lecture seven: adolescence

Question 1

stages of development review

Answer 1

• infancy: birth to 1 yr
  
  • neonatal: birth to 2 wks of age
  • infant: 3 wks to 12 months of age
• toddlerhood: 13 months to 2 yrs (2 yrs, 11 months)
• early childhood:
  
  • preschool: 3-5 yrs
  • elementary school: 5-10 yrs (10 yrs, 11 months)
• adolescence: 11-18 yrs
• young adulthood: 18-22/25 yrs
  
  • pediatric PTs are often involved in the care of children through early adulthood
• adulthood: 22-40 yrs
• middle age: 40-65 yrs
• late adulthood (older adult): 65+

Question 2

adolescent period

Answer 2

• viewed as a transition period between childhood and adulthood
• begins with sexual maturity and ends with cessation of growth
• involves physical and psychological development
  
  • reach physical and sexual maturity
  • grow self-consciousness and search for identity
  • develop more sophisticated reasoning ability and abstract thinking

Question 3

puberty

Answer 3

• pre-adolescence
  
  • marked by rapid physical growth and development of secondary sex characteristics
    
    • females: 8-10 yrs of age
    • males: 9-11 yrs of age
• a child’s sexual and physical characteristics mature
• occurs due to gonadal hormone changes
• ends with onset of menses
  
  • females: menarche at age 12-13
  • males: production of sperm

Question 4

four major changes of puberty

Answer 4

• development of primary sex characteristics (sex organs)
• development of secondary sex characteristics
• rapid physical growth —> spurt in height and weight
• changes in body proportions

Question 5

primary sex characteristics

Answer 5

testes and ovaries

Question 6

secondary sex characteristics

Answer 6

physical appearance

Question 7

factors affecting timing of puberty

Answer 7

• genetics
• stress
• socioeconomic status
• environmental toxins
• nutrition and diet, exercise
• amount of fat and body weight
• chronic illness

Question 8

puberty in female athletes

Answer 8

• delayed menarche (first menstruation)
• menstrual irregularities
  
  • first ovulation cycle occurs after menarche
  • pubertal maturation: establishment of cyclic ovarian function
  • establishment of successive ovulatary cycles does not occur for months to years after menarche

Question 9

rapid physical growth

Answer 9

• puberty is second to the prenatal period as phase of most rapid growth
  
  • rate of physical growth slows down after puberty (adolescence)
• growth spurt begins with feet —> legs —> trunk

Question 10

rapid physical growth during puberty

Answer 10

• height
  
  • boys: 4-12 inches
  • girls: 2-8 inches
• weight
  
  • boys: 15-65 pounds
  • girls: 15-65 pounds

Question 11

rapid physical growth during adolescence

Answer 11

• height
  
  • girls
    
    • ceases growth between 16-17 yrs of age
    • reach 98% of final height by age 17
  • boys
    
    • continue to grow in height up to 18-20 yrs of age
    • reach 98% of final height by age 18

Question 12

body mass index

Answer 12

• underweight: <18.5
• healthy weight: 18.8 - 24.9
• overweight: 25 - 29.9
• obese: 30+

Question 13

body mass index for age

Answer 13

• underweight: <5%
• healthy weight: 5%-85%
• overweight: 85%-95%
• obese: 95%+

Question 14

changes in body proportions (puberty)

Answer 14

• face —> nose reaches adult size first
• hands and feet reach adult size before arms and legs
• limbs and trunk —> LE becomes longer than trunk
• bones often grow faster than muscles leading to motor awkwardness

Question 15

changes in body proportions (later in adolescence)

Answer 15

• growth slows down
• body proportions are similar to those of adults
• bone growth stops at approximately 18 for girls and 21 for boys
• permits adolescents to stabilize the organization of different muscular patterns (improved coordination)

Question 16

skeletal system maturation (growth plates)

Answer 16

• skeletal maturity is attained when epiphyseal plates close
• epiphyseal closure begins in childhood
  
  • ex: cranial bones fuse at approx 2 yrs old, fusion of vertebral arches of vertebral arches is typically in the first yr of life and in lumbar spine by 6 yrs
• epiphyseal closure is typically complete (all epiphyseal growth plates closed) at age 25
• precautions
  
  • fracture across growth plate can lead to asymmetrical growth of that joint
  • use of ultrasound is contraindicated over epiphyseal areas in children

Question 17

growth spurt

Answer 17

• for most people, height will not increase after age 18 to 20 due to closure in growth plates of long bones
• on average, females stop growing around age 13-15 and boys around 15-17

Question 18

skeletal system

Answer 18

• bone is immature through much of adolescence
  
  • more porous with thick periosteum
  • unstable physes (growth plates)
• indicator of maturation: compare ossification amount on x-ray with standards

Question 19

muscular system

Answer 19

• increase muscle size, strength, and endurance
• muscle mass increases first as body grows
• adult muscle diameter reached in early teens (12-15 yrs)
• increases in strength directly related to increases in muscle mass during growth
• strength increases linearly with age from childhood through adolescence (6-18 yrs)
  
  • girls: level off after age 15
  • boys: accelerates between age 13-20

Question 20

as skeletal system grows, muscles have to _________ to establish appropriate length-tension relationship

Answer 20

lengthen

Question 21

cardiopulmonary system

Answer 21

• at rest
  
  • pulse rate: 60-90 bpm
  • respiratory rate: 16-24 breaths/min
  • increase size of heart and blood volume
  • increase weight and volume of lungs
• during acute exercise
  
  • HR: higher during sub max and max exercise
  • stroke volume: lower
  • adjusted for mass, cardiac output (HR x SV = CO) is higher in children and teens
  • BP: lower at rest —> slope of systolic rise is less dramatic with exercise

Question 22

temperature regulation

Answer 22

• greater surface area-to-body mass ratio
• produce more metabolic heat/mass unit during physical activities (!)
• lower sweating capacity due to fewer sweat glands
• implication
  
  • at high temps: risk for heat-related injuries
  • at low temps: risk for increased heat loss

Question 23

exercise prescription

Answer 23

• frequency
  
  • 3-5 x per week
• intensity
  
  • 50-85% of VO2max
  • 40-50% in deconditioned individuals
  • borg scale of perceived exertion
• time
  
  • 30-60 min
  • if less than 30 min, increase frequency
• type
  
  • play, games, sports, chores, recreation, PE
  • keep it fun, developmentally appropriate and vary activities in context of family, school, and community activities

Question 24

fitness and wellness

Answer 24

• healthy musculoskeletal tissues
• healthy cardiovascular and pulmonary systems
• neuromuscular awareness
• facilitate main entrance of a healthy body weight
• psychological benefits

Question 25

psychosocial development and behavioral issues

Answer 25

• often becomes negative in their attitudes and interaction
  
  • growing self consciousness related to their changing bodies
• social antagonism
  
  • need for privacy, resent supervision and reactions, struggle for independence, wish to be free from restrictions and parental control
• search for identity
  
  • separation from the family
  • develop their own self concepts —> question and test out values and beliefs
  • emotion issues: confusion, depression, discouragement
• adolescence
  
  • identity vs confusion (erikson)

Question 26

growth spurt changes _________ and ___________

Answer 26

• self esteem; peer group status
  
  • grow self-consciousness

Question 27

young teens (13-14 yrs)

Answer 27

• most self-centered, seen from their point of view
• value peer’s opinions with the stereotypical adolescent preoccupations

Question 28

middle teens (15-16 yrs)

Answer 28

• better at compromising, more tolerant of others’ views
• think more independently and make more of their own decisions
• risk taking behaviors with a focus on the present and denial of consequence
• dating begins around 15-16 yrs

Question 29

late teens (17-18 yrs)

Answer 29

• develop a sense of seriousness
• ends when they take on adult work roles, marry, or become parents

Question 30

cognitive development

Answer 30

• ages 11-14
• increasingly capable of thinking hypothetically, applying formal logic, and using abstract concepts
• more relative and less absolute
• more self-reflective
• capable of considering an extended time perspective

Question 31

self esteem

Answer 31

• small gains in self esteem have been documented during second decade of life
  
  • initial decline in early adolescence, particularly among girls
  • low self esteem associated with depression, suicidal behavior, delinquent behavior, and drug use
• self esteem affected by personal judgement of
  
  • physical attractiveness, particularly among girls
  • acceptance by peers
  • academic competence
  • athletic ability and conduct
• perceived support from parents and peers is associated with adolescent self-esteem
  
  • peer support takes on increasing importance during this period

Question 32

depression/suicide

Answer 32

• symptoms and signs
  
  • feel sad, tired, withdrawn, think hopelessly or negatively
  • 5000 young people aged 15-24 commit suicide
  • 3rd leading cause of death in youths and young adults
• causes
  
  • problems with family, school, high expectations, relationship break ups, substance abuse, poor choices
• masked by anxiety, eating disorders, substance abuse, hyperactivity

Question 33

destructive behaviors

Answer 33

• disordered eating
  
  • bulimia, anorexia, obesity
  • signs include low energy, fatigue, preservation on food, and obsession with body image
• self injurious behavior
• substance abuse

Question 34

sexuality

Answer 34

• puberty accompanied by increase in sexual arousal
• end of high school —> 48% have had sexual intercourse
• children with special needs at greater risk for sexual abuse
• safe sex —> taking precautions and reduce change of STDs or pregnancy
• condom use —> 57%

Question 35

increased risk for injury in adolescent athletes

Answer 35

• sports specialization
  
  • neuromuscular control improves when adolescents play multiple sports
• rapid growth spurts and change in body proportion
  
  • decreased coordination
• increased training volume
  
  • training several hours each week and year round

Question 36

RED-S (relative energy deficiency in sport)

Answer 36

• insufficient caloric intake and/or excessive energy expenditure leading to inadequate energy to support body’s physiological functions
• common among adolescent athletes
• implications
  
  • decreased muscular strength and endurance performance
  • chronic fatigue
  • bone loss —> increased risk of stress fractures
  • psychological stress, depression, and anxiety

Question 37

ACL injury

Answer 37

• anterior cruciate ligament —> resist anterior translation of tibia
• typically occurs with rapid change in direction or during non contact situations (i.e. landing from a jump or a quick twisting motion)
• more common in female athletes

Question 38

ACL injury implications

Answer 38

• in a pediatric patient, ACL injuries can commonly occur with a fracture of the growth plate
  
  • growth plates typically close by ages 13-15 for girls and 15-17 for boys
• increased risk for osteoarthritis later in life
• rehabilitation
  
  • early on —> range of motion and mobility
  • gradually progress to strengthening, endurance, and neuromuscular training (hamstrings and gluteals)
  • later on —> sports specific activities