Puberty & Adolescence

Question 1

What is adolescence?

Answer 1

The transitional phase of growth and development between childhood and adulthood

Question 2

What are the 3 phases of adolescence?

Answer 2

1. Early: 11-13yrs
2. Middle: 14-17yrs
3. Late: 18-21yrs

Question 3

What is puberty?

Answer 3

The biological changes of adolescence that tends to occur at 11.2 years in girls and 11.6 years in boys and is often completed within 3-5 years

Question 4

What weight triggers pubertal hormonal changes in girls?

Answer 4

47kg

Question 5

What instigates puberty?

Answer 5

Pulsed release of gonadotrophin-releasing hormone (GnRH) from specialised nerve cells in the hypothalamus which travel in the blood to the pituitary where production of FSH/LH is stimulated which control the levels of hormones produced by the testes/ovaries (testosterone, oestrogen + progesterone)

Question 6

What is the average age for the adolescent growth spurt?

Answer 6

Girls: 10-18/19yrs
Boys: 12-20/22yrs

Question 7

What is the adolescent growth spurt?

Answer 7

Rapid increase in the rate of height and weight noted in virtually all of the long bones of the body EXCEPT the female pelvis which follows a smooth and continuous growth until adulthood

Question 8

How does bone grow during puberty and adolescence?

Answer 8

Mineral mass is the same in girls and boys until the onset of sexual maturation and then bone mass (size but not density) increases more in boys than girls due to a prolonged period of growth in males where bone building speed in the spine and hip increases by 5x so skeletal mass approx. doubles at the end of adolescence

Question 9

Why is girls diet important between the ages of 11 and 13 years?

Answer 9

They accumulate bone tissue at this age that equates to the amount lost during the 30 years following menopause

Question 10

What occurs physically in female puberty?

Answer 10

1. Breasts develop and enlarge
2. Pubic/axillary hair grows
3. Growth spurt and pelvis widens
4. Increases fat deposited in subcutaneous tissue esp. around hips and breasts

Question 11

What are the important Tanner stages of puberty in females?

Answer 11

1. Pre-pubertal so nothing
2. Areolar enlargement with breast bud and few darker hairs along labia
3. Enlargement of breast and areola as single mound and curly pigmented hairs across pubes
4. Projection of areola above breast as double mound and small adult configuration of pubic hair
5. Mature adult genitalia

Question 12

What is the menstrual cycle?

Answer 12

Cyclical series of events every 26-20 days where the hypothalamus secretes luteinizing releasing hormone (LHRH) to stimulate pituitary to produce FSH and LH

Question 13

What is the function of Follicle-Stimulating Hormone (FSH)?

Answer 13

Females: Aids maturation of ovarian follicles and stimulates oestrogen release leading to ovulation

Males: Stimulates spermatogenesis directly

Question 14

What is the function of Luteinizing Hormone (LH)?

Answer 14

Females: Stimulation of ovulation, development of corpus luteum and progesterone secretion

Males: Stimulates Leydig cells to secrete testosterone

Question 15

What are the 5 phases of the menstrual cycle?

Answer 15

1. Menstrual (1-5 days): ovum not fertilised so the corpus luteum degenerates due to LH decline, progesterone/oestrogen levels fall so endometrium cells die due to blood vessel spasming so it is shed
2. Menstruation (4-6 days)
3. Proliferation (6-14 days): ovarian follicle stimulated by FSH, matures and produces oestrogen which stimulates endometrium to thicken in prep. to receive the Graafian follicle
4. Ovulation (day 14)
5. Secretory (15-28 days): rising progesterone produced by corpus luteum in ovary, endometrium becomes oedematous and secretory gland produces watery mucus to help spermatozoa passage through tubes to uterus

Question 16

What is the earliest sign of male puberty?

Answer 16

Growth of the testicles - can be measured with an orchidometer

Question 17

What is the average adult testicle volume?

Answer 17

20ml

Question 18

What are the physical changes that occur in male puberty?

Answer 18

1. Increase in height, weight, muscle and bone
2. Larynx enlarges and voice deepens/breaks
3. Hair grows on face, axillae, chest, abdomen and pubis
4. Scrotum, penis and prostate gland enlarge
5. Seminiferous tubules mature and spermatozoa produced

Question 19

What is Spermarche?

Answer 19

Onset of sperm emissions

Question 20

Where are sperm formed and how much are formed?

Answer 20

In the seminiferous tubule of the testes at the rate of 300 million a day from puberty and throughout life

Question 21

What are the important Tanner’s stages of male puberty?

Answer 21

1. Prepubertal so nothing
2. Enlargement of testes > 4ml, reddening of scrotum and few darker hairs at base of penis
3. Lengthening of penis, further enlargement of testes to 6-10ml and curly pigmented hairs across pubes
4. Broadening of glands penis, growth of testes to 10-15ml and small adult configuration with thighs spared
5. Mature adult genitalia

Question 22

What problems can occur with puberty?

Answer 22

1. Precocious puberty before 8 in girls or 9.5 in boys (5x more common in girls)
2. Delayed puberty where there is lack of 2ndary sexual characteristics by 13 in girls and 14 in boys (more common in boys)
3. Lack of progression through Tanners within 4.5-5 years of onset

Question 23

When and why does sexual orientation become apparent?

Answer 23

During adolescence as a result of complex interactions between genetics, environment, emotional, hormonal and biological factors

Question 24

What occurs in the adolescent brain?

Answer 24

Just before puberty there is exuberant synaptogenesis and then the weaker connections are selectively pruned in several areas of the brain mostly in the frontal lobes inc. the prefrontal cortex where the adolescent loses ~3% of grey matter

Question 25

What is the prefrontal cortex responsible for?

Answer 25

``` Advanced reasoning Understanding cause and effect Impulse management Executive functioning Personality Reward Decision making Social decision making ```

Question 26

What area of the brain kicks into high gear in early adolescence and what does this explain?

Answer 26

The limbic system BUT the frontal lobe that controls impulses and engages longer-term perspectives matures later which explains why teens in mid-adolescence take more risks than older adolescents

Question 27

What are the components of cognitive ignition?

Answer 27

Advanced reasoning Meta-cognition Logical thought processes Abstract thinking

Question 28

What are Piagets stages of cognitive development?

Answer 28

1. Sensorimotor (0-2yrs): Infant explores world through direct sensory and motor contact - object permanence and separation anxiety develop 2. Pre-operational (2-6yrs): Child uses symbols (words and images) to represent objects but does not reason logically and child has ability to pretend - child is egocentric 3. Concrete operational (6-12yrs): Child can think logically about concrete objects and can add/subtract also understanding conversation 4. Formal operational (12yrs-adult): Adolescent can reason abstractly and think in hypothetical terms

Question 29

What forms the foundation of social relationships?

Answer 29

Social recognition which the amygdala of the limbic system is responsible for

Question 30

What is social recognition?

Answer 30

Recognising faces but also interactions in a social context by gaging ques

Question 31

What are the social developmental tasks that we have to go through?

Answer 31

1. Emotional separation from parents 2. Peer identity where you develop social autonomy (late adolescence) 3. Exploratory behaviours e.g. smoking, drinking, drugs 4. Development of intimate relationships 5. Development of vocational capabilities and financial independence e.g. 1st job

Question 32

How do we form an identity?

Answer 32

- Become independent - Achieve mastery/sense of competence e.g. hobbies - Establish social status i.e. what we look like - Experience intimacy - Determine sexual identity - Develop autonomy physically and psychologically

Question 33

What is the key stage of Erickson's psychosocial theory?

Answer 33

Identity vs Role Confusion: adolescents need to develop a strong personal identity where failure leads to role confusion and a weak sense of self

Question 34

What stage of Kohlberg's moral theory are most adolescents at?

Answer 34

Conventional: - Interpersonal concordance: being good is what pleases others so child adopts a conformist attitude to morality where right and wrong determined by majority - Law and order: being good means doing duty to society so we obey laws w/o question and show respect for authority Most adults and people do not progress to the post-conventional stage

Question 35

How does alcohol effect the adolescent brain?

Answer 35

The hippocampus is more vulnerable to the negative effects of alcohol which regulates working memory and learning but the brain is less sensitive to the sedative qualities of alcohol

Question 36

How does tobacco affect the adolescent brain?

Answer 36

There is worst cell damage in the hippocampus than in adults

Question 37

How does adolescent brain development affect sleep?

Answer 37

The circadian rhythm shifts forward so melatonin secretions that trigger sleepiness start later at night and turn off later in the morning thus, adolescents need more sleep (~9-10 hours) and most are sleep deprived

Question 38

What is emotional intelligence?

Answer 38

A trait that allows you to develop the skills necessary for managing emotions and successful relationships BUT emotional/social development is not an inevitable biological process during adolescence

Question 39

What different aspects are involved in emotional and social development?

Answer 39

- Self-awareness: what do I feel? - Social awareness: what do others feel? - Self-management: how can I control my emotions?

Question 40

How do drugs affect the adolescent brain?

Answer 40

Drugs such as cocaine and amphetamines target the DA receptor neurons in the brain which may affect brain development in areas of impulse control and ability to experience reward

Question 41

What does the quality of care-giving in the first 42 months give you an indication of?

Answer 41

Quality of romantic relationships in early adulthood

Question 42

When does psychopathology occur in adolescence?

Answer 42

1/2 of all mental health problems in children have been established by 14 years of age

Question 43

What is the best predictor of serious psychopathology in adolescence?

Answer 43

Disorganised attachment

Question 44

What are the steps of Bibace and Walsh's children's explanation of illness?

Answer 44

Phenomenism (2-4yrs): particular objects are blamed but no sense of mechanism Contagion (4-7): illness is caused by proximity to ill people/particular objects Contamination (7-9yrs): illness is caused by physical contact with an ill person and may be viewed as punishment for misbehaviour Internalisation (9-11yrs): illness located within body but may be caused by external factors e.g. people get colds from being cold PHYSIOLOGICAL (11-16yrs): illness caused by malfunctions in organs or systems which may be due to infection Psychophysiological (16+yrs): psychological factors e.g. stress/fatigue can affect physiological processes rather than being an outcome

Question 45

What is STEP approach to adolescent development in clinical settings?

Answer 45

S: Sexual maturation and growth (Tanner's staging and height/weight) T: Thinking (establish by asking questions about life) E: Education/employment (ask about school/work) P: Peers/parents (have they got friends and a good relationship with parents?)