Psychosocial Development and Social Context during Adolescence

1. Psychosocial Development and Social Context duringAdolescence Laura Kastner, Ph.D. Clinical Professor Psychiatry and Behavioral Sciences

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

3. Teens and their parents aren’t the only one with extreme emotions… Adolescent health practitioners benefit from self-awareness and understanding teens

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 consumed 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.” “Do you think my son might have a drug abuse problem?”

5. Psychosocial development during adolescence • Physical development • Cognitive development* • Social development* • Identity development*

6. Psychosocial implications of physical development Puberty Am I normal?

7. Communication Tip • Reassurance versus Validation (“listening”) “Don’t worry, you’ll go through puberty in a couple of years and catch up with a number of your peers by the end of high school” “For guys your age, being small for your age is painful. You are self-conscious about your body size relative to your peers all the time. It can be rough, especially when adults make light of it.”

8. Psychological context of sexuality Sexuality & extreme self-consciousness “I know I should be thinking about birth control but I don’t know where to start”

9. Communication Tip THE WEB! “Hey, it’s easier to go on the web. Here’s a cool website where you can see the pictures and investigate for yourself” The National Campaign To Prevent Teen Pregnancy.org Stay teen

10. LGBTQ youth • Could be the most all-defining aspect of their adolescent experience • Gay friendly = Encouragement to “come out”? • No No’s: “You’ll grow out of it”; “It’s a stage” • Never to early “to know” • Unconditional acceptance • Confidentiality emphasized • Safety first- depression/suicide/SA/Support

11. Cognitive Developmental Processes Shift from concrete to formal operations (Jean Piaget) abstract reasoning; hypothetical thinking; future time perspectives ; symbolic thought ( inconsistency of applying these abilities) Cognitive style is characterized by egocentricism “magical thinking” (implications for health education) And then the game-changer~ Brain imaging research…

13. Brain Maturation What are the implications of this delay in maturation for the PFC?

14. The dopamine pathway GO GET IT!

15. 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

16. 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 is compromised • 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

17. 32% Anxiety Depression Conduct Substance 60% 8% Archives Gen Psychiatry

18. Adolescent development qualifiers: • Teenage behavioral “manifestations” are neither universal or inevitable, they are more probable • Although gender, culture and age differences among adolescents can be important, temperament is also a powerful predictor of behavior • What is interpreted as “normal” depends on the clinician’s psychosocial assessment, sophistication of knowledge about adolescence and personal “filters.”

19. 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.

20. Social Context: Peers, “friends”, frenemies, and the digital social world Gender School context Race Income level Political background Religion Rural/urban Immigrant status

23. Identity development Progression associated with positive outcomes • 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.

24. 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.

25. t CULTURE s School

26. Culture mediates… everything? • Ethnic identity is influenced by parent messaging in minorities (Boyd-Franklin) • Values vary (respect for elders, religion sexuality, racism, individualism, self-expression and shame) • Clinical assumptions and alpha/beta errors (Sue) • Americanization in first generation immigrants • Implications for psychiatric dx and tx

27. Adolescence :a period of high risk and high opportunity • 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)

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

29. “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.

30. 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!

31. In summary, • Assess the “big picture” of a teen’s life • Appreciate that diversity includes many domains • Find something in the teen to enjoy • Be curious • Remember your own vulnerable teen moments • Be authentic, humble and sincere