Chronic Illness, Substance Use, and Other Adolescent Health Conditions
Chronic disease in a developmental frame
Adolescence is when adherence collapses: the teen wants to fit in, resents supervision, and takes risks. Asthma control worsens with vaping, smoking, and inhaled corticosteroid underuse; diabetes control deteriorates with missed insulin and with insulin omission for weight loss. Ask about adherence without shaming, and screen for depression in every chronic illness because it worsens outcomes. Begin transition planning at 12-14 years, not at 18.
Substance use
Screen yearly with CRAFFT; a score of 2 or more warrants brief intervention, and motivational interviewing outperforms confrontation. E-cigarettes are now the most common nicotine product among adolescents and cause dependence and lung injury; cannabis concentrates carry high potency and psychosis risk; alcohol and prescription opioid misuse frequently coexist with mood disorders. Confidentiality applies unless there is imminent danger.
Other high-yield conditions
Obesity: BMI percentile plus family-focused, motivational goals. Dysmenorrhea: NSAIDs with combined hormonal contraception; evaluate if treatment fails. PCOS: irregular cycles plus hyperandrogenism, not ultrasound alone. Iron deficiency from heavy menses or low intake. Concussion: cognitive and physical rest, then gradual return to learn before return to play. Acne: combination topical therapy; isotretinoin requires pregnancy prevention and monitoring. Sports preparticipation forms are not substitutes for a well visit.
Rule of thumb
When a previously stable chronic illness suddenly destabilizes in a teenager, ask three questions: is she depressed, is she using substances, and has she stopped taking the medication?