Transcript Understanding Your Adolescent Elise DeVore Berlan, M.D., M.P.H., F.A.A.P

Understanding Your
Adolescent
Elise DeVore Berlan, M.D., M.P.H., F.A.A.P
January 21, 2009
Section of Adolescent Medicine
Nationwide Children’s Hospital
Assistant Professor of Clinical Pediatrics
Who am I?
What do I do?
What is an Adolescent
Medicine Pediatrician?
Overview
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Understanding normal adolescent cognitive and
psychosocial development
Adolescent Mortality (Death = Big Trouble)
Adolescent Morbidity (Sex, drugs, rock and roll)
Parenting
Questions
Developmental Stages of
Adolescence
Early Adolescence: 10-13 years
 Middle Adolescence: 14-17 years
 Late Adolescence: 17-21 years
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Big Picture
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Cognition
Can see the “big picture”
 Can see things from someone else’s perspective
 Able to do long range planning
 Understand consequences of decisions
 Move from “concrete” to “abstract” thinking
 Related to age, intelligence
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Big Picture
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Physical changes
Adult stature and body composition
 Puberty complete
 Sexual maturity
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Big Picture
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Psychosocial Development
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Identity Development
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Psychosexual, vocational, moral
Emancipation from parents
 Can begin to support themselves socially,
emotionally, and financially
 Closely linked to the physical changes of puberty
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The Teen Brain
Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, Nugent TF 3rd, Herman DH, Clasen LS, Toga AW, Rapoport JL, Thompson PM:
Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National Academy of Sciences USA,
101: 8174-8179, 2004
The Teen Brain
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Frontal lobe is critical for impulse control, planning,
organizing, strategizing, and other executive functions.
Evidence is strong that it develops into the 20’s
Direct data about the relation of brain changes and
behavior changes is not established.
These findings may inform our understanding of
adolescent development.
Early Adolescence
Cognitive Development
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Concrete thinking
Egocentrism
Difficulty reflecting on others’ points of view
Extreme concern with own needs, and
assumption that these needs are equally
important to others
Tendency to magnify one’s personal situation
Early Adolescence
Cognitive Development
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“Imaginary Audience” – always on stage
Frequent daydreaming
Greater need for privacy – writing in diaries, etc.
“Personal Fable” and sense of invulnerability
Inability to perceive long-range implications of
current decisions and actions
LACK OF IMPULSE CONTROL
Early Adolescence
Psychosocial Development
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Rapid physical changes lead to preoccupation with
physical appearance and physical changes in body.
Seek constant reassurance of their own normalcy. AM I
NRML?
Increased interest in sexual anatomy and physiology:
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Periods, nocturnal emissions, masturbation, breast and penis
size
Attractiveness
Early Adolescence
Psychosocial Development
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Begin separation from parents.
Exploration and definition of independencedependence boundaries.
Less interest in parent/family activities
 Reluctance to tacitly accept parental advice
 Realizes the parent isn’t perfect!!!
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Early Adolescence
Psychosocial Development
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Importance of peer group and conformity with
peers increases.
Search for new people to love in addition to
parents.
Intense, idealized same-sex relationships common
(BFF)
 Limited capacity for intimacy given cognitive
constraints.
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Early Adolescence
Psychosocial Development
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Wide mood and behavior swings
Period of self-exploration and evaluation.
Erratic movement into and out of childhood
world.
Old coping skills no longer effective.
Middle Adolescence
Cognitive Development
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Begin the gradual realization that others have
needs of their own.
Idealism and commitment to social causes
common.
Further ability to use abstract thinking, but
inconsistently applied.
May revert to more concrete levels at times of
stress.
 May lead to inconsistent or “irrational” behavior.
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Persistence of sense of immortality.
Middle Adolescence
Psychosocial Development
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Increase in intensity of emotions
Peak of child-parent control battles.
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Able to conceive of “ideal” parents, contrast with
own parents.
Intermittent seeking and rejection of parental
support.
Middle Adolescence
Psychosocial Development
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Peer group becomes primary means of social
support, buffering the separation process.
Peers are “everybody” and define “everything”.
Peer group allows forum for testing new
identities.
Role experimentation, limit-testing, risk-taking
fostered by persistent sense of invulnerability.
Middle Adolescence
Psychosocial Development
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Re-establishment of body image.
Strong emphasis on being attractive
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(Clothes, makeup)
Increasing sexual interest, curiosity,
experimentation, partnerships.
Confusion regarding sexual orientation may
peak.
Late Adolescence
Cognitive Development
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Further refinement of abstract thinking.
Greater sense of time and the future.
Ability to assess the long-term consequences or
benefits of actions.
More able to think ideas through and express
selves in words.
Greater ability to delay gratification.
Late Adolescence
Psychosocial Development
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Acceptance of body image.
Consolidation of personal identity .
Further steps toward emancipation.
Practical vocational goals
 Beginnings of financial independence
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Re-establishment of relationship with parents
(“adult-adult” interaction).
Late Adolescence
Psychosocial Development
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Decreased need for peer affiliation.
Increased emphasis placed on individual
friendships.
Increased capacity for intimacy and
movement toward more stable relationships.
Adolescent
Health Issues
Adolescents are, by and large, a healthy
population. What places their health in
greatest jeopardy are the choices they
make about their own behaviors.
 ¾ of adolescent mortality is preventable
 Mortality rates for males are nearly three
times those of adolescent females
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Adolescent Mortality
From: National Adolescent Health Information Center
Car Crashes - Factors
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Risk taking behaviors
Immature judgment
Use of substances
Poor driving skills – lack of experience
Distractions – passengers, music, makeup,
eating, cell phones, texting, etc.
Seat belts
Male gender
Car Crashes – Parent prevention
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Model good driving behaviors
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Drive safely, limit distractions, use seat belt
Closely supervise/monitor driving
Set rules
No or limit passengers
 No substance use
 Restrict night driving
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Be available for rides, use a code word
Enforce curfews, ask about seat belt use
Homicide
Contrary to popular belief a typical
homicide involves:
 Two
young males of the same race who know
each other,
 The influence of alcohol, and
 An argument that escalates in the presence of
a gun.
Prothrow-Stith D, Spivak H, Sege R. Interpersonal Violence Prevention: A recent public health mandate. Oxford Texbook of Public
Health., vol 3. New York: Oxford University Press, 2002.
Suicide
High school students, during the past 12 months:
 17% “seriously considered attempting suicide”
 16% made a suicide plan
 8% attempted
According to the Youth Risk Behavior Survey – A national survey of high school
students done by the CDC. www.cdc.gov
Suicide
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Firearm, hanging, intoxication
Risk factors:
Depression and anxiety problems
 High stress
 Recent family, relationship, or life situation change
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Concern for suicide if:
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Change in eating or sleeping
Withdrawal
Violent actions, running away
Drug or alcohol use
Change in personality or appearance
Depressive symptoms: boredom, lack of
pleasure in everyday activities, change in
schoolwork
Extreme concern for suicide
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Teens might say: “nothing else matters”, “things
would be better if I weren’t here”
Verbal hints: “I won’t see you again”
Putting affairs in order
Is depressed but suddenly cheerful
Psychosis – hallucinations, paranoia
What should parents do
if concerned about suicide?
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Talk to your child
You may need to get corroborating information
from school personnel or your child’s friends
Talk with your pediatrician and/or seek
psychiatric help
If all else fails, go to an Emergency Room
Suicide – Parent Prevention
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Know what is going on with your child
Make sure your child has another trusted adult
in their lives to talk to
No guns at home, or lock guns and keep ammo
separated
Keep medications guarded or discreet, even
Tylenol, anti-depressants
If signs of mental distress, seek help
Take any suicidal gesture seriously
Sex, Drugs, and
Rock-n-Roll
Teen Sexual Behaviors
http://www.teenpregnancy.org/resources/data/pdf/TeenSexActivityOnePagerJune06.pdf
Teen Sexual Behaviors
http://www.teenpregnancy.org/resources/data/pdf/TeenSexActivityOnePagerJune06.pdf
Teen Sexual Behaviors
Teen Sexual Behaviors
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Unhealthy consequences of sexual activity
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Unintended pregnancy
Sexually transmitted infection
Psychosocial changes
Teens frequently engage in “sexting”, and sexually
charged conversations online or on phone
Dating violence is common
Higher risk of negative consequences happening if
drugs or alcohol are involved, large age discrepancy
between partners
Parenting
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COMMUNICATE!!!
Share your values and expectations
 Talk about healthy relationships, sexuality early on
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Actively monitor and supervise your teen
Where are you going?
 With who?
 Check in…
 See them when they come home
 Set and enforce a reasonable curfew
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Role model healthy relationship behavior
Parenting
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If your teen is sexually active…
Be aware of his/her relationships
 Have conversations about birth control and
condoms
 Support doctor visits for reproductive health
 STAY COMMUNICATING!!!
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Drugs
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In general, substance use has declined in recent
years.
Girls and boys have similar rates of substance
use.
Substance use increases with age in all racial and
ethnic groups.
Marijuana is most commonly used illicit drug.
Drug use over the ages…
12th graders
Use in 1970
Use today
Alcohol
~70%
~ 45%
Tobacco
~37%
~22%
Illicit drugs
~30%
~22%
Current issues in drug use
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Abuse of prescription drugs
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Binge drinking
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1/10 12th graders reported using Vicodin in last year
¼ 12th graders reported in last month
Rise in use of inhalants
Heroin epidemic in Ohio
Parents should…
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Role model
Communicate expectations early on
Set rules
Keep communicating…even when it is hard
Code word
 White lies
 Values
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Parents should…
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Monitor
Lock ALL alcohol and prescription drugs
 Look at your kids when they come home
 Smell your kids when they come home
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Sound the alarm if there are major changes in
your child’s behavior, personality, or school
performance.
Authoritative Parenting Is…
Warm in tone
 Firm in discipline
 Rich in communication
 Emphasizes mutual trust and respect
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Additional resources
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Center for Young Women’s Health
www.youngwomenshealth.org
 There is also a link to their male health site
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Parenting Teens Online
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www.parentingteensonline.com
Upcoming Symposium for parents of pre-teen girls
Healthy Strong and Ready for Teens
April 18, 2009 at Fawcett Center
Thank you!!!
[email protected]