ABP Adolescent common mistakes
ABP Adolescent · Understand the traps and how to avoid them.
In a vignette that gives both breast and pubic hair findings, assigns a single overall Tanner stage and bases counseling on that blended number.
The two sequences mature independently, but candidates treat Tanner staging as one ordinal scale and average the findings.
What to do instead
Report breast/genital and pubic hair stages separately (for example, 'Tanner B3, PH4'), and use the breast/genital stage when judging growth-spurt and menarche timing.
Reassures a 14-year-old boy with no testicular enlargement, or a 13-year-old girl with no breast budding, as a 'late bloomer' without a bone age or gonadotropin levels.
Constitutional delay is common, so candidates anchor on normal variation and miss the age thresholds that separate it from hypogonadism.
What to do instead
Use the thresholds (no breast budding by 13, no testicular enlargement by 14), obtain bone age and LH/FSH with testosterone or estradiol, and add karyotype or MRI when gonadotropins are abnormal.
Interviews the adolescent only with a parent in the room and accepts the parent's answers to HEADSSS questions, never arranging confidential time.
Visit time is short and raising sensitive topics feels awkward, but teens withhold substance use, sexual activity, and safety concerns when a parent is present.
What to do instead
Explain confidentiality and its limits at the start, then interview and examine the adolescent alone; document a private HEADSSS assessment and tell the teen what will be shared with the parent.
Offers HPV vaccine only to female patients or waits until age 13, and forgets the 16-year MenACWY booster or the 11–12 Tdap dose.
Outdated framing of HPV as a cervical-cancer vaccine and incomplete recall of the adolescent platform cause missed opportunities.
What to do instead
Give HPV to all adolescents at 11–12 with catch-up through 26, Tdap at 11–12, MenACWY at 11–12 plus a booster at 16, and annual influenza; use every visit to catch up.
Treats a PHQ-A score as diagnostic, never asks directly about suicidal ideation, plan, or access to means, and starts an SSRI without screening for manic symptoms.
The screener is treated as a substitute for a risk interview, and brief visits discourage asking about suicide and bipolarity.
What to do instead
Use a positive screen to trigger a private risk assessment (ideation, plan, intent, means, prior attempts), counsel on lethal-means restriction, and ask about decreased need for sleep, grandiosity, and bipolar family history before starting an antidepressant.
Excludes an eating disorder because the patient is male, has a normal BMI, or denies vomiting, without asking about purging, laxatives, diet pills, or compulsive exercise.
Prototype bias (thin, female, restricting) and reliance on weight rather than behavior lead to missed atypical presentations.
What to do instead
Screen all adolescents (for example, with SCOFF), ask specifically about purging and compensatory behaviors, and obtain orthostatics, electrolytes, and an ECG; apply medical instability criteria for admission regardless of BMI.
Defers evaluation of a 16-year-old with primary amenorrhea after a negative pregnancy test and TSH, omitting FSH/LH, prolactin, karyotype, and pelvic ultrasound.
Pregnancy and thyroid disease are over-weighted while outflow obstruction, gonadal dysgenesis, and hypogonadotropic hypogonadism are overlooked.
What to do instead
Evaluate at 15, or at 13 without secondary sexual characteristics, or at 14 with cyclic pain or virilization; order FSH/LH, prolactin, TSH, karyotype, and pelvic ultrasound, adding testosterone when virilized.
Orders only a urine NAAT for chlamydia and gonorrhea in a sexually active 18-year-old with oral or anal exposure, or skips annual screening in a sexually active woman aged 24 or younger.
Candidates assume urine testing covers all sites and that screening should be symptom-driven rather than routine.
What to do instead
Screen all sexually active women aged 24 or younger annually and men with risk factors; use site-specific NAATs (urine, rectal, pharyngeal) based on exposures, and add HIV and syphilis testing according to risk.
Tells a 17-year-old with type 1 diabetes or asthma to 'find an adult doctor' at graduation without assessing self-management skills, insurance, or a written transition plan.
Transition is treated as a single transfer event rather than a years-long process, and adult-provider availability is assumed.
What to do instead
Begin transition planning at 12–14, gradually shift visit time to the adolescent, teach disease self-management, create a written plan with an identified adult provider, and confirm insurance and medication access before transfer.
Attributes recurrent vomiting and compulsive hot showers in a daily cannabis user to gastroenteritis or cyclic vomiting, and responds to any substance use with a lecture instead of a brief intervention.
Cannabis hyperemesis is underrecognized, and clinicians default to advice-giving rather than motivational interviewing.
What to do instead
Recognize cannabis hyperemesis (abdominal pain, vomiting, compulsive bathing) and treat with cannabis cessation; use SBIRT or motivational interviewing and offer harm-reduction and treatment resources rather than a lecture.