The document discusses the importance of understanding adolescent psychological development for clinicians, highlighting various developmental stages and changes in behavior, cognition, and identity during adolescence. It emphasizes the significance of recognizing normal developmental behaviors, the impact of hormonal and brain maturation, and the challenges faced by adolescents, including identity crises and peer influence. Additionally, it calls for clinicians to take a comprehensive view of the adolescent's life and to engage authentically with them while considering the psychosocial aspects of their health.

1. Adolescent
Psychological
Development
Turki Homod ALBatti, MD.
Clinical Associate Professor
Child Psychiatry

2. Why is it important for a adolescent
health clinicians to know the basics
about adolescent development?
• They are frequently asked the question by
parents, “Is this normal or a sign of pathology?”
(e.g. moodiness, withdrawal, rebelliousness,
defiance, irrationality, argumentativeness)
• They can be faced with teen emotions while
interviewing adolescent patients that impede
diagnosis and treatment.

3. Why is it important for a clinicians to
know the basics about adolescent
development?
They may experience personal reactions that hinder effective
medical transactions if they don’t understand the dynamics of
adolescent development.

4. “My 15 year old son…
“ My 15 year old son, Randy, is rude, won’t talk at dinner, wants to just
hang out in his room, won’t share any information with us, cares more
about his electronics than anything, becomes irrational when we
confront him, hogs the bathroom, is highly emotionally reactive, and
has lied, snuck out and drank alcohol at a party and violated our
internet rules.”
“A website on drug abuse cited these warning signs:
• withdrawal
• moodiness
• increased family conflict
• argumentativeness
• over-reactivity to criticism
• sloppiness in appearance
• spending time isolating in room
• poor attitude
• disrespect
• loss of interest in family activities.”
“Does my son have a drug abuse problem?”

5. definition of puberty
• Pubertas – Latin word for “adult”
• Narrow definition: The process by
which an individual becomes capable
of reproduction.
– The activation of the HPG/HPA axis
• Broad definition: The physical,
psychological, and cultural changes
that occur as the growing child
transitions into adulthood.

6. time periods of adolescent
• Adolescence is a unique developmental period
– it keeps changing!
• Early adolescence – 11 to 13 years old
– Continues to be pushed earlier (9-10…)
• Middle adolescence – 14 to 17 years old
• Late adolescence (early adulthood) – 18 to 20
years old
– Continues to be pushed later (21-24…)

7. Adolescent Psychological
Development
• Physical development
• Cognitive development
• Social development
• Identity development
• Moral development

8. The hormonal changes brought on by puberty can
affect the adolescent’s behavior in at least three ways.

9. 9
Adolescence can be divided into 3
sections
A.) Early – ages 11-14
B.) Mid – ages 14-16
C.) Late – ages 17-19
Many aspects of adolescence persist into
20’s

10. impacts of puberty
• Sleep patterns
– Delayed phase preference
– 9 hours: 1 am to 10 am
• Family relations
– Transformation of parent-child bond
• Peer relations
– Transformation of friendships, romantic
relationships

11. identity development
• Adolescence  Erickson stage of identity
crisis
• Identity
– Sense of individual self
– Selection of commitments, beliefs, values
• Interpersonal process
– Taking their place in the adult community

12. cognitive changes
• Importance of conceptual structure of thinking
 Propositional logic: thinking constrained by logical relations
– Emphasis on rationality and scientific methodology
• Importance of conceptual resources employed
in thinking
 Five process: Attention, working memory, processing speed,
organization, meta-cognition

13. cognitive changes
• Piaget’s – Formal Operational Thought
– Logical, abstract thinking
• Thinking about possibilities
– “If-then” thinking
– Connection between how things are and how they
might have been or could be.
• Thinking about thinking
– Understanding knowledge (how/when gained)
– Monitoring one’s own mental states

14. relativism
• Not everything is “black and white”
– Recognition of importance of perspective
– Death of childish “realism/absolutism”
Can result in extreme skepticism
• Rejection of authority
• Rejection of cultural/social norms
• Everything is “ok” – no right/wrong
Tolerance for different beliefs
• Though less tolerance for actual interaction/helping

15. impacts of puberty
• Self-esteem
– Changing body image
– Changing sense of self
• Moods
– Increased stress + Increased sensitivity
• Fluctuation of moods
– Due to hormones or environment?
– “Storm and stress”: myth or fact?

16. adolescent egocentrism
• Increased introspection, self-consciousness,
rationalization
• Responsible for adolescent version of
egocentrism.
– Imaginary audience
– Personal fable
– Importance of personal individuality

17. • Crisis never begins: diffusion
• Crisis begins –> ends with foreclosure
• Crisis begins –> ends with achievement
• Psychosocial moratorium
– Period of exploration
• Importance in contemporary society?

18. 18
Early Adolescence
A.) Focus upon physical changes
B.) Developing interests which may change
rapidly
C.) Need adult supervision
D.) Need structure and monitored
expectations

19. 19
Early Adolescence, cont.
E.) Want greater privacy
F.) More aware of emotional experience
G.) Beginning to reflect on self and
experience
H.) Impulse control can be a challenge

20. 20
Mid Adolescence
A.) More time with peers
B.) Strong desire to belong, activities based
on belonging
C.) Beginning partnering

21. 21
Mid Adolescence, cont.
D.) Abstract reasoning, problem solving
used more frequently
E.) Wants and utilizes more independence
in decision making
F.) Expects competence and expects to
make contributions to social groups

22. 22
Late Adolescence
A.) Greater self-direction, self-monitoring
B.) Greater capacity for judgment and
impulse control

23. 23
Late Adolescence, cont.
C.) More independent decision making
D.) More involvement in longer term
relationships
E.) Parents/adults more in the role of
advisor/ mentor
F.) More consistent values and beliefs

24. 24
Characteristics of Positive Youth
Development:
Confidence
Competence
Caring
Connection
Character

25. 25
Youth who do well:
A.) Have a positive connection with their
school
B.) Have positive relationships with youth
who have a positive relationship with
school
C.) Are engaged positively with adults who
care about them

26. Physical development
• Pubertal development
• Bodily changes resulting in increased self-
consciousness, preoccupation and questions
of “Am I normal?’
• Alterations in sleep (and less!)
• Sexual interests and changes in social
responses
• Sexual identity development

27. Cognitive Development
(historical review)
• Shift from concrete to formal operations, allowing
for greater abstract thinking skills, symbolic
reasoning and hypothetical analysis (Jean Piaget)
• Cognitive style is characterized by egocentricism
• “magical thinking”; imaginary audience”; “myth
of immunity”; and “personal fable” (Elkind)
• And then the game-changer~ Brain imaging
research…

28. Emotion Brain-(limbic system)
• Amygdala-fear and anxiety center (fight,
flight, flood)
(this is an “amygdala
hijack” in action)
• Also hypocampus, ventral striatum,
hypothalamus, nucleus accumbens

30. Brain Maturation
• Recent research shows that much of which has
been attributed to hormones is probably related
also to changes in brain structure (Giedd, 1999).
• The prefrontal cortex (“CEO”) of the adolescent
(~13yo) becomes pruned, sloughing off up to 40%
of its neural branches, as it grows new
neural connections for more
sophisticated functioning.
• Greater refinements in neural connectivity and
extensive myelination continue through
adolescence; the brain does not fully mature until
the early 20’s.

31. Teen Brain
NASCAR
Metaphor
• Big engine—maturing bodies,
independence-striving
• Poor Driver—immature PFC and judgment
• Faulty Brake system—immature inhibitory
mechanisms in PFC
• High octane fuel—hormones

32. Put
simply…
…
• During adolescence, behavior is often
more governed by the emotional centers
than the thinking centers of the brain,
especially during high arousal situations
and in peer presence.

33. Adolescence:
“Storm and stress” theory
• Adolescent difficulties are neither inevitable or
universal
• Research on large populations of adolescents
indicates that teens experience more rapid mood
changes but no more depression/anxiety/pathology
than adult samples (Csikszentmihalyi & Larson)
• Surveys reveal that most adolescents describe
themselves as “mostly happy” and are adequately
adjusted (Offer)

35. Developmental research qualifiers:
• Marked changes in moodiness, emotional reactivity and
risk-taking among adolescents are neither universal or
inevitable (cultural and class differences exist)
• Although gender, culture and age differences among
adolescents can be important, temperament is a powerful
predictor of behavior
• Discussions with parents about their interpretations
regarding their teen’s behavior is tricky terrain
• What is interpreted as “normal” depends on the clinician’s
psychosocial assessment, sophistication of knowledge
about adolescence and personal “filters.”

36. Neuroendocrine system changes
• Testosterone in boys can increase by 100% by the
end of puberty, and 20 X more than girls of same
age.
• Amygdala has receptors for testosterone, which
probably contributes to increased novelty seeking,
territoriality and exploration for stimulation.
• Hormones have impact on neurotransmitters,
moods and symptoms: norepinephrine
(energizer); dopamine (pleasure); and serotonin
(mood stabilization, relaxation, confidence)

37. Sensitivity of the teen brain to
substances
• Alcohol stimulates the release of dopamine during the
“sensitive period” of adolescence, decreasing the natural
production.
• Heavy alcohol use interferes with memory and glutamate
functioning.
• Nicotine stimulates dopamine supply and affects other
neurotransmitters, allowing rapid addiction.
• Dopamine “squirts” result from computer games,
stimulating media, gambling and other high arousal
pursuits.
• Changes in circadian rhythms alter alert-fatigue signals,
affecting memory and biorhythms

38. In sum, the impact of brain changes on
adolescent reasoning, behavior and mood:
• Decision-making models don’t apply in high
arousal situations ( “cold” logic, as compared to
“hot” arousal situations)
• Impulse control reduction
• Poor risk assessment
• Executive functioning impairment
• Desire to escape boredom and negative affect by
“revving” up and seeking stimulation
• Parental disciplinary efforts at times of high
arousal can result in explosive conflict

39. Social Development
• Desire for increased independence
• Preference for spending time with peers, orienting
increasingly to peers for social influence and
values clarification
• Most teens are more “attached” to their parents,
but they prefer the company of their friends
• Individuation from the family
• Cultural context plays a large role in determining
diverse paths within these developmental and
universal trajectories.

40. Ethnic Diversity
• Developing a strong ethnic identity contributes to
high self-esteem among ethnic minority
adolescents (Carlson et al, 2000).
• Parents and role models are key for establishing
pride in shared values, traditions and practices of a
cultural group.
• Adolescence may be the first time they reflect on
the implications of their group identification.

41. Identity development
• Erik Erikson’s major task of adolescence was
constructed as “identity v. role confusion” (Who
am I uniquely?)
• Researchers have documented how teens explore
beliefs with various levels of “crisis and
commitment” (e.g. religion, politics, sexuality,
educational and vocational choices).
• By their twenties, they will have an integrated set
of values reflecting their experiences and parental,
generational and cultural influences.

42. Moral development theories focus on moral
reasoning (highly dependent on environment and
cognitive maturity)
• Lawrence Kohlberg’s theory demonstrates that
adolescents’ moral reasoning reflects a maturing
value on the rights of others, the importance of
law and justice and universal principles.
• Carol Gilligan pioneered the special value that
females place on responsibility and the caring of
others for moral reasoning.
• Jonathan Haidt and others emphasize that moral
reasoning doesn’t necessarily dictate moral action.

43. Kohlberg’s stages of moral
reasoning
Level 1
1. Obedience and punishment orientation (How do I avoid punishment?)
2. Self interest orientation (What’s in it for me?)
Level 2
3. Interpersonal conformity orientation (I’ll be good to you if you are good to
me)
4. Authority and social order orientation
(Law and order morality)
* *** Level 3
5. Social contract orientation
(What makes a society run smoothly; concepts of liberty,
justice, democratic principles)
6. Universal principles
(principled conscience, e.g. Golden Rule,
civil disobedience)

44. Adolescence as a period of
normal risk-taking and behavioral
experimentation
• Adaptive identity development for most, but can
carry high risks and long term harm for others
• Early adolescence as a time of particular
vulnerability (school failure, STD’s, substance
use)
• Family cohesiveness and authoritative parenting
are significant predictors for successful and safe
adolescent outcome (Baumrind; Shedler and
Block; Blum)

45. Parenting strengths that predict optimal
adjustment in late adolescence
• Close relationship to caring parent figure
• Authoritative parenting: warmth, effective
communication, monitoring and structure.
• Socioeconomic advantages
• Connections to extended supportive family networks
• Bonds to prosocial adults outside the family
• Connections to prosocial organizations
• Attending effective schools

46. “My 15 year old son…
Remember Randy’s “warning signs”:
• withdrawal
• moodiness
• increased family conflict
• argumentativeness
• over-reactivity to criticism
• sloppiness in appearance
• spending time isolating in room
• poor attitude
• disrespect
• loss of interest in family activities.”
In the context of positive reports about functioning in family, school,
extracurricular activities, emotional/social life, Randy is likely
experiencing normal adolescent development.

47. Take homes
• Remember your own teen vulnerabilities—it will enhance
your empathy
• Normal adolescent development is usually messy—so
you’ll hear about messy behaviors and see them too—even
when they are healthy!
• A comprehensive teen, parent, and social system review is
the only way to evaluate many of the problems you are
consulted about (e.g. drugs, depression, etc).
• Most morbidity and mortality among adolescents has
psychosocial/behavioral components, so focusing just on
“medical issues” is not an option.
• Because teens are vulnerable, fascinating and challenging,
they can be among your most rewarding patients when you
connect with them in a genuine way!

48. A clinician’s crash course in
adolescent development.
In summary,
• Assess the “big picture” of a teen’s life
• Appreciate that diversity includes many
domains
• Find something in the teen to appreciate
• Be curious
• Remember your own vulnerable teen
moments
• Be authentic, humble and sincere