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Understanding Your Adolescent Elise DeVore Berlan, M.D., M.P.H., F.A.A.P January 21, 2009 Section of Adolescent Medicine

Understanding Your Adolescent Elise DeVore Berlan, M.D., M.P.H., F.A.A.P January 21, 2009 Section of Adolescent Medicine Nationwide Children’s Hospital Assistant Professor of Clinical Pediatrics. Who am I? What do I do? What is an Adolescent Medicine Pediatrician?. Overview.

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Understanding Your Adolescent Elise DeVore Berlan, M.D., M.P.H., F.A.A.P January 21, 2009 Section of Adolescent Medicine

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  1. Understanding Your Adolescent Elise DeVore Berlan, M.D., M.P.H., F.A.A.P January 21, 2009 Section of Adolescent Medicine Nationwide Children’s Hospital Assistant Professor of Clinical Pediatrics

  2. Who am I?What do I do?What is an Adolescent Medicine Pediatrician?

  3. Overview • Understanding normal adolescent cognitive and psychosocial development • Adolescent Mortality (Death = Big Trouble) • Adolescent Morbidity (Sex, drugs, rock and roll) • Parenting • Questions

  4. Developmental Stages of Adolescence • Early Adolescence: 10-13 years • Middle Adolescence: 14-17 years • Late Adolescence: 17-21 years

  5. Big Picture • Cognition • Can see the “big picture” • Can see things from someone else’s perspective • Able to do long range planning • Understand consequences of decisions • Move from “concrete” to “abstract” thinking • Related to age, intelligence

  6. Big Picture • Physical changes • Adult stature and body composition • Puberty complete • Sexual maturity

  7. Big Picture • Psychosocial Development • Identity Development • Psychosexual, vocational, moral • Emancipation from parents • Can begin to support themselves socially, emotionally, and financially • Closely linked to the physical changes of puberty

  8. The Teen Brain Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, Nugent TF 3rd, Herman DH, Clasen LS, Toga AW, Rapoport JL, Thompson PM: Dynamic mapping of human cortical development during childhood through early adulthood. Proceedings of the National Academy of Sciences USA, 101: 8174-8179, 2004

  9. The Teen Brain • Frontal lobe is critical for impulse control, planning, organizing, strategizing, and other executive functions. • Evidence is strong that it develops into the 20’s • Direct data about the relation of brain changes and behavior changes is not established. • These findings may inform our understanding of adolescent development.

  10. Early AdolescenceCognitive Development • Concrete thinking • Egocentrism • Difficulty reflecting on others’ points of view • Extreme concern with own needs, and assumption that these needs are equally important to others • Tendency to magnify one’s personal situation

  11. Early AdolescenceCognitive Development • “Imaginary Audience” – always on stage • Frequent daydreaming • Greater need for privacy – writing in diaries, etc. • “Personal Fable” and sense of invulnerability • Inability to perceive long-range implications of current decisions and actions • LACK OF IMPULSE CONTROL

  12. Early Adolescence Psychosocial Development • Rapid physical changes lead to preoccupation with physical appearance and physical changes in body. • Seek constant reassurance of their own normalcy. AM I NRML? • Increased interest in sexual anatomy and physiology: • Periods, nocturnal emissions, masturbation, breast and penis size • Attractiveness

  13. Early Adolescence Psychosocial Development • Begin separation from parents. • Exploration and definition of independence-dependence boundaries. • Less interest in parent/family activities • Reluctance to tacitly accept parental advice • Realizes the parent isn’t perfect!!!

  14. Early Adolescence Psychosocial Development • Importance of peer group and conformity with peers increases. • Search for new people to love in addition to parents. • Intense, idealized same-sex relationships common (BFF) • Limited capacity for intimacy given cognitive constraints.

  15. Early Adolescence Psychosocial Development • Wide mood and behavior swings • Period of self-exploration and evaluation. • Erratic movement into and out of childhood world. • Old coping skills no longer effective.

  16. Middle Adolescence Cognitive Development • Begin the gradual realization that others have needs of their own. • Idealism and commitment to social causes common. • Further ability to use abstract thinking, but inconsistently applied. • May revert to more concrete levels at times of stress. • May lead to inconsistent or “irrational” behavior. • Persistence of sense of immortality.

  17. Middle Adolescence Psychosocial Development • Increase in intensity of emotions • Peak of child-parent control battles. • Able to conceive of “ideal” parents, contrast with own parents. • Intermittent seeking and rejection of parental support.

  18. Middle Adolescence Psychosocial Development • Peer group becomes primary means of social support, buffering the separation process. • Peers are “everybody” and define “everything”. • Peer group allows forum for testing new identities. • Role experimentation, limit-testing, risk-taking fostered by persistent sense of invulnerability.

  19. Middle Adolescence Psychosocial Development • Re-establishment of body image. • Strong emphasis on being attractive • (Clothes, makeup) • Increasing sexual interest, curiosity, experimentation, partnerships. • Confusion regarding sexual orientation may peak.

  20. Late Adolescence Cognitive Development • Further refinement of abstract thinking. • Greater sense of time and the future. • Ability to assess the long-term consequences or benefits of actions. • More able to think ideas through and express selves in words. • Greater ability to delay gratification.

  21. Late Adolescence Psychosocial Development • Acceptance of body image. • Consolidation of personal identity . • Further steps toward emancipation. • Practical vocational goals • Beginnings of financial independence • Re-establishment of relationship with parents (“adult-adult” interaction).

  22. Late Adolescence Psychosocial Development • Decreased need for peer affiliation. • Increased emphasis placed on individual friendships. • Increased capacity for intimacy and movement toward more stable relationships.

  23. Adolescent Health Issues • Adolescents are, by and large, a healthy population. What places their health in greatest jeopardy are the choices they make about their own behaviors. • ¾ of adolescent mortality is preventable • Mortality rates for males are nearly three times those of adolescent females

  24. Adolescent Mortality From: National Adolescent Health Information Center

  25. Car Crashes - Factors • Risk taking behaviors • Immature judgment • Use of substances • Poor driving skills – lack of experience • Distractions – passengers, music, makeup, eating, cell phones, texting, etc. • Seat belts • Male gender

  26. Car Crashes – Parent prevention • Model good driving behaviors • Drive safely, limit distractions, use seat belt • Closely supervise/monitor driving • Set rules • No or limit passengers • No substance use • Restrict night driving • Be available for rides, use a code word • Enforce curfews, ask about seat belt use

  27. Homicide Contrary to popular belief a typical homicide involves: • Two young males of the same race who know each other, • The influence of alcohol, and • An argument that escalates in the presence of a gun. Prothrow-Stith D, Spivak H, Sege R. Interpersonal Violence Prevention: A recent public health mandate. Oxford Texbook of Public Health., vol 3. New York: Oxford University Press, 2002.

  28. Suicide High school students, during the past 12 months: • 17% “seriously considered attempting suicide” • 16% made a suicide plan • 8% attempted According to the Youth Risk Behavior Survey – A national survey of high school students done by the CDC. www.cdc.gov

  29. Suicide • Firearm, hanging, intoxication • Risk factors: • Depression and anxiety problems • High stress • Recent family, relationship, or life situation change

  30. Concern for suicide if: • Change in eating or sleeping • Withdrawal • Violent actions, running away • Drug or alcohol use • Change in personality or appearance • Depressive symptoms: boredom, lack of pleasure in everyday activities, change in schoolwork

  31. Extreme concern for suicide • Teens might say: “nothing else matters”, “things would be better if I weren’t here” • Verbal hints: “I won’t see you again” • Putting affairs in order • Is depressed but suddenly cheerful • Psychosis – hallucinations, paranoia

  32. What should parents do if concerned about suicide? • Talk to your child • You may need to get corroborating information from school personnel or your child’s friends • Talk with your pediatrician and/or seek psychiatric help • If all else fails, go to an Emergency Room

  33. Suicide – Parent Prevention • Know what is going on with your child • Make sure your child has another trusted adult in their lives to talk to • No guns at home, or lock guns and keep ammo separated • Keep medications guarded or discreet, even Tylenol, anti-depressants • If signs of mental distress, seek help • Take any suicidal gesture seriously

  34. Sex, Drugs, and Rock-n-Roll

  35. Teen Sexual Behaviors http://www.teenpregnancy.org/resources/data/pdf/TeenSexActivityOnePagerJune06.pdf

  36. Teen Sexual Behaviors http://www.teenpregnancy.org/resources/data/pdf/TeenSexActivityOnePagerJune06.pdf

  37. Teen Sexual Behaviors

  38. Teen Sexual Behaviors • Unhealthy consequences of sexual activity • Unintended pregnancy • Sexually transmitted infection • Psychosocial changes • Teens frequently engage in “sexting”, and sexually charged conversations online or on phone • Dating violence is common • Higher risk of negative consequences happening if drugs or alcohol are involved, large age discrepancy between partners

  39. Parenting • COMMUNICATE!!! • Share your values and expectations • Talk about healthy relationships, sexuality early on • Actively monitor and supervise your teen • Where are you going? • With who? • Check in… • See them when they come home • Set and enforce a reasonable curfew • Role model healthy relationship behavior

  40. Parenting • If your teen is sexually active… • Be aware of his/her relationships • Have conversations about birth control and condoms • Support doctor visits for reproductive health • STAY COMMUNICATING!!!

  41. Drugs • In general, substance use has declined in recent years. • Girls and boys have similar rates of substance use. • Substance use increases with age in all racial and ethnic groups. • Marijuana is most commonly used illicit drug.

  42. Drug use over the ages…

  43. Current issues in drug use • Abuse of prescription drugs • 1/10 12th graders reported using Vicodin in last year • Binge drinking • ¼ 12th graders reported in last month • Rise in use of inhalants • Heroin epidemic in Ohio

  44. Parents should… • Role model • Communicate expectations early on • Set rules • Keep communicating…even when it is hard • Code word • White lies • Values

  45. Parents should… • Monitor • Lock ALL alcohol and prescription drugs • Look at your kids when they come home • Smell your kids when they come home • Sound the alarm if there are major changes in your child’s behavior, personality, or school performance.

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