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American Academy of Pediatrics
Textbook of Adolescent Health Care / Edition 1

Textbook of Adolescent Health Care / Edition 1


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Product Details

ISBN-13: 9781581102697
Publisher: American Academy of Pediatrics
Publication date: 06/01/2011
Pages: 1500
Sales rank: 1,048,900
Product dimensions: 8.80(w) x 11.00(h) x 2.70(d)

About the Author

Martin Fisher, MD, FAAP is Chief of the Division of Adolescent Medicine at Cohen Children’s Medical Center of Northwell Health in New Hyde Park, New York and Professor of Pediatrics in the Zucker School of Medicine in Hempstead, New York.  He is Past President of the Society for Adolescent Health and Medicine and of the North American Society for Pediatric and Adolescent Gynecology, and has served as editor in chief of the Textbook of Adolescent Health Care, published by the American Academy of Pediatrics.  He is editor of PREP Adolescent Medicine, an associate editor of Adolescent Medicine: State of the Art Reviewers, an associate editor of Current Problems in Pediatric Health Care and the Co-Chair of the Adolescent Panel of Bright Futures. Dr Fisher has published over 70 articles in peer-reviewed journals, over 70 chapters and reviews, and has presented over 100 abstracts and lectures in national and international meetings.

Elizabeth M. Alderman, MD, FAAP, is Professor of Clinical Pediatrics at the Albert Einstein College of Medicine of Yeshiva University and Director of the Post-doctoral Training Program in Adolescent Medicine. The current president of the North American Society for Pediatric and Adolescent Gynecology, she has also served as chair of the AAP Section on Adolescent Health and on the executive council of New York, Chapter 3 of the AAP.

Richard Kreipe, MD, FAAP, FSAM, FAED, is the founding Director of the Child and Adolescent Eating Disorder Program at the University of Rochester Medical Center, and a board-certified pediatrician and adolescentmedicine specialist, as well as a Fellow of the Academy for Eating Disorders. Dr.Kreipe is a consultant to the American Psychiatric Association regarding diagnostic criteria for eating disorders in young people, and is a past-President of the Society for Adolescent Health and Medicine.

Read an Excerpt

Textbook of Adolescent Health Care

By Martin M. Fisher, Elizabeth M. Alderman, Richard E. Kreipe, Walter D. Rosenfeld

American Academy of Pediatrics

Copyright © 2011 American Academy of Pediatrics
All rights reserved.
ISBN: 978-1-58110-269-7


History of Adolescent Medicine and Health Care



Interest in providing specialized health care to adolescents is a product of ideas about youth that emerged during the early 20th century. The work of developmental psychologist G. Stanley Hall was primarily responsible for establishing adolescence as a distinct developmental category. Hall was also the first to suggest establishing a branch of medicine for adolescents, writing that his book had prompted a deluge of letters from parents and relatives of young people asking for medical advice. "Had I been a physician" Hall wrote, "I might have easily worked up a lucrative practice from such cases"

Yet a new medical field dedicated to this age group did not appear until the 1950s, when adolescent medicine evolved as a subspecialty of pediatrics. This did not mean that adolescents' health care needs were ignored. Rather, the settings in which young people received health care have changed considerably over the course of history.

Prior to the early 20th century, most adolescents, as well as children and adults, received health care from female family members within the home. This was especially true in colonial America, when the number of trained physicians was much lower than in Europe. Advice for caring for sick family members was available in newspapers, almanacs, and domestic medical manuals written by physicians. When an ailment proved to be beyond the healing capabilities of a homemaker, she would rely on a midwife, who typically had training and experience not only in labor and delivery but diagnosis and treatment of illness.

Enslaved African-American youth also received most of their health care within the household or plantation. Typically, slaves received health care from older slave women, who relied on home remedies adapted from West African healing traditions. Owners of large plantations also contracted with local white physicians to provide care for slaves of all ages. After the importation of slaves was outlawed in 1808, slaveholders took special interest in protecting the fertility of young female slaves, because the only legal way to increase the slave population was through reproduction. The estimated mean age of menarche among adolescent female slaves was 15.


Prior to the 1920s, a significant percentage of adolescents were compelled to start working for wages at an early age to help support their families. The first national labor data on youth employment, collected in 1880, indicate that 32% of all males and 12% of all females aged 10 to 19 worked for wages. These figures varied considerably according to race and ethnic background; the labor force participation rate of children aged 10 to 19 was considerably higher among black males (66%) and females (44%) than among white males (43%) and females (13%). Likewise, the rate among foreign-born children exceeded that of their counterparts born in the United States — by about 9% and 16% among males and females, respectively. These differences may be largely attributable to the higher earnings levels of white and native-born families. In addition, labor force participation among rural children exceeded urban rates by about 8%.

The poor conditions of many places of employment took a heavy toll on young persons' health. Work in crowded textile mills and sweatshops led to high rates of respiratory illnesses, especially tuberculosis, which was the leading cause of death among adolescents and young adults at the turn of the 20th century. Young workers frequently were injured by heavy machinery too large for them to operate safely. Although some factories, mines, and logging camps contracted with physicians to provide medical service to employees on a fixed per annum basis, most employers did not provide health care or health insurance for their employees. Those who were absent from work because of illness or injury typically lost their jobs.

Larger cities built general hospitals and freestanding dispensaries to provide free health care for growing numbers of poor and immigrant adolescents who needed medical attention. The first children's hospital in the United States opened in Philadelphia in 1855. Several other large cities, such as Boston, Washington, DC, Detroit, and Chicago, created children's hospitals in the late 19th century. In 1909, there were only 25 children's hospitals in the country, compared with 4,359 general hospitals. Children's hospitals seldom treated patients over the age of 12. Administrators of general hospitals recognized that young children needed to be separated from the rest of the hospital population, but they placed adolescents with adult patients. Thus, those who could afford to do so still employed private physicians and nurses to care for them within their homes.

During the 19th century, a variety of public agencies and private philanthropic organizations created institutions for sick and needy adolescents. Although not all of these were designed for health care, the rapid spread of illness among those housed in close quarters necessitated the creation of hospitals and infirmaries as auxiliaries to orphanages, almshouses, and asylums for adolescents with physical, cognitive, or sensory disabilities. Boarding schools for Native American children, started in the late 1870s to separate Native American children from their traditions and make them truly "American," proved to be breeding grounds for contagious diseases, especially tuberculosis and trachoma. White adolescents in private and public schools also were vulnerable to epidemic diseases, such as measles, whooping cough, scarlet fever, diphtheria, and tuberculosis. School boards attempted to control the spread of disease by requiring school children and adolescents to be vaccinated against smallpox, diphtheria, and other diseases prior to attending school. Then as now, a number of parents objected strongly to compulsory vaccination. Some felt that vaccination was dangerous, whereas others resented the intrusion of state officials into private family matters. To prevent the spread of disease and to protect students' health, schools began in the 1890s to hire physicians as medical inspectors. These physicians identified a set of diseases that seemed to be caused and/or exacerbated by the environment of 19th-century schools, many of which lacked adequate light, ventilation, heat, or sanitary facilities. Medical experts noted that American school rooms, especially those in urban areas, were breeding grounds for the spread of disease and called for reforms that would eliminate hazards to student health.


At the same time, child welfare reformers successfully lobbied for legislation to protect the nation's children and youth. Their activism led to the creation of the US Children's Bureau in 1912. This agency led efforts to improve child health and welfare, as well as movements to outlaw child labor and mandate school attendance through the age of 16. As a result of these reforms, school attendance for adolescents grew dramatically. According to US Census figures, in 1890 only 6.7% of 14- to 17-year-olds were enrolled in high school. By 1920, this figure had risen to 32.3% and by 1930 more than 50% of adolescents were enrolled in junior and senior high schools. During the Great Depression, widespread unemployment and New Deal legislation further restricting child labor pushed high school attendance rates to 75% and graduation rates to 50%.


The first mention of an outpatient clinic specifically for adolescents was in a 1918 article from Archives of Pediatrics. The article described a separate clinic for girls aged 11 to 16 established by San Francisco physician Amelia E. Gates, MD, as a branch of the children's clinic at the Stanford University Medical School 2 years earlier. Gates observed that malnourishment was a common problem among her patients, with a significant number recorded as underweight for their age, anemic, or having some other dietary deficiency. Postural defects and scoliosis were present in more than one-quarter of her patients. Investigation and treatment of menstrual problems formed a large part of the work of the clinic. Gates wrote it was "surprising how many girls come to us with no knowledge either of the advent or the meaning of the menstrual function," because of erroneous information gathered from other girls or lack of adequate instruction from mothers. Gates believed that one of her main objectives was to make up for this lack of information. Diseases of the teeth and gums were the most common of all, but Gates lacked sufficient facilities for even the most basic dental work.

Gates observed that when the clinic started, she was concerned mainly with medical issues, but she soon found that given her clientele, who came predominantly from working-class families in the Bay area, she and her staff "could hardly confine ourselves to medical work alone" but that the "psychical phenomenon" of the adolescent period was central to their functions as well. A number of the girls in her clinic were referred from associated charities and under the care of foster mothers. The staff also had to deal with other problems in the home, mental overstrain in school, worries about finding employment after graduation, and "the various social maladjustments of our modern life." The clinic "assumed the character of a girls club," providing after-school activities and "wholesome amusement" for the girls' leisure hours. According to Gates, many of the girls looked forward to coming to the clinic, "knowing they can bring their small troubles and worries and feeling sure of a sympathetic understanding and an attempt at effective help." Gates wrote that even after finding jobs, former patients still "hold their allegiance to the clinic and return to us from time to time," usually because of physical disability caused by work-related injuries.


During the late 1910s and 1920s, the educational psychologist Lewis Terman argued that public schools also should treat physical illnesses and defects that hindered a student's academic success. He proposed that schools hire nurses, who would not only examine students at school but follow up on cases by visiting the students' homes to ensure that medical treatment was being followed. He also realized that many families, especially immigrant, urban, and rural poor, could not afford medical care on their own. Therefore, he argued that the second essential step in promoting the health of students was to create medical clinics in the nation's schools. These suggestions met with fierce opposition from the American Medical Association (AMA) and other medical organizations, who saw this as the first step toward "socialized medicine." Terman replied that free medical and dental clinics for the nation's children and youth were no different from universal public school education supported by taxpayer dollars. Nevertheless, opposition from the AMA led public schools to abandon school medical clinics as a health care strategy. Instead, they limited their role to providing health education and ensuring that students were properly vaccinated and in sufficiently good health to attend school.

Instead, traditional fee-for-service practice remained the primary model for adolescent health care delivery for decades. Access to these services depended heavily on one's ability to pay. The shortcomings of this system became painfully apparent during the Great Depression of the 1930s, as millions of Americans lost their jobs and could no longer afford physicians' fees. Among the most destitute were the nation's rural farm families, who had the lowest per capita income in the nation and experienced the highest rates of preventable illnesses such as pellagra, hookworm, syphilis, tuberculosis, malaria, and typhoid fever. To address the plight of the nation's farm families, Franklin D. Roosevelt and Congress created the Farm Security Administration (FSA). In addition to providing low-interest loans and other financial benefits to impoverished farmers, the FSA also created a network of prepaid medical cooperative plans that at the agency's peak enrolled more than 650,000 poor rural farmers and their families. Because the FSA targeted those who had few resources to pay for medical care and was a voluntary program that allowed for free choice of physician, the program did not encounter the same attacks from medical organizations about the "socialization of medicine" as did other state-funded health care programs. Although the FSA was disbanded during World War II, the agency's medical program served as a model for the growth of third-party insurance in the postwar period.


World War II and its aftermath led to increased attention on the health of adolescents, especially of the nation's young men. Data collected by the Selective Service indicated that 25% of the 18- and 19-year-old registrants who reported for the draft were rejected for military service. Despite the efforts of the FSA, rejection rates were higher for farmers (41%) than for other occupational groups. Racial discrimination and unequal access to health care also led to higher rates of rejection among blacks than among white registrants. These observations led William M. Schmidt, MD, regional medical consultant for the US Children's Bureau, to call once again for the creation of medical clinics in the nation's schools, as well as reforms in medical education that would better equip pediatricians and general practitioners to care for adolescents.


The mainstream medical profession continued to oppose school-based medical care, as well as President Truman's efforts to establish national health insurance. However, these calls for increased attention to the health of adolescents led to the emergence of adolescent medicine as a pediatric subspeciality. The first medical unit in the United States devoted exclusively to adolescents was founded by J. Roswell Gallagher, MD, at Boston Children's Hospital in 1951. The Adolescent Unit represented a major shift in approach to the teenage patient: before the 1950s, most physicians who treated adolescents discussed the patient's health problems with the parent and seldom allowed young people to speak for themselves. In contrast, Gallagher and his staff insisted that teenaged patients needed a doctor of their own who would see patients separately from their parents, who would protect their confidentiality, and who would place teenagers' concerns first. The Boston Adolescent Unit served as a model for other hospitals in North America. By the mid- 1960s, there were 55 adolescent clinics in hospitals in the United States and Canada, and today more than half of all children's hospitals in the United States have units dedicated to the health care of teenagers. The expansion of adolescent health services led to the creation of a professional organization for adolescent specialists, now called the Society for Adolescent Health and Medicine (SAHM), established in 1968, and the founding of its official professional journal The Journal of Adolescent Health Care, first published in 1980 (now the Journal of Adolescent Health) In 1991, an application was made by leaders in the field to institute a board-certification examination for physicians interested in becoming subspecialists in adolescent medicine. The American Board of Pediatrics is the parent board for this examination. However, because of a joint agreement with the American Board of Family Practice and the American Board of Internal Medicine, after completing 3-year residencies in pediatrics, family medicine, or internal medicine, physicians become board-eligible following the successful completion of a fellowship program certified by the Accreditation Council on Graduate Medical Education.


Excerpted from Textbook of Adolescent Health Care by Martin M. Fisher, Elizabeth M. Alderman, Richard E. Kreipe, Walter D. Rosenfeld. Copyright © 2011 American Academy of Pediatrics. Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Part 1
Foundations of Adolescent Health
Section 1
Chapter 1
History of Adolescent Medicine and Health Care
Chapter 2
Epidemiology of Mortalities and Morbidities in Adolescents
Chapter 3
International Adolescent Health
Section 2
Growth and Development
Chapter 4
Normal Pubertal Physical Growth and Development
Chapter 5
Adolescent Brain and Cognitive Changes
Chapter 6
Adolescent Sexual Development and Behavior
Chapter 7
Adolescent Sexual Development
Section 3
Approach to the Patient and Family
Chapter 8
Medical History
Chapter 9
Physical Examination and Laboratory Screening
Chapter 10
The Approach to Symptoms in the Adolescent Patient
Chapter 11
Legal and Ethical Issues in Adolescent Health Care
Chapter 12
Adherence Issues
Section 4
Health Supervision and Preventive Care
Chapter 13
Screening in Adolescent Health Care
Chapter 14
Chapter 15
Anticipatory Guidance
Chapter 16
Adolescent Nutrition and Physical Activity
Section 5
Management Issues
Chapter 17
Complementary and Alternative Medicine
Chapter 18
Pain in Adolescents: Pathophysiology and Management
Chapter 19
Palliative Care and Psychological Aspects of Death and Dying in Adolescence
Chapter 20
Pharmacologic Considerations
Chapter 21
Health Policy and Financing for Adolescent and Young Adult Health Services
Section 6
Office-Based Practice
Chapter 22
The Adolescent-Friendly Practice
Chapter 23
Documentation, Coding, and Billing
Section 7
Non-Office Based Practice Settings and Issues
Chapter 24
The Adolescent In-patient Unit
Chapter 25
School-based Health Care
Chapter 26
College Health
Chapter 27
Health Care of Incarcerated Adolescents
Chapter 28
Health Care of Adolescents in Military Settings
Section 8
Special Populations of Adolescents
Chapter 29
Adolescents in Foster Care
Chapter 30
Immigrant Adolescents
Chapter 31
Transition of Adolescents with Special Health Care Needs to Adulthood
Chapter 32
Solid Organ Transplantation
Section 9
Family Relationships
Chapter 33
Communication Between Parents and Adolescents
Chapter 34
Parenting the Adolescent
Chapter 35
Divorce, Separation, and Blended Families
Chapter 36
Adoption and Adolescence
Chapter 37
Adolescents with Lesbian or Gay Parents
Chapter 38
Family Systems Approaches to Adolescent Health and Illness
Section 10
The Adolescent’s Environment
Chapter 39
Chapter 40
Socioeconomic Status
Chapter 41
The Media
Chapter 42
Computers, Technology, and the Internet
Chapter 43
Cultural Considerations in Adolescent Health Care
Chapter 44
Religion and Spirituality
Chapter 45
Cults and Adolescents
Chapter 46
Environmental Health
Chapter 47
Adolescents at Work
Chapter 48
Part 2
Adolescent Sexuality and Reproductive Health
Section 1
Chapter 49
Adolescent Sexual Behaviors
Chapter 50
Issues Affecting Gay, Lesbian, and Bisexual Youth
Chapter 51
Medical Treatment of the Transgender Adolescent
Chapter 52
Chapter 53
Sexually Transmitted Infections
Chapter 54
Adolescent Pregnancy
Chapter 55
Adolescent Parenthood
Chapter 56
Abortion in Adolescents
Chapter 57
Sexual Dysfunction
Section 2
Reproductive Health
Chapter 58
Physiology of Menstruation
Chapter 59
Perineal and Vaginal Abnormalities
Chapter 60
Cervical Findings and the Papanicolaou Smear
Chapter 61
The Uterus and Adnexa
Chapter 62
Chapter 63
Menstrual Disorders: Dysmenorrhea and Premenstrual Syndrome
Chapter 64
Abnormal Uterine Bleeding
Chapter 65
Chapter 66
Breast Disorders in the Female
Chapter 67
Pubertal Gynecomastia
Chapter 68
Disorders of the Male Genitalia
Part 3
Medical and Surgical Disorders
Section 1
The Endocrine System
Chapter 69
Growth Disorders
Chapter 70
Disorders of Puberty
Chapter 71
Pituitary Disorders
Chapter 72
Thyroid Disorders in Adolescents
Chapter 73
Diabetes Mellitus
Chapter 74
Adrenocortical Disorders
Chapter 75
Bone Health and Disorders
Section 2
Eating Disorders
Chapter 76
Anorexia Nervosa
Chapter 77
Bulimia Nervosa
Chapter 78
The Female Athlete Triad
Chapter 79
Section 3
The Cardiovascular System
Chapter 80
Chest Pain in Adolescents
Chapter 81
Hyperlipidemia and Atherosclerosis
Chapter 82
Congenital Heart Disease
Chapter 83
Carditis in the Adolescent
Chapter 84
Valvular Heart Diseases
Chapter 85
Cardiac Dysrhythmias
Chapter 86
Sudden Cardiac Death
Chapter 87
Shock in the Adolescent Patient
Section 4
The Respiratory System
Chapter 88
Upper Respiratory Tract Infections
Chapter 89
Lower Respiratory Infections
Chapter 90
Chapter 91
Vocal Cord Dysfunction in Adolescents
Chapter 92
Cystic Fibrosis
Chapter 93
Sleep Disorders
Chapter 94
Chapter 95
Pulmonary Embolism
Section 5
The Gastrointestinal System
Chapter 96
The Approach to Abdominal Pain
Chapter 97
Function GI Disorders
Chapter 98
Disorders of the Esophagus
Chapter 99
Peptic Ulcers and Other Disorders of the Stomach and Duodenum
Chapter 100
Disorders of the Liver and Pancreas
Chapter 101
Diseases of the Gallbladder
Chapter 102
Chapter 103
Diarrhea in the Adolescent
Chapter 104
Inflammatory Bowel Disease
Chapter 105
Celiac Disease
Chapter 106
Section 6
Hematology and Oncology
Chapter 107
Disorders of the Red Blood Cells
Chapter 108
Hemostasis and Thrombosis
Chapter 109
White Blood Cell Disorders in Adolescents
Chapter 110
Lymphadenopathy and Splenomegaly
Chapter 111
Malignant Solid Tumors
Chapter 112
Brain Tumors in Adolescents
Chapter 113
Hematopoietic Stem Cell (Bone Marrow) Transplantation
Chapter 114
Cancer Survival Issues
Section 7
The Urinary System
Chapter 115
Proteinuria and Hematuria
Chapter 116
Urinary Tract Infections
Chapter 117
Nephritis and Nephrosis
Chapter 118
Hypertension: Significance, Diagnosis, and Management
Chapter 119
Voiding Disorders
Section 8
Connective Tissue Disease, CFS, Fibromyalgia
Chapter 120
Systemic Lupus Erythematosus
Chapter 121
Juvenile Idiopathic Arthritis
Chapter 122
Vasculitis and Associated Illnesses
Chapter 123
Fibromyalgia Syndrome in Adolescents
Chapter 124
Chronic Fatigue Syndrome
Section 9
Central Nervous System
Chapter 125
Central Nervous System Infections
Chapter 126
Chapter 127
Seizures in Adolescents
Chapter 128
Motor Unit Disorders
Chapter 129
Movement Disorders and Ataxia
Chapter 130
Demyelinating Diseases
Chapter 131
CNS Trauma
Chapter 132
Intracranial Vascular Malformations
Chapter 133
Chapter 134
Altered States of Consciousness
Section 10
Infectious Diseases
Chapter 135
Fever of Unknown Origin
Chapter 136
Common Viral Infections in Adolescents
Chapter 137
Infectious Mononucleosis and Mononucleosis-Like Syndromes
Chapter 138
HIV and AIDS in Adolescents
Chapter 139
Bacterial Infections
Chapter 140
Tick-Borne Diseases
Chapter 141
Chapter 142
Parasitic Infections
Chapter 143
Prevention of Travel-Related Infections
Section 11
Chapter 144
Chapter 145
Dermatitis and Papulosquamous Diseases
Chapter 146
Chapter 147
Miscellaneous Dermatologic Disorders in Adolescence
Section 12
Genetic Disorders
Chapter 148
Genetic Disorders
Chapter 149
Genetic Predisposition to Common Disorders
Chapter 150
Special Issues of Genetic Testing in Adolescent Patients
Section 13
Allergies and Immunologic Disorders
Chapter 151
Environmental Allergies
Chapter 152
Food Allergies
Chapter 153
Section 14
Disorders of the Eyes, Ears, Nose, and Throat
Chapter 154
Eye Disorders
Chapter 155
ENT Disorders
Chapter 156
Medical and Psychosocial Considerations for the Deaf Adolescent
Chapter 157
Adolescent Oral Health
Section 15
Chapter 158
Disorders of the Upper Extremities
Chapter 159
Disorders of the Lower Extremities
Chapter 160
Bone and Joint Infections
Chapter 161
Bone Tumors
Chapter 162
Disorders of the Spine
Chapter 163
Chest Wall Abnormalities
Section 16
Sports Medicine
Chapter 164
Preparticipation Evaluation
Chapter 165
Rehabilitation and Strength Training
Chapter 166
Exertional Heat-Related Illnesses
Chapter 167
Sport Psychology
Part 4
Psychosocial Issues
Section 1
Adolescents and Violence
Chapter 168
Physical Abuse
Chapter 169
Sexual Abuse and Assault
Chapter 170
Prostitution and Sex Trafficking
Chapter 171
Adolescents in Gangs
Section 2
Substance Abuse
Chapter 172
Overview: Substance Abuse
Chapter 173
Chapter 174
Chapter 175
Chapter 176
Chapter 177
Chapter 178
Hallucinogens, Club Drugs, Inhalants, and Other Substances of Abuse
Chapter 179
Abuse of Prescription Drugs
Chapter 180
Overdose of Prescription Drugs
Chapter 181
Office Management and Laboratory Testing
Chapter 182
Treatment Options
Section 3
Psychiatric Behavioral, and Developmental Health Problems
Chapter 183
Somatoform Disorders in Adolescents
Chapter 184
Mood Disorders in Adolescents
Chapter 185
Disorders of Anxiety in Adolescents
Chapter 186
Disorders of Behaviors
Chapter 187
Personality Disorders in Adolescents
Chapter 188
Psychotic Disorders in Adolescents
Chapter 189
Psychiatric Emergencies in Adolescents
Chapter 190
Adolescent Psychopharmacology
Chapter 191
Mental Health Treatment Modalities for Adolescents
Chapter 192
Neuropsychologic Testing of Adolescents
Section 4
Educational Issues
Chapter 193
Academic Overachievement and Underachievement
Chapter 194
Psychoeducational Assessment of Adolescents
Chapter 195
Gifted Adolescents
Chapter 196
ADHD in Adolescents

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