Do two or more of the following apply?

• Loss of enthusiasm

• Constant tiredness

• Difficulty sleeping

• Loss of appetite

• Poor concentration

• Falling school performance no

Continued on next page rGo to chart Adolescent weight problems (p.139)

see your doctor within 24 hours

Possible cause and action Your child may have a serious mental health problem that needs early treatment to prevent difficulties relating to social skills and education. Your doctor may arrange for your child to be admitted to hospital for assessment. Your child may be given drug treatment to control the symptoms and counselling to deal with any underlying problems.

Have these symptoms lasted less than 2 weeks?

Has your child talked about or threatened suicide?

Go to chart School difficulties (p.9

Patient confidentiality

An adolescent may avoid consulting a doctor for fear that information will be passed on to his or her family. However, your child should be aware that doctors are bound by rules of confidentiality. Even if a child is under age 16, a doctor will maintain confidentiality as long as he or she is convinced that the child has a mature outlook and is fully capable of making informed decisions on health matters, including contraception. Doctors cannot disclose personal information given to them by a patient over the age of 16 without the consent of the patient. The only exceptions are in situations where the information is needed by the police in relation to a serious crime or to safeguard other people.

yes no

Possible cause and action Your child may be depressed. Talk to him or her to see if there is an underlying problem. offer your support and encouragement, and try to reduce or remove any sources of stress that may be worsening the problem. If your child is no better in a week or so, consult your doctor. He or she may recommend counselling or family therapy. In some cases, treatment with antidepressants is recommended.

possible cause and action Adolescence is a period full of emotional highs and lows. As long as a low mood does not last long or seem overly intense, there is no cause for concern. Try not to make a fuss about your child's behaviour. Encourage your child to talk to you or to friends about his or her feelings. Consult your doctor if your child's symptoms continue to be worrying.

call your doctor now

Possible cause and action Your child may be severely depressed and need urgent medical assessment. Suicide threats should always be taken seriously, even if they have been made repeatedly. If your doctor is unavailable, call a local support line immediately (see Useful addresses, p. 311). Teenage suicide attempts are often impulsive and may follow family quarrels or the breakup of a relationship. These attempts rarely indicate a determined wish to die; however, your child may need to be admitted to hospital to prevent self harm and to begin treatment for depression.

Continued from previous page

Does your child seem particularly apprehensive or tense much of the time?


Is your child worried about a problem, such as exams, difficulties with friends, or parental separation?

no yes noj

Do any aspects of your child's behaviour suggest drug or solvent abuse or the excess use of alcohol?

yes no possible cause Drug or solvent abuse (below) may be causing your child's behaviour problems.

action Talk to your child, to try to find out whether he or she is using drugs or solvents. Explain the dangers of drug abuse, and try to provide your child with support. If your child is unwilling or unable to stop or denies drug usage, you should consult your doctor or a self-help group (see Useful addresses, p.311).

Is your child's behaviour aggressive or violent, or is he or she breaking the law?

Are you concerned that your child may be sexually active? no yes

Possible cause and action If possible, try to talk to your child about your concerns. Regardless of your opinion about his or her actions, you should make sure that your child is aware of the risk of an unwanted pregnancy and of sexually transmitted infections (see Sex and health, p.32). Your child is entitled to confidential medical care from a doctor even if he or she is under 16 (see Patient confidentiality, opposite).

Has your child stopped following his or her treatment plan for a long-standing medical condition?

Consult your doctor if you are unable to find an explanation for your child's behaviour on this chart and your child continues to behave in a worrying way.

possible cause Most adolescents experience periods of anxiety. This is a cause for concern only if it is severe enough to interfere with day-to-day functioning.

action Talk to your child, and try to discover any underlying worries that he or she has. Offer your support and understanding. It may help to talk to your child's teachers. If your child's anxiety does not ease with time and extra support, consult your doctor. He or she may recommend counselling or family therapy.

possible cause and action Your child's anxiety may be a symptom of depression. Talk to your child about his or her feelings, and offer your support and understanding. If the symptoms persist for more than 2 weeks, without an obvious cause, consult your doctor. He or she may recommend counselling or family therapy.

j possible cause If your child is persistently antisocial or disruptive, he or she may have a conduct disorder. Consult your doctor.

action Your doctor may refer your child to a specialist for assessment. Counselling or family therapy will probably be recommended. However, long-standing behaviour problems may be difficult to change.

possible cause and action A reluctance to follow the treatment plan for a long-standing disease, such as diabetes mellitus or asthma, is common in adolescents, even if they have previously been responsible. This is usually due to a child's resentment of being different from others or the need to feel in control of his or her life. Talk to your child, but do not get aggressive or angry. Explain the dangers of not taking a prescribed medication as advised. You should also consult your doctor, who may be able to help by talking to your child. He or she may recommend counselling.

Recognizing drug and solvent abuse

You are unlikely to discover any physical evidence that your child is taking drugs unless he or she wants you to do so. Most adolescent drug users will use the drugs they buy immediately or will be careful to hide any evidence. Behavioural changes are often the only clues. You should bear in mind, however, that most teenagers experience mood swings and other behavioural changes as a normal part of adolescence.

Although different drugs have different effects, the most common signs of regular drug or solvent abuse are:

• Behavioural changes, such as unusual mood swings, irritability, or aggressiveness

• Lying and/or secretiveness about activities

• Lethargy, sleepiness, or drowsiness

• Falling school performance

• Loss of interest in friends or usual activities

• Altered sleep patterns

• Inability to account for money spent

• Disappearance of money or belongings If you suspect that your child is abusing drugs or solvents, choose a good time to discuss your concerns. If your child denies drug or solvent use or seems unable or unwilling to stop, consult your doctor or a self-help group (see Useful addresses, p.311).

[53 Problems with puberty in boys

The time when a child goes through the physical changes involved in becoming an adult is known as puberty. on average, most boys start puberty at 12 years of age; however any age between 9 and 15 years is considered normal. The earliest sign of puberty is usually enlargement of the penis and testes. other signs of puberty include the ability to ejaculate seminal fluid, the growth of body and facial hair, and deepening of the voice. In boys, the adolescent growth spurt does not tend to occur until puberty is well established. occasionally, puberty may be associated with a temporary enlargement of breast tissue (see Breast development in males, below), which can be embarrassing but is no risk to health.


Is your child showing any of the following signs of puberty?

• Enlargement of the penis and testes

• Pubic hair growth

• A deepening voice

• Frequent erections

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