İnterviewing with adolescents

Prof Dr Müjgan AlikaşifoğluCerrahpaşa Tıp Fakültesi

Çocuk Sağlığı ve Hastalıkları Anabilim DalıAdolesan Bilim Dalı

Developmentally oriented approach

• In the course of interviewing and evaluating the adolescent, the health care provider should be conscious of the adolescent’s developmental process and tasks.

• Evaluative expectations should be based on the stage of emotional development the adolescent has attained.

• Early or middle adolescents, certainly cannot be expected to think and behave as logically as adults.

• These are sample questions regarding various adolescent tasks:

Body image• “Do you have any questions or problems with

the physical changes you are experiencing?”• “Do you like yourself as you are?”

Peer relationships• “Who is your best friends?”• “How many close friends do you have?”• “What do you do for fun?”Independence• “Do you get along with your parent?”• “Over what issues do family arguments

occur?”

Identity• “Are you satisfied with the way things are

going for you?”• “If you could change certain aspects of your

life, what would you do and why?”• “What are your plans for the future?”

Sexuality• “Are you dating?”• “Do you have questions or concerns about

sexual activities, contraception….?”

• We use HEADSSS interview to obtain psychosocial/developmental information

It covers:• Home• Education• Activities• Drugs• Sexuality• Suicide• Safety

• An advantage of this approach is that the practitioner moves from less personal questions to more personal and potentially threatining questions.

• Home:• “Where is the teen living?”• “Who lives with the teen?”• How is the teen getting along with parents and

siblings?”• “Have there been any recent moves?”

Education• Is the teen at school?• What is the teen good and bad at in school?• What classes are particularly interesting or boring?• What grade average the teen maintain?• Has the teen repeted or failed any classes?• Has the teen received any suspansion?• How is the teen getting along with teachers?• What goals does the teen have when he or she finishes

school?

• If the teen is older or out of school, the practitionaire should ask about employment

Activities• What does the teen do after school?• What does the teen do to have fun and with whom?• Does the teen participate in any sports activities?• Community activities?• What reading does the teen do?• What music does the teen like?• What are the teen’s hobbies?• Does the teen have friends?• A best friend?• How much time does the teen spend watching TV or playing

computer games or searching internet?

Drugs• What types of drugs are used by the teen’s

peers?• What types of drugs do family members use?• What types of drugs does the teen use and in

what amount and frequency?

Sexuality• Is the teen dating?• What are degree and types of sexual

experiences?• Is the teen involved with another individual in a

sexual relationship?• Has the teen had sexual intercourse?• If yes: ow old was the teen in his or her first

sexual intercourse?

Suicide• Has the teen had any prior suicide attempts?• Does the teen have any current suicidal ideation?• It is very appropriate to ask direct questions about

suicidal ideation, such as “Have you ever thought about killing yourself? Or have you ever tried? Or Would you kill yourself? Or Do you have a plan?

• Direct questions do not precipitate suicidal action and are the best way to obtain such information.

Sexual or physical abuse.• In any teen who has significant problems in

any of the previously mentioned areas, it is critical to ask about physical or sexual abuse

This includes:• Individual with run away behavior• Significant family disfunction• Change in school grades• Lack of friends• Substance abuse• Early onset of sexual activity• History of suicide attempt

Physical examination• The physical examination provides an

excellent opportunity to educate the adolescent about his or her changing body. For example, female adolescent may be taught to performe routin breast examinations

• or young male adolescent may be reassured about genital development

• Who should be present during the physical examination?

• Some adolescent prefer to have the parent present• The teen could be asked first whether he or she

prefered that the parent be in the room during the examination.

• Particularly younger adolescents and developmentally delayed adolescents may wish to have a parent with them.

• Male doctors should use a chaperon during the breast and genital examination of female patients.

• Theoritically, the same concept would hold for a female examinner during genital examination of a male, although this usually has not occured in clinical practice.

Closure

• At the close of the initial or follow-up visit, the health care provider should address the following issues:

• Provide a brief summary of the proposed diagnosis and treatment, addressed primarily to the adolescent.

• Parent who accompany the adolescent to the visit should be included in a final discussion of the nonconfidential issues, so that they can help support the plans.

• Discuss any other resources available to the adolescent

• Allow the adolescent time to discuss any final questions or concerns

• Schedule any follow up appointments• Inform the adolescent that the health care

provider is available at other times.