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Adolescent developmental trajectories

Adolescent developmental trajectories. Dr Julie Alderson Paediatric Clinical Psychologist BCH. Aims. Revision : what adolescent development is Recent advances : adolescent thinking Position : the adolescent “patient” within family and healthcare systems

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Adolescent developmental trajectories

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  1. Adolescent developmental trajectories Dr Julie Alderson Paediatric Clinical Psychologist BCH

  2. Aims Revision: what adolescent development is Recent advances: adolescent thinking Position: the adolescent “patient” within family and healthcare systems Prompt thinking: how cancer & treatment can impact on adolescent development

  3. Adolescent to adult

  4. Theorists Freud - psychosexual development, adolescence as a recapitulation of the development of sexualawareness in infancy. Piaget - cognitive development,seeing the development of abstract thinking abilities as makingpossible the transition to independent adult functioning. Erikson - developmentof personal identity

  5. Biopsychosocial Adolescence involves biological (puberty, sexual development & brain) , psychological and social changes.

  6. To Do • Challenge authority • Seek spiritual paths • Take risks • Experiment with drugs, alcohol and sex • Change educational environment • Challenge moral and social structure of society • Develop relationships • Demand rights • Understand sexuality • Renegotiate rules at home Take responsibility for self and others Get job

  7. Nutshell • Grow up • Find self • Get a sexuality that fits

  8. The problem/beauty of adolescence • the Piagetian concept of "formal operations" in thinking style not established. • egocentric and feel invulnerable to harm. • depend more on intuition than rational thinking.

  9. You said my risk of developing skin cancer is greater than other peoples’ Concrete: Well, I’ve had holidays in Spain for the 5 years before coming to this clinic and I’ve come to no harm. My skin copes well with sun. Abstract: I’ve seen no problems yet but I may have already done some damage and increased my risk further. I’d better be extra careful in future – just in case.

  10. Neurological development Adolescents are not adults. They are on their way to becoming adults.

  11. Early to mid 20’s The prefrontal cortex (PFC) is one of the last areas of the brain to mature Executive functions are not reliably in full effect • Make complex judgments • Weigh closely competing alternatives • Control impulses • Take the long view.

  12. Interpretation of body states (Baird & Bennett, 2006) • Visuospacial working memory (Kilgore et al, 2002) • Greater activation of PFC in adults than adolescents on stop task (Rubia et al, 2000) • Intention (Blakemore et al, 2007) • Interpretation of emotional stimuli (Baird et al,1999; Kilgore et al, 2007; Thomas et al, 2007)

  13. Interpretation of emotional stimuli

  14. Response to fear face Adults • correctly identified the expression as fear • relied on the frontal cortex, which governs reason and planning

  15. Response to fear face Adults Adolescents shocked, surprised, angry mostly used the amygdala, a region that guides "gut" reactions • correctly identified the expression as fear • relied on the frontal cortex, which governs reason and planning

  16. Implications of… • Interpretation of body states (Baird & Bennett, 2006) • Visuospacial working memory (Kilgore et al, 2002) • Greater activation of PFC in adults than adolescents on stop task (Rubia et al, 2000) • Intention (Blakemore et al, 2007) • Interpretation of emotional stimuli (Baird et al,1999; Kilgore et al, 2007; Thomas et al, 2007)

  17. Implications • PFC matures more slowly than other brain structures • Leads to impulsivity, gut reactions & risk-taking • Impacts on decision making & understanding others’ communication • Knock on effects on emotional expression

  18. Knock on effects on emotional expression Dad says • “It’s got so that I’m afraid to remind him to do his physio. Whenever I say to him it’s time to do it; he looks at me with sheer vitriol; like he could kill me!”

  19. Knock on effects on emotional expression Dad says Son says “He’s always wound-up and he takes it out on me. He’s always on at me about what I should do next. I just look at him and think: looser”. • “It’s got so that I’m afraid to remind him to do his physio. Whenever I say to him it’s time to do it; he looks at me with sheer vitriol; like he could kill me!”

  20. Add cancer • a ball in uniform circular motion subjected to a centrifugal force and accelerates away from the centre. • a ball in uniform circular motion held to its path by a string tied to a post stuck in the ground. the ball is subjected to a centripetal force by the string.

  21. Add cancer • a ball in uniform circular motion subjected to a centrifugal force and accelerates away from the centre. • a ball in uniform circular motion held to its path by a string tied to a post stuck in the ground. the ball is subjected to a centripetal force by the string.

  22. Not problem thinking Not deficient, but fully developed for adolescence: ie, to deal with the tremendous transitions that humans face at this stage of life. (National Institute of Health 2006)

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