Adolescence

1. Adolescence

2. Puberty (pubescence) • Puberty is probably initiated by the increased release of the Gonadotrophic Releasing Factor (hypothalamus). • The GRF causes the increased secretion of Luteinizing Hormone which causes the testes to produce Testosterone and the ovaries to produce Oestradiol. • GRF also causes the secretion of the Follicle Stimulating Hormone (pituitary). This causes the development of the seminiferous tubules in the testes and the follicles in the ovaries.

3. Puberty - Females • Puberty in females occurs at the same time as it does in males, however, the changes are more obvious (especially as in females puberty is associated with the growth spurt). • The menarche in females, presents a clear change from childhood to adulthood.

4. Female changes • In females, breast and pubic hair development mark the beginning of the growth spurt. • The menarche (11-15 years) follows the peak of the growth spurt. There are irregular “periods” up to two years from the menarche (anovulatory menstruation) which often lead to anxiety. • Females are not usually fertile until two years after the menarche, ovarian follicles develop but ovulation does not take place. However, females are able to have sexual intercourse by this time.

5. Changes - Males • Puberty, indicated by the presence of pubic hair, starts at the same time as females ( c. 12 years) but the growth spurt occurs later. • Males are fertile from the time their testes begin to enlarge ( 12 years), although they are unable to have sexual intercourse at this time. • In males, there is no clear social change from childhood to adulthood. • Males are usually 15-16 years old before voice change and facial hair become obvious.

6. Sex • Legitimate sex is difficult or impossible, this leads to problems related to sexual promiscuity. • Consider the effects of teenage pregnancy on education, employment, financial stability etc. • Consider the problem of medical confidence in females under 16 years. • Consider the problems of children who mature early or late. • Claims of sexual experience are probably exaggerated.

7. Food and sleep • Food has psychological importance (for parents and child). Food may become the centre of conflict, as it was between the toddler and parents. • There is an increased need for food in adolescence because of the rapid growth. • Adolescents probably do not sleep more than adults, their sleep patterns are just more antisocial. There is an increase in physical energy.

8. The sociology of adolescence • There is emotional, physical and financial separation from the family. • The adolescent must accept that he has no right to be loved or receive affection and accept his own responsibility for the future. • The adolescent must develop appropriate sexuality and a moral code. • He or she must relate in an adult fashion to other adults and come to accept adults as peers, selecting some as friends. • There is a role change from being a child to being an adult. “There is also role conflict as the adolescent must perform the role of ‘son” and “boyfriend” for example.

9. Adolescence as societal In primitive societies adolescence and puberty occurred at the same time. Here: • The relatively late school leaving age (or unemployment) increasing physical and financial dependence. • Consider the pressure of study, work or unemployment. • Consider the conflict between needing affection and needing respect and independence. • Reproductive ability precedes ability to adapt to emotional consequences of relationships. • Parenting and coping with ignorance and emotions. • The dependent parent needing emotional or physical support from the adolescent. May result in loss of opportunity to experiment with life skills.

10. Psychology of adolescence • Brook (1985 p. 41) "Independence and dependence is the key to the psychology of adolescence".

11. Formal operations • The adolescent is in the Piagetian stage of “Formal Operations”. • Can make hypotheses about causation and make deduction from the hypothesis in order to solve a problem. • Experience of the problem is not required, the adolescent can look to the future to imagine the unexperienced. • Mental constructs can themselves be objects to be manipulated. For example, the adolescent would be able to tackle the question “if red and green make yellow, would a red cat and a green cat have yellow kittens?”, the younger child would disregard the question as foolish.

12. Not all formal • The younger child (concrete operations) would devise an hypothesis to explain a given situation but would find it difficult to give up this hypothesis even when it did not work in explaining the situation. • Piaget (1972) argued that not all adults ever achieve the stage of formal operations.

13. Perception of others Selman (1980) found that the child’s perspective of others developed as maturation took place.

14. Development of morality (Kohlberg 1969

15. Egocentricity • Elkind (1967) suggested that adolescents enter a new period of egocentricity • The adolescent’s new ability to consider others thoughts in relation to their own is said to cause confusion as to which thoughts belong to whom. • ‘I am necessarily right, therefore you are necessarily wrong’ – result of a weak ego, too frightened to accept fallibility. • For the adolescent there is only right and wrong, black and white (inability to see more than one perspective when second perspective challenges a valued personal construct). This is evidence of a weak ego undergoing change. • This second egocentric period makes the adolescent appear selfish and uncaring. However, this is probably not the case, adolescence has a heightened awareness of the needs of others.

16. Elkind – The ‘normal psychosis’ • “Imaginary audience”, an aspect of egocentrism where the adolescent considers that because he has a thought (I am ugly), everyone else necessarily believes it. • Conversely, Elkind also argued that adolescents exhibit the “personal fable”. Here, the adolescents thoughts and feelings are perceived as being unique or special. This is perhaps the origin of the “nobody understands me” so commonly expressed by adolescents. • Perhaps the personal fable is better illustrated by adolescent’s feelings of omnipotence and immortality (Elkind op.cit). This last often gets the adolescent into trouble. Adolescents fight wars and ride motorcycles in part because they believe they can never die. These ideas are irrational of course and have led the adolescent period to be call "The Normal Psychosis”.

17. Disengagement • Freud – new awareness of sex and love outside the family leads to a wish to disengage from the family • However, the ego is vulnerable and defence mechanisms are brought in to protect the self • Baittle and Offer (1971) argued that non conformity and rebellion is an aid to disengagement. If parents are considered stupid it is easier to give them up. • Adolescent’s ideas tend to be the negation of their parent’s ideas. At this stage adolescents are still not able to voice their own independent ideas. There is still a (negative) dependence on the parents. • Root (1957) argued that the loss of the parents in disengagement results in a grief like reaction. This is manifested in multiple, intense, short lived partnerships. This can be related to the reaction of the toddler in separation anxiety who will demand physical security from one person after another. Root (ob.dem) argued that the adolescent “gang” was needed as a replacement for the lost parents.

18. Individuation • Blos (1962) argued for the second individuation period (individuation .. becoming an individual) in adolescence (first seen in the pre-school child). • In both cases this is characterised by a move from dependence to independence, there is a process of psychological maturation with vulnerability of the ego, sometimes leading to psychological disturbance.

19. Regression • Blos (1967) claimed that adolescents exhibited regression. Regression demonstrated the need to come to terms with infancy, so that it could be seen as historical, as a memory. • Signs of regression include idolisation (of pop stars), replacing the preschool child’s idolisation of parents. Adolescents exhibit “merger” as they become submerged by or ‘at one with’ issues such as religion or nature conservation.

20. Ambivalence • Blos (1967) used the term “ambivalence” to mean the shifting of emotions, contradictions of thought and feeling, fluctuation of mood. • This “ambivalence” is characteristic of the pre-school child’s temperament. Mood swings may be more obvious because the adolescent is relatively uninhibited. They may not have learned the effect their behaviour has on others, or are cognitively unable to appreciate the effect on others (contrary to Piagetian theory).

21. Psychiatric conditions • High incidence of psychiatric disorders in adolescence, especially schizophrenia and neuroses. • Anorexia nervosa usually presents in adolescence. Results in altered body image, weight loss and amenorrhoea (poorly understood). Relationship with mother usually disturbed. • Neuroses, anxiety and obsessive disorders relatively common. Phobias and school refusal. • Homosexuality, sadism and masochism usually present in adolescence.

22. Adolescence and depression • Depression is relatively common. Signs include; sleep disturbance, eating disorders, lack of drive, lack of affect, social isolation, feeling of worthlessness and academic failure. • Thoughts or actions related to suicide are common. However, these are probably related to the irrational belief in immortality (“I will not die”), so that feelings on suicide are often in the form of “that will show them”. “The adolescent sees himself at his funeral. He does not see himself disappearing from the scene.

23. It don’t have to be all bad Ironically, adolescence is a time when the child really becomes part of their family. This is only achieved when the child becomes ‘equal’, and ‘independent’. Only then can the young person give as well as receive. The move from childhood to adulthood is necessarily explosive in character but it is a necessary and important part of growing up. Respect is the key to working with adolescents – treat the adolescent as an adult, expect child-like behaviour in return and respect both the process and the child whose metamorphosis is a huge endeavour and a worthwhile achievement.

24. NAWCH (1990) Standards Adolescents .... • are going through a time of major physical, psychological and social change when their needs are quite different from those of children and adults. • should be together in a separate unit which is furnished to meet their needs and is linked to the paediatric department. • should be cared for by appropriately qualified staff who understand their physical and emotional needs and who respect their increasing need for independence. • need privacy and should be treated with sensitivity, honesty and tact at all times. • should have care which takes account of cultural and ethnic factors and the needs of those with a disability or chronic illness. • have the right to be informed about their condition and medical care and to participate in decisions about treatment. • should be able to discuss their physical and emotional problems in confidence. • should be able to have their parents visit at any time and stay overnight if they wish. • should have every opportunity to maintain contact with family and friends. • need space for recreational activities and a quiet area for study. • should be provided with a written philosophy of the unit and agreed house rules with which they should be expected to

25. NAWCH Guidelines for providers • Most adolescents should be treated in a separate adolescent unit. Some adolescents would be better treated in specialised (psychiatric) unit. • A consultant with special interest in adolescents should oversee the unit. Nurses should usually have a paediatric qualification. There should be links with the mental health team. Play specialists should be appointed. • Adolescents drug users will have less opportunity to influence others if nursed on an adult unit. • There should be 15 beds per 200,000 adolescent population. • 2-4 bedded units are most appropriate. There should be privacy. • There should be 24 hour access by parents and facilities that encourage and promote independence. Parental involvement in care should be encouraged. There should be links with community organisations for adolescents. Full information should be given to adolescents. There should be confidentiality. • There should be educational provision and a quiet area for study. There should be an area where noisy recreation and social interaction can take place. • Adolescents should be able to make their own drinks and snacks and have a choice of menu. • Sanitary facilities should be appropriate to adolescents needs (eg facilities for shaving). Adolescents should be able to wear and store their own clothes and have access to laundry facilities. • The facilities available should be appropriate for children with special needs.

26. Some Quotes

27. Socrates, 5th Century BC “Our Adolescents now seem to love luxury. They have bad manners and contempt for authority. They show disrespect for adults and spend their time hanging around places gossiping with one another. They are ready to contradict their parents, monopolise the conversation in company, eat gluttonously, and tyrannise their teachers.”

28. Sandstrom CI (1979) The psychology of childhood and adolescence Pelican pp 239 ‘Gudrun is growing very fast and is terrifically tall, and she is beginning to get a figure too, her hips are getting rounder and so are her breasts. Two days after her eleventh birthday she had her first menstruation. I thought she was far too young but the doctor says that girls mature earlier these days. She takes the same size in shoes as I. When she is away from home they say she is kind, well brought up and helpful. But when she is at home she is rude, sour, impudent and quarrelsome. When I ask her to tidy up, she just opens the door of the clothes closet and throws everything in. Shoes and exercise books are thrown in a drawer together with stockings and handkerchiefs. She often begins howling if she is not allowed to go to the pictures, even if she was there the night before. She is getting on well at school, but could do better if she would work harder. She has begun attending a dancing school and enjoys herself very much, but she says she doesn’t like it.`

29. Andrew Dunford (12) U.K. ‘Dictators would be tickled to death (because of an absence of weapons).’

30. Sense of humour in early adolescence I would get rid of bad people I would get rid of bad people and certainly get rid of bad people who write things twice. Christopher Marsh

31. LefkiSilvestrou (17) Cyprus We are young people. We come from countries all over the world. We believe in different gods but we can join our hands and rebuild a peaceful world.

32. Toni Taylor (12) If I ruled the world there’d by generosity and kindness. If anyone was unkind (e.g. murder) or cruel, the penalty would be death. Even if they were sorry they would still be put to death.

33. JosaphenePanayiota (17) Cyprus The world is like a crystal ball ready to smash into pieces at any moment. We, the younger generation, hold the ball in our hands. We mustn”t let it crash. We can bring love and peace. We can fight for this. Well let’s fight. We are holding the world in our hands. We can stop war and hate and bring back the missing love. Yes we can, because life and the world belong to us.

34. Paula Lagerstam (15) Poland • If your friend is hungry or thirsty - Give him your share. • If your friend is in want of love - Love him. • If your friend is in want of home and clothes - Give him a cottage and clothes. • If your friend is lonely - Keep him company. • If your friend is lying - Silence him. • If your friend calls to you - Listen to him. • If your friend is laughing - Laugh with him. • If your friend is crying - Cry with him. • If your friend is ill - Fetch help. • If your friend dies - Don”t forget him.

35. References • Baittle B, Offer D (1971). On the nature of adolescent rebelliun. In, FC Feinstein, P Giovacchini, A Miller (eds). Annals of Adolescent Psychiatry. New York. Basic Books. Blos P (1962). On adolescence. London. Collier-Macmillan. • Blos P (1967). The second idividuation process of adolescence. Psychoanalytic study of the child. 22:162-86 Brook CGD (1985). All about adolescence. New York. Wiley. • Elkind D (1967). Egocentrism in adolescence. Child Development. 38:1025-34 • Kohlberg L (1969). Stages in the development of moral thought and action. New York. Holt, Rinehart and Winston. • Piaget J (1932). The moral judgement of the child. London. Routledge and Keegan Paul. • Piaget J (1972). Intellectual evolution from adolescence to adulthood. Human Development. 15:1-12 Selman RL (1980). The growth of interpersonal understanding: developmental and clinical analyses. New York.