Adolescent Medicine

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Adolescent Medicine

Throughout its history, the field of adolescent medicine has striven to address the needs of the whole person from a variety of psychological, sociological, and physiological perspectives, not simply diseases or disorders that affect adolescents. Currently, the trend in adolescent health care has been to go even further beyond the disease paradigm and examine not only health risks but also assets in the environment that contribute to an adolescent's physical and emotional well-being.

The field began in the early twentieth century with the work of G. Stanley Hall, a developmental psychologist who firmly established adolescence as a distinct developmental category. Hall was also the first to suggest establishing a field of medicine for adolescents. Yet a new medical specialty dedicated to this age group did not appear until the 1950s, when adolescent medicine first emerged as a branch of pediatrics. The first medical unit in the United States devoted exclusively to adolescents was founded by Dr. J. Roswell Gallagher at Boston Children's Hospital in 1951. The Adolescent Unit represented a major shift in approach to the teenage patient: prior to the 1950s, most physicians who treated adolescents discussed the patient's health problems with the parent, and seldom allowed young people to speak for themselves. In contrast, Gallagher and his staff insisted that teenaged patients needed "a doctor of their own" who would see patients separately from their parents, who would protect their confidentiality, and who would place teenagers' concerns first.

The Boston Adolescent Unit served as a model for other hospitals in North America. By the mid-1960s, there were fifty-five adolescent clinics in hospitals in the United States and Canada, and by 2002 over half of all children's hospitals in the United States had units dedicated to the health care of teenagers. The expansion of adolescent health services led to the creation of a professional organization for adolescent specialists, the Society for Adolescent Medicine (SAM), established in 1968; the founding of a professional journal, The Journal of Adolescent Health, first published in 1980; and the decision in 1991 to institute a board-certification examination for physicians interested in becoming subspecialists in adolescent medicine.

Despite this dramatic growth in the field of adolescent medicine, there still is a critical shortage of age-appropriate health services for American teenagers. A report entitled Partners in Transition: Adolescents and Managed Care, issued in 2000 by Children Now, a national nonprofit child policy organization based in Oakland, California, provides an overview of the gaps in adolescent health care that still exist in our society. The report states that twenty percent of teenagers surveyed had gone without medical treatment they thought they needed because there were no appropriate services in their community, because they lacked transportation to medical facilities, and/or because they feared their parents would be notified if they sought medical care.

In addition, since the 1960s, adolescents have engaged in behaviors that placed them at risk for new health problems. Changing social norms during this period exposed teenagers to new "social morbidities" such as sexually transmitted diseases, drug addiction, violence, and pregnancy. Although these problems have affected the population as a whole, they appear to affect teenagers disproportionately and may be responsible for the fact that adolescent mortality has risen since 1960, while mortality for other age groups has declined.

Adolescence as a social category also appears to be both disappearing and expanding. Children are exposed to violence, sexuality, and other "adult" themes at ever earlier ages. There is even evidence that children are literally "growing up" faster than ever before, since improved health care and nutrition has caused a steady decline in the age of puberty. At the same time, growing numbers of young adults are living with parents for longer periods of time because of unemployment, divorce, graduate education, loneliness, or the high cost of housing. Since the late 1960s, the number of adult children living with parents has more than doubled from 2 million to 5 million, and it is estimated that nearly 40 percent of all young adults have returned to their parents' home at least once. Therefore, it appears that the period of economic dependency usually associated with adolescence is expanding into the twenties, and for some individuals, the thirties and forties. The Society for Adolescent Medicine responded to these changes in both the biological and social features of adolescence by recently adopting a position statement that declared that adolescent medicine covered the ages of ten to twenty-five, with some members even arguing that the field should be extended to cover the late twenties and early thirties.

Experts in adolescent medicine have also attempted to deal with the complex issues that continue to plague adolescents. One of the major goals of the National Longitudinal Study of Adolescent Health (Add Health), the Search Institute, and other institutions dedicated to improving adolescent health has been to reconceptualize health as more than the absence of disease or risk, but also in terms of assets in family and community that help young people engage in positive behaviors. Researchers involved in these studies have helped communities around the country begin initiatives that bring together families, schools, youth-serving organizations, congregations, and other institutions "to build the foundation of development that all young people in our society need."

Since its inception, the field of adolescent medicine has led the way in helping to ensure that all adolescents have access to quality medical care, regardless of race, gender, sexual orientation, or socioeconomic status. Adolescent specialists argue that giving teenagers age-appropriate care not only helps eliminate the most troubling adolescent health problems, such as pregnancy and substance abuse, but can also prevent adult health problems by educating young people about the importance of lifelong healthy habits.

See also: Adolescence and Youth.

bibliography

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Brumberg, Joan Jacobs. 1988. Fasting Girls: The Emergence of Anorexia Nervosa as a Modern Disease. Cambridge, MA: Harvard University Press.

Brumberg, Joan Jacobs. 1997. The Body Project: An Intimate History of American Girls. New York: Random House.

Elkind, David. 1998. All Grown Up and No Place to Go. Reading, MA: Addison-Wesley.

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Hall, G. Stanley. 1904. Adolescence: Its Psychology and Its Relation to Physiology, Anthropology, Sociology, Sex, Crime, Religion, and Education. New York: Appleton.

Hall, G. Stanley. 1905. "Adolescence: The Need of a New Field of Medical Practice." The Monthly Cyclopaedia of Practical Medicine, n.s., 8: 242.

Halpern, Sydney. 1988. American Pediatrics: The Social Dynamics of Professionalism 1880-1980. Berkeley: University of California Press.

Jones, Kathleen W. 1999. Taming the Troublesome Child: American Families, Child Guidance, and the Limits of Psychiatric Authority. Cambridge, MA: Harvard University Press.

Lesko, Nancy. 1996. "Past, Present, and Future Conceptions of Adolescence." Educational Theory 46: 453-472.

Prescott, Heather Munro. 1998. "A Doctor of Their Own": The History of Adolescent Medicine. Cambridge, MA: Harvard University Press.

Resnick, Michael D., et al. 1997. "Protecting Adolescents from Harm: Findings from the National Longitudinal Study on Adolescent Health." JAMA 278/10: 823-832.

Schulenberg, John, Jennifer L. Maggs, and Klaus Hurrelmann. 1997. Health Risks and Developmental Transitions During Adolescence. Cambridge, UK: Cambridge University Press.

Society for Adolescent Medicine. 1997. "Clinical Preventive Services for Adolescents: A Position Paper of the Society for Adolescent Medicine." Journal of Adolescent Health 21: 203.