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The authors examined the associations between parental variables and child syncope (fainting). Children ages 7 to 18 years undergoing tilt-table testing for neurocardiogenic syncope (NCS) at a pediatric cardiac center served as participants (N = 56). Results revealed that fathers' shortness of breath and overall psychological distress were significantly related to syncope frequency and emergency room (ER) visits for girls. Mothers' overall psychological distress, depressive symptoms, and shortness of breath were associated with boys' frequency of syncope and ER visits. Fathers' psychological factors were highly correlated with syncope for the children diagnosed negative for NCS. The frequency of children's syncope was higher in stepfamilies than in homes with both biological parents, and the correlations between children's syncope and the stepfathers' psychological symptoms were greater than for the children and their biological fathers in intact families. The role of parental psychological factors on child syncope is supported.

The authors examined the association of psychological adjustment, styles of coping, and disease severity for children with recurrent syncope. Participants were 44 children and adolescents with a history of recurrent syncope and 40 healthy comparison control children. Dependent variables were measures of internalizing adjustment (e.g., anxiety, depression, withdrawal) reported by children and their parents and styles of coping reported by children. Parents reported higher frequencies of the internalizing of behavioral symptoms (i.e., anxiety, withdrawal) for children with recurrent syncope compared with their healthy counterparts. Children's self-reports did not reveal significant differences between the syncope and comparison groups in psychological adjustment and styles of coping. The authors conclude from these findings that adjustment difficulties, including symptoms of anxiety and social withdrawal, may occur with recurrent syncope. Implications for clinical practice and future research are discussed.

Social skills and psychological adjustment for survivors of childhood cancer were investigated. Cancer survivors included 42 children and adolescents ranging in age at evaluation from 6 to 18 years with a mean age of 13.1 years. Measures included teacher and parent ratings of social skills and adjustment and parent ratings of family functioning. The findings showed that social skills and psychological adjustment as rated by both parents and teachers were primarily associated with academic functioning. In addition, family cohesiveness was found to account for nearly one third of the variance in survivors' adjustment when rated by teachers, and length of time off treatment accounted for a significant percentage of the variance in children's adjustment when rated by parents. The findings underscore the importance of a multi-informant approach to the assessment of psychological adjustment of pediatric cancer survivors and demonstrate the role of learning difficulties and family functioning in influencing social skills and adjustment for these children and adolescents.

Human sexuality can be defined as including the physical characteristics of and capacities for specific sex behaviors, together with psychosocial values, norms, attitudes, and learning processes that influence these behaviors. It also includes a sense of gender identity and related concepts, behaviors, and attitudes about the self and others as women or men in the context of one's society. At the dawn of the new century, adolescent sexuality remains a topic of concern to adults throughout the world. This concern is not unique to this new age. In each era of recorded history, adults have been concerned about adolescent sexual behavior, particularly sexual intercourse and its consequences. Things have not changed all that much in the realm of adolescent sexual behavior. What has changed is our ability to prevent the serious consequences of this behavior and, hopefully, to help adolescents avoid behaviors that put them at risk for the negative consequences of expressing their burgeoning sexuality. This article reviews the major influences on adolescents developing' sexuality, the data on adolescent sexual activity, some tips on caring for adolescents comprehensively, and ends with some predictions of how this issue will be addressed in the new century.

Levonorgestrel implants (Norplant) and medroxyprogesterone acetate injections (Depo-Provera) represent additional contraception options for adolescents. The purpose of this study was to examine prospectively clinical profiles among adolescents who chose one of the two long-term contraceptives compared with profiles among those who chose the combined oral contraceptive pill (OCP).Girls who needed contraception and did not require confidentiality were presented with a contraceptive menu consisting of Norplant (n = 58), Depo-Provera (n = 66), or OCP (n = 75). At baseline and follow-up visits over 6 months, patients were interviewed regarding gynecologic history, side effect symptoms, and satisfaction. The average age of subjects was 15.5 years (range 11 to 20 years); 66% were African-American and 34% white.Significantly more teens who chose Depo-Provera (73%) reported having used some method of birth control previously than those selecting either Norplant (30%) or OCP (26%). Adolescents who chose either Norplant (34%) or Depo-Provera (43%) were significantly more likely to have been pregnant previously than those choosing OCP (12%). Those selecting Depo-Provera were significantly more likely to report a history of genital infection with Chlamydia trachomatis (42%) than those in the other two contraceptive groups (22%). Prevalences of reported recent depression and fatigue before initiation of treatment were high, exceeding 35% across the three groups. A total of 105 and 40 adolescents were assessed at 3 and 6 months, respectively. At follow-up, more than 80% of OCP users maintained regular menstrual cycles, whereas over 80% of those choosing Norplant or Depo-Provera had disrupted cycles. Complaints of nausea and dizziness among Norplant users and fatigue among Depo-Provera and OCP users increased significantly between the baseline and follow-up visits. Reports of local reactions to the Norplant device were common but not clinically significant. Blood pressure readings, facial acne, and body mass index did not change over time in any treatment group. Subjects in the Norplant and Depo-Provera groups appreciated freedom from daily compliance to maintain contraceptive effectiveness and the "hidden" nature of the method. Appointment compliance at the end of 6 months was 78% for Depo-Provera, 40% for Norplant, and 46% for OCP.The implant and injection forms of contraception appear to be especially popular among girls with previous pregnancies or birth control use. The common occurrences of medical symptoms and sexually transmitted diseases before initiation of therapy underscore the importance of baseline evaluation. Norplant users may be warned about nausea and dizziness as well as minor local symptoms around the insertion site and unpredictable uterine bleeding patterns. Adolescent patients choosing Depo-Provera may expect amenorrhea by the end of 6 months of therapy along with possible fatigue. Early intervention may be needed with adolescents who choose Norplant or OCP to encourage better compliance with follow-up appointments.

From a health care point-of-view, the most needy adolescents in the United States are those who become incarcerated in the juvenile justice system. These youngsters have poor health care before incarceration is not much better. Their health problems range from the results of trauma to the consequences of sexual activity to severe psychological problems. Their health needs include: (1) prevention of health problems which contribute to behaviors for which youths are incarcerated; (2) comprehensive assessment and care; (3) continuity of care after discharge from the institutions; (4) comprehensive health education and health promotion; (5) professional, competent health care providers; (6) educated, sympathetic administrators and supervisory personnel; and (7) adequate financing of health services. Concerned health providers must become advocates for these adolescents and for their health care in correctional and political settings.

Adolescent pregnancy and its consequences continue as major sources of morbidity in the United States. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The physician who cares for adolescents has the responsibility of helping parenting teens to find needed support so that they will be able to overcome this significant hurdle. Attention from public agencies has focused on increasing condom use as one approach to adolescent pregnancy prevention. The major advantage of using condoms is that they also prevent transmission of sexually transmitted diseases. Of note is that level of knowledge about condoms is not related to their use, and engaging in high-risk behaviors is related to a decreased likelihood of condom use. With rates of condom use estimated at less than 50%, rates of sexually transmitted disease remain high, as reported in recent surveys.Sexual activity among adolescents had increased in the US over the past 20 years. Surveys suggest that 14-44% of males and 7-30% of females under age 15 have had sexual intercourse. Risk factors for early sexual activity include low socioeconomic status, low future achievement orientation, and peer and media influence. Surveys indicate, however, that less than 50% of youths use condoms when having intercourse. Both pregnancy and sexually transmitted disease (STD) rates are therefore elevated in these populations in the US. 40% of female American adolescents are impregnated before turning 20 years old; approximately 75% of these pregnancies are unplanned. Of the more than 1 million annual adolescent pregnancies, 400,000 are aborted, 470,000 are born to term, and the rest result in spontaneous miscarriage. Only 5% of those ultimately born are turned over for adoption. The US public annual monetary cost of these unwanted and unplanned pregnancies is estimated to be $20 billion. Teen mothers usually do not finish their education, do not support themselves financially, have failed marriages, produce babies with relatively more health problems, and have more babies grouped close together by age. US adolescents and youths are simply not using contraception effectively. Condoms are especially appropriate and recommended within this age group due to the often sporadic nature and multiplicity of their sexual contacts, as well as the ability of condoms to reduce the risk of both pregnancy and STD transmission. Physicians need to teach and counsel their young clients, and advocate that they receive services targeted to their needs. Finally, any such interventions should be developed with the understanding that the level of knowledge about condoms is not related to their use, and that high- risk sex behavior is related to a decreased likelihood of condom use. Risk prevention efforts should reach young adolescents before they initiate and become accustomed to sexual risk-taking, and aim to change attitudes toward peer beliefs and behaviors; decrease perceived costs; and increase attitudes about the effectiveness of condoms in preventing STDs.

The influence of physiologic, psychologic, and cultural influences on human sexuality is reviewed. These factors are considered in the exploration of how adolescents express their sexuality and the consequences of that expression.

This article describes the various hallucinogens with which adolescents may come in contact. Perspective is provided as to the importance of the various hallucinogens and to their effects on adolescent users.

Adolescents require specialized health care because of their unique developmental needs. The medical or surgical treatment of a disorder may be straightforward and little different from that of a child or adult; but, because of cognitive, physical, and psychosocial stages of development, consideration of these attributes assumes great importance if optimal results are to be achieved. Establishing outpatient and inpatient facilities for adolescents requires meticulous planning and continuing commitment, careful selection of professional staff, elimination of barriers to health care, respect for privacy and confidentiality, and knowledge of laws affecting consent for care. Teenagers are often unsure of themselves, have difficulty relating to adults, and their actions often belie their true feelings. It is necessary to establish rapport and trust with patients and other professionals.

This research tested the hypothesis that in hyperactive children a low dose of methylphenidate (0.3 mg/kg) would produce scores superior to those with a high dose (1.0 mg/kg) or placebo on the matching familiar figures test (MFF), a primary index of impulsivity. The hypothesis was based on an earlier finding that the highest percentage of correct responses on a short-term memory task were found in hyperactive subjects who were receiving 0.3 mg/kg of methylphenidate whereas at 1.0 mg/kg the percentage correct returned to the placebo level. The hypothesis was verified in that the low dose reduced the number of errors on the MFF significantly more than did placebo or the high dose. This work demonstrates that, for both learning and impulsivity in hyperactive children, the lower dose of the two doses of methylphenidate studied produced the preferable effect.

A prospective study was performed to examine the prevalence of pharyngeal gonorrhea in two urban female adolescent populations and to compare pharyngeal infection with a history of orogenital activity and concurrent genital gonorrhea. Group I was drawn from a children's hospital adolescent clinic and group II was drawn from a public health clinic for sexually transmitted diseases. None of the 240 adolescents in group I had a pharyngeal culture positive for Neisseria gonorrhoeae compared with 3.4% in group II. Only 2.5% of group I had genital gonorrhea, but 33% of group II had positive genital cultures. In only two of the 20 patients with pharyngeal gonococcal infection was the pharynx the only infected site. The addition of routine pharyngeal culturing for gonorrhea yielded only 1% additional gonorrhea cases. There was a significant relationship between concurrent genital and pharyngeal gonorrhea. These findings indicate that routine screening for pharyngeal gonorrhea is not productive in some adolescent populations. A more economic approach would be to use gonorrhea treatment that is effective against both genital and pharyngeal gonorrhea or to obtain pharyngeal cultures in those adolescents returning for test-of-cure cultures after antibiotic treatment for genital gonorrhea.

In this article, we have tried to point out ways in which the initial interview can be facilitated, and in which it can be made to be both a pleasant and informative experience for the adolescent patients, and a productive and enjoyable encounter for the practitioner. The major areas include appropriate attitudes of personnel and the physical environment in which the patient is seen; the way in which a physician can introduce him- or herself to the family; methods of obtaining information from adolescent patients; differences of which one should be aware when interviewing adolescent patients at different developmental levels; and ways in which to establish rapport and to approach especially sensitive issues. Techniques to reduce anxiety in the physical examination and how to conclude the encounter are also reviewed. By using some of the techniques discussed for the initial encounter, and by incorporating those into his or her own style, the ability to care for adolescent patients can be enhance so that the physician can enjoy and, therefore, be willing to address effectively the health needs of adolescent patients.