6: Adolescence Flashcards
What is adolescence?
When is it?
phase between childhood & adulthood
- Start: may be begining of puberty
- end: artificially (curtural dependant) about 18 (new definition: 10-25)
What is Adrenarche?
When and why does it start?
Precursor of Puberty (role is still uncertain)
- Starts
- Females: 6-9 years
- Males: 7-10 years
- Rise in adrenal 19- carbon steroid production, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS).
- Manifests clinically as the appearance of axillary and pubic hair, usually about age 8.
What are the main physical changes in adolescence in females?
- growth of pubic hair
- growth spurt
- menarche (first period)
- development of breastsa
- change in body shape
What are the main physical changes in adolescence in males?
- growth of pubic and underarm hair
- development of testicles and penis
- beard growth
- growth spurt
- Change in body shape
- change in voice
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What is the normal onset of adolescence in boys and girls
often = begin of puberty (but might be 10-25)
- Begining
- Girls: 8-13
- Boys 10-13 1/2
Explain how and why there was a change in onset of puberty in boys and girls
It decreased
- main factor thought to be: nutrition
What are the main endocrine changes associated with puberty?
- Adrenarche
- production of sex steroids in adrenals driven by ACTH production
- Pruberty
- sex steroid production in gonads driven by GnRH secretion
- increase in estrogen
- increase in androgens
- sex steroid production in gonads driven by GnRH secretion
Explain growth patterns in girls and boys in puberty
Normally: Girls have growth spurt earlyer at begining of puberty
Boys have growth spurt later in puberty
What are the main psychological changes in puberty?
Cognition e.g. morality
Identity
Increased self-awareness
Affect expression and regulation
And also
- social changes
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What are the normal social changes puberty?
Decrease of family and increase in importance of peer group (+wider social peer group)
- Peers have a higher influence which can also go wrong if teenagers experience rejection
- Teenagers also develop social role, occupatione etc.
Explain the development mismatch hypothesis (in puberty)
- There is a constant development cognitice regulation and control
- But a fast development of dopaminergic activity and sensation seeking
–> Leads to risky behaviour due to miscalculation of risk
Explain the biological changes in the brain of teenagers
- Thickening of Cortex
- Thinning of cortex
- –> transformaiton of grey to white matter with use of neurons
What are the main features of Anorexia Nervosa?
- Restriction of energy intake –> significantly low body weight in the context of age, sex, developmental trajectory and physical health
- Fear of gaining weight or becoming fat
- does not have to be vocalised (behaviour is enough)
- Lack of recognition of low body weight and disturbane in shape/weight perception
Explain the Etiology of Anorexia Nervosa
Many factors are involved!
- Genetics and prenatal factors (e.g. hormones) influence trait and cognigitve style. Expecially endangered if
- obsessionality
- perfectionalist
- deficits in social cognition
- inflexibility
- Leading to dieting behaviour, weight loss, starvation, and an increase in anxiety and depression
Explain the outcome and treatment for anorexia nervosa
- 80% recover after 5 years
- 20% chronic type
- High mortality rate: 5-10% of which 1 in 5 is suicide
- Treatment
- Family intervention
- For abnormal eating attitudes and depression: cognitive behavioural therapy.
- Small % need admission for weight restoration
Summarise the range of mood dirsorders in adolescence
- Depression
- Low mood/sadness
- Loss of enjoyment (anhedonia)
- Loss of energy
- Seen in
* changes to appetite, sleep, concentration, libido, self esteem etc.
- Seen in
- Many Subtypes
- repressive episode (only once) vs recurrent depression
- bipolar depression
- Psychotic depression, Atypical depression, Seasonal affective disorder (SAD), Inflammatory subtype
What are the associated problems with depression in adolescence?
- Increased risk of self-harm
- Association with anxiety disorders; eating disorders [females];conduct problems; substance misuse
- Familial aggregation (genetic and learning)
What are the two types of pre-pubertal depression?
- No recurrent risk in adult life
- common to present with co-morbit behavioural problems
- no familar connection
- Risk of Recurrence in adult life
- less common
- highly familiar pattern
- high rates of anxiety and bipolar disorders
What is adolescent depressive disorder?
- Irritability instead of sadness/low mood Especially in boys
- Somatic complaints and social withdrawal are common
- Psychotic symptoms rare before mid-adolescence
What are the different types of adolescent depressive disorder?
Defined by time-frame
- short term
- High rates of persistence and recurrence (20% in 1 yr)
- long term
- Significant continuity to adolescence and adulthood (40-70%)
• Impairment relationships/education in adulthood
- Significant continuity to adolescence and adulthood (40-70%)
What is the aetiology of depressions in adulthood?
Summarise the treatment plan for depression
- Mild depression
- Cognitive behavioural therapy [Individual or group]
- Interpersonal psychotherapy for adolescents
- Brief Psychosocial Intervention
- Moderate-Severe Depression
- Antidepressants e.g. SSRI’s: fluoxetine • Could be SSRI + CBT
- Combined treatment–> highest rate of symptomatic remission in 37% combined vs 20% fluoxetine alone (March et al., 2004)
What are possible causes for depression?
- Familial aggregation; genetic factors known
- Effects of family interaction e.g. criticism
- Life events, adversities
- physical closeness
- peers, rejection, bullying
- exams
- Endocrine disorders
What are other terms for conduct disorders?
Persistent failure to control behaviour appropriately within socially defined rules.
- antisocial behaviour
- offending
Name some examples of signs of conduct disorders
- Oppositional behaviour, defiance
- Tantrums
- Excessive levels of fighting or bullying, assault Running away from home
- Truancy
- Cruelty to animals
- Stealing
- Destructiveness to property
- Fire-setting
What are the developmental factors that have to be taken into consideration in a child with conduct disorders?
- Changes in family relationships – less direct surveillance, physical closeness, joint activities
- Peers – increased involvement with peers; may amplify antisocial behavior
- Experimentation and risk taking – rule violation, drugs & alcohol, petty offending frequent.
Summarise the epidemiology of conduct disorders
- 4% at ages 5-10 years; 6% at ages 10-15 years; overall 5% at ages 5-15 years.
- Higher in deprived inner-city areas
- Boys: girls 3:1
- Age of onset may vary
Associated with
- Larger family size
- lower socio-economic status
Summarise the possible cuases for conduct disorders
- Genetic – weak
- Child – difficult temperament
- Environment:
- Family
- poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression
- Wider environment
- poor schools
- neighbourhoods
- Family
What are the outcomes of Conduct disorders?
- poorer outcome with more problems in child, and family
- Risk of antisocial personality disorder in males
- Range of emotional and personality disorders in females
How can someonw interve in a child/ teenager with conduct disorder?
- For child – problem solving skills.
- Parent training
- Family intervention
- Address problems across contexts e.g. in school
