Adolescent Care Research Articles

Assessing the resilience of HIV healthcare services provided to adolescents and young adults after the COVID-19 pandemic in the city of Beira (Mozambique): an interrupted time series analysis

BackgroundThe COVID-19 pandemic has put the provision of health services globally at risk. In Sub-Saharan Africa, it had a major impact on HIV services. However, there is a lack of data on the post-pandemic period. This study aims to evaluate the resumption of HIV services and retention in care for adolescents and young people in the period following the COVID-19 pandemic.MethodsA retrospective cohort study was conducted using interrupted time series analysis. Three periods were considered: pre-pandemic (form June 2019 to March 2020), pandemic (form April 2020 to March 2022) post-pandemic (from April 2022 to March 2023). Six outcome measures were considered: number of outpatient visits, HIV tests, HIV positivity ratio, the antiretroviral treatment (ART) non-adherence ratio, recall ratio, and the return ratio for adolescent and young adults on ART.ResultsDuring the study period, 447,515 outpatient visits and 126,096 HIV tests were recorded. After a reduction at the beginning of the pandemic period, both visits and tests increased during the pandemic (p < 0.05) and decreased in the post-pandemic (p < 0.05), recovering the pre-pandemic trends. The HIV positivity ratio slightly decreased from 3.3% to 1.7% during the study period (p < 0.05). The ART non-adherence ratio decreased from 23.4% to 2.4% throughout the study period (p < 0.05), with a drop at the beginning of the post-pandemic period (p < 0.05). The recall ratio increased during the study period (p < 0.05) with a drop at the beginning of the pandemic and post-pandemic periods (p < 0.05). The return ratio decreased at the beginning of the pandemic (p < 0.05) but returned to the pre-pandemic ratio in the post-pandemic period.ConclusionsThe post-pandemic values of the investigated outcomes were comparable to pre-pandemic period, or even improved. Differently from other services, such as the community activities, that have been severely affected by COVID-19 pandemic, the HIV service system has shown resilience following emergency situation.

Pediatric to Adult Transition in Inflammatory Bowel Disease: Consensus Guidelines for Australia and New Zealand.

The incidence of pediatric inflammatory bowel disease (IBD) is rising, and there is an increasing need to support adolescents when they transition to adult care. Evidence supports the use of a structured transition process but there is great variation across Australasia. The study aim was to develop evidence and expert opinion-based consensus statements to guide transitional care services in IBD. A modified UCLA-RAND methodology was employed to develop consensus statements. An IBD expert steering committee was formed and a systematic literature review was conducted to guide the drafting of consensus statements. A multidisciplinary group was formed comprising 16 participants (clinicians, nurses, surgeons, psychologists), who anonymously voted on the appropriateness and necessity of the consensus statements using Likert scales (1 = lowest, 9 = highest) with a median ≥7 required for inclusion. Patient support groups, including direct input from young people with IBD, informed the final recommendations. Fourteen consensus statements were devised with key recommendations including use of a structured transition program and transition coordinator, mental health and transition readiness assessment, key adolescent discussion topics, allied health involvement, age for transition, and recommendations for clinical communication and handover, with individualized patient considerations. Each statement reached median ≥8 for appropriateness, and ≥7 for necessity, in the first voting round, and the results were discussed in an online meeting to refine statements. A multidisciplinary group devised consensus statements to optimize pediatric to adult transitional care for adolescents with IBD. These guidelines should support improved and standardized delivery of IBD transitional care within Australasia.

Assessing the Knowledge and Comfort Level of US Family Medicine Residents Regarding Consenting and Confidentiality in Adolescent Health Care.

Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.

Removing Barriers and Honoring Autonomy: Rethinking Mental Health Professional Assessments in Adolescent Gender-Affirming Medical Care.

Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC. MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum's criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively.

Youth and Guardian Expectations of Privacy in Adolescent Health Care

PurposeAdolescent access to confidential care is codified by most states with age-specific laws; however, adolescent and guardian awareness of these laws are poorly understood. In this study, we assessed adolescent and guardian perceptions of conditional confidentiality in health care. MethodsWe surveyed youth aged 11–18 years, and guardians accompanying youth seeking care at an urban adolescent outpatient clinic that provides adolescent primary and subspecialty care. Participants completed brief True/False surveys which queried whether a parent would be notified for common, hypothetical scenarios. We analyzed adolescent responses by age group and compared responses of adolescents and guardians. ResultsTwo hundred seventy nine adolescents and 178 guardians completed the survey. Among participants, 86% of adolescents and 67% of guardians believed they understood which health topics were confidential. Adolescent and guardian answers aligned with mandatory reporting laws for scenarios concerning safety and suicidality. Younger adolescents consistently underestimated their legal right to privacy for all hypothetical scenarios. Many adolescents anticipated disclosure to parents for confidential services, including contraception, pregnancy, and sexually transmitted infection testing. Guardians expected disclosure about sexual health services at higher rates than they did about substance use. DiscussionWe identified age-associated knowledge gaps among participants pertaining to adolescent privacy in the clinical setting. These deficits were found in a setting where adolescent privacy is routinely discussed, and our findings may underestimate the knowledge gap in the general pediatric population where confidentiality may not be discussed as often. Providers caring for adolescents share the responsibility of educating both youth and families about the importance of adolescent confidentiality.

Effect of adding Schroth physiotherapeutic scoliosis specific exercises to standard care in adolescents with idiopathic scoliosis on posture assessed using surface topography: A secondary analysis of a Randomized Controlled Trial (RCT).

Adolescent idiopathic scoliosis (AIS) is a three-dimensional structural asymmetry of the spine and trunk affecting 2-4% of adolescents. Standard treatment is observation, bracing, and surgery for small, moderate, and large curves, respectively. Schroth exercises aim to correct posture and reduce curve progression. This study aimed to determine the effect of Schroth exercises added to the standard care compared to standard care alone on torso asymmetry in AIS. In a randomized controlled trial (NCT01610908), 124 participants with AIS (age: 10-18, Cobb: 10°-45°, Risser: ≤3) were randomly assigned to the control (Standard care only) or Schroth (Standard care + Schroth treatment) group. Schroth treatment consisted of 1-hour weekly supervised sessions and 30-45 minutes of daily home exercises for six months. The control group received Schroth exercises in the last six months of the 1-year monitoring period. Markerless 3D surface topography assessed torso asymmetry measured by maximum deviation (MaxDev) and root mean square (RMS). Intention to treat linear mixed effects model analysis was compared to the per protocol analysis. In the intention to treat analysis, the Schroth group (n = 63) had significantly larger decreased RMS (-1.2 mm, 95%CI [-1.5,-0.9]mm, p = 0.012) and MaxDev (-1.9mm, 95%CI [-2.4,-1.5]mm, p = 0.025) measurements compared to controls (n = 57) after six months of intervention. In the per protocol analysis (Schroth n = 39, control n = 36), the Schroth group also had a significantly larger decrease compared to the control in both the RMS (-1.0mm, 95%CI [-1.9, -0.2]mm, p = 0.013) and MaxDev measurements (-2.0mm, 95%CI [-3.3,-0.5]mm, p = 0.037). For the control group, both the intention to treat and per protocol analysis showed no difference in RMS and MaxDev in the last six months of Schroth intervention (p>0.5). Schroth Exercise treatment added to standard care (observation or bracing) reduced asymmetry measurements in AIS. As expected, a greater effect was observed for participants who followed the prescribed exercise treatment per protocol.

Enablers and barriers to primary health care access for Indigenous adolescents: a systematic review and meta-aggregation of studies across Australia, Canada, New Zealand, and USA

BackgroundIndigenous adolescents access primary health care services at lower rates, despite their greater health needs and experience of disadvantage. This systematic review identifies the enablers and barriers to primary health care access for Indigenous adolescents to inform service and policy improvements.MethodsWe systematically searched databases for publications reporting enablers or barriers to primary health care access for Indigenous adolescents from the perspective of adolescents, their parents and health care providers, and included studies focused on Indigenous adolescents aged 10–24 years from Australia, Canada, New Zealand, and United States of America. Results were analyzed against the WHO Global standards for quality health-care services for adolescents. An additional ninth standard was added which focused on cultural safety.ResultsA total of 41 studies were included. More barriers were identified than enablers, and against the WHO Global standards most enablers and barriers related to supply factors – providers’ competencies, appropriate package of services, and cultural safety. Providers who built trust, respect, and relationships; appropriate package of service; and culturally safe environments and care were enablers to care reported by adolescents, and health care providers and parents. Embarrassment, shame, or fear; a lack of culturally appropriate services; and privacy and confidentiality were common barriers identified by both adolescent and health care providers and parents. Cultural safety was identified as a key issue among Indigenous adolescents. Enablers and barriers related to cultural safety included culturally appropriate services, culturally safe environment and care, traditional and cultural practices, cultural protocols, Indigenous health care providers, cultural training for health care providers, and colonization, intergenerational trauma, and racism. Nine recommendations were identified which aim to address the enablers and barriers associated with primary health care access for Indigenous adolescents.ConclusionThis review provides important evidence to inform how services, organizations and governments can create accessible primary health care services that specifically meet the needs of Indigenous adolescents. We identify nine recommendations for improving the accessibility of primary health care services for Indigenous adolescents.

Promoting evidence-based care for children and adolescents on the autism spectrum

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that has been increasing in worldwide prevalence,1 including Singapore. In this latest issue of the Annals, we share the latest Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents, discussed by Wong et al.2 This is the culmination of the tremendous effort of cross-sectoral professionals coming together to generate recommendations of practice for the community, aspiring in goals of using high-quality evidence to promote high-quality care for families and children on the autism spectrum. The first CPG on ASD in Preschool Children was published in March 2010,3 and the current updated version presents an opportunity to extend the guidelines to adolescents, as well as bring together more professionals within other non-health sectors to participate in its shaping. We highlight some of the key features of the CPG in tandem with evolving and important issues pertinent to practitioners in Singapore in the field of ASD.

2023 clinical practice guidelines on autism spectrum disorder in children and adolescents in Singapore

Introduction: Autism is a neurodevelopmental condition that is increasing in prevalence worldwide. There has been an exponential increase in autism-related research since 2010, when the first Singapore Clinical Practice Guidelines (CPG) on autism was published. Understanding of autism has since evolved to adopt a lifespan approach beyond that of a childhood condition. The aim of this CPG was to provide an updated set of recommendations for children and adolescents to aid clinical practice for professionals. Method: A multidisciplinary workgroup that comprised representatives from various sectors worked on this CPG. Clinical questions were organised into 10 different sections, each with its own subgroup of members. Seventeen existing international guidelines were evaluated using the Appraisal of Guidelines for REsearch &amp; Evaluation II (AGREE-II) framework, of which 4 met criteria to act as references. Literature review across multiple databases was conducted between January 2011 to 2023; Grading of Recommendations, Assessment, Development and Evaluation (GRADE-like) methodology was used to synthesise evidence. Recommendation statements were derived, following Delphi-style consensus surveys among the workgroup. The draft guidelines underwent external review and public consultation before being formalised. Results: Recommendation and good practice statements pertaining to care of children and adolescents on the autism spectrum across 10 different sections were developed. Evidence matrices complement these recommendations and detail relevant evidence behind each recommendation statement. Conclusion: It is intended for these guidelines to promote effective management and healthcare services for children and adolescents on the autism spectrum, by reinforcing good and evidence-based clinical practice within our national context.

Determination of factors influencing the retention in HIV care of adolescents during the Covid-19 pandemic in Lusaka Zambia

Background: Adolescents (ages 18-24) living with HIV are prone to disengagement from care, risking health deterioration and viral transmission. Identifying key barriers to adolescent retention is crucial for intervention development. This study aims to explore barriers and facilitators to adolescent HIV care retention. In Zambia, where 32% of 15–17-year-olds and 60% of 18–19-year-olds are sexually active, with low condom use rates, the risk of HIV and STIs is high. Despite Ministry of Health strategies, many HIV-positive adolescents in Zambia struggle with adherence. This study sought to investigate how various factors interact to influence HIV retention among adolescents in Lusaka, Zambia, employing an adapted Andersen framework. Its objectives include understanding factors impacting HIV retention, analysing predisposing factors, and examining health system influences on adolescent HIV care retention in Lusaka, Zambia. Methods: The study was conducted at University Teaching Hospital (UTH), Chilenje Hospital, and Chawama, Mtendere, and Kalingalinga) clinics in Lusaka, Zambia. Non-probability sampling, specifically purposive sampling, was employed. Semi-structured questionnaires were used for data collection and the quantitative data was analyzed using STATA 16.0. Findings will be disseminated through healthcare community, policy circles, among stakeholders and shared with UNZA's library. Ethical approval was obtained from The University of Zambia Biomedical Research Ethics Committee (UNZABREC) and permission from the Zambia National Health Research Authority (ZNHRA). Informed consent was obtained from participants, emphasizing voluntariness and the right to withdraw. Anonymity, confidentiality, and privacy was strictly upheld throughout the study. Results: The results highlight the nuanced nature of factors influencing adolescent retention in HIV care, emphasizing the importance of predictors such as education level, alcohol intake, belief in HIV cure through prayers, and perception of HIV as a significant life problem. The findings align with prior studies, warranting further exploration of support networks and experiences of non-engaged adolescents. Conclusion: In summary, this study makes a significant contribution to public health research by delving into the intricate factors impacting adolescent retention in HIV care in Lusaka, Zambia. The findings, aligned with research inquiries and existing literature, shed light on education, substance use, and psychosocial aspects. These insights lay the groundwork for tailored interventions, highlighting the significance of patient-centered strategies. Moreover, the study emphasizes the necessity for continued exploration of support networks, disclosure challenges, and broader societal dynamics affecting healthcare engagement. This insight informs future research endeavors aimed at enhancing the well-being of adolescents living with HIV. Recommendations include improve medication access through mobile services, provide financial aid integrated with counseling, personalize adherence plans, involve social networks, respect religious beliefs, address geographic disparities, monitor long-term health, and pilot targeted interventions. Policies should establish guidelines for medication access and financial assistance.

ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards.

ESCAP statement on the care for children and adolescents with gender dysphoria: an urgent need for safeguarding clinical, scientific, and ethical standards.

Sustainable action is needed more than ever: the European Society for Child and Adolescent Psychiatry welcomes the efforts of the European Commission and the decisions of the European Parliament on mental health care for children, adolescents and young people and calls on the Member States to act quickly.

Sustainable action is needed more than ever: the European Society for Child and Adolescent Psychiatry welcomes the efforts of the European Commission and the decisions of the European Parliament on mental health care for children, adolescents and young people and calls on the Member States to act quickly.

Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional Practices.

The care of adolescents in reclusion has been a field of work for occupational therapists in different parts of the world. The objective of this study was to describe and analyze Brazilian occupational therapists' practices with adolescents in reclusion. Research conducted in Brazil, identifying 56 professionals, invited to answer a questionnaire (n = 43); participate in discussion groups (n = 9); and interview (n = 4). Professionals reported different visions that guide their practices, including the identification of individual skills and the profession's possibilities for social action. Occupational therapists have specificities to work in these institutions, highlighting the possibilities of acting with a focus on social change. Practices in occupational therapy can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements that inform the profession. Reflections on the practice carried out, according to a critical perspective, enable a performance in occupational therapy that intends social change.

Improving supportive, palliative and end of life care for teenagers and young adults with cancer in adult haematology services.

Adolescents with haematological malignancies within adult services, in the UK from 16years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.

Treatment Effects of Introducing the Neurosequential Model of Therapeutics in a Norwegian Residential Treatment Facility for Children Aged 7–13

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child’s unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy.

Confidentiality in the Care of Adolescents: Policy Statement.

Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.

Confidentiality in the Care of Adolescents: Technical Report.

Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.

Effects of modafinil on nocturnal sleep patterns in patients with narcolepsy: A cohort study

BackgroundPatients with narcolepsy often experience disturbed nighttime sleep. Modafinil is commonly prescribed for hypersomnolence, but its impacts on nocturnal sleep remain unclear. This study uses actigraphy to examine the effect of modafinil on both hypersomnolence and nocturnal sleep patterns in patients with narcolepsy. MethodsPrior to treatment, 87 patients with narcolepsy wore an actigraphy for 7–14 days to assess their nighttime sleep. After evaluation, they received a daily dose of 200–400 mg of modafinil in the morning and wore an actigraphy again six months after initiating treatment. Questionnaires, including the Epworth-Sleepiness-Scale (ESS), the Visual-Analogue-for-Hypersomnolence (VAS), and the Short-Form-36-Health-Survey (SF-36), were used to evaluate hypersomnolence and quality of life both before and after treatment. Paired t-tests and independent samples t-tests were used for pre- and post-treatment comparisons and subgroup analysis. We used the Pearson's correlation test to measure the correlations between the sleep parameters of the actigraphy and data of the questionnaires. ResultsImprovements in hypersomnolence were noted following modafinil treatment, and we observed no significant deterioration in nocturnal sleep parameters by the actigraphy. The total number of awakenings by actigraphy significantly decreased (p = 0.005), especially in females (p = 0.008), while sleep onset latency significantly increased in children/adolescents (p = 0.014). Correlations were found between the sleep parameters of the actigraphy and ESS, VAS, and SF-36 scores. ConclusionModafinil treatment may not worsen nighttime sleep in patients with narcolepsy. However, it should be administered with care in children and adolescents.

Self-management including exercise, education and activity modification compared to usual care for adolescents with Osgood-Schlatter (the SOGOOD trial): protocol of a randomized controlled superiority trial.

Osgood-Schlatter is the most frequent growth-related injury affecting about 10% of physically active adolescents. It can cause long-term pain and limitations in sports and physical activity, with potential sequela well into adulthood. The management of Osgood-Schlatter is very heterogeneous. Recent systematic reviews have found low level evidence for surgical intervention and injection therapies, and an absence of studies on conservative management. Recently, a novel self-management approach with exercise, education, and activity modification, demonstrated favorable outcomes for adolescents with patellofemoral pain and Osgood-Schlatter in prospective cohort studies. The aim of this trial is to assess the effectiveness of the novel self-management approach compared to usual care in improving self-reported knee-related function in sport (measured using the KOOS-child 'Sport/play' subscale) after a 5-month period. This trial is a pragmatic, assessor-blinded, randomized controlled trial with a two-group parallel arm design, including participants aged 10-16 years diagnosed with Osgood-Schlatter. Participants will receive 3 months of treatment, consisting of either usual care or the self-management approach including exercise, education, and activity modification, followed by 2 months of self-management. Primary endpoint is the KOOS-child 'Sport/play' score at 5 months. This protocol details the planned methods and procedures. The novel approach has already shown promise in previous cohort studies. This trial will potentially provide much-needed level 1 evidence for the effectiveness of the self-management approach, representing a crucial step towards addressing the long-term pain and limitations associated with Osgood-Schlatter. Clinicaltrials.gov: NCT05174182. Prospectively registered December 30th 2021. Date of first recruitment: January 3rd 2022. Target sample size: 130 participants.

Adolescent gender dysphoria management: position paper from the Italian Academy of Pediatrics, the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, the Italian Society of Adolescent Medicine and the Italian Society of Child and Adolescent Neuropsychiatry

BackgroundIn response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD.Main bodyRecognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care.ConclusionMaintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents.