Editorial Adolescent Psychiatry, 2019, Vol. 9, No. 2 67 Editorial Critical Issues in Adolescent Mental Health in the Emergency Department: Looking Beyond Triage and Risk Assessment “Adolescence is like having only enough light to see the step directly in front of you.” Sarah Addison Allen, The Girl Who Chased the Moon Adolescents are not simply young adults, and very little prepares us as providers and physicians to deal with teenagers in the acute setting. In fact, it is not until the turn of the 20th century that adolescence was recognized as a distinct phase behaviorally and from a neuroendocrine perspective, thanks to the pioneer- ing work of Hall (1904), whose work opened the door to exploration of the changes during adolescence and the distinction of adolescents from adults, culminating in the sub-specialty of adolescent medicine (Alderman, Rieder & Cohen, 2003; Hardoff, & Eisenstein, 2004). Hall described adolescence as a time of “storm and stress,” and it is now well recognized that many mental illnesses have their onset during the teenage years, yet adolescent psychiatry as a subspecialty is not still well-demarcated; emergency adoles- cent psychiatry is even less well-delineated and understood (McCarthy, Abenojar, & Anders, 2009). There is much hope that our level of understanding of teenage development will be booming soon: the largest long-term study of brain development and child health in the United States, the Adolescent Brain Cogni- tive Development (ABCD) study (Brooks, 2018) has just released its baseline interim data, allowing re- searchers access to data that will shed light on how adolescent brain development unfolds. Crises in adolescent patients are challenging, because they combine the baseline intrapsychic torment of adolescence to added stressors, and strain budding coping mechanisms and support systems. From the physician’s perspective, especially in emergency situations, balancing the developmental limitations with evidence-based, scientifically-backed treatments can be daunting. This special thematic issue aims to give the reader an overview of commonly encountered problems in adolescents visiting acute settings, especially the emergency department. The collection of articles and topics has been selected with the intention to highlight management and practical considerations while respecting diagnostic limitations. In the adolescent patient, clear diagnoses are often lacking, and present- ing problems frequently transcend diagnostic labels. Thus, we have included articles on agitation, border- line features, and inappropriate acting out in youth, as these represent major challenges to the ED clini- cian. We begin with a fairly common topic affecting young adults, Addressing Crises in Teen Pregnancy. In this article, Doghor, Okotcha, and Onigu-Otite cover the pertinent management aspects of the young pregnant teenager, and how to handle recrudescence of symptoms in the wake of the upheaval represented by pregnancy, especially given backgrounds of sexual trauma and dysfunctional environments. The second article, addressing Depression and Suicidal Ideation in Adolescents Presenting to The Emergency Department, touches on a very common presentation that keeps physicians awake at night. One can anguish over whether discharging a patient home was the right decision, whether a life hangs in the balance. Yet, predicting self-harm potential is still sometimes more an art than a science, and this arti- cle helps further understanding of approaching this thorny area. Many self-harm threats stem from borderline personality features, but mood dysregulation is often de- scribed in the popular vernacular as bipolar, muddying the diagnostic picture. Thus, the article is followed by The Evaluation and Management of Non-Suicidal Self Injury in Adolescents by Sindhu A. Idicula, Amy Vyas and Nicole Garber. 2210-6774/19 $58.00+.00 © 2019 Bentham Science Publishers