“It was the best of times; it was the worst of times.” Charles Dickens’ famous opening lines probably have a familiar, if not painful, ring for any of us who have lived though “the age of adolescence.” In making the final push to adulthood, children can find themselves entangled in a myriad of biological, psychological, and social challenges that are at once, compelling and frustrating. These challenges are the developmental stepping stones into adulthood.

Historically, teens and young adults have been labeled as troublesome, largely because of their varied responses to the developmental issues they face. It’s not an easy time for young adults to go through; nor is it “business as usual” for the medical practitioner who chooses to work with this population.

Finding a health care provider who is sensitive to the particular needs of teens can be essential in smoothing out the rocky transition from child to adult. A physician specializing in adolescent medicine can bridge the health care gap between pediatric and general medicine.

We define adolescence as a loosely grouped number of years that range from age 12 to 25.

Dr. Bruce Brown, director of Adolescent Programs at EMMC, describes adolescent medicine as “a vertical discipline where you go deeply into learning about both medical and developmental aspects of the adolescent patient, taking into account the changes in thinking and judgment as well as physical and emotional issues. During these years, a link between the physician and the young patient becomes more important as they navigate from adolescence into adulthood.”

Common issues in adolescent medicine can include one or more of the following:

. Depression and suicide.

. Sexuality, sexual practices, unwanted pregnancy and STDs.

. Body and self-image.

. Substance abuse.

. Anger and stress management.

. Sports injuries and physically risky behavior.

. Eating disorders in both male and females.

In dealing with these issues, the adolescent medicine specialist must focus on more than one level of treatment and care simultaneously. It is not enough to cure the problem; the provider must assess the patient’s knowledge and awareness of health risks, and promote and educate about prevention.

As Dr. Brown notes, this is where the major difference between adolescent medicine and other primary care disciplines emerges.

“Having the time to devote to these particular issues is crucial,” Brown said. “Primary care doctors are under pressure to deliver services quickly; as an adolescent medicine doctor, I have the ability and, more importantly, the time to work on figuring out the relationship between the health problem that the teen has, and whatever else is going on in their lives.”

Another area of importance is understanding the needs of both the adolescent patient and the parent. From the adolescent’s perspective, Dr. Brown sees the key questions as being, “Am I normal, and-or how do I cope with this?” Also, the adolescent expresses the very real concern of how he or she will be treated in the healthcare system.

During adolescence, many teenagers don’t yet know how to express their health struggles in a way that helps them the most. For parents, issues surround their responsibility to their child and whether they are “doing their job” to protect and to promote good health practices. At the heart of these concerns is confidentiality.

As Dr. Brown notes, “It’s a mistake to go overboard emphasizing the privacy and confidentiality issues if, by doing so, you alienate the parents. Usually, the more my role overlaps with both patient and parent, the happier everyone is.”

Renegotiations of confidentiality occur as adolescents become young adults who are more responsible for their own health decisions.

The success of treating young adults goes far beyond just diagnostics and prognoses. Adolescent treatment must embrace the whole person, including a child’s best and worst attributes, to help them grow into a healthy, functioning adult.

Dr. Linda Austin hosts “What’s On Your Mind” at 1 p.m. Thursdays on Maine Public Radio, and EMMC’s “Health Talk” throughout the week.