New Problems in Todays Technological Era An Adlerian Case.docx

New Problems in Today's Technological Era:
An Adlerian Case Example
Zachary D. Bloom and Dalena Dillman Taylor
Abstract
Adolescents' Internet use, when done properly, can be viewed as
a healthy, appro-
priate way to facilitate social interest. However, without
guidance, the Internet can
create a variety of problems for adolescents and their families.
The authors of this
article contend that extreme stances regarding adolescent
Internet use can negatively
affect adolescent development. The authors present a case study
in which Adlerian
therapy was used to facilitate developmentally appropriate
Internet use in a family
that originally banned adolescents from using the Internet at
home.
Keywords: Individual Psychology, Adler, adolescents,
technology, Internet,
pornography
Alfred Adler first presented Individual Psychology after the
turn of the
20th century. Nearly a century later, one development that
Adler could
not imagine was the vast expansion of technology in the daily
lives of in-

dividuals. In 2008, according to the National Campaign to
Prevent Teen
and Unplanned Pregnancy (NCPTU, 2008), 87% of adolescents
had a cell
phone, 79% of adolescents had a computer, and 33% had a web
cam. The
Internet's wealth of information, media, and social networking
opportuni-
ties are available at the click of a button or the swipe of a
finger. If Adler
were still alive today, how would he address the technological
advances
in our society and their impact on human nature? We attempt to
answer
this question in the context of adolescent development through
the use of a
case study.
Adolescents on the Internet
In today's world, the coming-of-age experience for adolescents
is dif-
ferent from that of past generations. It is estimated that 89% of
adolescents
have a profile on a social networking website (e.g., Facebook),
and in 2008
between 78% and 80% of adolescents posted, sent, and received
pictures
and video on the Internet (NCPTU, 2008). Although many
adolescents pri-
marily use this technology to benignly connect socially with
others (Reich,
The Journal o f Individual Psychology, Vol. 71, No. 2, Summer
2015
©2015 by the University of Texas Press

Editorial office located in the College of Education at Georgia
State University.
Published for the North American Society of Adlerian
Psychology.
164 Zachary D. Bloom and Dalena Dillman Taylor
Subrahmanyam, & Espinoza, 2012), Internet use has been
associated with
various problems, including addiction, gambling, bullying, and
stealing
(Mitchell, Becker-Blease, & Finkelhor, 2005). In addition,
perhaps because
adolescence is a normative time for curiosity about sex
(American Academy
of Pediatrics, 2013; Berk, 2008), 18%-22% of male and female
adolescents
have used the Internet to share sexually provocative images of
themselves,
and 39% have used technology to send sexually provocative
messages
(NCPTU, 2008). Research has identified that these behaviors
are correlated
with multiple issues of concern to counselors, including
impulsivity and
substance abuse (Temple et al., 2014), legal problems (Mitchell,
Finkelhor,
Jones, & Wolak, 2012), and risky sexual practices (Rice et al.,
2012).
With increased access to the Internet in affordable and
anonymous ways
(Cooper, 1998), adolescents are increasingly exposed to

sexually explicit
materials online, whether they pursue them purposely or
encounter them
accidentally (Weber, Quiring, & Daschmann, 2012). Despite
some research
that has failed to identify negative impacts on adults who use
sexually explicit
material (Poulsen, Busby, & Galovan, 2013), a variety of
negative conse-
quences have been established for adolescents who use such
material. The
identified consequences include social isolation, symptoms of
depression,
conduct problems (Owens, Behun, Manning, & Reid, 2012), and
risky sexual
practices (Wright & Randall, 2012). Consequently, there is a
call for thera-
pists to address the adverse effects related to adolescents'
pornography use
(Bloom & Hagedorn, 2015; Peter & Valkenburg, 2010; Weber et
al., 2012).
With more than 1 billion active Facebook users who each month
spend
more than 640 million minutes online (Statistic Brain, 2014),
Adler's social
interest is actively demonstrated on a worldwide level in a
drastically dif-
ferent realm from when the concept was first developed. Even
though the
world today is indeed different from the one Adler knew,
Adlerian therapy
is suited for it (Carlson, Watts, & Maniacci, 2006). A
compelling compo-
nent of Adlerian theory is Adler's continual striving to perfect
his theory,

as evidenced through the maturity of the theory over time
(Ansbacher &
Ansbacher, 1956). In Adler's absence, practicing Adlerian
therapists are
compelled to adapt his theory to fit the evolving technological
world.
Adolescent Development
Although some researchers believe that contemporary
adolescence
has extended into the mid-20s (Gallo & Gallo, 2011; National
Institute
of Mental Health, 2011), for the purpose of this discussion, we
focus pri-
marily on early adolescence (11-13 years), the crux of the
transition from
N ew Problems in Today's Technological Era 165
childhood to adulthood. During this crucial milestone between
childhood
and adulthood, adolescents enter a period of change that affects
all lines of
development: physical, sexual, social, emotional, and cognitive.
During early adolescence, beyond changes in physical maturity,
in-
dividuals also begin to develop interest in sexual experiences
and more
intimate or romantic relationships with their peers (American
Academy of
Pediatrics, 2013). Although they develop strong relationships
with both

sexes during this time, adolescents often struggle with
perceptions of body
image and feelings of self-esteem because they are questioning
their own
development in comparison to their peers (Berk, 2008; Centers
for Disease
Control and Prevention, 2014). Adolescents tend to seek out
independence
from their parents while simultaneously spending significantly
more time
with peers, in an evolving effort to find their identity (American
Academy of
Pediatrics, 2013).
The transition from childhood into early adolescence shows
changes
in an individual's cognitive development. Children tend to be
concrete in
their thinking, often dichotomizing subjects into black or white
categories
while also beginning to develop an increased capacity for
abstract thought
(Berk, 2008; Centers for Disease Control and Prevention, 2014).
Despite
these changes in cognitive development, early adolescents focus
more on
the present because they struggle with an inability to consider
the long-
term consequences of their actions (National Institute of Mental
Health,
2011). Perhaps it is for this reason that between one and two of
every five
male and female adolescents have used technology to
experiment sexually
(NCPTU, 2008), without recognizing some of the consequences
of their ac-

tions (Mitchell et al., 2012; Owens et al., 2012).
Developmental Implications
In our society, the Internet can play a supportive role in
adolescents'
pursuits of identity formation and social interest, if it is used in
constructive
and appropriate ways— yet it is crucial for parents to monitor
adolescents'
Internet activities to ensure their appropriate use (Wang,
Bianchi, & Raley,
2005). Extreme stances toward Internet use (e.g., completely
unrestricted
access, absolutely restricted access) could impede an
adolescent's develop-
ment of social interest in today's society (Wang et al., 2005).
The following
case study demonstrates the consequences of an extreme stance
taken
against Internet use.
The case example should illustrate the counseling process
through an
Adlerian lens, with a focus on developmental concerns in
relation to today's
technological world. The case example describes a typical
clinical scenario
and does not represent any real single case.
166 Zachary D. Bloom and Dalena Dillm an Taylor
Case: Identifying Features and Presenting Concerns

The client, David, a 13-year-old only child and Caucasian male,
was
brought to his initial intake session by his father, Mr. Smith.
David reported
on his experiences of sadness and isolation, particularly in
response to be-
ing homeschooled and not having access to the Internet. David
stated that
his parents' ban on Internet use made it difficult to complete his
homework
and created a barrier between him and his peers at church, who
were more
involved with one another through their use of e-mail and social
media.
Further, David reported that his peers discussed mainstream
media that
David had never seen, which added to his feelings of isolation.
By the conclusion of the intake session, David reported that the
"real
reason" he was being "punished with counseling" was because
he sneaked
onto his father's computer to access pornography. Consequently,
David
reported that his father "screamed at him and grounded him
indefinitely."
David's father confirmed the story and added that he had
forbidden David
from masturbating— he viewed masturbating as a "sin"— and
had hoped
that not having any discussion about sexuality whatsoever
would "preserve
David's innocence."
Like many peers of his age, David appeared to struggle with
body im-

age and self-esteem because of his lack of friendships and the
tension in his
relationship with his father. David's cognitive level— his focus
on the present
as opposed to future consequences of his actions— was also
similar to that
of his peers of his age. However, his emotional development
appeared to
be lagging behind, as evidenced by a lack of solid peer
relationships and
expressed role confusion.
Treatment Plan and Treatment
Adlerian theory emphasizes optimism, free w ill, and the
subjective na-
ture of human beings (Ansbacher & Ansbacher, 1956). Because
Adlerian
theory is a wellness-oriented model, Adler proposed that all
individuals
are born with an innate ability to develop social interest. Adler
also be-
lieved in the goodness of individuals, indicating that all people
are socially
embedded, holistic, creative, purposeful, goal oriented, unique,
and sub-
jective (Ansbacher & Ansbacher, 1956; Dinkmeyer, Dinkmeyer,
& Sperry,
1987). David's family was also approached as a whole, with an
emphasis on
finding significance and belonging in the family system and in
society. The
process of family counseling proceeded through the four phases
of Adlerian
theory: (a) establishing an egalitarian relationship, (b)
investigating the life-

style, (c) gaining insight, and (d) reeducating and reorienting.
After the intake, it became apparent to the counselor that
David's par-
ents were hesitant to get involved in therapy and that they
viewed David as
the "identified patient." A decision was made to see David in
weekly indi-
vidual sessions and to conduct biweekly parent consultations to
decrease
the protective barrier and/or resistance between the parents and
counselor.
Phase 1: Establishing an Egalitarian Relationship
In Phase 1 the counselor focuses on establishing a strong
therapeutic
alliance in which the counselor conveys and the client
experiences trust,
care, and acceptance (Kottman, 2003). The counselor creates an
atmo-
sphere of warmth and trust by providing the client opportunities
to share
experience of self, others (e.g., parents), and the world by
encouraging the
client to present his or her needs, desires for the session, and
thoughts re-
garding potential goals for therapy. The counselor, in turn, uses
reflections
on feeling and content and encouraging statements to
communicate to the
client that he or she is heard, understood, and considered an

expert on
his or her own experiences. By understanding the client's
perceptions of
the presenting issue and early life experiences, the counselor
can begin to
formulate hypotheses regarding the client's mistaken beliefs and
lifestyle
(Ansbacher & Ansbacher, 1956; Kottman, 2003). However, most
of this in-
vestigation takes place in Phase 2, and thus is described in more
depth in
the following section.
Initially, David presented as discouraged by the pressure
imposed on
him by his father and his own limited capabilities, and as
socially isolated,
given that he was homeschooled and had minimal interactions
with others
outside his family. Because peers are crucial to adolescents'
overall social
and emotional development, David's feelings of isolation and
loneliness
were pronounced.
During initial parent consultations, the counselor provided the
choice
for David to participate in the conversation and encouraged him
to volun-
teer information if his father or mother stated any events that he
perceived
as untrue. For the first two consultations, David, his mother,
and his father
were present. In these meetings, the father presented as loud,
domineering,
and distracted by his phone only when David would speak.

During the con-
sultations, David's mother appeared to stay in the shadow of her
husband.
She spoke only when the counselor posted a question directly to
her.
At the end of the first two parent consultations, the counselor
encour-
aged the father to explore his own self-defeating beliefs,
concluding that he
might be more capable of accepting his son as he is and more
open to al-
lowing his son more freedom to use the Internet in an
appropriate way. The
counselor feared that the father's ban on Internet use impaired
David's ability
to socially connect with others, particularly because of his
already-isolated
environment. The counselor noted this hypothesis and decided
to evaluate
its validity when collecting evidence concerning David's, his
mother's, and
his father's lifestyles during the next phase of counseling.
Phase 2: Investigating the Lifestyle
According to Dinkmeyer and Sperry (2000), counselors exhibit
the tru-
est form of empathy when they fully understand the client's
lifestyle. This
allows the counselor to help clients modify their beliefs and

adopt a more
socially interested outlook on life. In this case, the counselor
chose to con-
duct a genogram with the family to gain both a visual and
verbal perspective
on David's lifestyle and his parents' lifestyles. A brief synopsis
for each
member is presented in the following sections.
Father. Based on early life experiences, Mr. Smith found
significance in
controlling himself, others, and situations in order to feel safe
in the world.
Later in life, he stated that he found God and became a born-
again Christian,
which he reported as shifting his view on life. Yet it became
apparent that his
need to control is still present in his life, as evidenced by
statements made
in the intake session of verbal and emotional abuse toward his
wife. His life-
style convictions indicated the following: "I must be in charge
to feel safe,"
"I must protect my son from making my mistakes," "It's
hopeless for me to
change, but I can control my son's actions."
Mother. Mrs. Smith presented as stuck in life. She expressed a
desire
to divorce her husband because of his emotional abuse;
however, she ap-
peared dependent on him financially and emotionally, and so
she expressed
feeling uncertain about leaving. Mrs. Smith found significance
and belong-
ing in her family and the world by pleasing others. She

identified her goals
in consultations as wanting what is best for David. Her lifestyle
convictions
indicated "I am worthless and deserve to be hurt," and "If I
please others,
they won't hurt me; therefore, I must always please everyone."
David. At age 13, David presented as striving toward
superiority. He
needs to have control over his situation, and this is clear from
power strug-
gles with his father. He exhibited symptoms of depression, as
evidenced by
sulking during family sessions and sharing feelings of isolation,
helpless-
ness, and hopelessness. David's Internet activity could be a
transgression
against his father, and he was shamed for his curiosity. His
lifestyle convic-
tions indicated "I am bad, others must punish me, the world is
unsafe," and
"M y needs are shameful, punishable, others correct me, tell me
what to
think and feel; therefore, I lack ability to control myself and my
actions, and
others must do it for me."
The lifestyle investigation revealed that each member
contributed to the
underlying issues, but David's parents refused to participate in
family inter-
ventions, and so David would be the only one returning for

treatment.
Phase 3: Gaining Insight
In Phase 3, the counselor balances a nondirective and a
directive role
with adolescents to create an atmosphere of sharing power and
to enable
the client to gain awareness of the purposefulness of his or her
responses to
specific life situations (Dinkmeyer et al., 1987; Kottman, 2003).
The focus in
this phase was on understanding the client's current beliefs and
goals that
formulate one's private logic (Dinkmeyer et al., 1987), on
sharing hypoth-
eses about the goals of the client's lifestyle, and on modeling
social interest
for the client. During Phase 3 with David, the counselor
followed the family
activity with processing and debriefing. In the family sessions,
the coun-
selor had realized the lack of power David had in his family, his
discomfort
in vocalizing his thoughts and feelings in his family, and the
overall sense
of insecurity he felt when around his parents. The counselor
focused on
establishing a sense of safety in the counseling relationship by
modeling a
trusting relationship. David began to voice that he wanted his
future family
to be different than his current one. He set goals of owning a
farm and hav-
ing his own family. Although David appeared motivated and
was striving

for superiority in most of his actions and behaviors, he was
unaware of how
these current goals fit into his current lifestyle.
In parent consultations, it was critical for Mr. Smith to gain
insight into
his views about self, others, and the world and the impact those
views were
having on his parenting and on David's view of self. Over the
course of parent
consultations, Mr. Smith began to make some progress in
allowing himself
to see the potential impact of his private logic on his own and
his family life.
Mrs. Smith was present during these sessions as well. She
appeared
encouraged that Mr. Smith was gaining awareness about his
actions and
seemed as hopeful about his possible changes. The counselor
also meta-
communicated that her lack of involvement in the family was a
clear
message to David that Mr. Smith held all the power; therefore,
Mrs. Smith
was not a secure person to confide in for David. She appeared
receptive to
these hypotheses and eager to implement her insights to
improve her ability
to connect with and support David.
Phase 4: Reeducation and Reorientation
In the reorientation phase, the counselor helps clients
implement so-
cially interested goals and behaviors (Dinkmeyer et al., 1987) in

order
to shift clients' private logic to a view of the world that
encompasses a
greater level of social interest. The counselor's role is as an
active teacher
and encourager (Kottman, 2003), which helps clients establish
realistic
goals, develop problem-solving and decision-making skills, and
find func-
tional alternatives.
During this phase, the counselor and David worked on
establishing real-
istic goals and problem solving situations so as to meet his
emotional needs.
The counselor and David identified goals and various ways to
socialize for
David (i.e., he was allowed access to the library). In addition,
incorporating
more peers into his life helped David with his feelings of
isolation.
The counselor also explored David's goals for his future family
and real-
istically discussed his ability to achieve those goals while also
encouraging
his ability to note the differences between what he wants and
does not want,
and then implementing his view of self, others, and the world to
create an
optimal life for himself. Additionally, the counselor offered

David psycho-
education about sex in individual sessions. The counselor
normalized David's
curiosity and worked with David to process some of the things
he saw in por-
nography while using appropriate, professional (or educational)
language.
Although most of this sex education and deconstruction of
pornography
occurred in individual sessions with David, a portion of it was
conducted in
the parent consultations with Mr. and Mrs. Smith—despite their
hesitance to
participate in therapy. By this time, having participated in
Phase 3, Mr. Smith
had already gained some awareness of the thoughts and
behaviors that af-
fected his family and, therefore, was open to discussing his
son's sexual
curiosity in parent consultations, especially once he had come
to view his
son's sexuality as a normal and healthy part of adolescent
development.
The counselor worked with Mr. Smith to set realistic goals for
his son, and
the counselor encouraged Mr. Smith to see the intention in his
son's use of
pornography before shaming him first. The counselor held two
family ses-
sions toward the end of treatment to achieve attainable goals for
both David
and his parents.
David and his parents worked to find common ground in
discussing

issues related to sexuality, and David gained valuable
information about
himself and his family that he could use to make more informed
deci-
sions regarding his behaviors as he thought about his future.
David's shift
in present thinking to considering long-term consequences
indicated that
he increased his overall cognitive development so that it came
to match
age-related developmental expectations. The counselor mediated
discus-
sions regarding healthy Internet use, limitations on computer
use, parental
involvement in sex education, and discussing appropriate social
activities
or hobbies (i.e., volunteering at church)— all the things that
David could
do to increase healthy peer relationships. Both David's self-
confidence and
his parents' ability to hear David and appropriately respond to
his wants
increased. David's overall increase in healthy peer relationships
and his in-
creased self-confidence gave a boost to his emotional maturity.
Conclusion
Use of the Internet enables billions of people to access
information, view
media, and connect with others in previously unfathomable
ways. As such,

the contemporary world is different from the world in which
Adler lived and
developed his theory and practice. However, the major tenets
that drove
Adlerian therapy in the past are still viable for today's
counseling clientele
(Carlson et al., 2006). During the transition from childhood to
adolescence,
it becomes especially important for individuals to strive toward
significance
and belonging. The Internet (and social media especially) offers
the tools
to foster those developmental needs in adolescents. However,
Internet use
has been linked to various interpersonal problems for some of
its users. If
Adler were alive today, he would have embraced technological
advances,
but he would have been most concerned about the widespread
availabil-
ity and ease of access to pornographic materials for adolescents
(see Adler,
1931). Adler believed that parents should create space for and
respond to
an adolescent's questions about sex rather than preemptively
shunning an
adolescent's sexual curiosity. Adler would have promoted and
encouraged
parents and other adults to have open conversations with their
adolescents
about sexuality. He would have also encouraged parents to
collaborate with
their adolescents in finding a balance of Internet use as one
means of striv-
ing for significance and belonging during this developmental
stage.

While establishing fair and appropriate boundaries around
adolescent
Internet use might be an intimidating subject for parents,
engaged parental
involvement with adolescents about their online activities can
foster trust and
communication in the family system, thus potentially
eliminating the condi-
tions that contribute to extreme parental stances on adolescent
Internet use
and the resultant negative emotional and behavioral
consequences. With
open dialogue and involved parenting, parents and guardians put
themselves
in an empowered position to assist their children's continuous
development
of social interest as they move from childhood into adolescence.
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Information Technology
and Organizational
Learning
Managing Behavioral Change
in the Digital Age
Third Edition
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Information Technology
and Organizational
Learning
Managing Behavioral Change
in the Digital Age
Third Edition
Arthur M. Langer
CRC Press
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v
Contents
Fo r e w o r d xi
Ac k n o w l e d g m e n t s xiii
Au t h o r xv
I n t r o d u c t I o n xvii
c h A p t e r 1 th e “ r Av e l l” c o r p o r At I o n 1
Introduction 1
A New Approach 3
The Blueprint for Integration 5
Enlisting Support 6
Assessing Progress 7
Resistance in the Ranks 8
Line Management to the Rescue 8
IT Begins to Reflect 9
Defining an Identity for Information Technology 10
Implementing the Integration: A Move toward Trust and
Reflection 12
Key Lessons 14
Defining Reflection and Learning for an Organization 14
Working toward a Clear Goal 15

Commitment to Quality 15
Teaching Staff “Not to Know” 16
Transformation of Culture 16
Alignment with Administrative Departments 17
Conclusion 19
v i Contents
c h A p t e r 2 th e It d I l e m m A 21
Introduction 21
Recent Background 23
IT in the Organizational Context 24
IT and Organizational Structure 24
The Role of IT in Business Strategy 25
Ways of Evaluating IT 27
Executive Knowledge and Management of IT 28
IT: A View from the Top 29
Section 1: Chief Executive Perception of the Role of IT 32
Section 2: Management and Strategic Issues 34
Section 3: Measuring IT Performance and Activities 35
General Results 36
Defining the IT Dilemma 36
Recent Developments in Operational Excellence 38
c h A p t e r 3 te c h n o l o gy A s A vA r I A b l e A n d re s p
o n s I v e
o r g A n I z At I o n A l d y n A m I s m 41
Introduction 41
Technological Dynamism 41
Responsive Organizational Dynamism 42

Strategic Integration 43
Summary 48
Cultural Assimilation 48
IT Organization Communications with “ Others” 49
Movement of Traditional IT Staff 49
Summary 51
Technology Business Cycle 52
Feasibility 53
Measurement 53
Planning 54
Implementation 55
Evolution 57
Drivers and Supporters 58
Santander versus Citibank 60
Information Technology Roles and Responsibilities 60
Replacement or Outsource 61
c h A p t e r 4 o r g A n I z At I o n A l l e A r n I n g th e o r I e
s A n d
te c h n o l o gy 63
Introduction 63
Learning Organizations 72
Communities of Practice 75
Learning Preferences and Experiential Learning 83
Social Discourse and the Use of Language 89
Identity 91
Skills 92
v iiContents

Emotion 92
Linear Development in Learning Approaches 96
c h A p t e r 5 m A n A g I n g o r g A n I z At I o n A l l e A r n
I n g A n d
te c h n o l o gy 109
The Role of Line Management 109
Line Managers 111
First-Line Managers 111
Supervisor 111
Management Vectors 112
Knowledge Management 116
Ch ange Management 120
Change Management for IT Organizations 123
Social Networks and Information Technology 134
c h A p t e r 6 o r g A n I z At I o n A l tr A n s F o r m At I o n
A n d t h e
bA l A n c e d s c o r e c A r d 139
Introduction 139
Methods of Ongoing Evaluation 146
Balanced Scorecards and Discourse 156
Knowledge Creation, Culture, and Strategy 158
c h A p t e r 7 vI r t uA l te A m s A n d o u t s o u r c I n g 163
Introduction 163
Status of Virtual Teams 165
Management Considerations 166
Dealing with Multiple Locations 166
Externalization 169
Internalization 171
Combination 171
Socialization 172

Externalization Dynamism 172
Internalization Dynamism 173
Combination Dynamism 173
Socialization Dynamism 173
Dealing with Multiple Locations and Outsourcing 177
Revisiting Social Discourse 178
Identity 179
Skills 180
Emotion 181
c h A p t e r 8 sy n e r g I s t I c u n I o n o F It A n d
o r g A n I z At I o n A l l e A r n I n g 187
Introduction 187
Siemens AG 187
Aftermath 202
ICAP 203
v iii Contents
Five Years Later 224
HTC 225
IT History at HTC 226
Interactions of the CEO 227
The Process 228
Transformation from the Transition 229
Five Years Later 231
Summary 233
c h A p t e r 9 Fo r m I n g A c y b e r s e c u r I t y c u lt u r e
239

Introduction 239
History 239
Talking to the Board 241
Establishing a Security Culture 241
Understanding What It Means to be Compromised 242
Cyber Security Dynamism and Responsive Organizational
Dynamism 242
Cyber Strategic Integration 243
Cyber Cultural Assimilation 245
Summary 246
Organizational Learning and Application Development 246
Cyber Security Risk 247
Risk Responsibility 248
Driver /Supporter Implications 250
c h A p t e r 10 d I g I tA l tr A n s F o r m At I o n A n d c h A
n g e s I n
c o n s u m e r b e h Av I o r 251
Introduction 251
Requirements without Users and without Input 254
Concepts of the S-Curve and Digital Transformation
Analysis and Design 258
Organizational Learning and the S-Curve 260
Communities of Practice 261
The IT Leader in the Digital Transformation Era 262
How Technology Disrupts Firms and Industries 264
Dynamism and Digital Disruption 264
Critical Components of “ Digital” Organization 265
Assimilating Digital Technology Operationally and Culturally
267
Conclusion 268
c h A p t e r 11 I n t e g r At I n g g e n e r At I o n y e m p l oy
e e s t o
Ac c e l e r At e c o m p e t I t I v e A dvA n tA g e 269

Introduction 269
The Employment Challenge in the Digital Era 270
Gen Y Population Attributes 272
Advantages of Employing Millennials to Support Digital
Transformation 272
Integration of Gen Y with Baby Boomers and Gen X 273
i xContents
Designing the Digital Enterprise 274
Assimilating Gen Y Talent from Underserved and Socially
Excluded Populations 276
Langer Workforce Maturity Arc 277
Theoretical Constructs of the LWMA 278
The LWMA and Action Research 281
Implications for New Pathways for Digital Talent 282
Demographic Shifts in Talent Resources 282
Economic Sustainability 283
Integration and Trust 283
Global Implications for Sources of Talent 284
Conclusion 284
c h A p t e r 12 to wA r d b e s t p r A c t I c e s 287
Introduction 287
Chief IT Executive 288
Definitions of Maturity Stages and Dimension Variables in
the Chief IT Executive Best Practices Arc 297
Maturity Stages 297
Performance Dimensions 298

Chief Executive Officer 299
CIO Direct Reporting to the CEO 305
Outsourcing 306
Centralization versus Decentralization of IT 306
CIO Needs Advanced Degrees 307
Need for Standards 307
Risk Management 307
The CEO Best Practices Technology Arc 313
the CEO Technology Best Practices Arc 314
Maturity Stages 314
Middle Management 316
The Middle Management Best Practices Technology Arc 323
the Middle Manager Best Practices Arc 325
Maturity Stages 325
Summary 327
Ethics and Maturity 333
c h A p t e r 13 c o n c l u s I o n s 339
Introduction 339
g l o s s A ry 357
re F e r e n c e s 363
I n d e x 373

x i
Foreword
Digital technologies are transforming the global economy.
Increasingly,
firms and other organizations are assessing their opportunities,
develop-
ing and delivering products and services, and interacting with
custom-
ers and other stakeholders digitally. Established companies
recognize
that digital technologies can help them operate their businesses
with
greater speed and lower costs and, in many cases, offer their
custom-
ers opportunities to co-design and co-produce products and
services.
Many start-up companies use digital technologies to develop
new prod-
ucts and business models that disrupt the present way of doing
busi-
ness, taking customers away from firms that cannot change and
adapt.
In recent years, digital technology and new business models
have dis-
rupted one industry after another, and these developments are
rapidly
transforming how people communicate, learn, and work.
Against this backdrop, the third edition of Arthur Langer’ s
Information Technology and Organizational Learning is most
welcome.

For decades, Langer has been studying how firms adapt to new
or
changing conditions by increasing their ability to incorporate
and use
advanced information technologies. Most organizations do not
adopt
new technology easily or readily. Organizational inertia and
embed-
ded legacy systems are powerful forces working against the
adoption
of new technology, even when the advantages of improved
technology
are recognized. Investing in new technology is costly, and it
requires
x ii Foreword
aligning technology with business strategies and transforming
cor-
porate cultures so that organization members use the technology
to
become more productive.
Information Technology and Organizational Learning addresses
these
important issues— and much more. There are four features of
the new
edition that I would like to draw attention to that, I believe,
make
this a valuable book. First, Langer adopts a behavioral
perspective
rather than a technical perspective. Instead of simply offering
norma-
tive advice about technology adoption, he shows how sound

learn-
ing theory and principles can be used to incorporate technology
into
the organization. His discussion ranges across the dynamic
learning
organization, knowledge management, change management,
com-
munities of practice, and virtual teams. Second, he shows how
an
organization can move beyond technology alignment to true
technol-
ogy integration. Part of this process involves redefining the
traditional
support role of the IT department to a leadership role in which
IT
helps to drive business strategy through a technology-based
learn-
ing organization. Third, the book contains case studies that
make the
material come alive. The book begins with a comprehensive
real-life
case that sets the stage for the issues to be resolved, and smaller
case
illustrations are sprinkled throughout the chapters, to make
concepts
and techniques easily understandable. Lastly, Langer has a
wealth of
experience that he brings to his book. He spent more than 25
years
as an IT consultant and is the founder of the Center for
Technology
Management at Columbia University, where he directs
certificate and
executive programs on various aspects of technology innovation
and
management. He has organized a vast professional network of

tech-
nology executives whose companies serve as learning
laboratories for
his students and research. When you read the book, the
knowledge
and insight gained from these experiences is readily apparent.
If you are an IT professional, Information Technology and
Organi-
zational Learning should be required reading. However, anyone
who
is part of a firm or agency that wants to capitalize on the
opportunities
provided by digital technology will benefit from reading the
book.
Charles C. Snow
Professor Emeritus, Penn State University
Co-Editor, Journal of Organization Design
x iii
Acknowledgments
Many colleagues and clients have provided significant support
during
the development of the third edition of Information Technology
and
Organizational Learning.
I owe much to my colleagues at Teachers College, namely,
Professor
Victoria Marsick and Lyle Yorks, who guided me on many of

the the-
ories on organizational learning, and Professor Lee Knefelkamp,
for
her ongoing mentorship on adult learning and developmental
theo-
ries. Professor David Thomas from the Harvard Business School
also
provided valuable direction on the complex issues surrounding
diver-
sity, and its importance in workforce development.
I appreciate the corporate executives who agreed to participate
in the studies that allowed me to apply learning theories to
actual
organizational practices. Stephen McDermott from ICAP
provided
invaluable input on how chief executive officers (CEOs) can
success-
fully learn to manage emerging technologies. Dana Deasy, now
global
chief information officer (CIO) of JP Morgan Chase,
contributed
enormous information on how corporate CIOs can integrate
tech-
nology into business strategy. Lynn O’ Connor Vos, CEO of
Grey
Healthcare, also showed me how technology can produce direct
mon-
etary returns, especially when the CEO is actively involved.
And, of course, thank you to my wonderful students at
Columbia
University. They continue to be at the core of my inspiration
and love
for writing, teaching, and scholarly research.

x v
Author
Arthur M. Langer, EdD, is professor of professional practice
of management and the director of the Center for Technology
Management at Columbia University. He is the academic direc-
tor of the Executive Masters of Science program in Technology
Management, vice chair of faculty and executive advisor to the
dean
at the School of Professional Studies and is on the faculty of the
Department of Organization and Leadership at the Graduate
School
of Education (Teachers College). He has also served as a
member of
the Columbia University Faculty Senate. Dr. Langer is the
author
of Guide to Software Development: Designing & Managing the
Life
Cycle. 2nd Edition (2016), Strategic IT: Best Practices for
Managers
and Executives (2013 with Lyle Yorks), Information
Technology and
Organizational Learning (2011), Analysis and Design of
Information
Systems (2007), Applied Ecommerce (2002), and The Art of
Analysis
(1997), and has numerous published articles and papers, relating
to digital transformation, service learning for underserved
popula-
tions, IT organizational integration, mentoring, and staff

develop-
ment. Dr. Langer consults with corporations and universities on
information technology, cyber security, staff development, man-
agement transformation, and curriculum development around the
Globe. Dr. Langer is also the chairman and founder of
Workforce
Opportunity Services (www.wforce.org), a non-profit social
venture
x v i Author
that provides scholarships and careers to underserved
populations
around the world.
Dr. Langer earned a BA in computer science, an MBA in
accounting/finance, and a Doctorate of Education from
Columbia
University.
x v ii
Introduction
Background
Information technology (IT) has become a more significant part
of
workplace operations, and as a result, information systems
person-
nel are key to the success of corporate enterprises, especially
with

the recent effects of the digital revolution on every aspect of
business
and social life (Bradley & Nolan, 1998; Langer, 1997, 2011;
Lipman-
Blumen, 1996). This digital revolution is defined as a form of “
dis-
ruption.” Indeed, the big question facing many enterprises
today is,
How can executives anticipate the unexpected threats brought
on by
technological advances that could devastate their business? This
book
focuses on the vital role that information and digital technology
orga-
nizations need to play in the course of organizational
development
and learning, and on the growing need to integrate technology
fully
into the processes of workplace organizational learning.
Technology
personnel have long been criticized for their inability to
function as
part of the business, and they are often seen as a group outside
the
corporate norm (Schein, 1992). This is a problem of cultural
assimila-
tion, and it represents one of the two major fronts that
organizations
now face in their efforts to gain a grip on the new, growing
power of
technology, and to be competitive in a global world. The other
major
x v iii IntroduCtIon

front concerns the strategic integration of new digital
technologies
into business line management.
Because technology continues to change at such a rapid pace,
the
ability of organizations to operate within a new paradigm of
dynamic
change emphasizes the need to employ action learning as a way
to
build competitive learning organizations in the twenty-first
century.
Information Technology and Organizational Learning integrates
some
of the fundamental issues bearing on IT today with concepts
from
organizational learning theory, providing comprehensive
guidance,
based on real-life business experiences and concrete research.
This book also focuses on another aspect of what IT can mean
to
an organization. IT represents a broadening dimension of
business life
that affects everything we do inside an organization. This new
reality is
shaped by the increasing and irreversible dissemination of
technology.
To maximize the usefulness of its encroaching presence in
everyday
business affairs, organizations will require an optimal
understanding
of how to integrate technology into everything they do. To this
end,
this book seeks to break new ground on how to approach and

concep-
tualize this salient issue— that is, that the optimization of
information
and digital technologies is best pursued with a synchronous
imple-
mentation of organizational learning concepts. Furthermore,
these
concepts cannot be implemented without utilizing theories of
strategic
learning. Therefore, this book takes the position that technology
liter-
acy requires individual and group strategic learning if it is to
transform
a business into a technology-based learning organization.
Technology-
based organizations are defined as those that have implemented
a means
of successfully integrating technology into their process of
organiza-
tional learning. Such organizations recognize and experience
the real-
ity of technology as part of their everyday business function. It
is what
many organizations are calling “ being digital.”
This book will also examine some of the many existing organi-
zational learning theories, and the historical problems that have
occurred with companies that have used them, or that have
failed
to use them. Thus, the introduction of technology into
organizations
actually provides an opportunity to reassess and reapply many
of the
past concepts, theories, and practices that have been used to
support
the importance of organizational learning. It is important,

however,
not to confuse this message with a reason for promoting
organizational
x i xIntroduCtIon
learning, but rather, to understand the seamless nature of the
relation-
ship between IT and organizational learning. Each needs the
other to
succeed. Indeed, technology has only served to expose problems
that
have existed in organizations for decades, e.g., the inability to
drive
down responsibilities to the operational levels of the
organization, and
to be more agile with their consumers.
This book is designed to help businesses and individual manag-
ers understand and cope with the many issues involved in
developing
organizational learning programs, and in integrating an
important
component: their IT and digital organizations. It aims to provide
a
combination of research case studies, together with existing
theories
on organizational learning in the workplace. The goal is also to
pro-
vide researchers and corporate practitioners with a book that
allows
them to incorporate a growing IT infrastructure with their exist-
ing workforce culture. Professional organizations need to
integrate

IT into their organizational processes to compete effectively in
the
technology-driven business climate of today. This book
responds to
the complex and various dilemmas faced by many human
resource
managers and corporate executives regarding how to actually
deal
with many marginalized technology personnel who somehow
always
operate outside the normal flow of the core business.
While the history of IT, as a marginalized organization, is rela-
tively short, in comparison to that of other professions, the
problems
of IT have been consistent since its insertion into business
organiza-
tions in the early 1960s. Indeed, while technology has changed,
the
position and valuation of IT have continued to challenge how
execu-
tives manage it, account for it, and, most important, ultimately
value
its contributions to the organization. Technology personnel
continue
to be criticized for their inability to function as part of the
business,
and they are often seen as outside the business norm. IT
employees
are frequently stereotyped as “ techies,” and are segregated in
such a
way that they become isolated from the organization. This book
pro-
vides a method for integrating IT, and redefining its role in
organiza-
tions, especially as a partner in formulating and implementing

key
business strategies that are crucial for the survival of many
companies
in the new digital age. Rather than provide a long and extensive
list of
common issues, I have decided it best to uncover the challenges
of IT
integration and performance through the case study approach.
x x IntroduCtIon
IT continues to be one of the most important yet least
understood
departments in an organization. It has also become one of the
most
significant components for competing in the global markets of
today.
IT is now an integral part of the way companies become
successful,
and is now being referred to as the digital arm of the business.
This
is true across all industries. The role of IT has grown
enormously in
companies throughout the world, and it has a mission to provide
stra-
tegic solutions that can make companies more competitive.
Indeed,
the success of IT, and its ability to operate as part of the
learning
organization, can mean the difference between the success and
failure
of entire companies. However, IT must be careful that it is not
seen as
just a factory of support personnel, and does not lose its

justification
as driving competitive advantage. We see in many organizations
that
other digital-based departments are being created, due to
frustration
with the traditional IT culture, or because they simply do not
see IT
as meeting the current needs for operating in a digital economy.
This book provides answers to other important questions that
have
challenged many organizations for decades. First, how can
manag-
ers master emerging digital technologies, sustain a relationship
with
organizational learning, and link it to strategy and performance?
Second, what is the process by which to determine the value of
using
technology, and how does it relate to traditional ways of
calculating
return on investment, and establishing risk models? Third, what
are
the cyber security implications of technology-based products
and
services? Fourth, what are the roles and responsibilities of the
IT
executive, and the department in general? To answer these
questions,
managers need to focus on the following objectives:
• Address the operational weaknesses in organizations, in
terms of how to deal with new technologies, and how to bet-
ter realize business benefits.
• Provide a mechanism that both enables organizations to deal
with accelerated change caused by technological innovations,

and integrates them into a new cycle of processing, and han-
dling of change.
• Provide a strategic learning framework, by which every new
technology variable adds to organizational knowledge and
can develop a risk and security culture.
x x iIntroduCtIon
• Establish an integrated approach that ties technology account-
ability to other measurable outcomes, using organizational
learning techniques and theories.
To realize these objectives, organizations must be able to
• create dynamic internal processes that can deal, on a daily
basis, with understanding the potential fit of new technologies
and their overall value within the structure of the business;
• provide the discourse to bridge the gaps between IT- and non-
IT-related investments, and uses, into one integrated system;
• monitor investments and determine modifications to the life
cycle;
• implement various organizational learning practices, includ-
ing learning organization, knowledge management, change
management, and communities of practice, all of which help
foster strategic thinking, and learning, and can be linked to
performance (Gephardt & Marsick, 2003).
The strengths of this book are that it integrates theory and
practice
and provides answers to the four common questions mentioned.

Many
of the answers provided in these pages are founded on theory
and
research and are supported by practical experience. Thus,
evidence of
the performance of the theories is presented via case studies,
which
are designed to assist the readers in determining how such
theories
and proven practices can be applied to their specific
organization.
A common theme in this book involves three important terms:
dynamic , unpredictable , and acceleration . Dynamic is a term
that rep-
resents spontaneous and vibrant things— a motive force.
Technology
behaves with such a force and requires organizations to deal
with its
capabilities. Glasmeier (1997) postulates that technology
evolution,
innovation, and change are dynamic processes. The force then is
tech-
nology, and it carries many motives, as we shall see throughout
this
book. Unpredictable suggests that we cannot plan what will
happen
or will be needed. Many organizational individuals, including
execu-
tives, have attempted to predict when, how, or why technology
will
affect their organization. Throughout our recent history,
especially
during the “ digital disruption” era, we have found that it is
difficult,
if not impossible, to predict how technology will ultimately

benefit or
x x ii IntroduCtIon
hurt organizational growth and competitive advantage. I believe
that
technology is volatile and erratic at times. Indeed, harnessing
tech-
nology is not at all an exact science; certainly not in the ways in
which
it can and should be used in today’ s modern organization.
Finally, I
use the term acceleration to convey the way technology is
speeding up
our lives. Not only have emerging technologies created this
unpre-
dictable environment of change, but they also continue to
change it
rapidly— even from the demise of the dot-com era decades ago.
Thus,
what becomes important is the need to respond quickly to
technology.
The inability to be responsive to change brought about by
technologi-
cal innovations can result in significant competitive
disadvantages for
organizations.
This new edition shows why this is a fact especially when
examining
the shrinking S-Curve. So, we look at these three words—
dynamic,
unpredictable, and acceleration— as a way to define how
technology

affects organizations; that is, technology is an accelerating
motive
force that occurs irregularly. These words name the challenges
that
organizations need to address if they are to manage
technological
innovations and integrate them with business strategy and
competi-
tive advantage. It only makes sense that the challenge of
integrating
technology into business requires us first to understand its
potential
impact, determine how it occurs, and see what is likely to
follow.
There are no quick remedies to dealing with emerging
technologies,
just common practices and sustained processes that must be
adopted
for organizations to survive in the future.
I had four goals in mind in writing this book. First, I am inter-
ested in writing about the challenges of using digital
technologies
strategically. What particularly concerns me is the lack of
literature
that truly addresses this issue. What is also troublesome is the
lack
of reliable techniques …
Journal of Adolescent Health 56 (2015) 3e6
www.jahonline.org
Review article
Health for the World’s Adolescents: A Second Chance in the

Second Decade
Bruce Dick, M.B. a,*, and B. Jane Ferguson, M.Sc. b
a Johns Hopkins Bloomberg School of Public Health, Baltimore,
Maryland
b World Health Organization, Geneva, Switzerland
Keywords: Adolescent health; Mortality; Disability-adjusted
life years; Health-related behaviors; Determinants; Policies;
Universal
health coverage; Indicators; Intersectoral collaboration;
Program guidance
A B S T R A C T
TheWorldHealthOrganizationhasproducedamultimedia,interactiv
eonlinereportentitledHealthfortheWorld’s
Adolescents: A Second Chance in the Second Decade. The
report provides an overview of global and regional esti-
mates of adolescent mortalityand disability-adjusted
lifeyears,disaggregated byage, sex, and cause, and country-
level dataon health-related behaviors and conditions among
adolescents. Itoutlines the reasons whyadolescence
is a unique period in the life course requiring special attention
and synthesizes current thinking about the
determinants that underlie the differences inhealth
statusbetween adolescents. Forthe firsttime, thisnew report
pulls together recommendations and guidance from across the
World Health Organization relating to
interventions directed to a range of priority health problems,
including use of alcohol and other psychoactive
substances, AIDS, injuries, mental health, nutrition, sexual and
reproductive health, tobacco use, and violence,
focusing on four core functions of the health sector: supportive
policies, service provision, strategic information,
and working with other sectors. The report concludes with 10
key actions that would strengthen national
responses to adolescent health, and outlines the approaches that

are needed to overcome the obstacles to
accelerating evidence-informed actions to improve the health of
adolescents worldwidedwith all the benefits
that this will have for public health in the present and across the
life course, for this generation and the next.
� 2015 Published by Elsevier Inc. on behalf of Society for
Adolescent Health and Medicine.
* Address correspondence to: Bruce Dick, M.B., Chemin des
Noyers 5bis, 1295
Tannay, Switzerland.
E-mail address: [email protected] (B. Dick).
1054-139X/� 2015 Published by Elsevier Inc. on behalf of
Society for Adolescent Health and Medicine.
http://dx.doi.org/10.1016/j.jadohealth.2014.10.260
Much has been written over the past 25 years about the need to
direct more attention and resources tothehealthand development
of adolescents. During this time, we have seen progress on
many
fronts: a better understanding of the health status of
adolescents;
growing clarity about the determinants underlying death,
disease,
and health-related behaviors during adolescence; a stronger
evidence base for interventions; and increased commitment and
action from national governments and nongovernmental organi-
zations. This journal exemplifies the growing body of research
focusing on adolescent health, although evidence from the low-
and middle-income countries where the vast most of the world’s
adolescents live is still relatively limited.
A number of recent publications have advocated on behalf of
adolescents from a range of perspectives, including public
health,
human rights, and socioeconomic development [1e10].

However,
although highlighting the progress that has been made, these re-
ports also stress that much more needs to be done if we are to
take
advantage of this period of the life course to improve the
present
and the future for individuals, families,communities, and
countries.
The World Health Organization’s Health for the World’s
Adolescents:a second chance in the seconddecade (H4WA)
willboth
contribute to the groundswell of attention being directed toward
adolescents and support accelerated action, including follow-up
to the 2011 World Health Assembly Resolution on Youth and
Health Risks.
H4WA is a multimedia, interactive online, fully referenced
report that can be found at http://www.who.int/adolescent/
second-decade. Readers can download and print a summary
Delta:1_given name
Delta:1_surname
http://www.who.int/adolescent/second-decade
http://www.who.int/adolescent/second-decade
mailto:[email protected]
http://crossmark.crossref.org/dialog/?doi=10.1016/j.jadohealth.2
014.10.260&domain=pdf
http://www.jahonline.org
http://dx.doi.org/10.1016/j.jadohealth.2014.10.260
B. Dick and B.J. Ferguson / Journal of Adolescent Health 56
(2015) 3e64
that is available in all official UN languages, but the report
itself is

only Web based, which allows the inclusion of videos,
interactive
graphics, and direct links to documents that are mentioned in
the
report.
H4WA focuses primarily on the health of adolescents
(10e19 years) and the role of the health sector in improving and
maintaining adolescent health. It is directed at senior-level and
mid-level staff in ministries of health, and partners in the health
sector who are providing technical, financial, and implementa-
tion support for interventions that contribute to adolescent
health and development. However, it should also appeal to many
other audiences: advocates, service providers, educators, and
even young people themselves.
H4WA has received input from across the World Health
Organization (WHO) and from experts in the field of adolescent
health. In addition, WHO organized two online consultations,
one with primary care providers and the other with adolescents.
The consultation with primary care providers covered a range
of issues relating to the provision of health services to adoles-
cents. It was conducted via an open-access online survey in
English, and 735 primary care providers from 81 countries
participated, most from high- and middle-income countries.
The adolescent consultation was open to all adolescents aged
between 12 and 19 years and was conducted via an open-access
online survey that was available in Arabic, Chinese, English,
French, Russian, and Spanish. A total of 1,143 adolescents from
104 countries participated in the consultation, most from low-
and middle-income countries.
WHO additionally organized a global photo competition for
adolescents aged 14e19 years. All the photos included in H4WA

were taken by the 10 winners of the competition.
A Picture of Adolescent Health
H4WA provides new estimates of mortality and disability-
adjusted life years (DALYs) lost during adolescence, based on
the 2012 WHO global health estimates. Data from the 2000 es-
timates are provided for comparison. The estimates are
available
by cause, sex, age (10e14, 15e19, and 10e19 years), and WHO
regions. There are also country-level data on health-related
behaviorsdincluding trendsdfrom the health behavior in
school-age children surveys and the global school-based student
health surveys.
The leading causes of death among adolescents globally in
2012 were road injury, AIDS, suicide, lower respiratory
infections, and interpersonal violence. The most important dif-
ference from the 2000 mortality data is that human immuno-
deficiency virus (HIV) is now estimated to be the number 2
cause
of mortality among adolescents; in 2000, HIV was not among
the
top 10 causes of death.
The increase in adolescent HIV mortality is likely the result of
more children living to adolescence through improved pediatric
HIV treatment and care. It may also reflect the limitations in
our current knowledge and estimation of survival times for
HIV-positive children. At the same time, there is good evidence
on the poor quality of, and retention in, services for adolescents
living with HIV, indicating the need for improved service de-
livery for this group.
Between 2000 and 2012, there were significant declines in
mortality among adolescents because of maternal causes and

measles, which demonstrates what is possible with concerted
efforts.
Regional mortality highlights include
(1) One of every three deaths among adolescent males in the
low- and middle-income countries in the Americas Region is
due to interpersonal violence.
(2) One of every five deaths among adolescents in high-income
countries is due to road traffic injuries.
(3) One of every five deaths among adolescent males in the low-
and middle-income countries of the Eastern Mediterranean
region is due to war and conflict.
(4) One of every six deaths among adolescent females in the
south-east Asia region is due to suicide.
(5) One of every six deaths among adolescents in the African
region is due to HIV.
DALYs declined between 2000 and 2012 for all adolescents
except 15- to 19-year-old males in the Eastern Mediterranean
region and the Americas Region. DALYs for all adolescents
declined
most in the south-east Asia region (21%) and the Western
Pacific
and European regions (16% and 17%, respectively). The
smallest
declines took place in the Eastern Mediterranean region (4%).
The major causes of DALYs changed little between 2000 and
2012. In 2012, depression, road injuries, iron-deficiency
anemia,
HIV, and intentional self-harm were the top five global causes
of

DALYs for adolescents. The one notable change from 2000 was
the high ranking of HIV.
The DALYs highlight not only the epidemiologic transition
that takes place during adolescence but also a number of gender
differences (e.g., more interpersonal violence and war-related
deaths among male adolescents and maternal problems
affecting females).
In terms of health-related behaviors, the report shows that
fewer than one in four adolescents meets recommended guide-
lines for physical activity; in some countries, as many as one in
every three is obese. And in most countries in every region, at
least half of younger adolescent boys report serious injuries in
the preceding year.
Fortunately, there is also some positive news concerning
adolescent behavior. In most countries, half or more of 15-year-
olds who are sexually active report using condoms the last time
that they had sex, and cigarette smoking is decreasing among
younger adolescents in many high-income countries.
In addition to these data, the report has a section outlining the
availability and important gaps in strategic information, particu-
larly program input and output data A clear message from the
report is that the data available to inform policy-making and
pro-
gramdesignandmonitoringare farlessadequatethanthedatathat
are available for other age groups. This requires urgent
attention.
Support for Action in Countries
For the first time, H4WA collates all WHO recommendations
and guidance from across the organization relating to adolescent
health, including use of alcohol and other psychoactive sub-

stances, HIV, injuries, mental health, nutrition, sexual and
reproductive health, tobacco use, and violence.
Health services
A number of specific analyses were carried out for H4WA to
place the provision of health services for adolescents within the
context of universal health coverage. In terms of needed health
(2015) 3e6 5
services, the report compiles all the health services and
interventions addressed in WHO Guidelines, including HIV,
immunization, the integrated management of common condi-
tions, mental health, nutrition, physical activity, sexual and
reproductive health and maternal health, substance use, tobacco
control, violence, and injuries. Concerning sufficient quality, a
new synthesis of standards for the provision of health services
to
adolescents has identified eight standards on the basis of the
national standards from 25 countries, existing WHO guidance,
and a literature review. Finally, in response to the need to
ensure
that services do not expose the user to financial hardship,
obstacles
and solutions of particular importance to adolescents were
identified to maximize the range of services and the number of
adolescents covered by effective prepaid pooling arrangements,
and to reduce out-of-pocket payments at the point of use.
Strategic information
H4WA includes 32 proposed core adolescent health indicators,
on the basis of the WHO/International Health Partnership

measurement framework, for use in countries. Thirteen of the
indicators measure impact, eleven measure outcome/coverage,
five measure inputs/outputs, and three measure determinants.
Seventeen of the 32 indicators have already been reviewed in
terms of their quality and availability, an additional eight are
included in existing nationally representative multicountry
surveys, and five others are collected in WHO-supported
surveys.
Supportive policies
H4WA includes a new analysis of 109 national health policy
documents. Eighty-four percent of the policies included some
attention to adolescents, with three-quarters of them focusing
on sexual and reproductive health, including HIV/AIDS;
approxi-
mately one-third address tobacco and alcohol use among
adolescents and one-quarter address mental health. Specific
consideration of other important issues, such as injuries,
nutrition
or physical activity among adolescents, is infrequent in national
policies. Fifty-two of the countries specify goals related to
adoles-
cents, but only 32 of the countries spell out measureable targets
in
their policy documents, and these mostly address changing the
prevalence of a specific health condition or increasing coverage
or
access to health services for adolescents. H4WA also includes a
specific review of mental health policies from 30 countries.
Strengthening other sectors
Responding to the major causes of mortality and lost DALYs
during the adolescent years will require engaging a range of
sectors beyond just the health sector. Section 9 of the report

focuses on interventions with parents, the creation of safe and
supportive communities, education and the school environment,
social protection, and preparing for and obtaining decent work.
It
highlights success stories and lessons learned about overcoming
the challenges to convergence between sectors.
Ten Key Actions to Strengthen National Responses
H4WA proposes the following:
(1) Understand that adolescent health is essential for public
health.
(2) Strengthen advocacy for adolescent health.
(3) Incorporate a focus on adolescents into all health policies,
strategies, and programs.
(4) Use the response to adolescent health as an indicator of
equity.
(5) Involve adolescents and maintain a positive perspective
toward them.
(6) Support interventions that go beyond the individual
adolescent.
(7) Improve the collection, analysis, and use of data.
(8) Focus on universal health coverage for the second decade.
(9) Work with other sectors to improve the health of
adolescents.
(10) Define and fund research priorities.
Although many of these recommendations would be appli-
cable to all population groups, they are of particular importance
to the second decade because this period of the life course has

been so neglected.
There are many reasons why adolescent health has been
neglected in comparison with other age groups:
(1) Data are not disaggregated by age; what we fail to measure
we fail to act on.
(2) Consensus around global indicators to monitor adolescent
health is lacking.
(3) Interventions are often more complex than those for child
health.
(4) Action is required from a range of sectors.
(5) Many of the issues are culturally and politically sensitive.
(6) Research is limited, particularly in low- and middle-income
countries.
H4WA highlights a number of ways in which these obstacles
can be overcome.
(1) Move beyond the myths. There are still many myths about
adolescents that obstruct accelerated action: that they are
healthy and therefore do not need much attention; that
the only real problems that they face are related to sexual
and reproductive health; and that the evidence base is
weak and we do not really know what to do. None of these
are true.
(2) Define priorities beyond mortality. Deaths in adolescence
are
important, and no adolescent should die from a cause that is
preventable or treatable. But for public health more gener-
ally, more attention needs to go toward preventing the

health-compromising behaviors and conditions that arise
during adolescence and have a long-term impact on health
across the life course.
(3) Focusbeyondtheindividual.Althoughprovidinghealthservices
and improving adolescents’ own knowledge and skills are
important, these alone will not be enough to improve adoles-
cent health. Structural, environmental, and social changes will
also be essential, including more support for parents and
schools, and policies that protect and promote adolescents’
health.
(4) Act beyond single-problem thinking. Many of the behaviors
and conditions that undermine the health of adolescents
have common determinants and are linked. We must focus
on interventions that more effectively address the common
determinants of multiple risk behaviors.
(2015) 3e66
(5) Develop programs that are beyond “business as usual.”
As countries move toward universal health coverage,
ensuring that adolescents receive adequate consideration is
essential. There are many untapped resources to improve
and maintain the health of adolescents, including adoles-
cents themselves and interactive media and technologies.
(6) Be challenged beyond aspirations. A human rightsebased
approach stresses the obligations of governments. Setting
clear goals and targets and monitoring progress give focus to
these obligations. Consensus is needed on a set of measur-
able and achievable goals and targets, which countries can
select and adapt as necessary.

In the second decade of the millennium, we have many op-
portunities to improve health in the second decade of life.
H4WA
aims to support countries, and partners accelerate action and
increase accountability for adolescent health. It was launched at
the 2014 World Health Assembly, and there have been proposals
for adolescent health to be taken up in subsequent sessions of
WHO’s Governing Bodies.
References
[1] Lloyd CB. Growing up global: The changing transitions to
adulthood in
developing countries. Washington, D.C: The National
Academies Press; 2005.
[2] Jimenez EY, Fares J, Gauri V, et al. World development
report 2007:
Development and the next generation. Washington, D.C: The
World Bank;
2006.
[3] The state of the world’s children 2011. Adolescence: An age
of opportunity.
New York: United Nations Children’s Fund; 2011.
[4] Progress for children: A report card on adolescents, number
10. New York:
United Nations Children’s Fund; 2012.
[5] Moving young. New York: United Nations Population Fund;
2006.
[6] Generation of change: Young people and culture. New York:
United
Nations Population Fund; 2008.
[7] The Lancet series on adolescent health, 2012. London: The

Lancet, 2012.
Available at: http://www.thelancet.com/series/adolescent-
health-2012.
Accessed February 13, 2014.
[8] The Lancet series on adolescent health, 2007. London: The
Lancet, 2007.
Available at: http://www.thelancet.com/series/adolescent-
health. Accessed
February 13, 2014.
[9] Emerging issues in adolescent health. J Adolesc Health
2013;52-
(Supplement 2):S1e45. Available at:
http://www.jahonline.org/issues?
issue_key¼S1054-139X%2812%29X0007-7. Accessed February
6, 2014.
[10] Supplement on multiple risk behaviour in adolescence. J
Public Health
2012;34:i1e56.
http://refhub.elsevier.com/S1054-139X(14)00687-9/sref1
http://www.thelancet.com/series/adolescent-health-2012

http://www.thelancet.com/series/adolescent-health
http://www.jahonline.org/issues?issue_key=S1054%2D139X%2
52812%2529X0007%2D7
52812%2529X0007%2D7
52812%2529X0007%2D7
http://refhub.elsevier.com/S1054-139X(14)00687-
9/sref10Health for the World's Adolescents: A Second Chance
in the Second DecadeA Picture of Adolescent HealthSupport for
Action in CountriesHealth servicesStrategic
informationSupportive policiesStrengthening other sectorsTen
Key Actions to Strengthen National ResponsesReferences
70 Journal of Human Reproductive Sciences / Volume 8 / Issue
2 / Apr - Jun 2015
development takes place; adolescents
develop abstract thinking and reasoning.
Emotionally, they develop a sense of identity
during late adolescence; social involvement,
peer interaction, as well as sexual interest,
develop in this phase. Different behavioral
experimentation is seen in early adolescence,
risk taking in middle adolescence, and later
adolescents learns to assess their own risk
taking.[3]
As per the 2014 data, published by U.S
Census Bureau, adolescents (10–19 years
of age) count approximately 1.2 billion
across the globe.[4] Nearly, 70% of total

adolescent (10–19 years of age) population
o f t h e w o r l d r e s i d e s i n d e v e l o p i n g
countries.[5,6] Developing countries in recent
decades are going through a rapid change
due to – urbanization, migration, education,
and mixing of cultures, which are having
a definite impact on the attitude toward
sexuality in adolescents.
In developing countries like India, the
adolescents are also subjected to early
marriage, which results in teenage pregnancy
and adolescent fatherhood. In most cases,
females in comparison to males are subjected
to early marriage. Early exposure to sexual
relationship also increases the risk of
sexually transmitted diseases. As the culture
I N T R O D U C T I O N
Growth and development are continuous
processes, which bring a change in an
individual, every moment. Development
of sexuality starts as early as in intrauterine
life following conception and continues
through infancy, childhood, adolescence,
adulthood till death.[1] During infancy,
there is no awareness of gender. The child
acknowledges its gender in early childhood
as early as by 3 years. Self-awareness about
sexuality (gender role, gender identity)
evolves during the childhood.[2] Biological
research evidences are suggestive of the
definite role of androgens in deciding the
gender sensitive roles and gender-specific
behaviors.[2] Adolescence is a phase of

transition during which major developments
of sexuality takes place. Puberty is reached
during adolescence, which is a major
landmark in the development of sexuality.
The hypothalamo-pituitary-gonadal axis
function is highly essential for the sexual
development during puberty.
Adolescence can be broadly divided into
three stages: Early (10–13 years), middle
(14–16 years), and late (17–19 years). Physical
changes start in early adolescence, where
they are very concerned about their body
image. During adolescence cognitive
ABSTRACT
Adolescence, derived from the Latin word “adolescere” meaning
“to grow up” is a critical
developmental period. During adolescence, major biological as
well as psychological
developments take place. Development of sexuality is an
important bio‑psycho‑social
development, which takes an adult shape during this period.
During adolescence, an
individual’s thought, perception as well as response gets
colored sexually. Puberty is an
important landmark of sexuality development that occurs in the
adolescence. The myriad
of changes that occurs in adolescents puts them under enormous
stress, which may
have adverse physical, as well as psychological consequences.
Understanding adolescent
sexuality has important clinical, legal, social, cultural, as well
as educational implications.

KEY WORDS: Adolescence, development, puberty, sexuality
Review Article
Understanding normal development of adolescent
sexuality: A bumpy ride
Sujita Kumar Kar,
Ananya Choudhury1,
Abhishek Pratap Singh1
Department of Psychiatry,
King George’s Medical
University, Lucknow,
Uttar Pradesh, 1Department of
Psychiatry, Institute of Human
Behavior and Allied Sciences,
New Delhi, India
Address for correspondence:
Dr. Sujita Kumar Kar,
Department of Psychiatry,
King George’s Medical
University, Lucknow,
Uttar Pradesh, India.
E‑mail: [email protected]
Received: 18.04.2015
Review completed: 01.05.2015
Accepted: 04.05.2015
Access this article online
Quick Response Code:
Website:
www.jhrsonline.org
DOI:

10.4103/0974-1208.158594
Kar, et al.: Adolescent sexuality: A bumpy ride
71Journal of Human Reproductive Sciences / Volume 8 / Issue 2
/ Apr - Jun 2015
of the developing country facilitates early marriage, as well
as early pregnancy and adolescent fatherhood, the family
and the society usually prepare the adolescents for the same
which colors the adolescents attitude toward sexuality.
In some reserved cultures, sexuality is discussed little so
there is little scope to explore sexuality, and it still remains
as a myth or enigma for the adolescent, which affects their
perception of sexuality.
D E V E L O P M E N T O F S E X U A L I T Y I N A N
A D O L E S C E N T
During adolescence, the physical growth, psychological as
well as cognitive development reaches its peak. Adolescent
sexuality development can be better explained with the
bio-psycho-social model.[7] Biological factors, psychological
factors, as well as social factors have equal importance in
determining, the development of sexuality in adolescents.
Biological factors are the genetic factors and neuro-endocrinal
factors, which determine the biological sex and also having
an influence on the psychological sex. During adolescence
the gonadal hormones, cortisol, and many other hormones
play a role in causing the onset of puberty.[8] The secondary
sexual characters are expressed due to this neuro-endocrinal
influence.

In both males and females-pubic hairs, axillary hairs
develop which take a gender specific growth pattern. In
males, there occurs enlargement of genitals, appearance
of beard and mustache, and the physique takes a typical
masculine shape. In females, there occurs development
of breast; menstruation starts, genitalia takes an adult
shape, and the physique changes to a feminine type.
An adolescent’s interest in a sexual relationship is also
influenced by the hormones.
Individual’s personality or temperament is an important
psychological factor that also decides the attitude
toward sexuality. Introvert adolescents face difficulty in
approaching and responding sexually.
Social factors or environmental factors also play a significant
role in the development of adolescent sexuality. The attitude
of the parents toward sexuality, parenting style, peer
relationship, cultural influences are the important social
factors which facilitates the sexual learning and decides the
sexual attitude of the adolescent.
Other than the biological, psychological, and social factors,
many more factors such as political, legal, philosophical,
spiritual, ethical, and moral values significantly influence
the sexuality development.[9] Media also influences the
sexuality in adolescents.[10] In the recent decades, there is
an exponential growth in the media coverage worldwide.
Adolescents’ access literature related to sexuality, sexual
crimes, and violence through media which affects the
adolescent’s perception and attitude toward sexuality.[10]
Similarly television, internet also exposes the adolescents
to literature and movies with sexuality content, influencing
their perception about sexuality.[11]

Sigmund Freud had proposed his theory of psychosexual
development, where he described about – oral phase, anal
phase, phallic phase, latency phase, and genital phase as the
landmark steps of psycho-sexual development.[12] During
these phases, different body parts behave as most erotogenic
and the individual attempts to explore or stimulate these
erotogenic zones in order to get gratification.[12] The
table 1 below mentions about the onset of the phases
of psychosexual development across life time.[12]
Table 1: Phases of psycho-sexual development
Phase of psychosexual development Lifetime
Oral phase Birth to 18 months
Anal phase 18 months-3 years
Phallic (oedipal) phase 3-5 years
Latency phase 5 years to puberty
Genital phase Puberty to till end of life
During early adolescence, an individual enters the genital
phase from latency phase and throughout the adolescence
the genital phase is maintained. The sexuality, which
remains quiescent during the latency phase, becomes active
during the genital phase.
During adolescence, an individual’s need for intimacy and
love making with opposite gender increases. Adolescents
explore about different appropriate ways to express the
love and intimacy.[13]
The development of an adolescent occurs not in isolation,
rather in the background of the family, society in a defined
culture, which significantly influences the adolescent
sexuality.[13] Society’s attitude and cultural perception of
sexuality largely have an influence on the families in which
an adolescent nurtures and his or her sexuality cherishes.

G E N D E R A N D A D O L E S C E N C E
Puberty changes differ in both the sexes. On an average
females experience these changes 12–18 months earlier
than males. Furthermore, the time of attaining maturity can
impact the adolescent development differently.[14]
Early maturing boys having good body image are more
confident, secure, and independent as compared to
late maturing boys. However, they may have increased
72 Journal of Human Reproductive Sciences / Volume 8 / Issue
2 / Apr - Jun 2015
aggressiveness due to a surge of hormones.[15,16] They are
more likely to be sexually active and participate in risky
behavior.[15,16]
Early maturing girls on the other hand, are very
self-conscious, insecure, and more likely to develop eating
disorders.[17] They are more likely to face sexual advances
from older boys, more chances of unwanted pregnancies
and more likely to be exposed to alcohol and drug abuse.
As per a research in the United States, during childhood-boys
as compared to girls are more likely to face negative health
outcomes like aggressive behavior and depression.[18] On
the other hand, during adolescence, the girls are more
likely to face the higher risk of negative health outcomes.[18]
The effect of discrimination, gender, poverty, and abuse
make the adolescent girls more vulnerable to the adverse
outcomes.[19]

In areas of conflict (war prone zones, countries with political
instability, and religious conflicts), young girls are at higher
risk of sexual abuse and trafficking and young boys are
more likely to be recruited as child soldiers.[20] The culture
influences the roles and expectations from girls and thus
has an impact on their access of information, education,
and opportunity.
A D O L E S C E N T S E X U A L B E H AV I O R
Adolescence is the period during which an individual’s
thought perception, as well as response gets colored
sexually. Adolescence is the age to explore and understand
sexuality. Sexual curiosity in the adolescence led to exposure
to pornography, indulgence in sexual activities, and also
increases the vulnerability for sexual abuse.
Halpern et al., studied on western population regarding
sexual behavior patterns of adolescents and explored the
possible factors attributing to the sexual behaviors.[21] In
this study, they studied over 11,000 adolescents between 18
and 27 years of age and found that more than 90% lose their
virginity before marriage.[21] The virgin population is found
to be younger in age, have the poor physical maturity, higher
body mass index, more religious inclination, and often
had perceived disapproval for sex during adolescence by
parents.[21] By the late teenage and early 20’s, most individuals
experience oral or vaginal sex irrespective of marital status
as found in different studies from US.[22,23] It was seen that
early exposure to vaginal sex during adolescence increased
the risk of sexual transmitted disease, however, the risk
gradually declines with age.[24-26] It was also reported that,
those who were exposed early to vaginal sex found to have
more number of sexual partners which might have a link
with the increased risk of sexually transmitted diseases.[26,27]

In recent years, internet has brought a revolution
i n a d o l e s c e n t ’ s a t t i t u d e a n d p e r c e p t i o n t
o wa r d
sexuality.[11] Adolescents acquire extensive information
related to sexuality, which may be misguiding and can have
a significant negative impact on the sexual behaviors.[11]
Sexuality is a complex human behavior, which is largely
influenced by factors such as physical appearance,
psychological factors, social factors, cultural norms, and
past experiences.[2]
Most of the studies focus on vaginal sex on the sexual
behavior in adolescence and hardly few studies discuss
the non-vaginal sexual behavior.[26] There is a need to
explore the non-vaginal sexual behaviors (oral sex, anal sex)
which may be potential routes of transmission of sexually
transmitted diseases including HIV infection/AIDS as
adequate protections like use of condom is taken in these
methods like vaginal sex.[26,28-32]
C H A L L E N G E S FA C E D
Adolescents face a great challenge in their early adolescence.
Many critical biological, as well as psychological changes,
occur during this phase for which many adolescents are not
prepared enough to cope with, which often puts them under
stress. Onset of menstruation, change in voice (puberphonia)
in boys, development of secondary sexual characteristics,
and psychological changes often perceived as challenges.
Family and society’s attitude, as well as a cultural influence
on these changes, during puberty, plays a major role in
deciding the adolescent’s sexual behavior after puberty.
Sexual exposure during adolescence is a matter of serious
concern due to the risk of transmission of sexually

transmitted infections including HIV infection/AIDS,
teenage pregnancy, and adolescent fatherhood.[13,33] In many
developing countries, as well as underdeveloped countries,
early sexual exposure leading to HIV infection is a matter
of great concern.[34,35] Early marriage leading to early sexual
exposure, and pregnancy also has adverse consequences on
the reproductive health.[5,36]
I n m a n y d e ve l o p i n g c o u n t r i e s a n d m o s t o f
t h e
underdeveloped countries, formal sex education in school
mostly does not exist; if it exists, then mostly found to
be inadequate. Lack of proper sex education often leads
to unprotected sex, unintended pregnancy, and sexually
transmitted diseases.
Due to multiple reasons adolescents are exposed to
unprotected sex. Lack of awareness and improper sex
education is an important reason of unprotected sex in
adolescents.[5] In developing and underdeveloped countries,
the parent – child communication related to sexuality and
73Journal of Human Reproductive Sciences / Volume 8 / Issue 2
/ Apr - Jun 2015
sexually transmitted diseases is poor.[5] Adolescents get little
opportunity to discuss about their sexuality related issues,
which likely to hamper the healthy sexual development.[7]
Difficulties associated with the sexual approaches and
encounters are not the only challenge in adolescence.
Interpersonal violence is one of the notable concerns in

adolescents.[13] It may result in physical, as well as sexual
abuse. Most of the interpersonal violence is related to
sexuality. Usually, the adolescents are not trained enough
in the parenting skills due to, which teenage pregnancy
and adolescent fatherhood becomes a challenge.[13] Clinical
and educational interventions on adolescent sexuality focus
mostly on coital sexual activities of adolescents. However,
there are plenty of evidence regarding adolescent’s
involvement in non-coital activities, which are potential
routes of transmission of sexually transmitted diseases
including HIV infection.[5,26,28-32,37] There is a need to
focus
on non-coital sexual activities during clinical assessment
and health education.
C O N C L U S I O N
Understanding the sexuality development of adolescent is of
utmost importance. Without this understanding, one cannot
move forward for clinical or educational intervention.
Understanding the factors influencing sexuality is also
useful for intervention. At the same time, understanding
adolescent sexuality, will also help parents to understand
the difficulties of their children better and will help them
to guide their children in the crossroads of adolescence.
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