Ethics and adolescent care: an international perspective.

PURPOSE OF REVIEW: This update reviews the concepts underlying ethical issues in various contexts and countries, highlighting the evolution in the use of the core values underpinning the field and practice of bioethics as applied to healthcare. RECENT FINDINGS: It stresses the specific position of the adolescent as being a unique individual searching for autonomy and, most of the time, being competent to make decisions regarding the adolescent's own health. It briefly outlines the principles of a 'deliberative' approach in which the practitioner, while keeping in mind the legal context of the country where the practitioner is working, assesses to what extent the adolescent can be considered as competent, and then discusses with the adolescent the medical and psychosocial aspects of the various actions to be taken in a situation, as well as the basic ethical values linked with each of the various options available. The deliberation can involve relevant stakeholders, provided the issues concerning confidentiality have been fully discussed with the adolescent. SUMMARY: This process forces the practitioner, the adolescent patient and those who care for the adolescent patient to look outside their usual frameworks and make a decision that is in the best interest of the young person, and is informed by various ethical values.

Reading comprehension, word decoding and spelling in girls with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (AD/HD): performance and predictors.

BACKGROUND: Difficulties with aspects of literacy are often seen in children with autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (AD/HD). The bases of the connections between these disorders and literacy difficulties are poorly understood. Furthermore, it is not clear if existing research is representative for girls. AIMS: There were three aims: (1) to compare performance in reading comprehension, word decoding, and spelling in girls with ASD (n = 20), AD/ HD (n = 36), and community girls with typical developing (girls; n = 54); (2) to assess rates of reading and writing disorders within groups; and (3) to examine the predictive value of measures of autistic and AD/HD symptomatology to reading comprehension in the whole girl sample. METHODS & PROCEDURES: Participants were aged between 8 and 17 years, and had a full scale IQ>70. Standardized tests of literacy, oral vocabulary, and non-verbal ability were administered. Parent ratings of degree of autistic symptomatology and both parent and teacher ratings of AD/HD symptomatology were collected for all girls. OUTCOMES & RESULTS: Girls with diagnosed ASD could not be separated significantly from typically developing girls or girls with AD/HD on average performance on any literacy test. However, among girls with ASD, 40% had at least one reading and writing disorder. Girls with AD/HD performed lower than typically developing girls in reading comprehension, word decoding, and spelling, and 56% had at least one reading and writing disorder. In regression analysis, using the total sample, both degrees of autistic and AD/HD symptomatology negatively contributed to the variance in reading comprehension after controlling for oral vocabulary, word decoding, and non-verbal ability. Whereas AD/HD contributed to the variance in reading comprehension once autistic symptomatology was controlled for, the opposite was not true. However, a large bivariate correlation between autistic and AD/HD symptomatology somewhat complicates the interpretation of that result. CONCLUSIONS & IMPLICATIONS: The findings highlight the importance of monitoring and supporting the literacy development in girls with ASD or AD/HD. Results from regression analyses suggested that word decoding and/or oral vocabulary training may not be sufficient for the girls fully to overcome difficulties in the important skill of reading comprehension.

Addressing ethical dilemmas in the clinical care of adolescents: an international view.

This chapter reviews some basic concepts underlying ethical issues in adolescence and provides a step-by-step procedure to address ethical dilemmas involving minor adolescents, based on a deliberative approach. "Deliberation" with the patient, along with involving the opinion of relevant stakeholders if possible, allows for a careful, multidisciplinary examination of all options, the medical and psychosocial consequences, and the moral values stressed by each option. Although the final decision regarding which ethical option should be chosen usually belongs to the health care providers and his or her patient, the deliberative approach provides the ingredients for sound, unbiased decision-making.

Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: a qualitative study.

BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age). METHODS: Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis. RESULTS: Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network. CONCLUSIONS: Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.

Parenting styles and treatment of adolescents with obesity.

Professional caregivers have an important task in building a trusting relationship with parents and adolescents and in supporting parents in their parental roles. Our clinical experience of some 300 adolescents with obesity between 9 and 18 years of age and their parents has convinced us that consideration of parenting styles is fundamental in the treatment of children and adolescents with obesity. Typical case situations supporting the significance of parenting styles and illustrating the relationships between parents and adolescents with obesity can be identified. Group sessions with parents are the preferred mode for discussing typical parenting issues in the management of obese adolescents. The purpose of this paper is to describe different parenting styles, and to present a set of typical case situations and treatment strategies for nurses working with adolescents with obesity.

Adolescent health, school health activities, community contexts, and health surveys in Sweden.

School health activities have been very important in improving adolescent health in Sweden for almost 200 years. In the 1800s, emphasis was on medical services. Vaccination programs and medical examinations became the key issues. Deterioration of adolescent health in the 1960s changed the objectives of both school education and health services to health promotion. Important members of the community followed suit and involvement of the local community has remained a hallmark, even though the extent and direction varies. The subsequent period was characterized by substantial improvement in adolescent health behavior. The latter years of the 1980s and the 1990s saw deterioration of adolescent health behavior. Less emphasis on health promotion, decentralization of school health responsibility from physicians to administrators, and heavy savings directed toward schools were important mediators. Adolescents were also more engaged in international youth cultures with liberal practices, such as drug use. Community surveys of adolescent health behaviors have proven to be important in mobilizing broad local involvement in adolescent health promotion. The lesson learned is that health promotion has to involve as many community members as possible. Coordinating resources and having unified objectives is cost efficient

Suicidal thoughts related to psychoactive substance abuse among adolescents.

The enquiry of suicide is of particular importance. According to WHO statistics suicide in people aged from 15 to 24 years has shown the greatest increase of relative mortality. In the group of suicidal adolescents, depression, behavioural disorders, abuse of different substances and personality deviations are frequent factors in presence. The aim of our investigation was to determine the correlation between psychoactive substance abuse and the occurrence of suicidal thoughts in adolescents. The specific "Q 2000" test was used to question 600 adolescents, from Tuzla and Sarajevo Cantons, with the same gender and age distribution and rural-urban ambient. The more prevailing suicidal idea occurrence was observed in cannabis abusers (50.0%) and alcohol abusers (36.6%) in comparison to non-abusers regardless gender and/or living ambient (settlement types) (19.5% and 17.6% per each, x2 = 17.184 p = 0.00001). The augmentation in number of suicidal ideas was not observed in tobacco smokers.