PE6.1-12 | Adolescent Health — Glossary

A cutaneous manifestation of insulin resistance characterised by dark, velvety hyperpigmentation at the neck, axillae, and groin; a visible clinical marker of metabolic risk in obese adolescents.

In adolescence, the hyperactive symptoms of childhood ADHD often diminish while inattentive features (disorganisation, forgetfulness, difficulty sustaining attention) persist and cause academic underperformance.

WHO-defined developmental period from 10 to 19 years of age, encompassing puberty and the transition from childhood to adulthood.

Iron-deficiency anaemia affecting up to 56% of adolescent girls in India, driven by menstrual losses, poor dietary iron, and high growth-related demands; addressed by WIFS.

Pregnancy in a person under 20 years of age; associated with elevated risks of anaemia, pre-eclampsia, preterm birth, low birth weight, and social/educational disruption.

The maturation of the adrenal cortex leading to increased DHEAS secretion, which drives pubic and axillary hair development independently of gonadal puberty.

Traumatic childhood events (abuse, neglect, domestic violence, household dysfunction) that are the strongest environmental risk factor for adolescent depression, anxiety, suicide risk, and substance use.

Adolescent-Friendly Health Clinic — the block/CHC-level service-delivery node for RKSK, providing confidential and non-judgmental adolescent health services in a designated space.

Adolescent Friendly Health Services — health services designed to meet WHO quality criteria for accessibility, acceptability, and effectiveness for the 10–19 year age group.

The anorexia nervosa subtype where the significantly low body weight is maintained despite recurrent binge eating and/or purging episodes.

The anorexia nervosa subtype characterised by weight loss through dieting, fasting, and/or excessive exercise, without recurrent binge eating or purging episodes.

Markedly diminished interest or pleasure in all or almost all activities — one of the two core (must-have) symptoms for MDD diagnosis, and often more prominent than mood in adolescent presentations.

A DSM-5 eating disorder characterised by restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and disturbance in body image perception.

The measurement of physical dimensions (height, weight, circumferences) and their comparison against reference standards for nutritional and growth assessment.

Proactive, age-appropriate health education given to adolescents at well-child/adolescent visits to prevent future health problems before they arise.

Adolescent Reproductive and Sexual Health — the predecessor programme to RKSK (pre-2014); had a narrower focus restricted to reproductive health, replaced by RKSK's broader six-domain framework.

Eating a definitively large amount of food in a discrete time period with a subjective sense of loss of control over eating — a core feature of both BN and binge eating disorder.

Body mass index plotted against age on sex-specific growth charts; the appropriate adiposity measure for adolescents because normal adiposity changes with pubertal stage.

The persistent misperception of one's own body as fat or larger than it is, despite objective evidence of emaciation — a core cognitive feature of anorexia nervosa (DSM-5 Criterion C).

A DSM-5 eating disorder characterised by recurrent binge eating followed by compensatory behaviours, occurring at least once weekly for 3 months, with self-evaluation unduly influenced by body shape and weight.

Cognitive Behavioural Therapy for Eating Disorders — the evidence-based first-line psychological treatment for adults with bulimia nervosa and for adolescents when FBT is not available.

Extension of the columnar epithelium from the endocervical canal onto the ectocervix, physiologically present in adolescent girls and increasing susceptibility to chlamydial and gonococcal infection.

A trained healthcare worker present during physical examination to protect patient dignity and clinician integrity; mandatory for genital and breast examinations in adolescents.

A structured psychotherapy that targets negative automatic thoughts and behaviours; first-line psychological treatment for adolescent depression and anxiety disorders, delivered over 8–16 sessions.

Behaviour used to prevent weight gain after binge eating — includes purging types (self-induced vomiting, laxative/diuretic misuse) and non-purging types (excessive exercise, fasting).

The ethical and legal obligation to protect patient-disclosed information; has a safety-override exception when the adolescent or others are at serious risk of harm.

The AFHS principle that information shared by an adolescent in a health encounter is protected from disclosure to parents or others, except where safety requires override.

The ethical obligation to keep adolescent health information private, communicated clearly at the start of consultation; breached ONLY when there is immediate risk of serious harm to the patient or others.

The most common cause of delayed puberty — a normal variant in which puberty begins late (positive family history), bone age is delayed, and adult height is ultimately normal.

A validated 6-item brief screening instrument (Car, Relax, Alone, Forget, Friends, Trouble) for adolescent substance use; score ≥2 indicates need for brief intervention or referral.

Convention on the Rights of the Child — UN treaty ratified by India, establishing the legal basis for adolescent rights to health, privacy, and participation in healthcare decisions.

Absence of breast bud by age 13 in girls or testicular volume <4 mL by age 14 in boys, requiring evaluation for constitutional delay or pathological cause.

The simultaneous coexistence of undernutrition (stunting, anaemia, wasting) and overnutrition (overweight, obesity) within the same population or household; increasingly seen in India's urban adolescents.

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (APA, 2013) — the standard classification and diagnostic criteria system for psychiatric disorders used in clinical practice and research.

The use of condoms for simultaneous protection against both STIs and unintended pregnancy, the recommended approach for sexually active adolescents.

Abnormal lipid levels including elevated LDL-C, elevated triglycerides, and/or reduced HDL-C; an early metabolic consequence of adolescent obesity and a direct risk factor for atherosclerosis.

A psychological state in which the patient does not perceive their illness as alien or distressing — characteristic of AN, where dietary restriction is experienced as achievement rather than a problem.

Levonorgestrel 1.5 mg taken as a single oral dose within 72 hours of unprotected intercourse to prevent unintended pregnancy; efficacy decreases with time (95% at 24h, 85% at 72h).

A three-phase outpatient treatment for adolescent anorexia nervosa that empowers parents to take charge of the patient's nutrition in Phase 1, gradually returning control to the adolescent as weight is restored.

A 2004 FDA warning noting a small increased risk of suicidal ideation (not completed suicide) in the first weeks of antidepressant treatment in children and adolescents; mandates close monitoring but does not prohibit use when indicated.

The most common benign breast mass in adolescent girls; smooth, mobile, firm, non-tender; usually managed conservatively with ultrasound monitoring.

The first-choice SSRI antidepressant for adolescent MDD (20–40 mg/day), based on TADS trial evidence; FDA black-box warning requires weekly monitoring at treatment start for activating side effects and suicidal ideation.

The only FDA-approved pharmacotherapy specifically for bulimia nervosa, prescribed at a dose of 60 mg/day (higher than the 20 mg antidepressant dose) as an adjunct to cognitive behavioural therapy.

Piaget's fourth stage of cognitive development (from ~12 years), characterised by abstract reasoning, hypothetical thinking, and systematic problem-solving.

Clinically significant distress arising from a mismatch between a person's gender identity and their biological sex; recognised in DSM-5 and ICD-11 as a clinical condition requiring affirming care.

A person's internal sense of their own gender (male, female, non-binary, or other), which is distinct from biological sex and from sexual orientation.

A DSM-5 anxiety disorder characterised by excessive uncontrollable worry across multiple domains for ≥6 months, with ≥3 somatic symptoms in adults (only 1 in children).

The principle that an adolescent who demonstrates sufficient intelligence and maturity to understand the nature and consequences of a healthcare decision has legal capacity to consent to that treatment without parental involvement.

Enlargement of the thyroid gland; classified by WHO as Grade 0 (no visible or palpable), Grade 1 (palpable but not visible with neck in normal position), Grade 2 (visible without neck extension).

A structured psychosocial screening tool for adolescent encounters covering 9 domains: Home, Education/Employment, Eating, peer Activities, Drugs, Sexuality, Suicide/depression, Safety.

The Drugs domain of the HEEADSSS psychosocial assessment, probing tobacco, alcohol, inhalants, cannabis, and other substance use; followed by CRAFFT screening if positive.

The Sexuality domain of the HEEADSSS psychosocial assessment, probing sexual activity, orientation, contraception use, STI risk, and concerns about relationships or abuse.

Dysregulation of the hypothalamic-pituitary-adrenal stress-response axis with elevated cortisol, consistently associated with adolescent and adult depression; contributes to vegetative symptoms (sleep, appetite, energy disturbance).

The hypothalamic-pituitary-gonadal axis: GnRH stimulates LH and FSH release from the pituitary, which drives gonadal steroid production (oestrogen/testosterone).

Systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg on two or more occasions in adolescents; requires lifestyle modification and repeat measurement.

Systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg in adolescents; requires evaluation for secondary causes and physician referral.

Abnormally low serum phosphate, critical in refeeding syndrome; serum phosphate <0.5 mmol/L is severe and can cause life-threatening cardiac arrhythmias.

Indian Academy of Paediatrics growth reference charts based on Indian children, used for height-for-age, weight-for-age, and BMI-for-age percentile assessment.

Erikson's Stage 5 psychosocial crisis, occurring during adolescence, in which the developmental task is achieving a coherent personal identity; failure results in role confusion.

Fasting blood glucose 100–125 mg/dL; a pre-diabetic state indicating insulin resistance and elevated risk of progression to type 2 diabetes without lifestyle intervention.

Deliberate inhalation of volatile solvents (whitener, petrol, adhesive) for intoxicating effects; carries risk of sudden sniffing death syndrome and is especially prevalent among street-involved adolescents.

Reduced cellular sensitivity to insulin, requiring the pancreas to secrete more insulin to maintain euglycaemia; the central pathophysiological link between obesity and type 2 diabetes, hypertension, and dyslipidaemia.

An evidence-based psychotherapy for adolescent depression that focuses on improving interpersonal relationships and navigating the role transitions characteristic of adolescence.

Fine, downy hair on the trunk and extremities that re-emerges in severe anorexia nervosa as a thermoregulatory response to loss of insulating body fat.

A DSM-5 mood disorder requiring ≥5 of 9 symptoms for ≥2 weeks including depressed/irritable mood or anhedonia; in adolescents, irritability may substitute for depressed mood as the core criterion.

The legal obligation under POCSO Section 19 for any person (including healthcare providers) to report suspected sexual abuse of a child under 18 years to the SJPU or local police within 24 hours.

Removal or securing of potentially lethal items (medications, pesticides, sharp objects) from the home as a crisis-intervention strategy when an adolescent is at risk of suicide; one of the most effective suicide prevention measures.

The first menstrual period, which is a late pubertal event typically occurring at Tanner Stage B4 breast development; mean age in India approximately 12.5–13 years.

An RKSK-linked programme providing subsidised sanitary napkins and menstrual hygiene education to rural adolescent girls through ASHA workers.

Indian legislation that decriminalised suicide attempts (Section 115), established advance directives, and replaced the Mental Health Act 1987; mandates rehabilitative care for persons who attempt suicide.

A cluster of cardiovascular risk factors — central obesity, elevated BP, dyslipidaemia (high TG/low HDL), and impaired fasting glucose — that confer a 5-fold higher risk of cardiovascular disease than the general population.

The first-line pharmacological treatment for ADHD (dosed at 0.3–1 mg/kg/day); available as short-acting (Ritalin) and long-acting (OROS-MPH/Concerta) formulations; requires monitoring of growth, appetite, heart rate, and blood pressure.

National Health Mission — the umbrella programme of the Ministry of Health and Family Welfare under which RKSK, RMNCHA, and other national health programmes are implemented.

Chronic conditions not transmitted by infection; the four main types are cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers; mental health disorders are also classified as NCDs.

Deliberate self-harm (cutting, burning, scratching) without suicidal intent, used as an emotional regulation strategy; significantly increases risk of future suicide attempts despite the absence of immediate intent to die.

BMI ≥95th percentile for age and sex on IAP sex-specific growth charts; associated with insulin resistance, metabolic syndrome, hypertension, and significantly elevated adult NCD risk.

A precancerous condition of the oral mucosa caused by areca nut and smokeless tobacco consumption; presents with progressive fibrosis limiting mouth opening; high malignant transformation potential.

One Stop Crisis Centre — a facility at district hospitals providing integrated medical, forensic, legal, and psychosocial services to survivors of sexual violence, mandated under POCSO Act 2012.

Reduced bone mineral density resulting from oestrogen deficiency (from AN-related amenorrhoea) and low IGF-1; may be irreversible and leads to elevated fracture risk in adulthood.

BMI between the 85th and 94th percentile for age and sex on IAP growth charts; warrants lifestyle counselling and monitoring for metabolic complications.

Bilateral painless enlargement of the parotid (salivary) glands, commonly seen in BN due to repeated vomiting-related stimulation — gives the 'chipmunk cheeks' appearance.

The maximum rate of height gain during the pubertal growth spurt — approximately 6–10 cm/yr in girls (peaking at ages 11–12) and 8–12 cm/yr in boys (peaking at ages 13–14).

An adolescent volunteer trained under RKSK (also called 'Saathiya') to deliver health information and promote healthy behaviours among peers in the community and school.

A validated 9-item self-report screening tool for adolescent depression; score ≥10 = moderate severity = active treatment indicated; item 9 (self-harm) reviewed independently.

WHO recommends a minimum of 60 minutes of moderate-to-vigorous physical activity daily for adolescents, plus muscle- and bone-strengthening activities at least 3 days per week.

Protection of Children from Sexual Offences Act 2012 — Indian law that criminalises all sexual acts involving persons under 18 years and mandates reporting of suspected abuse by any person within 24 hours.

A bead-shaped series of ellipsoid models (volumes 1–25 mL) used to assess testicular volume; testicular volume ≥4 mL marks onset of puberty (Tanner G2) in boys.

The appearance of secondary sexual characteristics before 8 years in girls or 9 years in boys, requiring investigation to exclude central (GnRH-dependent) or peripheral (GnRH-independent) causes.

Painful menstruation without identifiable pelvic pathology, affecting up to 50–80% of adolescent girls; first-line treatment is NSAIDs (mefenamic acid or ibuprofen) initiated at onset of flow.

The biologically driven process during adolescence by which secondary sexual characteristics develop and reproductive capacity is achieved, initiated by disinhibition of the HPG axis.

A potentially fatal metabolic complication of nutritional rehabilitation in severely malnourished patients, characterised by hypophosphataemia (± hypokalaemia, hypomagnesaemia) on reintroduction of calories, causing cardiac arrhythmias, neurological dysfunction, and haematological complications.

The mechanism by which the receiving health facility (CHC, district hospital) sends clinical outcome information back to the referring AFHC — essential for continuity of care and quality monitoring.

Behaviours during adolescence (substance use, unsafe sex, reckless driving) driven by a neurobiological developmental lag between the mature limbic system and the immature prefrontal cortex.

Rashtriya Kishor Swasthya Karyakram — India's national adolescent health programme (2014, under NHM) targeting 10–19-year-olds across six thematic areas.

Calluses or scarring on the dorsum of the hand (metacarpophalangeal joints) caused by repeated trauma from teeth during self-induced vomiting — pathognomonic of purging behaviour in BN or AN-BP.

The term for RKSK-trained peer educators in India; adolescents selected and trained to serve as community health promoters across the six RKSK domains.

The exception to adolescent confidentiality where disclosure to parents/authorities is obligatory to prevent serious harm, including when mandatory reporting under POCSO Act 2012 applies.

A structured intervention for adolescents with suicidal ideation: identifying warning signs, coping strategies, trusted contacts, emergency numbers, and removing means from the home; used for lower-risk situations as an alternative to emergency admission.

Time spent in front of digital screens; WHO/IAP recommends ≤2 hours recreational screen time per day for adolescents; excess screen time is associated with sedentary behaviour, disrupted sleep, and obesity.

A standardised scale (Tanner stages I–V) describing pubertal progress in secondary sexual characteristics, independent of chronological age.

Any sexual act involving a person under 18 years that is non-consensual, coercive, or involves exploitation of a power differential; under POCSO 2012, all sexual contact with a person under 18 is legally an offence.

The enduring pattern of emotional, romantic, and sexual attraction to others — heterosexual, homosexual, or bisexual — determined by biological and developmental factors and not a choice.

Special Juvenile Police Unit — the designated police body to receive mandatory POCSO reports and handle child abuse cases, available at district level across India.

Superior mesenteric artery syndrome — compression of the third part of the duodenum by the superior mesenteric artery in severely malnourished patients, causing partial or complete bowel obstruction.

An anxiety disorder characterised by intense fear of social situations and scrutiny, causing avoidance that significantly impairs school attendance, peer relationships, and daily functioning in adolescents.

The tendency of South Asians, including Indians, to have greater visceral adiposity and insulin resistance at any given BMI compared to Caucasians, resulting in higher metabolic NCD risk at apparently normal weight.

A treatment framework in which the least intensive intervention is applied first (psychoeducation, lifestyle) with escalation to more intensive interventions (CBT, medication) when lower steps are insufficient.

Sudden cardiac death from ventricular fibrillation caused by cardiac sensitisation to catecholamines by volatile hydrocarbons during inhalant abuse, triggered by physical exertion or fright.

Treatment of STIs based on clinical syndrome (discharge, ulcer, lower abdominal pain) rather than pathogen-specific diagnosis, providing combined cover for the most likely causative organisms.

Treatment for Adolescents with Depression Study — randomised controlled trial showing that fluoxetine combined with CBT is superior to either alone for moderate-to-severe adolescent MDD; the primary evidence base for fluoxetine in adolescent depression.

Equivalent to SMR; describes breast development (B1–B5) and pubic hair (PH1–PH5) in girls, and genital development (G1–G5) and pubic hair in boys.

A standardised 5-stage classification system (Tanner Stages 1–5) for rating pubertal progression in breast development, genital development, and pubic hair growth.

The onset of breast development (breast budding, Tanner Stage B2) in girls — the first sign of puberty in most girls, typically occurring at 8–13 years.

Potent carcinogens present in high concentrations in smokeless tobacco products (gutka, khaini); directly associated with oral cancer, oropharyngeal cancer, and oral submucous fibrosis in Indian adolescents.

Industrially formulated food products containing little or no whole food ingredients; high in added sugars, unhealthy fats, sodium, and food additives; strongly associated with obesity, diabetes, and cardiovascular disease.

Fat deposited around the abdominal organs (intra-abdominal/omental fat), as opposed to subcutaneous fat; metabolically active and directly associated with insulin resistance, inflammation, and cardiovascular risk.

A measure of central adiposity measured at the level of the umbilicus; supplements BMI in identifying metabolically at-risk adolescents, particularly in the South Asian phenotype where visceral fat accumulates at lower BMI values.

The eight quality benchmarks for adolescent-friendly health services: accessible, equitable, acceptable, appropriate, comprehensive, effective, efficient, and youth-friendly.

The four behavioural risk factors common to most NCDs: unhealthy diet, physical inactivity, tobacco use, and harmful alcohol use — all modifiable through individual and population-level interventions.

Weekly Iron-Folic Acid Supplementation — a RKSK sub-programme providing weekly IFA tablets (100 mg iron + 500 µg folic acid) to adolescent girls 10–19 years, with biannual deworming.