Adolescent Trends Research Articles

Is the adult emergency department really adults only?

AbstractObjectivesTo quantify the use of an adult emergency department (ED) by paediatric patients and identify the acuity and spectrum of these presentations.To determine the seniority and paediatric experience of emergency department staff involved with these patients.To address the appropriateness of the paediatric guidelines in an ‘adult only’ emergency department.SettingThe Royal Melbourne Hospital, an ‘adult only’ metropolitan tertiary hospital with 40,000 ED presentations annually and an admission rate of 30%.MethodsPaediatric (18 years and under) ED attendances were recorded retrospectively over 12 months. Prospective data were then gathered for two weeks on acuity, clinical data and disposition for each patient as well as seniority and extent of paediatric training of medical staff involved.ResultsPaediatric patients accounted for 3.9% of presentations in the retrospective study and 2.8% in the prospective study. In the younger age groups, paediatric patients were of higher acuity, with greater admission rates and less trauma than average, with opposite trends in adolescents. Amongst the adolescent group the rate of patients ‘who did not wait’ was double that of the general ED population. Most patients (74%) were managed by staff with no paediatric training. Australasian College for Emergency Medicine (ACEM) advanced trainees were the most confident in managing children.ConclusionsPaediatric patients do present to this ‘adult only’ ED. In this setting medical staff experience and training in paediatric management is variable. Suitable training and guidelines should be considered to address this issue. This study supports the ACEM requirement for paediatric training and has implications for emergency medicine paediatric training and Continuing Medical Education programs in the future. Multicentre studies, incorporating patient outcome data, would further clarify these issues.

Developmental trends in adolescents' psychological and legal competence to consent to abortion.

United States Supreme Court has affirmed the right of states to require parental consent or notice from minors seeking abortion. We examine an underlying presumption that minors are not competent to consent to abortion. Participants (N=75 age 13–21, seeking a pregnancy test at a women's medical clinic) completed an interview that was audiotaped and scored on four cognitive and volitional criteria of legal competence. Competence was compared in three age groups (≤15; 16–17; 18–21) for participants who considered abortion and for those who did not. Adolescents age 16–17 and adolescents ≤15, who considered abortion, appeared as competent as legal adults; only≤15-year-old adolescents who did not consider abortion appeared less competent. Regression analysis was used to identify psychosocial predictors of competence. Results challenge the presumption that minors are not competent. An alternate policy based upon informed consent and empowerment of minors as decision makers is proposed.

From sincerity to authenticity: adolescents' views of the "true self".

This study examined age-related trends in adolescents' view of sincerity and of honesty towards oneself. Subjects were 84 high school students in grades 8 to 12 (age range 12-18). Semistructured interviews with preplanned probes were used and analyzed using content categories reflecting different emphases on disclosing "facts" versus internal events (for sincerity) and on recognizing conflicts with others versus recognizing internal divisions (for honesty towards oneself). Results indicate clear age trends on these two dimensions and a close association between them. The age trends suggest that for the younger adolescent, being "genuine" consists mainly in disclosing facts that are in principle accessible to others. For the older adolescent, being genuine more frequently implies recognizing and expressing one's "true" nature. The findings are discussed both in light of recent research on the development of self-understanding and as challenging traditional paradigms of studying the self.