Female Age: 17

Background:

Min is a bright and active 17-year-old who is in your office for a Texas Health Steps preventive medical checkup. Min’s mother extols her daughter’s accomplishments and plans, but Min seems subdued and looks at the floor while her mother speaks. As part of the checkup, you ask Min’s mother to step into the waiting room while you speak privately with Min.

You take an open-ended, nonjudgmental approach to the discussion. “Min, it’s obvious how proud your mother is, but I’d like to hear more about how you think things are going.” The girl tells you she’s not the successful, well-adjusted student her mother described. She feels anxious and tired, has trouble concentrating, and is unsure what to do after graduation. She thinks there may be something seriously wrong but doesn’t want to worry her parents. Min’s physical exam reveals no medical issues that would explain her symptoms, and her medical record indicates that she has not been screened for mental health problems as an adolescent.