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Adolescence: development and the HEADSSS interview

  • Life stage

Adolescence brings puberty, abstract thinking and the search for identity. The HEADSSS interview screens for risks in private and with confidentiality.

Updated

What it is

Adolescence is the transition from childhood to adulthood, roughly 10 to 19 years by the WHO definition. It combines puberty (rated by Tanner stages), a maturing brain in which emotional and reward systems mature before the prefrontal control systems, abstract (formal operational) thinking and the search for identity. Most adolescent deaths and much illness come from preventable causes such as injuries, violence, self-harm and substance use, which the psychosocial HEADSSS interview is designed to uncover.

Key facts

  • Early adolescence (about 10 to 13): puberty, concrete thinking, same-sex peer groups; middle (14 to 17): peak peer influence and risk-taking, abstract thinking; late (18 and beyond): stable identity and relationships.
  • Early maturing girls have higher risk of depression, eating disorders and substance use; late maturing boys are more often bullied.
  • Most adolescents keep a positive relationship with their parents; constant severe conflict is not normal and needs attention.
  • Sleep shifts later in adolescence (delayed circadian phase), clashing with early school times.

Step by step

  1. Home: who lives at home, relationships, safety, recent changes.
  2. Education and employment: school performance, attendance, bullying, goals, work.
  3. Activities: friends, sports, screens and social media, sleep.
  4. Drugs: tobacco and vaping, alcohol, cannabis and other drugs, among friends first, then the adolescent.
  5. Sexuality: orientation and identity, relationships, consent, contraception, sexually transmitted infections.
  6. Suicide and depression: mood, self-harm, suicidal thoughts; asking does not increase risk.
  7. Safety: violence, abuse, weapons, seat belts and helmets, online risks.

Clinical notes

  • Order the HEADSSS questions from less to more sensitive, and normalize them: ‘many people your age...’.
  • Isolation, loss of interest, falling school performance and irritability are warning signs of depression or suicide risk.
  • Weight loss with fear of gaining weight, or secret eating and vomiting, point to an eating disorder.

Test yourself

Think of the answer, then tap the question to see it.

What do the letters of HEADSSS stand for?

Home, Education and employment, Activities, Drugs, Sexuality, Suicide and depression, Safety.

Why should part of the adolescent interview be done without the parents?

Confidentiality makes honest answers about drugs, sex and mood more likely; its limits (risk of serious harm) are explained at the start.

What is usually the first sign of puberty in girls, and in boys?

Breast budding in girls; testicular enlargement in boys.

Why are adolescents prone to risk-taking, according to brain development?

Emotional and reward systems mature before prefrontal control systems, and peer approval strongly increases risky choices.

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Connections

← All of behavioral science

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: Adolescent development (MedlinePlus, U.S. National Library of Medicine, 2025); Adolescent and young adult health (World Health Organization (WHO), 2024).

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Representative model, for educational purposes only.