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By Gail B. Slap, MD, MS (Auth.)

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Some adolescents may have the cognitive maturity and impulse control to develop problem-focused responses, whereas others may need to rely on emotionfocused responses that control stress without inflicting risk. In either case, adolescents can learn to ­ recognize 30 Adolescent Medicine: The Requisites in Pediatrics the emotional and physical discomfort induced by stress and, with guidance, can plan pro-social channels that help relieve the discomfort (Figure 5-1). Evaluation Annual Comprehensive Visit Screening questionnaires for violence-related attitudes and behaviors exist, but they are neither designed nor validated for use in clinical settings.

A meta-analysis of 32 studies involving children and adolescents with asthma demonstrated that interventions designed to enhance skill as well as knowledge related to asthma improved ­ Sexual and Reproductive Health Care Sexuality and reproductive health present specific c­ hallenges for adolescents with chronic conditions. Cognitive, motor, or social limitations may result in less exposure to peer- and school-based education about the development of secondary sex characteristics, menstruation, and personal hygiene.

Chronic Health Conditions 37 Table 6-1 Risk Factors for Self-Management Problems Domain Risk Factor Family Family dysfunction Other activities reduce treatment supervision Low education Adolescent Adjustment or coping problems Cognitive impairment Lack of belief in the benefit of treatment Fluctuating course High regimen complexity Side effects of regimen Treatment of asymptomatic disease Cost of medication and co-pays Poor provider–family communication Lack of access to care/inadequate follow-up Disease and regimen Health care self-efficacy, pulmonary function, daily activities, and school attendance.

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