1. Challenges and Management of Adolescents (2): Medical Perspective
الدكتور سعيد أحمد
22 ذوالقعدة 1437

2. Synopsis Introduction Overview of challenges Management of Challenges
Cultural
Developmental
Physiological
Biological
Mental
Management of Challenges
Summaries and Conclusion

3. Introduction
Adolescence (Latin, adolescere, "to grow up") is a transitional stage of physical and psychological development that generally occurs during the period from puberty to legal adulthood
Physical growth (particularly in males), and cognitive development can extend into the early twenties
It is defined biologically, cognitively, as changes in the ability to think abstractly and multi-dimensionally; or socially, as a period of preparation for adult roles.

4. Introduction
The study of adolescent development often involves interdisciplinary collaborations, as challenges span one or all areas of its components
The complexity of management therefore would be determined by accurate definition of the particulars of the challenge.
For example,
Neuroscience might focus on pubertal changes in brain structure;
Sociologists on the acquisition of social roles, while
Developmental psychologists would concentrate on relations with parents and peers

5. فَضَرَبْنَا عَلَىٰ آذَانِهِمْ فِي الْكَهْفِ سِنِينَ عَدَدًا (11)
Introduction
إِذْ أَوَى الْفِتْيَةُ إِلَى الْكَهْفِ فَقَالُوا رَبَّنَا آتِنَا مِن لَّدُنكَ رَحْمَةً وَهَيِّئْ لَنَا مِنْ أَمْرِنَا رَشَدًا (10)
فَضَرَبْنَا عَلَىٰ آذَانِهِمْ فِي الْكَهْفِ سِنِينَ عَدَدًا (11)
ثُمَّ بَعَثْنَاهُمْ لِنَعْلَمَ أَيُّ الْحِزْبَيْنِ أَحْصَىٰ لِمَا لَبِثُوا أَمَدًا (12)
نَّحْنُ نَقُصُّ عَلَيْكَ نَبَأَهُم بِالْحَقِّ ۚ إِنَّهُمْ فِتْيَةٌ آمَنُوا بِرَبِّهِمْ وَزِدْنَاهُمْ هُدًى (13)
وَرَبَطْنَا عَلَىٰ قُلُوبِهِمْ إِذْ قَامُوا فَقَالُوا رَبُّنَا رَبُّ السَّمَاوَاتِ وَالْأَرْضِ لَن نَّدْعُوَ مِن دُونِهِ إِلَٰهًا ۖ لَّقَدْ قُلْنَا إِذًا شَطَطًا (14)
هَٰؤُلَاءِ قَوْمُنَا اتَّخَذُوا مِن دُونِهِ آلِهَةً ۖ لَّوْلَا يَأْتُونَ عَلَيْهِم بِسُلْطَانٍ بَيِّنٍ ۖ فَمَنْ أَظْلَمُ مِمَّنِ افْتَرَىٰ عَلَى اللَّهِ كَذِبًا (15)

6. Developmental Challenges: Understanding the Scope
While it is true that each teenager is an individual with a unique personality, special interests, and likes and dislikes, there are also numerous developmental issues that everyone faces during the early, middle and late adolescent years
-(American Academy of Child and Adolescent Psychiatry).

8. Stages of Adolescent Development: Early (12-14 years)
Movement Toward Independence
Struggle with sense of identity, Moodiness, expressive
Less attention shown to parents, with occasional rudeness;
Realization that parents are not perfect; identification of their faults;
Search for new people to love in addition to parents;
Tendency to return to childish behavior;
Peer group influences interests and clothing styles.

9. Stages of Adolescent Development: Early (12-14 years)
Sexuality
Girls ahead of boys; Shyness, blushing, and modesty
Experimentation with body (masturbation);
Worries about being normal
Physical Changes
Gains in height and weight;
Secondary sexual maturation

10. Stages of Adolescent Development: Middle (15-16 years)
Movement Toward Independence
Self-involvement, confused concept of self
Complaints that parents interfere with independence;
Extremely concerned with appearance and with one's own body;
Lowered opinion of parents, withdrawal from them;
Periods of sadness at the psychological loss of the parents
Examination of inner experiences, which may include writing a diary
Sexuality
Concerns about sexual attractiveness;
Movement towards heterosexuality with fears of homosexuality;
Tenderness and fears shown toward opposite sex;

11. Stages of Adolescent Development: Late (17-19years)
Movement Toward Independence
Firmer identity; Self-reliance
Ability to delay gratification;
Ability to think ideas through; independent decisions
Stable interests;
Greater emotional stability
Higher level of concern for the future;
Thoughts about one's role in life
Sexuality
Fully developed secondary sexual characteristics
Concerned with serious relationships;
Clear sexual identity;

12. Adolescent Health Challenges
WHO Key facts
Around 1 in 6 persons in the world is an adolescent: that is 1.2 billion people aged 10 to 19.
An estimated 1.3 million adolescents died in 2015, mostly from preventable or treatable causes.
Road traffic injuries were the leading cause of death in 2012, with some 330 adolescents dying every day.
Other main causes of adolescent deaths include HIV, suicide, lower respiratory infections and interpersonal violence.
Globally, there are 49 births per 1000 girls aged 15 to 19 per year.
Half of all mental health disorders in adulthood start by age 14, but most cases are undetected and untreated.

13. Adolescent Health Challenges
Mental health
Depression is the top cause of illness and disability among adolescents
Suicide is the third cause of death.
Violence, poverty, humiliation and feeling devalued can increase stress, and worsen mental health problems.
Other symptoms of depreciating mental health include:
Passive-aggressive,
Prone to rebel,
Uncontrollable anger,
Early recognition of adolescent stress symptoms is vital.

14. Adolescent Health Challenges
Mental health
A Kajang (Malaysia) study (2014) conducted among 403 adolescents, for the purpose of determining stress experience, showed that adolescents are stressed, and that the majority exhibit psychological stress symptoms.
Panacea
Correct and adequate parental upbringing,
building life skills in children and adolescents and
providing them with psychosocial support in schools and other community settings can help promote good mental health.
Strong family ties
If problems arise, they should be detected and managed by competent and caring health workers.

15. وَإِذْ قَالَ لُقْمَانُ لِابْنِهِ وَهُوَ يَعِظُهُ يَا بُنَيَّ لَا تُشْرِكْ بِاللَّهِ ۖ إِنَّ الشِّرْكَ لَظُلْمٌ عَظِيمٌ (13)
وَوَصَّيْنَا الْإِنسَانَ بِوَالِدَيْهِ حَمَلَتْهُ أُمُّهُ وَهْنًا عَلَىٰ وَهْنٍ وَفِصَالُهُ فِي عَامَيْنِ أَنِ اشْكُرْ لِي وَلِوَالِدَيْكَ إِلَيَّ الْمَصِيرُ (14)
وَإِن جَاهَدَاكَ عَلَىٰ أَن تُشْرِكَ بِي مَا لَيْسَ لَكَ بِهِ عِلْمٌ فَلَا تُطِعْهُمَا ۖ وَصَاحِبْهُمَا فِي الدُّنْيَا مَعْرُوفًا ۖ وَاتَّبِعْ سَبِيلَ مَنْ أَنَابَ إِلَيَّ ۚ ثُمَّ إِلَيَّ مَرْجِعُكُمْ فَأُنَبِّئُكُم بِمَا كُنتُمْ تَعْمَلُونَ (15)
يَا بُنَيَّ إِنَّهَا إِن تَكُ مِثْقَالَ حَبَّةٍ مِّنْ خَرْدَلٍ فَتَكُن فِي صَخْرَةٍ أَوْ فِي السَّمَاوَاتِ أَوْ فِي الْأَرْضِ يَأْتِ بِهَا اللَّهُ ۚ إِنَّ اللَّهَ لَطِيفٌ خَبِيرٌ (16)
يَا بُنَيَّ أَقِمِ الصَّلَاةَ وَأْمُرْ بِالْمَعْرُوفِ وَانْهَ عَنِ الْمُنكَرِ وَاصْبِرْ عَلَىٰ مَا أَصَابَكَ ۖ إِنَّ ذَٰلِكَ مِنْ عَزْمِ الْأُمُورِ (17)
وَلَا تُصَعِّرْ خَدَّكَ لِلنَّاسِ وَلَا تَمْشِ فِي الْأَرْضِ مَرَحًا ۖ إِنَّ اللَّهَ لَا يُحِبُّ كُلَّ مُخْتَالٍ فَخُورٍ (18)
وَاقْصِدْ فِي مَشْيِكَ وَاغْضُضْ مِن صَوْتِكَ ۚ إِنَّ أَنكَرَ الْأَصْوَاتِ لَصَوْتُ الْحَمِيرِ (19)

16. Adolescent Health Challenges
‘Early’ pregnancy and childbirth
Global adolescent birth rate at 49 per 1000 girls - country rates range from 1 to 229 births per 1000 girls (The 2014 World Health Statistics).
Complications linked to pregnancy and childbirth are the second cause of death for year-old girls globally.
One of the specific targets of the health Sustainable Development Goal (SDG 3) is Universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes, by To support this, a proposed indicator for the "Global Strategy for Women’s, Children’s and Adolescents’ Health" is the adolescent birth rate.

17. Adolescent Health Challenges
‘Early’ pregnancy and childbirth
Better access to contraceptive information and services can reduce the number of girls becoming pregnant and giving birth at too young an age. Laws that specify a minimum age of marriage at 18 and which are enforced can help.
Girls who do become pregnant need access to quality antenatal care. Where permitted by law, adolescents who opt to terminate their pregnancies should have access to safe abortion.

18. Adolescent Health Challenges
HIV
More than 2 million adolescents are living with HIV.
Although the overall number of HIV-related deaths is down 30% since the peak in 2006 estimates suggest that HIV deaths among adolescents are rising, predominantly in the WHO Africa Region
In sub-Saharan Africa only 10% of young men and 15% of young women aged 15 to 24 are aware of their HIV status.
One of the specific targets of the health Sustainable Development Goal (SDG 3) is that by 2030, there should be an end to the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases, hepatitis, water-borne diseases and other communicable diseases. Given their high incidence rate, to achieve this, adolescents will need to be central to control efforts.

19. Adolescent Health Challenges
HIV
Panacea:
Young people need to know how to protect themselves and have the means to do so.
Abstinence remains the only 100% sure means of preventing sexually transmitted diseases including HIV/AIDS
Better access to HIV testing and counselling, and
Stronger subsequent links to HIV treatment services for those who test HIV positive, are also needed.

20. Adolescent Health Challenges
Other infectious diseases
Due to improved childhood vaccination, adolescent deaths and disability from measles have fallen markedly – for example, by 90% in the African Region between 2000 and But diarrhoea, lower respiratory tract infections and meningitis are among the top 10 causes of death for 10 to 19 year olds.

21. Adolescent Health Challenges
Violence
An estimated 180 adolescents die every day as a result of interpersonal violence. Around 1 of every 3 deaths among adolescent males of the low- and middle-income countries in the WHO Americas Region is due to violence. Globally, some 30% of girls aged 15 to 19 experience violence by a partner.
Cultism, political thuggery and unemployed juvenile delinquency are no news in many misguided black societies
Promoting nurturing relationships between parents and children early in life, providing training in life skills, and reducing access to alcohol and firearms can help to prevent violence. Effective and empathetic care for adolescent survivors of violence and ongoing support can help deal with the physical and the psychological consequences.

22. Adolescent Health Challenges
Alcohol and drugs
Alcohol reduces self-control and increases risky behaviours, such as unsafe sex, violence or risky driving.
It is a primary cause of injuries and premature deaths.
Drug use among 15 to 19 year olds is also a concern
Setting a minimum age for buying and consuming alcohol and regulating how alcoholic drinks are targeted at the younger market are among the strategies for reducing harmful drinking..

23. Adolescent Health Challenges
Injuries
Unintentional injuries are a leading cause of death and disability among adolescents. In 2012, some adolescents died as a result of road traffic accidents.
Young drivers need advice on driving safely, while laws that prohibit driving under the influence of alcohol and drugs need to be strictly enforced.
Blood alcohol levels need to be set lower for teenage drivers. Graduated licences for novice drivers with zero-tolerance for drink-driving are recommended.

24. Adolescent Health Challenges
Injuries
Drowning is also a major cause of death among adolescents – , two-thirds of them boys, drowned in 2012, and teaching children and adolescents to swim is a useful intervention to prevent this..

25. Adolescent Health Challenges
Malnutrition and obesity
Many boys and girls in developing countries enter adolescence undernourished, making them more vulnerable to disease and early death.
The number of adolescents who are overweight or obese is increasing in both low- and high-income countries.

26. Adolescent Health Challenges
Exercise and nutrition
Available survey data indicate that fewer than 1 in every 4 adolescents meets the recommended guidelines for physical activity - 60 minutes of moderate to vigorous physical activity daily.
Anaemia resulting from a lack of iron affects girls and boys, and is the third cause of years lost to death and disability. Iron and folic acid supplements help to promote health before adolescents become parents, and regular deworming in areas where intestinal helminths such as hookworm are common is recommended.

27. Adolescent Health Challenges
Tobacco use
The vast majority of people using tobacco today began doing so when they were adolescents.
Prohibiting the sale of tobacco products to minors and increasing the price of tobacco products through higher taxes, banning tobacco advertising and ensuring smoke-free environments are crucial.
Globally, at least 1 in 10 younger adolescents (aged 13 to 15) uses tobacco, although there are areas where this figure is much higher.

28. Adolescent Health Challenges
Rights of adolescents
The rights of children (people aged between 0-17 years) to survive, grow and develop are enshrined in international legal documents.
The Committee on the Rights of the Child (CRC), which oversees the child rights convention, in 2013 published guidelines on the right of children and adolescents to the enjoyment of the highest attainable standard of health, and a General Comment on realizing the rights of children during adolescence is under development, building on existing CRC guidelines on states’ obligations to recognise the special health and development needs and rights of adolescents and young people.
The Convention on the Elimination of Discrimination Against Women (CEDAW) also sets out the rights of women and girls to health and adequate health care

29. Summaries and Conclusions

30. والحمد لله !!!

31. References The Clorious Qur’an
Sahih Ahaadeeth of al-Bukhari, Muslim and Tirmidhiy as quotted
Other References
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