Adolescent Mental Health

1. Adolescent Mental Health Oliver O’Connell Psychiatrist

2. Adolescent Mental Health • Definition of Adolescence • Biopsychosocial development during adolescence • Biopsychosocial tasks of adolescence • Normal vs. abnormal adolescent behaviour • Resolution of Adolescence • Mental Illnesses arising in adolescence

3. Adolescent Mental Health • Definition: • Adolescence is the developmental phase that spans the transition period from the ending of the relatively complete childhood reliance on parents to the relatively complete reliance on oneself to manage one's own life. Thus the beginning and end dates vary greatly.

4. Adolescent Mental Health • Definition: • “adolescence begins in biology and ends in culture” longstanding definition of the onset of adolescence links it to puberty, when hormone activity produces the development of secondary sex characteristics (pubic hair and voice change in males; breast development and menarche in females). However, while these biological changes are evidence of the transition from childhood to adolescence, the transition out of adolescence is less well defined.

5. Adolescent Mental Health • Definition: • A hundred years ago, notions of adolescence were scarcely understood, since teens did not attend high school and most assumed adult roles of providing for their family and getting married at average ages of 14 and 15. • the time period of adolescence has been extended to include the ages of 10 through the mid twenties, with most researchers dividing the age span into early (10–13), middle (14–17) and late (18–mid twenties) adolescent

6. Adolescent Mental Health • Biopyschosocial tasks of adolescence: • (Physical, psychological and social development ). The problem is that these three domains may not keep up with each other. In the last 100 years the average age of puberty occurs 2 years earlier but there is no evidence that psychosocial developmental has kept pace.

7. Adolescent Mental Health • Physical development • A growth spurt precedes puberty by 1 year with girl's commencing about two years before boys and finishing at an earlier age. Emotional adjustment may be a problem for those whose pubertal level is out of synchrony with their peers. It is noted to be a problem for very early developing girls and late developing boys.

8. Adolescent Mental Health • Physical Development • Growth and maturation of the brain This leads to new behaviours that irritate and frustrate parents including changes in attention motivation…………need reward risk taking behaviour

9. Adolescent Mental Health • Psychosocial Development through adolescence. • Early adolescence: • Growth spurt • Puberty commences • Social move away from family towards peers (peer group becomes an alternative for life advice) • Thinking is concrete

10. Adolescent Mental Health • Mid Adolescence: 14-17years • Ability to think abstractly • Metacognition • Beginning of consolidation of the sense of self • Scant empathy and lack of tolerance for views of others

11. Adolescent Mental Health • Late Adolescence: 18 to mid twenties • Abstract thinking and ability to consider the future, deductive reasoning • Idealism becomes more practical and less doctrinaire • Parental values less likely to be challenged automatically

12. Adolescent Mental Health • Biopyschosocial tasks of adolescence: • To come to terms with body/brain changes • To cope with sexual development and psychosexual drives • To establish and confirm sense of identity • To learn more about sex roles • To synthesize personality • To struggle for independence and emancipation from family

13. Adolescent Mental Health • Normal adolescent behaviour: • is it normal to be abnormal in adolescence? • What Is Normal? • Become Aware of the Attitudes and Behaviours of Adolescents Your Child's Age • How Often Does the Behaviour Occur? • Does the Behaviour Interfere with the Teenager's Ability to Function in the Environment? • Does the Behaviour Interfere with Others? • Consider Individual Differences • Use your intuition

14. Adolescent Mental Health • Normal Adolescent Behaviour • Risk taking • Impulsivity • Novelty seeking • Reckless behaviour • Disobedience

15. Adolescent Mental Health • Normal Adolescent Behaviour: • Inconsistent, unpredictable, and paradoxical behaviour • Exploration and experimentation with self and world • Eagerness for peer approval and relationships • Strong moral and ethical perceptions • Competitive in play; erratic work play patterns • Better use of language and other symbolic material • Critical of self and others • Alternates between anxiety over loss of parent nurturing and hostility to parents

16. Adolescent Mental Health • Abnormal Adolescent Behaviour: • Apprehensions, fears, guilt and anxiety about sex, health, education • Defiant, negative, impulsive or depressed behaviour • Frequent somatic or hypochondriacal complaints • Illness denying behaviour • Learning erratic or deficient • Sexual preoccupation • Poor or absent personal relationships with adults or peers • Immature or precocious behaviour • Unwillingness to assume greater autonomy • Complete inability to substitute or postpone gratifications

17. Adolescent Mental Health • Severely abnormal Adolescent Behaviour: • Complete withdrawal into self, extreme depression • Acts of delinquency, asceticism, ritualism, obsessions • Neuroses, especially phobias; persistent anxiety, compulsions, inhibitions, • Persistent hypochondriasis • Sexual deviance • Complete inability to socialize or study • Anorexia, Bulimia, • Psychoses:

18. Adolescent Mental Health • Resolution of Adolescence: • Separation from parents commensurate with being able to decide the course of one's own life • Attainment of a stable sexual identity • Ability to form a long-term sexual relationship • Attainment of a steady job or the preparation for a career • Attainment of a personal value system that respects both the needs of the self and the needs of others

19. Adolescent Mental Health • Mental Illnesses arising in adolescence • Epidemiology 1 in 4 have a mental disorder 9% are highly distressed 18-24year olds have the highest prevalence Youth suicide is the leading cause of death in 15-20 year olds

20. Adolescent Mental Health • Mental Illnesses arising in adolescence • Biology/Genetics • Risk factors: • Family history • Protectivefactors: • High Intelligence

21. Adolescent Mental Health • Mental Illnesses arising in adolescence • Social Environment • Risk Factors • Poverty • Discrimination based on race, religion etc. • Bullying, trauma, sexual abuse • Criminal opportunities

22. Adolescent Mental Health • Mental Illnesses arising in adolescence • Social Environment • Protective factors • Quality Schools • Cohesive Family • Neighbourhood Resources • Interested Adults

23. Adolescent Mental Health • Mental Illnesses arising in adolescence • Perceived Environment • Risk Factors • Models for deviant behaviour • Parent-friends conflict the norm

24. Adolescent Mental Health • Mental Illnesses arising in adolescence • Perceived Environment • Protective Factors • Models for conventional behaviour • High control against deviant behaviour

25. Adolescent Mental Health • Mental Illnesses arising in adolescence • Personality • Risk Factors • Low perceived life chances • Low Self-Esteem • Risk-Taking Propensity

26. Adolescent Mental Health • Mental Illnesses arising in adolescence • Personality • Protective Factors • Value on achievement • Value on health • Intolerance of deviance

27. Adolescent Mental Health • Mental Illnesses arising in adolescence • Alcohol and drug abuse • Anorexia, bulimia and other eating disorders • Anxiety disorders, OCD, Phobias, PTSD, PD • Attention Deficit Hyperactivity Disorder • Conduct Disorder • Bipolar Disorder/Depression

28. Adolescent Mental Health • Mental Illnesses arising in adolescence • Learning Disorders • Psychosis • Schizophrenia • Tourette’s

29. Adolescent Mental Health • Alcohol and drug abuse Warning Signs A drop in school performance A change in group of friends Delinquent behaviour Deterioration in family relationships

30. Adolescent Mental Health • Alcohol and drug abuse Warning Signs Red eyes Persistent cough Changes in eating and sleeping patterns Anxiety and depression

31. Adolescent Mental Health • Anorexia and Bulimia Warning signs Preoccupation with body image or food Bingeing, restricting, dieting Rapid weight changes Social withdrawal Irritability Moodiness

32. Adolescent Mental Health • Anxiety Disorders • Obsessive Compulsive Disorder • Phobias • Post Traumatic Stress Disorder • Panic Attacks and Panic Disorder

33. Adolescent Mental Health • Attention Deficit Hyperactivity Disorder • Normally begins in childood Inattention Daydreaming or hyperactive Forgetfulness Impulsivity Inability to complete tasks Interrupts others

34. Adolescent Mental Health • Conduct Disorder • Repetitive and persistent pattern of behaviour in which the basic human rights of others or major age-appropriate norms are violated

35. Adolescent Mental Health • Bipolar Disorder/Depression • Increased risk taking and recklessness • Impulsivity • Poor school performance • Low self-esteem • Insomnia or Hypersomnia • Changes in appetite or weight • Loss of emotional control

36. Adolescent Mental Health • Mental Illnesses arising in adolescence • Learning Disorders • Psychosis/Schizophrenia • Tourette’s

37. Adolescent Mental Health • Psychosis/Schizophrenia

38. Adolescent Mental Health • Tourettes • Co-occur with ADHD and OCD • Tic disorder