grow both physically and emotionally.

Children who experience abuse from parents are less able to cope with stress and form positive relationships with others. In an evaluation and assessment setting, a doctor may recognize that an adolescent may have anger problems as well as difficulty showing care and affection toward others.

Impact of Hunger and Poverty

According to an article in the journal Canadian Family Physician, neglect is the most common child abuse type.7 Neglect includes not providing enough food, clothing, or shelter to a child to help them feel safe. While parents do not likely wish to live in poverty, its effects can impact a young person's mental health.

Impact of Community Violence

Living in an environment with a high level of violence can make a child live in fear and feel unsafe.

More About Environmental Violence

Screening for Substance Abuse

Just as adolescents are more likely to engage in sexual exploration, they're also more likely to experiment with drugs and alcohol.1 Unfortunately, abusing substances can increase the risks for motor vehicle accidents and death.

Statistics on Adolescent Drug Use

In a survey of adolescent drug use by the National Institute on Drug Abuse, researchers found there were lower rates of prescription opioids and cigarette smoking over the past five years.8 However, vaping is on the rise in adolescents. This includes the use of vaping marijuana.

When asked about alcohol, the following grades reported past-month use of alcohol:8

8th Graders:
%
10th Graders:
%
12th Graders:
%

In terms of binge drinking (drinking four or more drinks in one sitting), rates have fallen among adolescents between 2014 and 2019.

The Dangers of Mixing Substances

Adolescents may not be as educated on the dangers of using multiple substances. These include mixing the following substances:

Adderall and Alcohol

Xanax and Alcohol

These combinations can increase the likelihood of alcohol sickness or other complications related to substance abuse.

How to Identify Adolescent Drug Use

One of the ways to identify adolescent drug use is to simply ask about what drugs or medications a young person has experimented with. They may also ask about a young person's family history of alcohol, tobacco, or drug abuse as this can increase the risks that a young person will also abuse drugs or alcohol.1

How to Treat Adolescent Drug Use

Treating adolescent drug use today not only helps prevent immediate risks for injury and overdose, but it also helps to prevent long-term complications and struggles with addiction.

Treating adolescents in environments where they are with other people their age can help them relate to the struggles they face and how to overcome them. Doctors may use therapies and sometimes medications to help a young person stop abusing drugs or alcohol.

More About Adolescent Substance Use Disorder