Asperger Syndrome in Adolescence: A Clinical Conundrum Complicated by DSM-5.

Asperger syndrome is a term used to provide a description of individuals with a normal or above normal intelligence but with limited social skills and stereotypic mannerisms. Although their language skills are normal, a variety of comorbidities can be seen including attention-deficit hyperactivity disorder, sleep disorders, depression, violent tendencies, anger, anxiety, and/or psychosis. It has been formally excluded from the American Psychiatric Association’s Diagnostic Statistical Manual of Mental Disorders (DSM-5) as of 2013.This article considers principles of management of youth with Asperger syndrome that includes supportive counseling, psychotherapy, and in some situations, psychopharmacology. Clinicians who care for adolescents can help their adolescent patients achieve useful lives even with a diagnosis of Asperger syndrome. The DSM-5 omission does not mean that this condition has disappeared nor will it cease to be a confusing, clinical conundrum for clinicians caring for youth.

Diabetes in adolescent patients: diagnostic dilemmas.

The classification of diabetes mellitus by types (1 or 2), or by age of onset (juvenile or adult), helps to clarify many aspects of pathophysiology, prognosis, and therapy. However, less-commonly encountered patients, presenting in childhood or adolescence, may not fit neatly into one or the other group. These include teenagers who present with new-onset diabetes with ketoacidosis, but who are later able to be managed permanently as type 2 patients. Other adolescent patients present with only minimal glucose intolerance, then proceed to develop type 1 diabetes, with evidence of autoimmune etiology, after a variable number of years. Four patients are presented to illustrate these diagnostic dilemmas.

Substance abuse: a pediatric concern.

Use of alcohol, tobacco, and other drugs is a worldwide problem and affects many children and adolescents. The use of opiates, cannabis, tobacco, and alcohol have been well recognized for centuries in India. Abuse of alcohol is widespread in college campuses. In the United States, in 1997, 54.3% of high-school students had used an illicit drug by the time they entered 12th grade. In India the use of drugs and alcohol within the context of religious beliefs and local traditions has been historically documented. Children & adolescents are exposed to alcohol, cannabis products, and tobacco product. Several risk factors and protective factors have been identified. A screening psychosocial history is the most useful tool to identify non-specific indicators of substance abuse. In India the use of pan masala, and home brewed products containing marijuana and alcohol have special significance. Pan masala is shown to have carcinogenic, genotoxic, and clastogenic properties. The pediatrician can play a vital role in the appropriate recognition and early referral.

Enuresis: current concepts.

Incontinence disorders are an important group of problems that clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, etiologic concepts of incontinence disorders, a general clinical approach to enuretic patients, laboratory evaluation and general principles of management. Neurological and nephrological concepts of enuresis are emphasized in this discussion.

Reproductive health: an international perspective.

The twentieth century began with approximately 1.6 billion human beings in the world and, with an increase of 96 million people per year, will end with over 6 billion people. Unless this trend is directly confronted by the world governments and their citizens, there will be nearly 8 billion by 2025 and over 11 billion by 2050. Thus, reproductive health is and will remain an issue of critical importance for all countries to realize and study. Part of this trend is because of the many pregnancies which occur in adolescents around the world. A number of issues have developed this century contributing to the many pregnant teenagers. For example, India has one of the world's largest populations of teenagers--over 23 million, representing over 26% of the total in the world. Effective methods for contraception and sexually transmitted diseases prevention are available, but not to all sexually active humans. However, many barriers to effective contraception exist around the globe. This article discusses some of them and also reviews use of contraceptive methods in various countries. These include oral contraceptives, emergency contraceptives, injectable and implantable contraceptives, intrauterine devices, barrier contraceptives and others. Reproductive health remains a critical, universal issue for all humans in the world. We all must examine the many pitfalls to controlling the world's populations, including lack of sex education, limited access to effective contraceptives, and others. We cannot afford to let the population continue unchecked. Effective strategies are needed at this time; otherwise, the population will continue to run out of control, negatively damaging the world for the coming generations. There is need to leave a positive, and not negative legacy for the next generation.