Sara, a 14-year-old, has come to the office for her school physical. She is very remote, moody, and unwilling to answer any questions you ask her as part of her physical exam. She seems to have changed a great deal in the past year, and is thinner, more unkempt, and lethargic. You notice also that her mother is constantly badgering her and rolling her eyes in exasperation at her lack of cooperation. What could you do to facilitate the examination and improve communication with Sara? What possible problems could Sara be experiencing? What should you do about the concerns that you have for Sara?