2. AdolescenceAdolescence
The Bottle NeckThe Bottle Neck
Menan Abd-El-Maksoud Rabie, MDMenan Abd-El-Maksoud Rabie, MD
MBBch, Msc, MD, Arab BoardMBBch, Msc, MD, Arab Board
Psychiatry ConsultantPsychiatry Consultant
Associate Professor of Psychiatry, Ain Shams UniversityAssociate Professor of Psychiatry, Ain Shams University
Associate Member of the International Federation ofAssociate Member of the International Federation of
Psychiatric Epidemiology (IFPEPsychiatric Epidemiology (IFPE((
3. ParentingParenting andand growing upgrowing up areare
both very stressful things to be doingboth very stressful things to be doing
And when a family tries to do themAnd when a family tries to do them
both at theboth at the same timesame time, it, it’’ss
inevitable that somewhere along theinevitable that somewhere along the
line there is going to beline there is going to be ……………………
frictionfriction
Dr David FongDr David Fong
4. The familyThe family
Family life exists on a continuum.Family life exists on a continuum.
Sometimes, itSometimes, it’’s absolutely great ands absolutely great and
sometimes, well, it really isnsometimes, well, it really isn’’t.t.
Furthermore, bear in mind thatFurthermore, bear in mind that
where a family stands on thiswhere a family stands on this
continuum varies acc. to stresses &continuum varies acc. to stresses &
strains they are under.strains they are under.
A huge interaction between a family,A huge interaction between a family,
its members and their environmentits members and their environment
are changing all the time.are changing all the time.
5. Successful familiesSuccessful families
The idea of typical family hasThe idea of typical family has
changed, but what a family needs tochanged, but what a family needs to
do hasndo hasn’’t changed that much (not int changed that much (not in
terms of earning money or living interms of earning money or living in
luxury, but in terms of contentment,luxury, but in terms of contentment,
adjustment and coping)adjustment and coping)
Family tasks are to fulfill:Family tasks are to fulfill:
* Physical needs * Psychological needs* Physical needs * Psychological needs
* Emotional needs * Spiritual needs* Emotional needs * Spiritual needs
6. Family tasksFamily tasks
Physical needsPhysical needs
Food, shelter, warmth, clothingFood, shelter, warmth, clothing
Psychological needsPsychological needs
Safety, length and durability of theSafety, length and durability of the
bondbond ““elastic bandelastic band”” dangerous if toodangerous if too
loose and crippling if too tight,loose and crippling if too tight,
Emotional needsEmotional needs
Allow emotions, behavioral thermostatAllow emotions, behavioral thermostat
Spiritual needsSpiritual needs
Dream, be ambitiousDream, be ambitious
7. a developmental period of dramatic change.a developmental period of dramatic change.
Adults on the outsideAdults on the outside more misunderstandingsmore misunderstandings &&
ignorance of what a teenager is trying toignorance of what a teenager is trying to
understand, do, feel, or be.understand, do, feel, or be.
Adult response is shaped by adult expectations,Adult response is shaped by adult expectations,
understanding and feelings. ranging from delight,understanding and feelings. ranging from delight,
admiration & interest to disapproval, disgust & fear.admiration & interest to disapproval, disgust & fear.
ADOLESCENCE
8. AdolescenceAdolescence
A long transitional developmental periodA long transitional developmental period
between childhood and adulthood.between childhood and adulthood.
A maturational developmental processA maturational developmental process
involving major physical, psychological,involving major physical, psychological,
cognitive, and social transformations.cognitive, and social transformations.
Its onset marked by puberty.Its onset marked by puberty.
9. AdolescenceAdolescence
Normal adolescence is aNormal adolescence is a
universal & extremeuniversal & extreme
internal & externalinternal & external
stress:stress:
marked emotionalmarked emotional
reactivityreactivity
volatile behavioralvolatile behavioral
unpredictabilityunpredictability
dramatic separationsdramatic separations
from family tiesfrom family ties
severe disruptions in thesevere disruptions in the
personal sense of self,personal sense of self,
leading to separation andleading to separation and
autonomyautonomy
10. AdolescenceAdolescence
AA time of reordering, realignment, andtime of reordering, realignment, and
transformation leading totransformation leading to
physicalphysical && cognitive developmentcognitive development
relational transformationsrelational transformations
psychological differentiationpsychological differentiation
interdependenceinterdependence
greater self coherence.greater self coherence.
11. STAGES OFSTAGES OF
ADOLESCENCEADOLESCENCE
Adolescence is usuallyAdolescence is usually
divided into phases ofdivided into phases of
early (12 to 14 years)early (12 to 14 years)
middle (14 to 17 years)middle (14 to 17 years)
late adolescence (17 tolate adolescence (17 to
19 years)19 years)
described in terms ofdescribed in terms of
physical, cognitive,physical, cognitive,
psychological, and socialpsychological, and social
changeschanges
Concrete self descriptionConcrete self description
Tortuous courseTortuous course
Definition of self portraitDefinition of self portrait
12. I- PhysicalI- Physical
ChangesChanges
Growth spurtGrowth spurt
Secondary sex characteristics begin to appear about aSecondary sex characteristics begin to appear about a
year after the onset of the growth spurtyear after the onset of the growth spurt (pubic hair &(pubic hair &
breast development in girls & pubic hair &genitalbreast development in girls & pubic hair &genital
development in boysdevelopment in boys((
Menarche (8-13 ys)Menarche (8-13 ys)
Spermache (9-14 ys)Spermache (9-14 ys)
The nose and mouth widen & the jaw juts out. The chin isThe nose and mouth widen & the jaw juts out. The chin is
the lastthe last
Body hair darkens and lengthensBody hair darkens and lengthens
Sweat glands become activeSweat glands become active body odorbody odor
Voice quality changesVoice quality changes
Complexion and acne problemsComplexion and acne problems
Endurance and strengthEndurance and strength
13. Thought experimentThought experiment
Imagine that over the next 3-4daysImagine that over the next 3-4days
You sprout hair allover your bodyYou sprout hair allover your body……
Your voice changes completelyYour voice changes completely ……
Your body odor changesYour body odor changes ……
You canYou can’’t judge distance becauset judge distance because
your limbs are growingyour limbs are growing ……
You have strange new urgesYou have strange new urges ……
You canYou can’’t control your moodt control your mood ……
Your sexual organs behave in aYour sexual organs behave in a
strange way and there are fluidsstrange way and there are fluids
14. II- CognitiveII- Cognitive
ChangesChanges
abstract thoughtabstract thought,, integrate concrete experiences,integrate concrete experiences,
possible scenarios, historical facts, and rememberedpossible scenarios, historical facts, and remembered
experiences into an abstract generalizationexperiences into an abstract generalization
information-processing skillsinformation-processing skills, selective, selective attentionattention,,
better short- and long-termbetter short- and long-term memorymemory, and, and
organizationalorganizational strategiesstrategies
knowledgeknowledge base, andbase, and decision-makingdecision-making
future orfuture or ideal possibilitiesideal possibilities; A teenager can be; A teenager can be
inspired by the "what ifs"inspired by the "what ifs"
self-reflectionself-reflection new dimensions of personal or moralnew dimensions of personal or moral
categorizations.categorizations.
multidimensional appreciationmultidimensional appreciation more complexmore complex
understanding of causality in academic, personal, andunderstanding of causality in academic, personal, and
interpersonal matters (but not everyday)interpersonal matters (but not everyday)
to becometo become relativerelative rather than absoluterather than absolute
18. BIRTH AGE 6 AGE 14-20
1-20 Stahl S M, Essential
Psychopharmacology (2000
19. These new capacities lead toThese new capacities lead to
preoccupation with the self,preoccupation with the self,
periods of private introspection,periods of private introspection,
self-consciousnessself-consciousness..
""the imaginary audiencethe imaginary audience""
falsely assume that others arefalsely assume that others are
as preoccupied with theiras preoccupied with their
behavior & appearance as theybehavior & appearance as they
are themselvesare themselves..
The ability to separate one's thinking from that of othersThe ability to separate one's thinking from that of others
enhances the capacity for perspective taking andenhances the capacity for perspective taking and
interpersonal empathyinterpersonal empathy
Cognitive ChangesCognitive Changes التغيراتالتغيرات
المعرفيالمعرفيةة
20. Adolescence begins when childrenAdolescence begins when children
stop asking questions-because theystop asking questions-because they
know all the answers.know all the answers.
Evan EsarEvan Esar
21. III-Psychological changesIII-Psychological changes
Changes in adolescentChanges in adolescent
internal world:internal world:
Choice andChoice and
consequenceconsequence
Adolescents areAdolescents are
making decisions formaking decisions for
the first timethe first time
without anwithout an
experience base,experience base,
they findthey find
information withinformation with
peers, TV or media.peers, TV or media.
Adolescents try onAdolescents try on
personalitiespersonalities
23. How parents can helpHow parents can help……
Parents need to be honest andParents need to be honest and
availableavailable
Parents need to set boundariesParents need to set boundaries
* realistic boundaries* realistic boundaries
* enforceable boundaries* enforceable boundaries
* beneficial for the family* beneficial for the family
24. III-Psychological changesIII-Psychological changes
How parents can helpHow parents can help……
Remember how it was for youRemember how it was for you
Give them spaceGive them space
Remember the boundariesRemember the boundaries
Be rational and calmBe rational and calm
26. Adolescent development is shapedAdolescent development is shaped
byby
Individual differencesIndividual differences
dialoguedialogue
ContextContext
(environment(environment((
TimingTiming
Arrested egoArrested ego
developmentdevelopment
Steady conformitySteady conformity
Progressive egoProgressive ego
developmentdevelopment
Accelerated egoAccelerated ego
developmentdevelopment
Stuart Hauser and colleaguesStuart Hauser and colleagues
27. Healthy adolescence results fromHealthy adolescence results from
healthy ego development thathealthy ego development that
generates an extensive andgenerates an extensive and
flexible repertoire of responsesflexible repertoire of responses
and a healthy balance ofand a healthy balance of
autonomy & involvement withautonomy & involvement with
othersothers
28. PARENT-PARENT- CHILDCHILD
DIALOGUEDIALOGUE
Conflict-resolution strategiesConflict-resolution strategies
Conflict starts with behaviors that deviateConflict starts with behaviors that deviate
fromfrom expectationsexpectations..
Children and parents argue more at theChildren and parents argue more at the
onset of pubertyonset of puberty,,
Parents and children argue more oftenParents and children argue more often
aboutabout such issues as curfews, chores,such issues as curfews, chores,
schoolwork, and personal hair and clothingschoolwork, and personal hair and clothing
stylesstyles
29. positive outcomespositive outcomes
Parent-child conflicts yieldParent-child conflicts yield positivepositive
outcomesoutcomes when they are:when they are:
temporary,temporary,
take place in the context of warm closetake place in the context of warm close
relationships, andrelationships, and
proceed with mature conflict resolutionproceed with mature conflict resolution
strategiesstrategies
end in negotiated compromises.end in negotiated compromises.
30. negative outcomesnegative outcomes
The inevitable troubles may result inThe inevitable troubles may result in
negative outcomesnegative outcomes when theywhen they
become pervasive,become pervasive,
occur with a backdrop of shaky emotionaloccur with a backdrop of shaky emotional
relationships,relationships,
involve parents or children who may beinvolve parents or children who may be
temperamentally or psychiatrically moretemperamentally or psychiatrically more
vulnerable, andvulnerable, and
escalate regularly to devaluing and hostileescalate regularly to devaluing and hostile
interactionsinteractions
end in withdrawal or disengagementend in withdrawal or disengagement
31. Adolescent development is better inAdolescent development is better in
parent-child relationship ccc byparent-child relationship ccc by::
Secure attachmentSecure attachment
Well-worn styles of discussionWell-worn styles of discussion
Supportive communicationSupportive communication
Adaptive strategies for conflictAdaptive strategies for conflict
resolutionresolution
Parents withParents with mature egomature ego
developmentdevelopment who have (selfwho have (self
awareness, appreciation of individualawareness, appreciation of individual
differences, reasonable approachesdifferences, reasonable approaches
to adolescent experimentation)to adolescent experimentation)
32. Balanced authoritative parentingBalanced authoritative parenting
Limit setting vs negotiationLimit setting vs negotiation
Respect autonomous expression vsRespect autonomous expression vs
disciplined conformitydisciplined conformity
Emotional responsiveness vs matureEmotional responsiveness vs mature
conflict resolutionconflict resolution
Stereotyped expectations vs newlyStereotyped expectations vs newly
encountered ideas and conceptsencountered ideas and concepts
33. From the Adult Side
increased feelings of inadequacy around parentingincreased feelings of inadequacy around parenting
greater anxietygreater anxiety
greater marital tensiongreater marital tension
Middle-age parents may be confronting diminishedMiddle-age parents may be confronting diminished
physical attractivenessphysical attractiveness && life opportunitieslife opportunities
dialoguedialogue adaptive responses to the adolescent'sadaptive responses to the adolescent's
emotional distancingemotional distancing
body changesbody changes
increased questioning of family rules and conventionsincreased questioning of family rules and conventions
different tastes in clothes and musicdifferent tastes in clothes and music
search for privacy and extrafamily relationships.search for privacy and extrafamily relationships.
34. From the Adolescent SideFrom the Adolescent Side
Adolescent fashion, behaviors,Adolescent fashion, behaviors,
and tastes are not merelyand tastes are not merely
"rebellious" alternatives to"rebellious" alternatives to
parental values and behaviors.parental values and behaviors.
Teenagers are learning andTeenagers are learning and
making serious life choicesmaking serious life choices
when they do the varied andwhen they do the varied and
sometimes extreme things theysometimes extreme things they
do.do.
For the teenager they areFor the teenager they are
explorations into who I haveexplorations into who I have
been, am, or could be.been, am, or could be.
Badges of membership in someBadges of membership in some
peer groups and non-peer groups and non-
membership in others.membership in others.
ٍٍself-discovery involvesself-discovery involves
discomfort, confusion, anxiety,discomfort, confusion, anxiety,
and unhappiness especially inand unhappiness especially in
Early adolescenceEarly adolescence
35. Peer PressurePeer Pressure
“The blind leading the blind“The blind leading the blind””
When teenagers pick a peer group withWhen teenagers pick a peer group with
behaviors and values more similar to thosebehaviors and values more similar to those
of their parents, the teenagers and parentsof their parents, the teenagers and parents
have a more harmonious journey.have a more harmonious journey.
Teenagers with ability in academic, athleticTeenagers with ability in academic, athletic
or arts are accepted by these peer groups.or arts are accepted by these peer groups.
If teenagers are rejected by more-If teenagers are rejected by more-
competent peer groups, they seek outcompetent peer groups, they seek out
groups who will accept and validate theirgroups who will accept and validate their
level of competence.level of competence.
36. Peer PressurePeer Pressure
Why peers can helpWhy peers can help……
Peers act as a mirrorPeers act as a mirror
Peers act as a testingPeers act as a testing
groundground
Peers provide socialPeers provide social
support and safetysupport and safety
Peers donPeers don’’t live in thet live in the
same house, they aresame house, they are
separate and privateseparate and private
from the family, theyfrom the family, they
are precious andare precious and
important.important.
37. Peer PressurePeer Pressure
“The blind leading the blind“The blind leading the blind””
How to deal with the peerHow to deal with the peer
pressurepressure
Offer your servicesOffer your services
Be interestedBe interested
DonDon’’t label or judget label or judge
DonDon’’t worry about your child going tot worry about your child going to
an irreversible path, this feeling isan irreversible path, this feeling is
usually amplified in the presence of ausually amplified in the presence of a
peer grouppeer group
38. Milestones of self developmentMilestones of self development
– generation of components of the selfgeneration of components of the self
– differentiation and exploration of thesedifferentiation and exploration of these
componentscomponents
– valuing of some parts and devaluing ofvaluing of some parts and devaluing of
others (self-esteem regulation)others (self-esteem regulation)
– dropping of devalued and developmentdropping of devalued and development
of valued partsof valued parts
– reconciling of contradictory self imagesreconciling of contradictory self images
– integration of self components.integration of self components.
Susan HarterSusan Harter
39. Process of Identity FormationProcess of Identity Formation
Identity diffusionIdentity diffusion: period of exploration of: period of exploration of
alternative selves toward a period of choice,alternative selves toward a period of choice,
commitment, and consolidation.commitment, and consolidation.
ForeclosureForeclosure: premature commitment Teenagers: premature commitment Teenagers
who foreclose the process adopt identitieswho foreclose the process adopt identities
prescribed by parents or other authority figuresprescribed by parents or other authority figures
without ever experiencing tension or exploringwithout ever experiencing tension or exploring
options.options.
identity confusionidentity confusion: failure to commit: failure to commit
appropriate in early adolescence, in laterappropriate in early adolescence, in later
adolescenceadolescence a maladaptive inability to seeka maladaptive inability to seek
decisions and make commitments.decisions and make commitments.
40. You should be concerned ifYou should be concerned if……
The problem persists for a period ofThe problem persists for a period of
months (become chronic)months (become chronic)
The problem is snowballingThe problem is snowballing……
The behavior is markedly differentThe behavior is markedly different
from that of a peer groupfrom that of a peer group
41. Pathological outcomes in identityPathological outcomes in identity
formation lead to turning against theformation lead to turning against the
self (e.g., depression, eatingself (e.g., depression, eating
disorders, and suicidality) or turningdisorders, and suicidality) or turning
against others or society (e.g.,against others or society (e.g.,
delinquent behaviors).delinquent behaviors).
42. External ProblemsExternal Problems
Domestic violenceDomestic violence
DivorceDivorce
BereavementBereavement
Being part of a single parent familyBeing part of a single parent family
Being part of a stepfamilyBeing part of a stepfamily
43. Healthier teenagers can see how they canHealthier teenagers can see how they can
be both smart and dumb, kind and mean,be both smart and dumb, kind and mean,
capable and incompetent, lovable orcapable and incompetent, lovable or
unpopular depending upon theunpopular depending upon the contextcontext..
Older adolescents integrate past, current,Older adolescents integrate past, current,
and future selves coordinating them intoand future selves coordinating them into
self-knowledge & acceptance. They willself-knowledge & acceptance. They will
refuse to participate in an activity withrefuse to participate in an activity with
reasons such as "That's not me."reasons such as "That's not me."
FindingFinding the real methe real me is a stable,is a stable,
comfortable sense of self with continuity tocomfortable sense of self with continuity to
childhood identities and confidence inchildhood identities and confidence in
future roles.future roles.
44. Guidelines for the ParentGuidelines for the Parent
What teenagers want from their familyWhat teenagers want from their family
BoundariesBoundaries
Compromise and negotiationCompromise and negotiation
Appropriate levels of responsibility forAppropriate levels of responsibility for
decisionsdecisions
Open communicationOpen communication
Adult reactions to adolescent problemsAdult reactions to adolescent problems
ConsistencyConsistency
To know where they standTo know where they stand
45. Guidelines for the ParentGuidelines for the Parent
BE SENSITIVEBE SENSITIVE
Stay available showing love, support,Stay available showing love, support,
commitment, and interest in yourcommitment, and interest in your
teenager.teenager.
Offer affection and protection withOffer affection and protection with
challenges acc to what they can handlechallenges acc to what they can handle
ListenListen
Search for and find opportunities toSearch for and find opportunities to
congratulate, and praisecongratulate, and praise
Avoid labeling, judging, devaluingAvoid labeling, judging, devaluing
Support emerging mature, autonomousSupport emerging mature, autonomous
46. Guidelines for the ParentGuidelines for the Parent
BE INFORMEDBE INFORMED
Help them ask and explore importantHelp them ask and explore important
questionsquestions
Make it possible for them to call for helpMake it possible for them to call for help
verbally rather than by acting upverbally rather than by acting up
Permit conflict and guide discussionsPermit conflict and guide discussions
Value stimulating conversations withValue stimulating conversations with
different points of viewdifferent points of view
Encourage them to adopt a personal valueEncourage them to adopt a personal value
systemsystem
Help them learn from their mistakesHelp them learn from their mistakes
through self-reflection and discussionthrough self-reflection and discussion
Ask questionsAsk questions
47. Guidelines for the ParentGuidelines for the Parent
NORMALISENORMALISE
Remember and remind them thatRemember and remind them that
adolescence is a processadolescence is a process
Foster a sense of "comfortable"Foster a sense of "comfortable"
continuitycontinuity
Remind teenagers that they areRemind teenagers that they are
going to school, working, and lovinggoing to school, working, and loving
for themselves and not for youfor themselves and not for you
Give them some slack for moodiness,Give them some slack for moodiness,
distancingdistancing
Remember teenagers have a lot ofRemember teenagers have a lot of
inside work to do that does notinside work to do that does not
48. Guidelines for the ParentGuidelines for the Parent
BE PREPAREDBE PREPARED
Promote greater differentiation while notPromote greater differentiation while not
disrupting enduring family connectionsdisrupting enduring family connections
Help adolescents develop disciplinedHelp adolescents develop disciplined
conformity to society's necessary rulesconformity to society's necessary rules
and expectationsand expectations
Respect (you don't have to like) their peerRespect (you don't have to like) their peer
choiceschoices
Low-key, accepting, calm parents hearLow-key, accepting, calm parents hear
more. . . . Kids keep talking to themmore. . . . Kids keep talking to them
Validate and encourage child's ownValidate and encourage child's own
capacity to copecapacity to cope
49. Guidelines for the ParentGuidelines for the Parent
BE OPEN AND ACCEPTINGBE OPEN AND ACCEPTING
Be firm and flexible about guidelines,Be firm and flexible about guidelines,
allowing for increased negotiatingallowing for increased negotiating
powerspowers
Support their dreams, while helpingSupport their dreams, while helping
them to plan, organize, and followthem to plan, organize, and follow
activities to completionactivities to completion
Ask if something is wrong whenAsk if something is wrong when
behavior changesbehavior changes
Let them set the pace and timing ofLet them set the pace and timing of
close and distant interactionsclose and distant interactions
50. Let your child be the teenager heLet your child be the teenager he
wants to be, not the adolescentwants to be, not the adolescent
you were or wish you had beenyou were or wish you had been
Laurence SteinbergLaurence Steinberg
