Adolescence

Question 1

Define Adolescence?

Answer 1

Adolescence is a transitional stage ofphysicalandpsychological developmentthat generally occurs during the period frompuberty to legal adulthood

Question 2

Stages of Adolescence?

Answer 2

Early - 11-14
Middle - 14-17
Late - 18-21

Question 3

Physical changes in Females?

Answer 3

Breast budding 
Pubic hair growth 
Growth spurt (peak)
1st period (Menarche) 
Underarm Hair 
Change in body shape 
Adult breast size

Question 4

What Marks the start of puberty in females?

Answer 4

Breast budding - 8 years old

Question 5

Physical changes in Males?

Answer 5

Growth of scrotum and testes 
Change in voice 
Increased dick size 
Pubic hair growth 
Growth spurt (peak)
Change in body shape 
Facial and underarm hair

Question 6

Peak and start of puberty in girls v.s boys?

Answer 6

Girls start (8 years - with breast budding) 
Boys start (10.5)

Peak for girls (11-13.5)
Peak for boys (13-15)

Question 7

Define puberty?

Answer 7

Process of physical changes through which a child’s body matures into an adult body capable of sexual reproduction

Question 8

What is puberty initiated by?

Answer 8

Initiated by the various hormones in the brain signaling to the tests/ovaries

Question 9

define Adrenarche?
- what does it cause
-

Answer 9

Adrenarche: increase in adrenal androgen production between 6-10yrs old in girls

Adrenarche occurs before puberty starts and = early sexual maturation stage (e.g axillary and pubic hair).

Question 10

Define Menarche?

Answer 10

Onset of first menstrual cycle

Question 11

Endocrinology of puberty?

• talk about GnRH axis switch on
• main male and female sex steroids
• Growth spurt mediator

Answer 11

Neurokinin B (NKB) + Kisspeptin = critical switch on of GnRH system

GnRH = stimulates gonadotrophin release from pit

LH stimulates Leydig (testes) and thecal cells (in ovary follicle) = androgens.

FSH = stimulates ovarian follicles, Sertoli cells [respond to FSH+ androgen - support development of spermatogonia]

Testosterone is the primary androgen from Leydig cells.

Oestradiol main female steroid hormone (androgens produced from thecal; cells converted to Oestradiol by nearby granulosa cells that contain aromatase).

IGF-1 rises due to GH – growth spurt mediator.

Question 12

Role of leptin in initiating puberty?

- hence effect of childhood obesity

Answer 12

Increased leptin stimulates kisspeptin and thus stimulates GnRH. [leptin = a permissive factor for puberty to occur]

Thus childhood obesity = early puberty.

Question 13

What change is seen in hypothalamus that allows the testosterone and oestrogen levels to rise in the body?

Answer 13

The hypothalamus and puberty become less sensitive to negative feedback so levels rise higher = development of secondary sexual characteristics.

Question 14

Summarise 2 theories about onset of puberty?

Answer 14

1. Maturation of CNS neurones = increased release of GnRH

2. Altered set-point of gonadal steroid feedback.

Question 15

Piaget’s cognitive development

Answer 15

Kohlberg’s theory of moral development

Birth → 2 = sensorimotor
2-7yrs = preoperational, uses symbols to represent the world
7-11yrs = concrete operational stage = logical reasoning
11-15 = formal operational stage = think in abstract, hypothetical and idealistic manner.

Question 16

Kohlberg’s theory of moral development?

Answer 16

Level 1+2 pre-conventional (desire to avoid punishment)

Level 3+4 Conventional - to illicit validation from others

Level 5+6 Internal moral code and independant of others

Question 17

Emotional development: self-concept - Harter’s 8 dimensional model of self-concept?

Answer 17

 Scholastic (concerned about education), job, athletic, physical appearance, social acceptance, close friends, romantic appeal and conduct of self – Some Jobs Are Pretty Shit, Can’t Really Complain.

• Self-concepts have clinical implications – 20-30% adolescents have low self-esteem which can lead to depression, anxiety, poor academia, social isolation, etc. However, people with good self-esteem can also be disposed to this!

Question 18

Self-concepts have clinical implications?

Answer 18

•Self-concepts have clinical implications – 20-30% adolescents have low self-esteem which can lead to depression, anxiety, poor academia, social isolation, etc. However, people with good self-esteem can also be disposed to this!

Question 19

Emotional development: Identity formation – Erikson’s 8-life-span stages?

Answer 19

Don’t need to know the stages but one stage is in age’s 10-20 which is “Identity vs. confusion”.

Question 20

What is necessary for identity development?

Answer 20

Only moratorium necessary for identity development.

moratorium (crisis, actively searching for identity)

Question 21

Integration
Assimilation
Separation

Marginalisation

Answer 21

 Integration – retain base culture, develop and maintain with mainstream culture as well. ++
 Assimilation – lose base culture, develop and maintain into mainstream culture. -+
 Separation – retain base culture, no development into mainstream culture. +-
 Marginalisation – lose base culture, no development into mainstream culture. –

Question 22

Impact of Social domains?

Answer 22

o Social domains – adolescents and parents may have different views about who has the final say depending upon the social “domains” – friendships, clothes, etc. – mid-adolescence is most intense negotiations

Question 23

Social development- Family? :

Answer 23

 Conflict with parents – most adolescents have good relationships, high confiding in mothers.
 Family connectedness is associated with – reduced risk behaviours and increased self-esteem.

Question 24

Social development -Peer development:

Answer 24

 Primary school (7-11) – goal to be accepted by peers, prefer same gender and gain loyalty.
 11-13 – expect genuineness, intimacy, common interests, emergence of cliques.
 13-16 – friendship goals, cross-gender relationships and develop larger groups.
 16-18 – emotional support expected and increase dyadic (between 2 people) romantic ties.

Question 25

Social development - Gender differences?

Answer 25

 Boys – less intimate, disclosing and friendships embedded in larger circles.
 Girls – close and confiding relationships but are more brittle.

Question 26

Social development - influence?

Answer 26

 Peers influence – interpersonal style, fashion/entertainment.
 Parents influence – academic choice, career choice and future aspirations

Question 27

Main features of anorexia nervosa?

Answer 27

Deliberate weight loss, induced and sustained by the patient.

Usually in adolescent girls and young women, but boys and young men also.

Dread of fatness persisting as an intrusive overvalued idea, with self-imposition of threshold (of what fat threshold)

Endocrine abnormalities - amenorrhoea, delayed growth (in younger people).
BMI <17.5

Question 28

Anorexia Causes?

Answer 28

genetics, perfectionism, temperament, abuse and adversity, high social class.

Question 29

ANOREXIA TRETAMENT?

Answer 29

Treatment – family intervention, cognitive behavioural therapy, NGT feeding tube.

Question 30

Summarise the range of mood disorders accompanying adolescent development?

Answer 30

Depression [pre-pubertal/adolescent depressive disorder]
Bipolar Affective Disorder
Mixed Anxiety and Depression
Psychotic depression

Question 31

Depression presentation?

Answer 31

Can be single symptom / Can be part of cluster

Question 32

Adolescent depressive disorder?

Answer 32

 Irritability instead of sadness (especially in boys), social withdrawal.
 Outcome with high recurrence and impairment in later adult relationships.

Question 33

Symptoms and classification of depression?

Answer 33

1) Persistent sadness or low mood and/or;
o (2) Loss of interest or pleasure – anhedonia.
o (3) Fatigue/low-energy – anergia.

 At least 1 of the above, most of the time for at least 2 weeks and some associated symptoms:

• loss of apatite
• comncentration/sleep e.t.c [total of 10]

 Total 10 symptoms then classify level of depression - <4 (not), 4 (mild depression), 5-6 (moderate), 7> (severe).

Question 34

causes of depression in adolescence?

Answer 34

Developmental consideration – as you develop, these happen which may predispose to depression (e.g more rejection and conflict, endocrine esp females)

Causes – genetics, family interactions (i.e. criticism), life events.

Question 35

Prognosis of depression in adolescence?

Answer 35

 Prognosis – major depression has a high risk of reoccurrence and pre-pubertal onset has a better prognosis.

Question 36

Interventions for depression in adolescence?

Answer 36

o Cognitive behaviour therapy.
o Interpersonal psychotherapy.
o Family intervention.
o Anti-depressants – SSRIs (for mod  severe depression).

Question 37

Define Conduct disorder?

Answer 37

 Conduct disorder – persistent (>6 months) failure to control behaviour appropriately within socially defined rules.

Question 38

 Developmental considerations - as you develop, these happen which may predispose to conduct disorders

Answer 38

o Family changes – less direct surveillance and physical closeness.
o Peer changes – increased involvement with peers may amplify Anti-social-behaviours.
o Experimentation and risk taking – rule violation, drugs and alcohol exposure.

Question 39

Conduct disorder Males v.s females

some causes

Answer 39

3M:1F, associated with lower socioeconomical status and large family size, week genretic.