Adolescence and Early Adulthood

Question 1

Define adolescence and adulthood

Answer 1

Adolescence – phase between childhood & adulthood
(Pubertal development may be start of adolescence)

Adulthood – legally, culturally variable
UN definition of children - <18 yrs

Question 2

What is adrenarche? When does it occur?

Answer 2

Adrenarche – Stimulation of adrenals to form DHEA and DHEAS. Pre-puberty may present will axillary and pubic hair (and aggression)
Females:6-9 yrs
Males:7-10 yrs

Question 3

What are the HPA and HPG axes controlling growth in adolescence?

Answer 3

CRH – ACTH – Androstenedione and DHEA
GnRH – LH/FSH – Androgen and Oestrogen

Menarche – First period (Can only be defined in retrospect, early cycles irregular)

Leptin from adipose permissive to GnRH from hypothalamus

Question 4

How do growth patterns in adolescence differ between sexes?

Answer 4

Boy and Girls different patterns
Female growth spurt – 11-13 yrs
Male growth spurt – 14-16 yrs

Question 5

Describe Kohlberg’s theory of moral development

Answer 5

At birth all humans have no moral or ethical stance.

There are 6 developmental stages, split into 3
different levels:

The first level is about avoiding
punishment.

The second level is about trying to
please others, and make sure that they are happy with what you do.

The third level involves thinking about
ethical principles.

Question 6

Describe Kohlberg’s theory of moral development

Answer 6

At birth all humans have no moral or ethical stance.

There are 6 developmental stages, split into 3
different levels:

Pre-conventional (1) about avoiding
punishment.

Conventional (2) about trying to
please others, and make sure that they are happy with what you do.

Post-conventional (3) involves thinking about ethical principles.

Question 7

According to Erikson’s developmental stages what occurs during adolescence?

Answer 7

In adolescence, one of the issues is a conflict between identity and confusion.

Adolescents wonder what they are meant to be
doing with life - causes internal conflict

Question 8

What is a theory regarding the formation of friendships in humans?

Answer 8

Friendships = reciprocal relationship mimicking attachments between children and their mothers. The type of friends that you develop is similar to the friendship you have with your mother.

Question 9

What determines friendships for children of various ages?

Answer 9

When younger, friendships are geographically based and practical

As cognitive function further develops, friendships are based on values and beliefs

Adolescents seek friends with same interests

Question 10

What are the Shaffer characteristics of friendship?

Answer 10

Interact on a regular basis
Sense of belonging
Share implicit or explicit norms in relation to
behaviours
Develop structure/social organization that enables
the group to work together for a shared goal

Question 11

What drives conflict between adolescents and parents and how can it be resolved?

Answer 11

Adolescence strive for autonomy
Can upset previous family patterns of functioning

Family’s problem solving skills
Family’s communication patterns
Belief system of individuals within the family
How the family interacts on day-to-day level
General consensus that adolescent and parental values are similar

Question 12

What are the observed pros and cons of increased social media use in young people?

Answer 12

Pros
Increased connection 
Relationship development 
Obtain information
Some increased wellbeing

Cons
Cyber bullying 
Innapropriate content 
Dangerous contacts (e.g pro-ana groups)
Some decreased wellbeing
Not secure

Question 13

Describe the prevalence of mental disorders in adolescents?

Answer 13

Many disorders occur frequently in adolescence: depression, anxiety, self-harm and suicidality

10% of children/young people (5-16 years) have a clinically diagnosable mental health problem

Yet 70% of children/adolescents who experience mental health problems have not had appropriate
interventions at a sufficiently early age

Increase in both self-harm and mental health disabilities in the UK

Eating disorders encompasses bulimia, anorexia, binge eating and other specified feeding disorders

Question 14

What is anorexia nervosa?

Answer 14

Cardinal features
Body weight (self-induced) maintained 15% below expected wight, or BMI < 17.5.
Psychopathology – dread of fatness, and preoccupation with this.
Endocrine disturbance: amenorrhoea, or delayed growth and puberty in younger sufferers.

Outcome
Community sample: 50% recover after 5 years
Clinic samples: after 1 year 37% recover; 25% weight gain but not menstruating; 37% underweight, symptoms.

Treatment
Family intervention For abnormal eating attitudes and depression: cognitive behavioural therapy.
Small % need admission for weight restoration

Question 15

What are the epidemiology and causes of anorexia?

Answer 15

Approx 0.5-1% adolescent females are anorexic. <10% anorexic patients are male.

Causes
Genetic predisposition, perfectionist temperament, specific subcultures, childhood abuse and adversities; perhaps higher social class.

Question 16

What are the symptoms of depression in adolescents?

Answer 16

Affective – sadness, loss of enjoyment, irritability

Cognitive – self-blame, hopelessness, guilt

Biological – disturbed sleep, reduced appetite

May reach threshold for disorder

Question 17

What factors may contribute towards depression in adolescents?

Answer 17

Endocrine change – especially female may increase risk low mood

Changes in family relationships –physical closeness, joint activities, family conflict

Peers – increased involvement with peers; peer rejection and conflict

Responsibilities and hassles: life events, exams, etc

Question 18

What is depressive disorder?

Answer 18

2-5% adolescents experience depressive disorder

Causes
Familial aggregation; genetic factors known
Effects of family interaction e.g. criticism
Life events, adversities

Prognosis
Major depression: Duration
In specialist CAMHS settings: 6-9 months
Primary care: 2-3 months
High risk recurrence
Prepubertal onset – better prognosis
Small number in adolescence – bipolar (mania, hypomania)

Treatment
Cognitive behavioural therapy
Interpersonal psychotherapy
Family intervention for associated family problems
Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.

Question 19

What is depressive disorder?

Answer 19

2-5% adolescents experience depressive disorder

Causes
Familial aggregation; genetic factors known
Effects of family interaction e.g. criticism
Life events, adversities

Treatment
Cognitive behavioural therapy
Interpersonal psychotherapy
Family intervention for associated family problems
Antidepressants – selective serotonin reuptake inhibitors e.g. fluoxetine for moderate – severe depression.

Question 20

What is the prognosis of depressive disorder?

Answer 20

Major depression: Duration
In specialist CAMHS settings: 6-9 months
Primary care: 2-3 months
High risk recurrence
Prepubertal onset – better prognosis
Small number in adolescence – bipolar (mania, hypomania)

Question 21

What is conduct disorder?

Answer 21

Persistent failure to control behaviour appropriately within socially defined rules.

Contributing factors

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.

Question 22

How may conduct disorder present in an adolescent?

Answer 22

Looses temper and argues
Defies adult requests or rules
Bullies, fights or intimidates,
Stealing, breaking into cars or houses, destroys property running away, truanting

Question 23

What are the epidemiology and associations of conduct disorder?

Answer 23

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
Genetic – weak
Child – difficult temperament
Family – poor parenting, discord, lack warmth, inconsistent discipline, coercive interaction, aggression
Wider environment (poor schools, neighbourhoods)

Question 24

What are the outcomes and interventions of conduct disorder?

Answer 24

Outcomes
Poorer outcome with more problems in child, and family
Risk of antisocial personality disorder in males
Range of emotional and personality disorders in females

Interventions
For child – problem solving skills.
Parent training
Family intervention
Address problems across contexts e.g. in school