This document provides information on physical and cognitive development during adolescence. It discusses the stages of puberty for both boys and girls, including physical and hormonal changes. It also covers some threats to adolescent well-being such as obesity, eating disorders, dropping out of school, drug and alcohol use, and sexually transmitted infections. The document describes factors that can contribute to the development of eating disorders in adolescents and the health consequences of anorexia, bulimia, drug dependence, and addiction.

1. Life Span DevelopmentSpring 2010PHYSICAL AND COGNITIVE DEVELOPMENT IN ADOLESCENCEChapter 11SOCIAL AND PERSONALITY DEVELOPMENT IN ADOLESCENCEChapter 12

2. AdolescenceAdolescence is the developmental stage between childhood and adulthoodInternationally, those who reach a certain age (often 18, though this varies) are legally regarded as adults and are held to be responsible for their actions. People below this age are considered minors. Adolescence is approximately between the ages 12 and 20 and encompasses both physiological and psychological changesAdolescence in Western societies tends to be a period of rebellion against adult authority figures, often parents or school officials, in the search for personal identity. Many psychologists regard adolescence as a byproduct of social pressures specific to given societies, not as a unique period of biological turmoil. The classification of a period of life as adolescence is a relatively recent development in many Western societies, one that is not recognized as a distinct phase of life in many other cultures.

3. Legal issues, rights and privilegesLegal responsibility for criminal action?India – 7Belgium – 18Legal working ageAge of consentVaries widely between jurisdictionsAge to voteJoin the military

4. Physical Changes During AdolescenceAdolescents develop physically at a rapid pace – dramatic changes in both height and weightPuberty (the period where sex organs mature) occurs during adolescencePuberty begins when the pituitary gland in the brain signals other glands in the children’s bodies to begin producing sex hormones at adult levelsPuberty begins earlier for girls – typically around age 11 or 12, compared to the average age of 13 or 14 for boysWide variations among individuals

5. Puberty in GirlsMenarche – the onset of menstruationThe most obvious signal of the onset of puberty for girlsEvidence has supported the fact that girls who are better nourished and healthier are more apt to start menstruation at an earlier age than those who are malnourished or suffer from chronic illness.The onset of puberty has gradually happened earlier and earlier over the past 100 years. End of 19th century – average age menstruation began = 14 or 15Today – average age = 11 or 12What are some factors that could have contributed to this pattern of change?

6. Puberty in Girls - continuedDevelopment of primary sex characteristicsDevelopment of the organs and structures directly related to reproductionEx: changes in the vagina or uterusDevelopment of secondary sex characteristicsVisible signs of sexual maturity that do not directly involve the sex organsEx: development of breasts and pubic hair

7. Puberty in BoysDevelopment of Primary sex characteristics – Age 12 (on average) – penis and scrotum begin to grow at an accelerated rate (they do not reach adult size until 3-4 years laterEnlargement of the prostate gland and seminal vesiclesSpermarche (1st ejaculation) usually around age 13Development of Secondary sex characteristics – Pubic hair, underarm hair, and facial hair begins to growVoices deepen as vocal cords become longer and larynx gets larger

8. Threats to Adolescents’ Well-BeingObesityAnorexia Nervosa and BulimiaDropping Out of SchoolIllegal DrugsAlcohol: Use and AbuseThe Dangers of Smoking CigarettesSexually Transmitted Infections

9. Obesity1 in 5 adolescents is overweight1 in 20 is classified as obese (body weight more than 20% above average)Reasons for obesity in adolescents the same as younger children, psychological consequences may be particularly severe during this phase of life when body image is of particular concernPotential health consequences are more problematic for obese adolescentsObesity strains the circulatory system, increasingly likelihood of high blood pressure and diabetesObese adolescents – 80% chance of becoming obese adultsLack of exercise is one of the main culprits, particularly for females

10. Eating DisordersEating disorders are complex conditions that arise from a variety of factors, including physical, psychological, interpersonal, and social issuesOnce started, however, they can create a self-perpetuating cycle of physical and emotional destruction.All eating disorders require professional help. People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem over-whelming. For some, dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, these behaviors will damage a person’s physical and emotional health, self-esteem, and sense of competence and control.

11. Anorexia NervosaAnorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. Anorexia Nervosa has four primary symptoms: Resistance to maintaining body weight at or above a minimally normal weight for age and height Intense fear of weight gain or being “fat” even though underweight. Denial of the seriousness of low body weight. Loss of menstrual periods in girls and women post-puberty. Health Consequences of Anorexia Nervosa:Abnormally slow heart rate and low blood pressureReduction of bone density (osteoporosis), which results in dry, brittle bones. Muscle loss and weakness. Severe dehydration, which can result in kidney failure. Fainting, fatigue, and overall weakness. Dry hair and skin, hair loss is common. Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

12. BulimiaBulimia is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. Three primary symptoms: Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior. Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise. Extreme concern with body weight and shape.Health Consequences of Bulimia:Electrolyte imbalances caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors. Inflammation and possible rupture of the esophagus from frequent vomiting. Tooth decay and staining from stomach acids released during vomiting. Chronic irregular bowel movements and constipation as a result of laxative abuse. Gastric rupture is an uncommon but possible side effect of binge eating.

13. Factors that can contribute to eating disorders:Psychological Factors:Low self-esteem Feelings of inadequacy or lack of control in life Depression, anxiety, anger, or lonelinessInterpersonal Factors:Troubled family and personal relationshipsDifficulty expressing emotions and feelingsHistory of being teased or ridiculed based on size or weight History of physical or sexual abuseSocial Factors:Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body" Narrow definitions of beauty that include only women and men of specific body weights and shapes Cultural norms that value people on the basis of physical appearance and not inner qualities and strengthsThe Media, Body Image, and Eating Disorders - Media images that help to create cultural definitions of beauty and attractiveness are often acknowledged as being among those factors contributing to the rise of eating disorders.

14. Dropping Out of SchoolHalf a million students drop out of school each year Consequences:High school dropouts earn 42% less than high school graduatesUnemployment rate for dropouts is 50%Why do adolescents leave school?PregnancyProblems with the English languageEconomic reasonsOthers?

15. Illegal DrugsRecent annual survey of nearly 50,000 U.S. students - indicated almost 50% of high school seniors and 20% of 8th graders reported having used marijuana within the past yearWhy do adolescents use drugs?Pleasant feeling (“high”)Escape pressures/ aversive feelingsThrill of doing something illegalPeer pressureDangers of illegal drug use:Addiction – many illegal drugs are addictive drugs – produce a biological or psychological dependence in users, leading to powerful cravingsAddiction causes physical changes to the nervous systemDependency – adolescents become dependent on drugs and need them to cope with the stresses of everyday lifeDrug use prevents them from confronting and resolving problems in their livesCasual users may turn to more dangerous forms of substance use

16. Dependence and AddictionPsychoactive drugs – chemicals that change perceptions and moods through their actions at the neural synapsesDifferent drugs have different effects. Ex: methamphetamine produces an intense “rush” and initial feelings of boundless energy. Ex: heroin, benzodiazepines may produce excessive feelings of relaxation and calm. What most drugs have in common, though, is overstimulation of the pleasure center of the brain, which leads to the compelling urge to useDrug addiction is compulsively using a substance, despite its negative and sometimes dangerous effects. Tolerance - continued use of psychoactive drugs produces tolerance The diminished effect with regular use of the same dose of a drugLeads to increased dosageEx: individuals with severe chronic pain taking opiate medications (like morphine) will need to continually increase the dose in order to maintain the drug's analgesic (pain-relieving) effectsDrug abuse is using a drug excessively, or for purposes for which it was not medically intended.

17. Dependence and AddictionA physical dependence on a substance (needing the drug to function) is not always part of the definition of addiction. Some drugs (for example, some blood pressure medications) don't cause addiction but do cause physical dependence. Other drugs cause addiction without physical dependence (cocaine withdrawal, for example, doesn't have symptoms like vomiting and chills; it mainly involves depression).Psychological dependence is the psychological need for a particular drug, such as for relief of negative emotionsUsers who stop taking psychoactive drugs may experience withdrawalThe discomfort and distress associated with discontinuing the use of an addictive drug

18. Psychoactive drugsThree major categories – depressants, stimulants, hallucinogensDepressants are drugs that inhibit the function of the central nervous system and are among the most widely used drugs in the world. These drugs operate by affecting neurons in the CNS, which leads to symptoms such as drowsiness, relaxation, decreased inhibition, anesthesia, sleep, coma and even death. All depressants also have the potential to be addictive.Drugs that are classed as depressants include alcohol, barbiturates and benzodiazepines.

19. Psychoactive drugsStimulants are a class of psychoactive drug that tend to increase activity in the brain. Stimulants are a class of psychoactive drug that increase activity in the brain. These drugs can temporarily elevate alertness, mood and awareness. While some stimulant drugs are legal and widely used, all can be addicting. While stimulants share many commonalities, each has unique properties and mechanisms of action. These drugs can temporarily elevate alertness, mood and awareness. While some stimulant drugs are legal and widely used, all can be addicting. Drugs that are classed as stimulants include caffeine, nicotine, cocaine, amphetamines and some prescription drugs. Psychedelic drugs, or hallucinogens, are psychoactive drugs that affect thinking, alter moods and distort perceptions. Hallucinogens are strong mood-changing drugs with unpredictable psychological effects. Persons using hallucinogenic drugs often report seeing images, hearing sounds, and feeling sensations that seem real, but do not exist.Drugs that are classed as psychedelics include marijuana, LSD, psilocybin (derived from a type of mushroom) and mescaline (found in the peyote cactus).

20. Alcohol: Use and AbuseBinge drinkingFor men – 5 or more drinks in one sittingFor women – 4 or more drinks in one sittingFacts about binge drinking:Frequent binge drinkers are eight times more likely than non-binge drinkers to miss a class, fall behind in schoolwork, get hurt or injured, and damage property.Nearly one out of every five teenagers (16 percent) has experienced “black out” spells where they could not remember what happened the previous evening because of heavy binge drinking.More than 60 % of college men and almost 50 % of college women who are frequent binge drinkers report that they drink and drive.Binge drinking during high school, especially among males, is strongly predictive of binge drinking in college.Binge drinking during college may be associated with mental health disorders such as compulsiveness, depression or anxiety, or early deviant behavior.In a national study, 91 percent of women and 78 percent of the men who were frequent binge drinkers considered themselves to be moderate or light drinkers.

21. Consequences of Binge DrinkingBrain EffectsSubtle changes in the brain may be difficult to detect but still have a significant impact on long-term thinking and memory skills. Research has shown that animals fed alcohol during this critical developmental stage continue to show long-lasting impairment from alcohol as they age It’s simply not known how alcohol will affect the long-term memory and learning skills of people who began drinking heavily as adolescents. Liver EffectsElevated liver enzymes, indicating some degree of liver damage, have been found in some adolescents who drink alcohol Young drinkers who are overweight or obese showed elevated liver enzymes even with only moderate levels of drinking Growth and Endocrine EffectsIn both males and females, puberty is a period associated with marked hormonal changes, including increases in the sex hormones, estrogen and testosterone. These hormones, in turn, increase production of other hormones and growth factors, which are vital for normal organ development. Drinking alcohol during this period of rapid growth and development (i.e., prior to or during puberty) may upset the critical hormonal balance necessary for normal development of organs, muscles, and bones.

22. The Dangers of Smoking CigarettesCigarette smoking among adolescents is one of the 10 Leading Health Indicators that reflect the major health concerns in the United States Cigarette smoking during childhood and adolescence produces significant health problems among young people, including: cough and phlegm productionan increase in the number and severity of respiratory illnessesdecreased physical fitnessan unfavorable lipid profilepotential retardation in the rate of lung growth and the level of maximum lung function. An estimated 440,000 Americans die each year from diseases caused by smoking.

23. Facts about adolescent smokingEach day, nearly 6,000 children under 18 years of age start smoking; of these, nearly 2,000 will become regular smokers. That is almost 800,000 annually. It is estimated that at least 4.5 million U.S. adolescents are cigarette smokers. Approximately 90 percent of smokers begin smoking before the age of 21. If current tobacco use patterns persist, an estimated 6.4 million children will die prematurely from a smoking-related disease. According to a 2001 national survey of high school students, the overall prevalence of current cigarette use was 28 percent. Of adolescents who have smoked at least 100 cigarettes in their lifetime, most of them report that they would like to quit, but are not able to do so. Cigarette advertisements tend to emphasize youthful vigor, sexual attraction and independence themes, which appeal to teenagers and young adults struggling with these issues. Tobacco use in adolescence is associated with a range of health-compromising behaviors, including being involved in fights, carrying weapons, engaging in high-risk sexual behavior and using alcohol and other drugs.

24. Sexually Transmitted InfectionsSexually Transmitted Infections (STIs) are infections that are spread through sexual contact.While adolescents represent approximately 25% of the sexually active population, they account for about one-half of all new sexually transmitted infections. Sexually active adolescents and young adults are more susceptible to STIs for biological, behavioral and cultural reasonsSTIs can affect future fertility and some can increase the chances of getting cancerAIDS is considered to be the deadliest of STIs, but there a number of other STIs that are far more common

25. HIV/ AIDSHuman immunodeficiency virus (HIV) breaks down the immune system — our body's protection against disease. HIV causes people to become sick with infections that normally wouldn't affect them.HIV is transmitted in blood, semen, vaginal fluids, and breast milk. The most common ways HIV is spread are by:having vaginal or anal intercourse without a condom with someone who has HIV/AIDS sharing needles or syringes with someone who has HIV/AIDS being deeply punctured with a needle or surgical instrument contaminated with HIV getting HIV-infected blood, semen, or vaginal secretions into open wounds or soresHIV causes AIDSAIDS is short for acquired immune deficiency syndrome. It is the most advanced stage of HIV disease

26. HPVGenital human papillomavirus (HPV) is the most common sexually transmitted infection (STI). The virus infects the skin and mucous membranes. There are more than 40 HPV types that can infect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), and anus, and the linings of the vagina, cervix, and rectum. You cannot see HPV. Most people who become infected with HPV do not even know they have it. Certain types of HPV can cause genital warts in men and women. Warts can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. Warts may appear within weeks or months after sexual contact with an infected person. Or, they may not appear at allOther HPV types can cause cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis. Cervical cancer does not have symptoms until it is quite advanced. For this reason, it is important for women to get screened regularly for cervical cancer.HPV is passed on through genital contact, most often during vaginal and anal sex. A person can have HPV even if years have passed since he or she had sex. Most infected persons do not realize they are infected or that they are passing the virus to a sex partner. Very rarely, a pregnant woman with genital HPV can pass HPV to her baby during vaginal delivery.

27. Genital HerpesGenital Herpes - Genital herpes is a common, highly infectious disease caused by a virus. It causes blisters or groups of small ulcers (open sores) on and around the genitals in both men and women. It cannot be cured, only controlled. Genital herpes is extremely widespread, largely because it is so contagious. Carriers can transmit the disease without having any symptoms themselves of active infection. There are two types: HSV-1 (herpes simplex virus) and HSV-2. Most genital herpes infections are caused by HSV-2. HSV-1 is the usual cause of what most people call "fever blisters" in and around the mouth and can be transmitted from person to person through kissing. Less often, HSV-1 can cause genital herpes infections through oral sexual contact. The genital sores caused by either virus look the same.

28. SyphilisSyphilis is a sexually transmitted infection caused by bacteria. Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex The highly infectious disease may also be passed, but much less often, through blood transfusions or from mother to fetus in the womb. Without treatment, syphilis can cause irreversible damage to the brain, nerves, and body tissues. Syphilis used to be deadly, but now can be treated effectively with antibiotics

29. Identity Formation during AdolescenceAccording to Erikson’s theory, adolescents strive to: discover what makes them unique and distinctiveidentify their strengths and weaknessesdetermine the roles they can best play in their futureIdentity vs. role confusion (identity confusion)Adolescents “try on” different rolesThey seek to make choices about their personal, occupational, sexual and political commitmentsPositive outcome:Awareness of self (unique qualities) Knowledge of rolesNegative outcome:Inability to identify appropriate roles in lifeThey may adopt socially unacceptable roles as an expression of who they do not want to be

30. James MarciaMarcia elaborated on Erikson’s proposal by suggesting this stage consists neither of identity resolution nor identity confusion as Erikson claimedHis theory states that there are two distinct parts that form adolescent identity: a crisis and a commitment. He defined a crisis as a time of upheaval where old values or choices are being reexamined. The outcome of a crisis leads to commitment to a certain value or role.Marcia proposed four stages of psychological identity development:Identity Diffusion – the status of individuals who have not yet experienced a crisis or made any commitments. They show little interest in such matters. Identity Foreclosure - the status of individuals who have made a commitment but not experienced a crisis. This occurs most often when parents hand down commitments to their adolescents, usually in an authoritarian way, before adolescents have had a chance to explore their own approaches. Identity Moratorium - the status of individuals who are in the midst of a crisis but whose commitments are either absent or only vaguely defined. Identity Achievement - the status of individuals who have undergone a crisis and made a commitment.

31. Psychological Difficulties During AdolescenceDepression in Adolescence:Everyone experiences bad moods and periods of sadnessMore than 25% of adolescents report feeling so sad or helpless for two or more weeks in a row that they stop doing normal activitiesTeenage depression isn’t just bad moods and occasional melancholy. Depression is a serious problem that impacts every aspect of a teen’s life. Left untreated, teen depression can lead to problems at home and school, drug abuse, self-loathing—even irreversible tragedy such as homicidal violence or suicide.

32. Signs and Symptoms of Depression in AdolescentsSadness or hopelessness Irritability, anger, or hostility Tearfulness or frequent crying Withdrawal from friends and family Loss of interest in activities Changes in eating and sleeping habits Restlessness and agitation Feelings of worthlessness and guilt Lack of enthusiasm and motivation Fatigue or lack of energy Difficulty concentrating Thoughts of death or suicide

33. Untreated Depression can lead to…Problems at school Depression can cause low energy and concentration difficulties. This may lead to poor attendance, poor grades, or frustration with schoolwork in a formerly good student.Running awayMany depressed teens run away from home or talk about running away. Such attempts are usually a cry for help. Substance abuseTeens may use alcohol or drugs in an attempt to “self-medicate” their depression. Eating disordersAnorexia, bulimia, binge eating, and yo-yo dieting are often signs of depression.Self-injuryCutting, burning, and other kinds of self-mutilation are almost always associated with depression. Reckless behaviorDepressed teens may engage in high-risk behaviors such as reckless driving, out-of-control drinking, and unsafe sex.ViolenceSome depressed teens become violent. Often violence occurs in victims of bullying. SuicideTeens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously.

34. Suicide warning signs in teenagersAn alarming and increasing number of teenagers attempt and succeed at suicide. According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for 15- to 24-year-olds. For the overwhelming majority of suicidal teens, depression or another psychological disorder plays a primary role. In depressed teens who also abuse alcohol or drugs, the risk of suicide is even greater.Teenagers who are depressed should be watched closely for any signs of suicidal thoughts or behavior. The warning signs include:Talking or joking about committing suicide. Saying things like, “I’d be better off dead,” “I wish I could disappear forever”Speaking positively about death or romanticizing dying (“If I died, people might love me more”). Writing stories and poems about death, dying, or suicide. Engaging in reckless behavior or having a lot of accidents resulting in injury. Giving away prized possessions. Saying goodbye to friends and family as if for good. Seeking out weapons, pills, or other ways to kill themselves.

35. Peer PressureDuring adolescence, peers play a large part in a young person's life and typically replace family as the center of a teen's social and leisure activities. Teenagers have various peer relationships, and they interact with many peer groups. Some kids give in to peer pressure because they want to be liked, to fit in, or because they worry that other kids may make fun of them if they don't go along with the group. Others may go along because they are curious to try something new that others are doing. The idea that "everyone's doing it" may influence some kids to leave their better judgment, or their common sense, behind.Two levels of Peer PressureThe first is the large group (ex: school, youth group, or sports team). This is the setting that gets the most attention. The large group exerts a general pressure on its members. It directs the trends in clothing, music, entertainment, and "political correctness". The second is in the close relationship with one or several best friends - This is the setting that is sometimes overlooked. The pressure which takes place among close friends is not so easy to escape. What your best friend approves of or disapproves of exerts great pressure on you. This pressure is personal and forceful.

36. Sexual OrientationOne important aspect of adolescence is forming one's sexual identity. All teens explore and experiment sexually as part of normal development. This sexual behavior may be with members of the same or opposite sex. For many adolescents, thinking about and/or experimenting with people of the same sex may cause concerns and anxiety regarding their sexual orientation. For others, even thoughts or fantasies may cause anxiety. These feelings and behavior do not necessarily mean an individual is homosexual or bisexual. Homosexuality is the persistent sexual and emotional attraction to someone of the same sex. It is part of the range of sexual expression. Many gay, lesbian and bisexual individuals first become aware of and experience their sexual thoughts and feelings during childhood and adolescence. Recent changes in society's attitude toward sexuality have helped gay, lesbian, and bisexual teens feel more comfortable with their sexual orientation.

37. Concerns about homosexual or bisexual feelingsDespite increased knowledge and information, gay, lesbian and bisexual teens still have many concerns. These include:feeling different from peers feeling guilty about their sexual orientation worrying about the response from their families and loved ones being teased and ridiculed by their peers worrying about AIDS, HIV infection, and other sexually transmitted diseases fearing discrimination when joining clubs, sports, seeking admission to college, and finding employment being rejected and harassed by others Gay, lesbian, and bixsexual teens can become socially isolated, withdraw from activities and friends, have trouble concentrating, and develop low self-esteem. Some may develop depression and think about suicide or attempt it.