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The objective of this study was to describe coping mechanisms used by adolescents during emergency treatment.A convenience sample of adolescent patients (aged 12–18 years) was surveyed in our large (87,000 annual visits) urban academic pediatric emergency department (ED) with an adapted Adolescent Coping Orientation for Problem Experiences survey. Parents were surveyed about their perceptions of their child's coping mechanisms. Participants were excluded if they were non–English speaking, in police custody, had altered mental status, or were hemodynamically unstable.Of the 123 adolescents approached, 93 participated (response rate, 76%) and 80 completed the survey (completion rate, 86%). Sixty percent were female, and the mean (SD) age was 15 (2) years. Most respondents were non–Hispanic black (62%). Adolescents presented for acute complaints (48%); chronic worsening problems (33%); and injury from an accident or assault (19%). While in the ED, 62% felt safe, 56% reported boredom, and 94% felt supported by their parents. Adolescents reported that listening to music (82%), sleeping (76%), and focusing on getting better (75%) would minimize their stress in the ED. A total of 50 parents completed the survey. There was 79% agreement between parents and adolescents regarding adolescents listening to music to cope in the ED. There was 72% agreement between parents and adolescents in regard to parental support.In this urban ED, parental involvement and listening to music were the most common coping strategies adolescents used during an ED visit. Attempts to improve patient-centered care should address opportunities for parental support and mechanisms for adolescents to listen to music.