Behavioral problems in adolescents

1. Behavioral problems in adolescents Doç Dr Müjgan Alikaşifoğlu

2. Adolescence, is a period of transition that for the most part are culturally determined and personally defined. • Most morbidity and mortality in this age group is atributable to preventable risk factors.

3. Threats to healthy youth devolopment • Personal and familial characteristics • Quality of the schools they attend • Communities in which they live

4. Greatest risk to healthy development of adolescents • Their behavior (i.e. Risky behaviors)

5. Adolescent risk behaviors Behaviors that can directly or indirectly compromise the well-being, the health and even the life course of young people

6. They can result in negative outcomes or adverse consequences. • I.e.,drug use can lead to trouble with parents or the law • Early sexual activity can lead to unintended child bearing; school dropout can result in chronic unemployment.

7. Risk behaviors can be considered, therefore, as risk factors for personally or socially or developmentally undesirable outcomes.

8. Adolescent risk behaviors Werner and Smith (1992) • Children at risk for negative outcomes (poverty, family instability, health problems) • Many of the children experienced negative outcomes as they entered adolescence and adulthood • One third became competent and successful adults

9. Why some who are reared under adverse circumstances become competent adults while others do not appear to overcome the adversities experienced in early life?

10. Resiliency • The process in which individuals show positive outcomes despite adversity • Is not a trait, it is a pattern of behavior • It represent an interaction between the individual and the environment

11. Resiliency Resilient individuals are: • Flexible • Not invulnerable* • Not unable to be defeated** *Resilience refers to avoiding the problems associated with being vulnerable. ** Cumulative risk can defeat the most resilient individual.

12. Resiliency • Resiliency is interactive with risk. • Resiliency refers to the process of overcoming the negative effects of risk exposure • A key requirement of resiliency is the presence of both risks and promotive (protective) factors

13. Risk factors Elements and experiences in a child or adolescent’s life that increase the likelihood of negative outcomes and decrease the likelihood of positive outcomes

14. Risk factors • Effects of risk are cumulative Multiple risk factors at a single point in time or over time increases the likelihood of negative outcomes.

15. There is great heterogeneicity in the linkage between involvement in risk behaviors and the likelihood of adverse outcomes. • There is also great heterogeneicity in the linkage between exposure to risk factors and likelihood of involvement in risk behaviors.

16. It is this heterogenecity or variability on both the antecedent and the consequent sides of engaging in risk behavior that has led to an important new focus of inquary concerning adolescent risk behavior, namely, the identification and assessment of protective factors.

17. Protective factors • Protective factors have both direct and indirect effects; • they lessen the likelihood of engaging in risk behaviors, or of adverse outcomes from having engaged in them, • but they also can serve as moderators of or buffer against exposure to risk factors or actual involvement in risk behaviors themselves.

18. Protective factors • Assets Positive factors that reside within the individual Competence, coping skills, self-efficacy • Resources Positive factors that are external to the individual Parental support, adult mentoring, community organizations

19. Risk- protective factors • Effects not uniform across social groups • May operate in different ways at different stages of development or at different exposure levels

20. Risky behaviors Significant public health problem Substance use Violent behavior Unsafe sexual practices

21. Three behaviors • Pose considerable health risks to adolescents • Play significant role in adolescent development • Amenable to public health intervention

22. Increasing public health concerns related to adolescents • Mental health disorders • Obesity

23. Sexual behavior • Initiation of sex • Level of sexual activity • Risky sexual behavior

24. Adolescent sexuality Human sexuality can be defined as including the physical characteristics of and capasities for specific sexual behaviors, together with psychosocial values, norms, attitudes and learning processes that influence these behaviors.

25. It also includes a sense of gender identity and related concepts, behaviors, and attitudes about the self and others as women or men in the context of one’s society.

26. Biological factors such as genotype and its phenotypic expression begin to affect sexuality from the moment of conception. Other influences begin at birth.

27. First, the family’s attitudes and expression of femaleness and maleness, rooted in the family’s culture and influenced by society as a whole, is expressed to the infant from birth onwards.

28. From the moment the newborn’s genitalia are seen at birth, a whole set of expectations and gender-specific attitudes are elicited from the family members. • These expectations and attitudes are largely a result of the parents’ cultural dictated norms.

29. Family: A chid’s first sense of its gender and what that means is conveyed by the parents early in childhood. As the child developes, it withnesses how the mother behaves as a woman, how the father expresses his masculanity, and how they behave with each other.

30. Since children learn best from the examples set by the most significant adults in their lives, these impressions are instrumental in helping the child define what a man or a woman should be, and how they will express themselves as members of their gender.

31. Absence of someone who fills the parental role can make it difficult for the child to understand the ways in which men and women behave with each other. • Girls “test” how to behave as women with their father or other men serving in the parental role. • Without this opportunity to “test out” in a safe relationship, girls may start “looking for daddy” and may engage in considerable risk taking behavior toward that end.

32. Inappropriate behavior on the part of the girl’s male parental figure may also negatively color her views of how to express her sexuality. • A girl or boy who is reared in a home in which the parents are caring, lowing, supportive, and affectionate toward each other most likely will be able to enter into mature, positive relationships when tehy reach adulthood.

33. Culture: • The adolescent’s expression of sexuality is greatly influenced by the culture in which she or he lives. • Culture assings very specific or less than clearly specific roles to men and to women. • When these roles are clearly defined, the choices open to the adolescent to express manhood or womanhood a few.

34. Cultural ambiguity regarding sexual behavior leaves the adolescent with many options but little guidance. • Similarly, how sexual feelings are expressed can be culturally dictated.

35. Society: • The media exerts a powerfull influence on adolescents by exposing them to an adult world of which they were unaware. • Many parents abdicate their responsibilities in teaching their children about sex and sexuality, leaving to peers and the media to be the major sources of information and role modeling in this area.

36. Negative consequences of adolescent sexuality • Premature sexual activity • Pregnancy • Sexually transmitted diseases • Sexual preferences • Gender identity issues

37. Substance use is an individual-level risk factor for adolescent sexual behavior • This risk factor is compensated for by: a) Personal assets b) Resources

38. Personal assets compensating for the risk ofsubstance use for sexual behavior • Self-esteem • Participation in extracurricular activities • School achievement and attachment • Religiosity • HIV and reproductive health knowledge • Positive attitudes towards condoms • Safer sex intentions • Seeing sex as nonnormative • Self-efficacy to refuse drugs and use condoms

39. Resources compensating for the risk ofsubstance use for sexual behaviors • Father’s education • Teacher support • Residence with both parents • Peer norms for sexual behaviors • Family socioeconomic status

40. Other risk factors for adolescent sexual behavior • Peer sexual behavior • Mother having had a child before 20 (sexual intercourse before 16) • Neighborhood poverty

41. Peer sexual behavior compensated by • Family socioeconomic status • Parental monitoring • Open parental communication

42. Mother having had a child before 20 compensated by • School attachment • Self-easteem

43. Neighborhood poverty counteracted by • Participation in extracurricular activities and community organizations

44. Substance use in adolescents Adolescents use drugs as: • An escape from environmental chaos • A way to mirror an adult lifestyle • A rite of passage into puberty • A way to cope with adolescent issues • A result of other dysfunctional processes • A result of pervasive influence of the media and their peers

45. A way of challenging authority • A way of fitting into a social situation at school, at work, at social clubs (gang) • Media influences • Comorbid conditions (eg, depression or anxiety) also contribute to the development and maintenance of drug abuse

46. Genetics: Alcoholism among first or second degree relatives Male gender Individual Abuse Antisocial behavior Parental rejection Aggressive temparament Lack of self control Early sexual activity Depression Low self-esteem Attention-deficit disorders Poor self-image Body modification Learning disorders Risk factors for substance abuse in adolescents

47. Family: • Disfunctional family dinamics • Permissiveness • Authoritarianism • Parental conflict, divorce, separation • Poor supervision, lack of supervision • Poor parental role modeling

48. Community/environmental/societal: • Easy availability of drugs and alcohol • Cultural and religious sanction • Acceptance of drug use behavior • Unemployment • Poor general quality of life in the neighborhood • Media influence • Criminal activities in neighborhood • Low religiosity • Increased use of drugs and alcohol in certain culture

49. Peer group influence • Drug using friends • Curiosity • Rebellion • Desire to belong • Independence • Risk taking behavior

50. School/academic • Poor school performance • Poor school environment • Truancy