Adolescent Screenings and Evaluations
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.
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:
Education and employment
Safety from injury/violence
Doctors will usually use this tool, which includes lots of questions in each category, in a quiet environment.1
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
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
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
- Call the National Suicide Prevention Lifeline (NSPL) at 1-800-273-TALK (8255)
- Text the Crisis Text Line by texting "HOME" to 741741
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
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.
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
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:
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 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.
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:
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
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