Teen Health: Top Issues That Are Overlooked

Adolescence is a time of great personal change.

Teens may get a bad rap for being rebellious, moody, and self-conscious, but that's actually not the case for the majority of youngsters. However, their sometimes erratic behavior can be difficult to interpret.

Since parents are the gatekeepers of their children's health, recognizing a problem and being vigilant about getting it addressed is important. The sooner a health issue is treated, the better the chances are of a full recovery.

To help make parents aware of under-diagnosed health problems, QualityHealth recently spoke with two adolescent medicine experts, Susan Yussman, MD, MPH, and Arik Marcell, MD, MPH. If you recognize any of these symptoms, it's wise to bring your concerns to the attention of your pediatrician as soon as possible.


According to the National Adolescent and Young Adult Information Center (NAHIC), the third most common form of death among teenagers is suicide. (Note: Unintentional injuries such as motor vehicle and other accidents are the most common form of death in this age group.) Susan Yussman, MD, MPH, believes many of these tragic deaths could be prevented if depression is spotted earlier and treatment is administered.

"Parents and physicians tend to be more focused on normal growth and development," says the adolescent medicine expert at the University of Rochester Medical Center. Mental health is often overlooked because so many of the common symptoms—such as social isolation and sullenness—can be attributed to what might be considered "typical" teenage moodiness. "It may surprise you to know that depression can also cause teens to act out aggressively."

Arik V. Marcell, MD, MPH, assistant professor at the Johns Hopkins Children's Hospital and director of adolescent services at the Harriet Lane Clinic concurs and says it's vital for parents to understand the risk factors and recognize the symptoms of depression.

The New York Times reported in April 2012 that depression risk factors for adolescents include having parents with depression—in particular a depressed mother and early exposure to stress and other negative experiences such as neglect or abuse. Hormonal factors associated with puberty and menstruation may also contribute to depression.

Other symptoms include:

  • Trouble making/keeping friends
  • Declining grades/truancy
  • Loss of interest in normal activities
  • Anger/irritability/hostility
  • Weepiness/sadness
  • Restlessness/agitation
  • Excessive sexual behavior
  • Acting-out behavior such as stealing, violence, and self-injury
  • Lack of hygiene or a decline in self-care
  • Negative self-talk or low self-esteem
  • Change in appetite or abnormal eating behavior
  • Frequent headaches and stomachaches
  • Difficulty concentrating or making decisions
  • Substance abuse

Adolescents with depression are at significantly higher risk for substance abuse, recurring bouts of depression, and other emotional health problems in adulthood. Both doctors point out that in medical school today there is more emphasis on mental health. "Pediatricians are taught to screen for mental health issues in adolescents, but if you don't get the answer you want from your child's physician, consult a mental health professional," advises Yussman.

Eating Disorders

During middle childhood, it's not unusual for teens to become more aware of their bodies and as a natural consequence, their diet. But eating disorders such as anorexia and bulimia are much more complicated than picky eating and can quickly spiral out of control.

Both may stem from depression (though clinical depression is more common) and affect adolescent girls and boys. "Recent studies report that anorexia is higher in boys than previously thought," says Dr. Marcell. "Today, 3 in 10 patients diagnosed with anorexia are boys—that's up from 1 in 10." Anorexics restrict certain types of food and often engage in more activity than eating which results in weight loss," says the Baltimore-based expert. Yussman adds that the average recovery time for anorexia is six years.

Though the typical anorexic is a white female from middle to upper socio-economic status, many overweight teens suffer from eating disorders as well. "Unhealthy eating behaviors include binging on certain foods then purging it," Dr. Yussman explains. "Some of these teens are also known for using diuretics and weight-loss pills in damaging ways."

Sexually-Transmitted Diseases (STDs)

During the teen years, many young people become sexually active for the first time. According to the Centers for Disease Control and Prevention, chlamydia is the most commonly reported STD in the United States. Like other STDs, chlamydia often has no symptoms, so many people with the disease don't know they have it. Although it's easy to cure, chlamydia can affect future fertility if left untreated which is why the CDC currently recommends that all sexually active females 25 years old and younger be tested annually.

"Teens and young adults account for a quarter of the sexually active population but are responsible for half of all STDs in this country," says Yussman. Aside from the lack of symptoms, many STDs go untreated because teens are inexperienced and don't recognize abnormalities in themselves and aren't aware of places to go for confidential services. "STD screening today is minimally invasive," says Marcell, explaining that chlamydia and gonorrhea can be detected with a urine test for a boy or a self-administered vaginal swab or a urine test for a girl.

The doctors advise parents to explain to their sons and daughters that anyone who is sexually active can get an STD. "Be sure males understand that using a condom offers protection from unwanted pregnancies but also protects against STDs," Marcell explains. "Young males should understand that even if his partner is using birth control, he could get a sexually-transmitted disease. Condoms protect against pregnancy and STDs. Using other forms of birth control alone such as the pill, the patch, or the IUD will not protect against STDs."


A concussion is a type of traumatic brain injury that can be caused by a bump, blow, or jolt to the head. A fall or seemingly mild bump on the head can also cause a concussion. Car accidents also put young, inexperienced drivers at increased risk of concussion.

Though more attention is currently being paid to head injuries—especially at the high school level where students play competitive sports—many concussions are overlooked. According to Dr. Marcell, collisions in football and soccer pose the greatest risk to the head.

"Regulations differ from state to state, of course, but all student athletes should have a baseline evaluation at school or through their pediatrician's office," he says. "If your child participates in sports, find out how concussions are monitored. If he plays on multiple teams with different trainers and coaches, make sure each one is aware of any head injuries that have occurred in other sports. You can't assume trainers and coaches necessarily talk to each other."

Concussions can have a more serious effect on a young, developing brain. Be sure your school has a concussion plan. If they don't, the CDC can help.




Interview with Susan Yussman, MD, MPH
Golisano Children's Hospital at the University of Rochester Medical Center

Interview with ArikV.  Marcell, MD, MPH
Assistant professor at the Johns Hopkins Children's Hospital and director of adolescent services

National Adolescent Health and Information Center (Univ. of California, San Francisco)

National Institutes of Health

American Psychological Association, http://www.apa.org