This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Adolescence, Subject name: Pediatrics
A 16-year-old girl, accompanied by her mother, is in your office for a well-adolescent visit. The mother asks about drug and alcohol abuse. You explain that the warning signs of abuse include which of the following? 
Select and explain. 
A. Excessive concern for weight and body configuration, B. Improved school performance, C. Recent changes from age-appropriate, acceptable friends to younger associates, D. Deterioration in personal habits, hygiene, dress, grooming, speech patterns, and fluency of expression
D: Deterioration in personal habits, hygiene, dress, grooming, speech patterns, and fluency of expression
Answer: D: Deterioration in personal habits, hygiene, dress, grooming, speech patterns, and fluency of expression 
Explanation: When an adolescent shows evidence of declining school performance or truancy, a change for the worse in personal habits and grooming, exaggerated mood swings, change in friends to an older and unacceptable group, and frequent hostile reactions in relationships with others, the possibility that he or she is abusing drugs or alcohol, or both, should be considered strongly. Dependence on drugs is a progressive disorder; therefore, prompt identification and intervention are required if serious complications are to be avoided. Routine health assessment of adolescents should include inquiry about the use of cigarettes, alcohol, and other drugs, and about school performance and family and peer relationships.