Adolescent Maladaptive Behaviors

1. Adolescent Maladaptive Behaviors Madeline Gervase RN,MSN,CCRN,FNP Advanced Practice Nurse

2. Maladaptive Behavior • What is it? Behavior that is deviant, maladaptive and personally distressful. Results in: Discouraging well-being, growth and fulfillment. Presents itself by: Addiction to drugs, eating disorders, non-compliance, etc…

3. 1. Biological Factors 2. Psychological Factors 3. Sociocultural Factors 4. Biopsychological Factors (Interactionist approach) Causes of Abnormal Behavior

4. Biological Factors: • Malfunctioning of the person’s body, specifically brain processes and genetic factors

5. Psychological Factors • Distorted thoughts, emotional turmoil, inappropriate learning, and troubled relationships

6. Sociocultural Factors • Frequency and intensity varies from culture to culture, and is based on social, economic, technological and religious aspects

7. Biopsychosocial:The Interactionist Approach • Biological, psychological and sociocultural factors may interact

8. Characteristics of Adolescent Disorders • Vary in severity based on developmental level, sex, and socioecomomic status • Duration: short-term to long-term – which could be for many years • Younger adolescents: fighting, arguing and being loud • Older adolescents: depression, drug abuse and skipping school

9. Gender Comparison on Behavior • Boys: Under-controlled, externalized behaviors. - fighting, destroying property

10. Gender Comparison on Behavior • Girls: Over-controlled and internalized behavior • Anxiety • Depression

11. Abnormal Behavior Associated With: • Increase of problems with fewer related adults in home • Biological parents unmarried • Separated or divorced parents • Families that receive public assistance • Family members who receive mental health services

12. Drugs and Alcohol……. • Why? • Reduce tension & frustration • Relieve boredom, curiosity • Escape realities of the world • Social reasons: make you feel comfortable and relaxed • Drugs provide: relaxation, skewed perceptions and a “pleasurable high”

13. Definitions: • Tolerance: More of the drug is needed to produce the original effect • Physical Dependence: Physical need for a drug, symptoms of withdrawel when drug is stopped • Psychological Dependence: Strong craving to keep using the drug for emotional needs such as to reduce stress

14. Alcohol: • Most widely used drug by U.S. adolescents Effects: depressant, slows brain activity - reduces inhibition and impairs judgement - excess, can damage or kill biological tissues – like muscle and brain cells - extreme intoxication can result in coma

15. Alcohol Effects: • Vary according to weight, amount drunk, person’s alcohol tolerance • More males binge drink than females • Alcoholism is the 3rd leading killer in the U.S. • 13 million people are alcoholics

16. Statistics…….. • In 1999, more than 50% of HS seniors drank every month. • Marijuana ( Cannabis sativa) is the most common illicit drug used by children and adolescents in the US

17. Risk Factors… • Heredity: more evidence of alcoholism related to genetic factors with an influence on environmental • Family influences • Peer Relations • Personality Characteristics • A strong family support system reduces alcohol abuse in adolescents

18. Cloninger’s Personality Characteristics • Four inherited “temperments” - novelty seeking - ha avoidance - reward dependence - persistence • Three learned “characters” - self-directedness - cooperativeness - self-transcendence

19. DRUGS…….DRUGS…….DRUGS…… • Hallucinogens: • LSD and Marijuana -”mind altering” drugs that produce hallucinations. Increased use by adolescents Experimental and peer influence

20. LSD • Is powerful in low doses • Objects glow and change shape • Kaleidoscope images • Pleasant and frightening images • Dizziness, nausea, tremors • Rapid mood swings, impaired attention span and memory

21. Marijuana • More mild than LSD – active ingredient THC • Increases heart rate and blood pressure • Combined excitation, depression and hallucinatory characteristics • Distorted perceptions of time and place • Changes in verbal behavior • Can effect reproduction system and cause birth defects

22. STIMULANTS • Increase CNS activity • Caffeine, nicotine, amphetamines and cocaine • Increase heart rate, respirations and temperature • Increases energy, decrease fatigue • Lifts mood and self-confidence • After effects wear off, become tired, irritable, depressed • Can be physically and psychologically addictive

23. CIGARETTES • Onset: 7-9 grades • In 1999, nearly 20% of 8th graders had smoked • Male % = Female % • Smoking in adolescents causes permanent genetic changes in lungs • Increases risk of lung cancer.

24. Cocaine • Coca plant • Exhilerated feelings followed by depressive feelings and lethargy • Insomnia & irritability • Can result in : Heart attack, stroke and seizures • Crack Cocaine: Inexpensive, purified, smokable form .

25. Amphetamine • Widely prescribed stimulant – sometimes in the form of “diet pills” • OTC – over-the-counter – “stay awake” pills. Sharp increase in use • Overall, amphetamine use has decreased • OTC diet pills has decreased, however, fairly common among women

26. Depressants • Slow down central nervous system bodily functions and behavior • Medically: reduce anxiety, induce sleep • Most widely used: alcohol, barbituates and tranquilizers

27. Depressants Barbituates: Induce sleep, reduce anxiety Decreased use since 1975 Tranquilizers: Reduce anxiety and induce relaxation Opiates: Opium and its’ derivative Effects last for several hours- depress CNS activity Euphoria Pain relief, increased appetite for food & sex Physically addictive drug Heroin: Opiate Body craves Withdrawel is very painful physically & mentally Heroine rates low – but, recent use increased

28. Female Changes: Acne Weaening tendons Decrease HDL ( The “good” cholesterol High blood pressure Male changes Shrinking testicles Reduced sperm count Impotence Premature baldness Enlarged prostate Breast enlargement Anabolic Steroids

29. Psychological Effects of Anabolic Steroids • Irritability and uncontrollable bursts of anger • Severe mood swings • May result in depression during withdrawel and when stopped • Impaired judgement • Feelings of invincibility • Paranoid jealousy • Increase use: 1999, 1.7% of 8th & 9th graders used steroids

30. Roles of Development:Parents, Peers & Schools in Adolescent Drug Abuse • Most adolescents use drugs at some point in their development • When using drugs to cope with stress, it can interfere with competent coping skills and responsible decision making • Parents, peers & social support play important roles in preventing drug abuse

31. Steps to Reduce Drug Use: • Early intervention • Peer led programs • Community-wide prevention efforts • Teacher support and training • Alternative physical activities to keep the body as well as mind occupied and challenged

32. Major Adolescent Problems • Depression • Suicide • Eating Disorders • Juvenile Delinquency • Substance Abuse • Adolescents are at most risk to have more than one problem. • Problem behaviors in adolescents are interrelated.

33. Depression Signs & Symptoms • Depressed mood most of the day. • Reduced interest or pleasure in all/most activities. • Significant weight loss or weight gain , significant increase or decrease in appetite. • Trouble sleeping or sleeping too much. • Psychomotor agitation or retardation.

34. Depression Signs & Symptoms • Persistent sad or irritable mood. • Fatigue or loss of energy. • Feeling worthless or guilty in an excessive or inappropriate manner. • Problems n thinking, concentration, or making decisions. • Recurrent thoughts of death or suicide.

35. Depression • 5 or more of these symptoms must be persist for 2 or more weeks before the diagnosis is made. • The way symptoms are expressed varies with the developmental stage of the child. • Children have difficulty in identifying & describing their internal emotional or mood states.

36. Associated Signs & Symptoms ofDepression • Frequent vague, non-specific physical complaints such as headache, muscle aches, stomach aches or tiredness. • Frequent absences form school or poor performance. • Talk of efforts to run away from home • Outburst of shouting, complaining, unexplained irritability, or crying. • Being bored. • Lack of interest in playing with friends.

37. Associated Signs & Symptoms of Depression • Social isolation, poor communication. • Alcohol or substance abuse. • Fear of death. • Extreme sensitivity to rejection of failure. • Increased irritability, anger or hostility. • Reckless behavior. • Difficulty with relationships.

38. Risk Factors for Depression • Family history of the disorder. • Stress • Cigarette smoking. • A loss of a parent or loved one. • Break-up of a romantic relationship. • Attentional, conduct or learning disorders. • Chronic illness, such as diabetes. • Abuse or neglect.

39. Risk Factors for Depression • Previous depressive episode • Family conflict. • Parents who are emotionally unavailable. Immersed in marital conflict, and economic problems. • Parental divorce. • Period of puberty. • Uncertainty regarding sexual orientation. • Poor peer relationships (friends).

40. Is Depression a serious problem? • 1/3 of adolescents who for to a mental health clinic suffer from depression. • Depression increases in the adolescent years, and being twice as common as in the elementary years. • In childhood, boys & girls appear ot be at equal risk for depressive disorders. • Adolescent girls are twice as boys . likely to develop depression

41. Suicide • Rate has tripled in the past 30 years in the US. 11.3 per 100,000 or 30,575 Americans completed suicide in 1998. • The third leading cause of death in 10-24 year olds. • Males are 5x as likely to commit suicide as females are.

42. Commit suicide more frequently Active methods for attempting suicide Shooting Attempt suicide more frequently Passive methods Sleeping pills Males vs.Females

43. Why Suicide? • Loss of boyfriend/girlfriend. • Poor grades at school. • Unmated pregnancy. • Drugs. • Family history of instability/unhappiness. • Lack of affection, emotional support, friendship. • Pressure for achievement by parents.

44. Why Suicide? • Mental illness. • Family discord. • Absence of biological parents. • Physical abuse. • Unemployment. • Interpersonal Stress. • Residential transience. • Chronic behavioral problems.

45. Eating Disorders • Increasing problem in adolescent girls who feel negative about their bodies I early adolescence were more likely to develop eating disorders later in adolescent. • Adolescent girls with a positive relationship with their parents tended to have healthier eating habits. • Girls who are both sexually active and in pubertal transition are morel likely to be dieting or engaging in an eating disorder. • 5 million Americans are affectd by an eating disorder each year.

46. Three most commonEating Disorders • Obesity • Anorexia Nervosa • Bulimia

47. Obesity • Children born in the USA today have a 50% chance of becoming overweight at some point in their lifetime. • 25% of today's adolescent are obese. • 80% of obese adolescents become obese adults. • 10% of children who DO NOT have obese parents become obese themselves. • 40% of children who become obese have 1 obese parent. • 70% of children who become obese have 2 obese parents.

48. Obesity • Identical twins have similar weights even when reared apart. • The dramatic increase in obesity is likely due to greater availability of food, energy saving devices, and declining physical activity, • American adolescents are more obese than European adolescents from other parts of the world.

49. Anorexia Nervosa • An eating disorder that involves the relentless pursuit of thinness through starvation. Self is viewed as “Fat”. Intense fear of gaining weight • Primarily affects females during adolescence and early adulthood. • 5% anorexics are male. • Most adolescents with this disorder are white & from well educated middle & upper class homes.

50. Anorexics • Avoid eating but have an intense interest in food. • Distorted body image perceiving they will only be attractive when they are skeletal appearance. • Repeatedly check body wieght. • As starvation continues the fat content of their bodies drops to a bare minimum; menstruation stops; behavior is hyperactive.