Teens get a chair of their own

The Weekend Australian - Travel - - Health -

From Health cover through pu­berty, are pre­oc­cu­pied with phys­i­cal changes and want to be like their peers,’’ she says.

‘‘ Any­thing that makes them dif­fer­ent to their peers is not wanted . . . we may see young peo­ple strug­gle with man­age­ment plans; they may feel it’s not worth­while tak­ing their med­i­ca­tion if they don’t see re­sults quickly; they may go into de­nial about their chronic ill­ness.

‘‘ It’s not un­usual for us to see teenagers and fam­i­lies strug­gle with tak­ing on the bur­den of man­ag­ing chronic ill­ness. One of the most im­por­tant pro­tec­tive fac­tors in all this is hav­ing a fam­ily with good com­mu­ni­ca­tion and good sup­port.’’

Mitchell Litch­field, 24, can tes­tify to the lack of re­sources and at­ten­tion from which ado­les­cent medicine has tra­di­tion­ally suf­fered. Hit with de­pres­sion from the age of about 18 un­til he was 22, his be­hav­iour be­came more dis­rup­tive and be­gan to get him in trou­ble with the law.

‘‘ I used to drink heav­ily and drown my sor­rows by go­ing out all the time,’’ he says. ‘‘ I started to get real an­gry — I was get­ting kicked out of home. I used to fight heaps, and be vi­o­lent.’’

But he quickly found that in his home town of Grif­fith there was lit­tle help, even though the shire has a pop­u­la­tion of nearly 25,000.

The threat of jail fo­cused his mind on the need to get help, and by chance a fam­ily friend was a fam­ily sup­port worker, and the first per­son Litch­field con­fided in about his anx­i­eties, about his life di­rec­tion, and about re­la­tion­ship dif­fi­cul­ties.

He later be­gan foot­ball coach­ing for young­sters aged 12 to 14, which he says helped get him back on track. ‘‘ It made me feel bet­ter about my­self, be­cause they (the young­sters) looked up to me, and par­ents would come to me and say I was do­ing a good job.’’

David Ben­nett, clin­i­cal pro­fes­sor in ado­les­cent medicine at The Chil­dren’s Hospi­tal at West­mead, says the study of teenagers’ health is­sues only be­gan in any mean­ing­ful way in the US in 1951, and has spread only very slowly be­cause of the wide­spread but mis­lead­ing no­tion that ado­les­cence is the health­i­est time of life.

An en­tire re­cent is­sue of the In­ter­na­tional Jour­nal of Ado­les­cent Medicine and Health (2007;(19)3) was de­voted to the health prob­lems of ado­les­cents in Aus­tralia. Ben­nett and Towns were the guest edi­tors. ‘‘ There’s a no­tion that the prob­lems of ado­les­cence are tran­si­tional and teenagers are likely to grow out of them,’’ Ben­nett says. ‘‘ There’s a mind­set of be­nign ne­glect. The truth is that chil­dren don’t tend to grow out of health-re­lated prob­lems and risky be­hav­iours — par­tic­u­larly those that in­volve ad­dic­tion and smok­ing and so on.

‘‘ This time of life has been de­scribed as the cru­cible for shap­ing the health of adult­hood and later life.’’

An edi­to­rial in the Bri­tishMed­i­calJour­nal ear­lier this year (2007;335:106-7), writ­ten by Philip Hazell, con­joint pro­fes­sor of child and ado­les­cent psy­chi­a­try at the Univer­sity of Syd­ney, found that while around 3 to 5 per cent of ado­les­cents were af­fected by de­pres­sion world­wide, Aus­tralian data sug­gested that 26 per cent of teenagers with men­tal disor­ders were treated in gen­eral or pae­di­atric prac­tice.

Only 9 per cent re­ceived care from spe­cial­ist men­tal health ser­vices, even though the prob­a­bil­ity of re­lapse was about 40 per cent within two years and 70 per cent af­ter five years.

In the edi­to­rial, which ac­com­pa­nied a study com­par­ing the ef­fec­tive­ness of dif­fer­ent treat­ments for de­pres­sion, pro­fes­sor Hazell said the op­ti­mal treat­ment for teenagers had been ‘‘ un­clear’’.

For the latest study, one group of de­pressed ado­les­cents was treated with a type of an­tide­pres­sant called a se­lec­tive sero­tonin re­up­take in­hibitor (SSRI) alone, and an­other group was treated with the SSRI com­bined with a type of coun­selling called cog­ni­tive be­havioural ther­apy. The re­sults sug­gested there was no dif­fer­ence in out­comes be­tween the two groups, al­though Hazell said the way the trial was con­ducted sug­gested that the ‘‘ im­pli­ca­tion for clin­i­cal prac­tice is that good qual­ity phar­ma­co­log­i­cal treat­ment in­volves more than sim­ply writ­ing the pre­scrip­tion’’.

Both Towns and Ben­nett agree that an­other ben­e­fit of the new chair of ado­les­cent medicine at Syd­ney Univer­sity will be the op­por­tu­nity to im­prove train­ing for med­i­cal stu­dents and doc­tors in ado­les­cent health is­sues.

‘‘ What an aca­demic chair can do is high­light the im­por­tance of spe­cial­ist train­ing,’’ Ben­nett says. ‘‘ At the mo­ment there’s noth­ing for GPs, and the Royal Aus­tralasian Col­lege of Physi­cians is in the process of de­vel­op­ing a cur­ricu­lum for train­ing in ado­les­cent medicine.’’

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