Biopsychosocial Development during Adolescence

1. 1 Biopsychosocial Development duringAdolescence

2. 2 OBJECTIVES Review the evolution of the concept of adolescence, and explore existing definitions Identify the main biological events and timings of puberty and growth Identify the psychological and social events of adolescent development Manage the delivery of health care according to adolescent bio-psychosocial development

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4. 4 Review the evolution of the concept of adolescence, and explore existing definitions

5. 5 what does adolescence mean in your society ?what did it mean for you ?

6. 6 Il y a quelques temps, deux philosophes s'exprimaient � propos de la jeunesse dans les termes suivants je citeIl y a quelques temps, deux philosophes s'exprimaient � propos de la jeunesse dans les termes suivants je cite

7. 7 Adolescence �The media present adolescence as hell on earth, chock full of evil cliques, domineering parents and wrenching decisions that will determine the rest of your life. Nah. Adolescence is a time to sit back, make some friends and maybe discover what you are good at. Don�t believe the hype.� Advice to 13 year olds from a 17 year old NYT, 1998

8. 8 HISTORICAL PERSPECTIVE The situation among the Greeks and Romans The XIXth. century: emergence of the concept The beginning of the 20th century: adolescence as a crisis different theories (Freud, Erikson, Piaget, Goldberg) The present situation: adolescence as a problem (e.g. the media) adolescence as a mirror of the society problems

9. 9 Definition by age ?

10. 10 ADOLESCENCE IN A TRANSITIONAL SOCIETY  Comme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progressionComme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progression

11. 11 ADOLESCENCE IN A TRANSITIONAL SOCIETY  Comme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progressionComme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progression

12. 12 ADOLESCENCE IN A TRANSITIONAL SOCIETY  Comme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progressionComme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progression

13. 13 ADOLESCENCE IN A TRANSITIONAL SOCIETY  Comme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progressionComme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progression

14. 14 ADOLESCENCE IN A TRANSITIONAL SOCIETY  Comme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progressionComme vous le voyez, ces derniers 100 � 150 ans ont �t� marqu�s par deux ph�nom�nes importants: - d'une part, l'�ge d'apparition de la pubert� tend � diminuer alors m�me que l'�ge marquant la fin de la pubert�, soit celui auquel la majorit� des jeunes aqui�remt une ind�pendance �conomique, tend lui � augmenter singul. ce n'est pas la situation actuelle en terme d'emploi qui va ralentir cette progression

15. 15 CONSEQUENCES FOR THE HEALTH PROFESSIONNAL our adolescence is no longer a reference (and this applies to parents as well) impact of socio-economic and cross cultural factors on health role of the health professional regarding the vocational issues adolescent face

16. 16 Identify the main biological events and timings of puberty and growth

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19. 19 THE GROWTH SPURT

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23. 23 BMI AND ETHNICITY

24. 24 OVERWEIGHT & OBESITY

25. 25 On this slide you can see the % of body fat according to Tanner stages. Both females and males start puberty with a similar % of body fat, but while females increase that % as you can see, and go out from puberty with more body fat than what they had at Tanner stage 1, with males it�s the opposite: their body fat decreases.On this slide you can see the % of body fat according to Tanner stages. Both females and males start puberty with a similar % of body fat, but while females increase that % as you can see, and go out from puberty with more body fat than what they had at Tanner stage 1, with males it�s the opposite: their body fat decreases.

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28. 28 Tanner stages

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31. 31 Slide... Slide Let us start talking about height velocity. As you can see here girls start growing in avarage 2 years earlier than boys but at the end boys will be taller (more or less 13 cm taller than girls). I�m sure you have that experience, sometimes the adolescent boy comes to see us very concerned about wanting to date a girl of the same age but feeling that she doesn�t look at him because he stiill looks like a kid. And this is the usual pattern. Now imagine what should be the feelings of that boy if he is a late maturer. Then his velocity curve wouldn�t be this one drawn here but somehow mooved to the right. For him peak height velocity will not be as the average at 14, but at 16 instead and remember that peak height velocity for the girl he is interested in happened at 12. Now try to imagine what means to wait for someone you love for such a long period of time! Slide Now let us talk about age of menarche. Menarche happens at the end of Tanner stage 3. Thus, here. This means that when first menses occur, growth spurt has already happened, and the girl will only grow 6 cm more and within the next 2 years. Finally Tanner stages are being more and more linked with hematological and biochemical changes. For instance here you can see how hematocrit changes according to the maturity stage. slideSlide... Slide Let us start talking about height velocity. As you can see here girls start growing in avarage 2 years earlier than boys but at the end boys will be taller (more or less 13 cm taller than girls). I�m sure you have that experience, sometimes the adolescent boy comes to see us very concerned about wanting to date a girl of the same age but feeling that she doesn�t look at him because he stiill looks like a kid. And this is the usual pattern. Now imagine what should be the feelings of that boy if he is a late maturer. Then his velocity curve wouldn�t be this one drawn here but somehow mooved to the right. For him peak height velocity will not be as the average at 14, but at 16 instead and remember that peak height velocity for the girl he is interested in happened at 12. Now try to imagine what means to wait for someone you love for such a long period of time! Slide Now let us talk about age of menarche. Menarche happens at the end of Tanner stage 3. Thus, here. This means that when first menses occur, growth spurt has already happened, and the girl will only grow 6 cm more and within the next 2 years. Finally Tanner stages are being more and more linked with hematological and biochemical changes. For instance here you can see how hematocrit changes according to the maturity stage. slide

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34. 34 Identify the psychological and social events of adolescent development

35. 35 THE IMPACT OF PUBERTY The ��booster�� of the adolescence process The adaptation to a new body image physiological clumsiness fatigue sexual arousal Exploratory behaviour, sensation seeking

36. 36 Suffer from mental health problems in a higher proportion (depression) Have a disturbed body image in a higher proportion Engage earlier in sexual activities including sexual intecourse (& no. of partners) Engage in exploratory behaviour (i.e. substance use) in a higher proportion WHAT WE KNOW: AMONG GIRLS Early maturing adolescent girls tend to :

37. 37 late maturing boys do suffer from mental health problems more often and have a disturbed body image in a higher proportionHOWEVER, early maturing boys, as girls do:  Suffer from mental health problems in a higher proportion (depression) Report early sexual activities a higher proportion Engage in exploratory behaviour & delinquant behaviour in a higher proportion WHAT WE KNOW: AMONG BOYS

38. 38 A national survey involving 3384 girls and 4044 boys aged 16 to 20 years (most being post-pubertal) Anonymous self administered questionnaire focusing on health, lifestyles and use of services A comparison of early, on time and late maturers EXAMPLE: THE SMASH SURVEY

39. 39 BODY IMAGEPercents of respondents who report to feeluneasy with their body image

40. 40 DEPRESSION Percents of respondents who report to feel highly depressed

41. 41 CANNABIS USE Percents of respondents who reportingcannabis use at least once over the last 30 days

42. 42 SEXUAL INTERCOURSE Percents of respondents who report at least one sexual intercourse in their life

43. 43 HYPOTHESES

44. 44 HYPOTHESES

45. 45 HYPOTHESES

46. 46 Identify the psychological and social events of adolescent development

47. 47 Features of adolescent development that occur universally

48. 48 A developmental definition of adolescence: general goals

49. 49 the process of autonomisation by which the child becomes more and more reliant on his own competences and less dependent on the opinion and support of his parents  the acquisition of a stable identity, the permanent feeling that an individual has that he knows who he is, what his life should look like and to some extent how others see him WHAT IS ADOLESCENCE ?

50. 50 Identity is a subjective sense as well as an observable quality of personal sameness & continuity, paired with some belief in the sameness & continuity of some shared world image

51. 51 THE ADOLESCENT PROCESSearly adolescence (10-13y.) Intellectual development concrete, egocentric Autonomisation self image centered on pubertal changes Independence less interest in parents� activities Intimacy relationships with same-sex friends Identity Sexual increased needs for privacy Moral idealistic goals Vocational lack of impulse control

52. 52 THE ADOLESCENT PROCESSmiddle adolescence (13-16y.) Intellectual development concrete, but more complex tasks Autonomisation self image making the body attractive Independence peak of conflicts with parents Intimacy peak peer group activities Identity Sexual exploratory behaviour Moral first job experiences Vocational testing of rules

53. 53 THE ADOLESCENT PROCESSlate adolescence (17-20 y.) Intellectual development abstract tasks, future perspective Autonomisation self image acceptance of one�s body Independence reacceptance of parent�s support Intimacy more intimate relationships Identity Sexual consolidation of sexual identity Moral can set limit, ability to compromise Vocational choice of vocation/profession

54. 54 What is a normal adolescent ?

55. 55 WARNING SIGNS Decreased school/professionnal achievement Isolation, lack of relationship Violence, deviant behavior Physical/functional symptoms

56. 56 A normal adolescent has a flexible behavior which evolves over time, and keeps creativity in at least some areas. He usually has good relationship with at least 1-2 peers One does not judge normality only in terms of behaviour but must reflect on the meaning of any behaviour and the context in which it takes place  Some behaviours are acceptable for older adolescents but may be less acceptable at younger ages

57. 57 SOME QUESTIONS How do you tailor the following behaviour to developmental stages ? Being drunk at age 15 ? At what age is it acceptable to overnight outside home without notifying the parents ? How do you tailor the following behaviour to different cultural backgrounds ? At what age is it considered as appropriate to have sex ?

58. 58 The parents tell you that their 16 year old son is withdrawn and doesn�t talk to them since three weeks. The boy himself says that he doesn�t feel sad and is enjoying playing his guitar and seeing his girlfriend. Case study

59. 59 Manage the delivery of health care according to adolescent bio-psychosocial development

60. 60 Use the following examples to reflect on the interractions between various types of behaviours and developmental tasks develop/provide messages and answers which are appropriate for their stage of development

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62. 62 CRITERIA Duration of the symptoms > 3 months Stability of symptoms (symptoms which don�t evolve over time) Symptoms which heavily impact on the adolescent�s daily life (family environment)

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64. 64 WRAP UP - EVALUATION