Chapter 97

### Introduction

The feeling of apartness from others comes to most with puberty, but it is not always developed to such a degree as to make the difference between the individual and his fellows noticeable to the individual.

W Somerset Maugham (1874–1965), Of Human Bondage

Adolescence is the transitional period of development between relatively dependent childhood and relatively independent adulthood. The time of onset and duration varies from one person to another but it is generally considered to occur between the ages of 10 and 19 years.1 It is a critical period of transition in the human lifespan, marked by rapid growth and physical and mental changes second only to infancy.

While biological changes drive this transition, the duration and characteristics of adolescence can vary depending on cultural and socioeconomic settings. Adolescence has also altered over the past century, occurring earlier and being influenced by societal changes such as later marriage, increased urbanisation, global communication, information technology, social networking and changing sexual attitudes and behaviours.1,2

Adolescent patients require special understanding and caring from their family doctor. They can present very challenging and sometimes confronting issues. A profound increase in mental health issues (particularly mood disorders)3 in adolescents has exacerbated the frequency of challenging adolescent consultations in general practice. Another common difficulty is establishing rapport and trust with adolescents, who may be trying to break away from the adult world to establish their own sense of adult self, so it can be vitally important to address confidentiality issues. Actively raising and clarifying confidentiality parameters and doing so at the beginning of the consultation can greatly assist the interaction with an adolescent patient.

In recent times, reference is made to the young person in the context of health policies. Young people are defined as those between the ages of 12 and 24 years and youths as those between 15 and 24 years.2 Some 18% of the population are young people, and they tend to have a low rate of GP visits; if they do visit, it is usually for physical reasons, despite the fact that the largest health burden for adolescents is actually mental health issues.

Early adolescence (10–14 years): ‘Am I normal?’

This stage is dominated by adjustment to physical and psychosexual changes and by the beginnings of psychological independence from parents. Girls generally advance through this stage more rapidly than boys.

Middle adolescence (14–17 years): ‘Who am I?’

Middle adolescence is a time when boys have caught up physically and psychologically with girls, so that peer group sexual attractions and relationships are common preoccupations at this stage. It is a phase of peer group alliances, clothes, music, jargon and food and drink. The average age for first sexual intercourse ...

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