The parents of a 16-year-old boy come to the pediatrician's office to discuss concerns about their son's behavior. The mother reports that he has been more distant and his grades have dropped over the past 2 months. The patient has no significant medical history and takes no medication. The parents ask if the physician can order a urine drug test without their son's knowledge. The father says, "We just want to get him help if he needs it." Which of the following is the most appropriate response to the parents?

Question

The parents of a 16-year-old boy come to the pediatrician's office to discuss concerns about their son's behavior.  The mother reports that he has been more distant and his grades have dropped over the past 2 months.  The patient has no significant medical history and takes no medication.  The parents ask if the physician can order a urine drug test without their son's knowledge.  The father says, "We just want to get him help if he needs it."  Which of the following is the most appropriate response to the parents?

Quizplus · Accepted Answer

Involuntary toxicological screening of adolescents is generally limited to patients who lack decision-making capacity or who require emergent clinical care. Responding to a parental request for drug testing without the knowledge of the adolescent requires a tactful and nonjudgmental approach that explores the parents' concerns and educates them about the limitations of drug testing (eg, false-positive results, negative results not excluding substance use, erosion of trust between the adolescent and parents or physician). In this case, the parents are concerned that dropping grades and distant behavior are signs of substance use but provide few details. The best approach is to acknowledge the parents' concerns and ask for more detailed descriptions of behavioral changes or any other evidence suggestive of substance use. This will give the physician a more complete understanding of why they think testing is necessary. It is also helpful to explain that substance use problems can usually be detected by establishing a trusting relationship with the patient and taking a careful history. The physician should then meet with the adolescent alone and explore the possibility of substance use and other mental health issues in privacy. Drug testing is usually unnecessary when patients are forthcoming about their drug use history. (Choice A) This statement inappropriately assumes that the parents have not tried talking to their son, places the burden on the parents to assess their son for substance use, and suggests that drug testing without the adolescent's consent remains an option. It would be better to inquire if the parents have spoken to their son about the issue and obtain a more detailed understanding of their concerns. (Choice B) Although depression should be considered as a possible cause of behavioral changes, it is premature to suggest any intervention before understanding the parents' concerns and evaluating the patient alone. (Choice D) This statement ignores the parents' concerns and desire to help their son and focuses on the physician's concerns about preserving a trusting physician-patient relationship. (Choice E) Although this statement acknowledges the parents' desire to be helpful, it blames them for potentially damaging their relationship with their son. It would be better to explain how testing without consent can erode trust in general rather than to assign blame. Educational objective: Parent-requested drug testing without the knowledge of an adolescent is not recommended. Responding to the request should include exploration of the parents' concerns, education about the limitations of drug testing, and evaluation of the patient privately. References: Testing for drugs of abuse in children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/24864184)

The Parents of a 16-Year-Old Boy Come to the Pediatrician's