Adolescent Development and Implications on Health Care

Question 1

Define adolescence?

Answer 1

Definition includes PHYSICAL and PSYCHOLOGICAL factors.
The period between childhood and adulthood which is age 12-21.
It is the period between onset of physical changes of puberty until adoption of “adult role”

Question 2

Storm and Stress

Answer 2

Not the norm for adolescents
Most adolescents navigate this interval with minimal functional difficulties
But, empiric evidence for:
Increased conflict with parents
Mood volatility (and increased negative mood)
A higher percentage of adolescents have symptoms, mostly of depression or anxiety, but not sufficient to mildly impair their functioning
Increased risk behavior, recklessness, and sensation-seeking.

About 20% of adolescents with moderate or severe symptomatology that impairs functioning In fact, in recent years, there has been lowered rates of sexual activity, pregnancy and STDs

Question 3

What is the difference between primary vs secondary sex characteristics?

Answer 3

Primary sex characteristics
The body organs and reproductive structures and functions that differ between women and men.
Gonads (testes and ovaries) things that you are born with.

Secondary sex characteristics
Characteristics of the body that are caused by HORMONAL changes DURING PUBERTY and last through adult life. I.E
Changes in genitals/breasts/voice
Pubic/body/facial hair

Question 4

What are the physical changes that take place in adolescence?

Answer 4

Gain 25% of final height
Doubling of body mass
Major increase in genital system and secondary sex characteristics
Changes in shoulder width, pelvic width
Change in facial structure and appearance

Question 5

Timing of pubertal changes?

Answer 5

For women breast development begins at 10 and ends around 14.5. The growth spurt begins at 10 and ends around 13. Pubic hair begins around 10.5. Menarche happens between the age of 12-13.

For men testes and scrotum development at 11.5 and ends around 14.5. Pubic hair begins at 12 and ends around 15.5. The growth spurt begins at 12.5 and ends around 15.5. The first ejaculation is at 13. The last thing to happen is the deepen voice which takes place at age 14ish.

Question 6

What can happen with poor adaptation?

Answer 6

Poor adaptation can slow puberty

Question 7

When an adolescence undergoes physical changes what do they need?

Answer 7

Physical changes demand accommodation (understanding, acceptance, coping)- it is a normative stress

Question 8

Rate of Maturation

Answer 8

Rate of maturation may have significant consequences for adolescents.
Early maturation usually benefits boys, but not girls.
Early maturing girls had more negative feelings about their physical development, while boys tend to have more positive feelings.
Late maturing boys have lower self esteem and more difficulties with independence

Question 9

Puberty-related behavioral and psychological domains

Answer 9

Adolescent period marked by:
-Increased biological driven intensity of emotions
-Greater inclination to seek experiences that create high--intensity feelings
-Emotion
Motivation
Arousal
Appetite
Drives
Peer affiliation
Romantic motivation
Sexual interest
Emotional intensity
Changes in fear regulation
Risk for mood disorders (females)
Increase risk-taking, novelty seeking, sensation seeking

Question 10

Adolescent cognitive development

Answer 10

refers to how a person perceives, thinks, and gains an understanding of his or her world through the interaction and influence of genetic and learned factors.

Question 11

Adolescent thinking from Concrete to Formal

Answer 11

Concrete: Here and Now (5 senses)
Formal
extends from about age 12 through adulthood
adolescents and adults develop the abilities to think about abstract or hypothetical concepts
consider an issue from another’s viewpoint, and solve cognitive problems in a logical way

Question 12

What does Formal thinking includes

Answer 12

Includes:
Abstraction
Hypothesizing
Combinatorial logic
Future considerations

Question 13

Personal Fable

Answer 13

“Personal Fable” is a belief held by many adolescents telling them that they are special and unique, so much so that none of life’s difficulties or problems will affect them regardless of their behavior

Question 14

Imaginary Audience

Answer 14

“Imaginary Audience” is a belief, often exhibited in young adolescents, that multitudes of people are enthusiastically listening to or watching him or her.

Question 15

Adolescent Egocentrism

Answer 15

phenomenon of adolescents’ inability to distinguish between their perception of what others think about them and what people actually think in reality.

Question 16

Identity Crises

Answer 16

Identity crisis – uncertainty and discomfort adolescents experience when searching for an individual and societal “role”

Question 17

Identity diffusion

1. Is the adolescent committed to an identity?
2. Is the individual searching for their identity?

Answer 17

When searching is absent and commitment is absent

James Marcia- Identity Statuses
have not thought about or resolved identity issues
have failed to chart future life course

Example “I really haven’t thought about whether I’ll go to college or not. I guess I’ve just been thinking about other things.”

Question 18

Identity achievement

1. Is the adolescent committed to an identity?
2. Is the individual searching for their identity?

Answer 18

When searching is present and commitment is present

James Marcia- Identity Statuses
have resolved identity issues by personally choosing particular goals, beliefs, and values

Example “I changed my major twice before hitting on something that really feels good to me. I kept thinking I didn’t want to become a teacher because that’s what everyone in my family does and I didn’t want to just follow along, but then I surprised myself with how much I like working with the kids. I can really imagine myself doing this forever and never getting tired of it!”

Question 19

Identity foreclosure

1. Is the adolescent committed to an identity?
2. Is the individual searching for their identity?

Answer 19

When searching is absent and commitment is present

James Marcia- Identity Statuses
“Have chosen” an identity without experiencing crisis or deciding what they want for themselves

Example “My parents went to college, so I probably will too. I guess I’ll be a teacher – everybody in my family does that.”

Question 20

Moratorium (a temporary prohibition of an activity)

1. Is the adolescent committed to an identity?
2. Is the individual searching for their identity?

Answer 20

When searching is present and commitment is absent

James Marcia- Identity Statuses
Experiencing identity crisis and actively questioning life choices and commitments

Example “I’ve been thinking a lot about my future. I used to think I’d be a teacher since I have so many relatives who teach, but I’m not really sure that I have the patience for that. I’ve always really liked sports and ACTION….so I’m thinking about some kind of physical education degree….but I want to see how other courses seem before I decide.”

Question 21

Moratorium

1. Is the adolescent committed to an identity?
2. Is the individual searching for their identity?

Answer 21

When searching is present and commitment is absent

Question 22

mneumonic for Phsychosocial screening

Answer 22

Home- environment, relationships
Education- academic performance, grade level, career aspirations
Eating- nutrition, attitudes
Activities- interests, work, participation
Affect/Anxiety
Drugs- smoking, drinking, drugs
Sexuality- behavior, orientation, attitudes
Safety- driving behavior, violence screen, abuse

Question 23

Developmental tasks of Adolescence

Answer 23

Win acceptance of peers
Achieve independence from the family (individuation)
Develop the capacity to love a person and be intimate
Achieve a comfortable sense of self
Body image
Self-image  (self-esteem, self-efficacy)
Sexual identity
Vocational identity
Achieve an effective value/moral system

Question 24

Adolescence Developmental Obsessions

Answer 24

Body image
Identity
Separation/Individuation
Socialization/Peers
Sexuality
Future orientation

Question 25

Development and High Risk Behavior

Answer 25

Some of the behaviors are normal in teens because:

Experimenting is part of growing up. This includes testing limits (in self and authority figures)

Peer affiliation is a strong need and teens perceive that others are doing behaviors

Behaviors are sometimes an attempt to cope, a reaction to stress, a way to “get away”

Teens are not consequential thinkers yet
Inexperienced in the world causes miscalculation

Question 26

Common behavioral problems

Answer 26

tobacco and substance use /abuse
nutrition/eating patterns 
exercise
accidents/injury
emotional liability/depression/coping
school performance
sexual behavior and orientation 
rape/abuse
body image problems and eating disorders
non-compliance with treatment regimens in chronic disease

Question 27

Goal of Primary Care in Adolescence

Answer 27

Screen for illness and risk of illness
Educate patient regarding health areas
Promote healthy behavior
Help develop healthy self-awareness and self-regulation
Help parents learn how to support healthy maturation

Question 28

How are adolescence underserved by the government?

Answer 28

Barriers identified:
Lack of age appropriate sites for care
Lack of confidential sites for care
Lack of provider training in adolescent medical problems, especially gynecologic and mental health related
Belief that adolescents are “generally healthy” and don’t need services
Less compelled to come in for services. Less preventive medicine visits
Care is time consuming
Unfavorable reimbursement for providers

Question 29

How are adolescence underserved by the government?

Answer 29

Barriers identified
Lack of age appropriate sites for care
Lack of confidential sites for care
Lack of provider training in adolescent medical problems, especially gynecologic and mental health related
Belief that adolescents are “generally healthy” and don’t need services
Less compelled to come in for services. Less preventive medicine visits
Care is time consuming
Unfavorable reimbursement for providers

Question 30

What are some behaviors that adolescent takes part in that lead to preventable deaths?

Answer 30

Smoking
Alcohol and other drug use
Diet and exercise habits leading to obesity
Conflict resolution and coping

Question 31

What are some behaviors that adolescent takes part in that lead to preventable deaths/

Answer 31

Smoking
Alcohol and other drug use
Diet and exercise habits leading to obesity
Conflict resolution and coping