Recommendation 22: All adolescents should be asked annually about learning or school problems.

  • Adolescents with a history of truancy, repeated absences, or poor or declining performance should be assessed for the presence of conditions that could interfere with school success. These include learning disability, attention deficit hyperactivity disorder, medical problems, abuse, family dysfunction, mental disorder, or alcohol or other drug use.

  • This assessment, and the subsequent management plan, should be coordinated with school personnel and with the adolescent's parents or caregivers.

Recommendation 23: Adolescents should receive a tuberculin skin test if they have been exposed to active tuberculosis, have lived in a homeless shelter, have been incarcerated, have lived in or come from an area with a high prevalence of tuberculosis, or currently work in a health care setting.

  • Adolescents with a positive tuberculin skin test should be treated according to CDC [Centers for Disease Control and Prevention] treatment guidelines.

  • The frequency of testing depends on risk factors of the individual adolescent.


The fourth set of recommendations involves the use of vaccinations to prevent infectious disease. National immunization policies have changed recently with the development of the vaccination against Hepatitis B virus and the resurgence of measles and rubella among adolescent and adult populations. Providers will need to determine the number and type of previous vaccinations to assess the immunization needs of the adolescent.

Recommendation 24: All adolescents should receive prophylactic immunizations according to the guidelines established by the federally convened Advisory Committee on Immunization Practices.

  • Adolescents should receive a bivalent Td [tetanus and diphtheria toxoid] vaccine booster at the 11–12 year visit if not previously vaccinated within 5 years. With the exception of the Td booster at 11–12 years, routine boosters should be administered every 10 years.

  • Adolescents should receive a second dose of MMR [measles–

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