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Development in adolescence
NORMAL DEVELOPMENT
Development in adolescence
What’s new? • The recent growth in molecular genetic research has focused attention on the contribution of genetics to normal developmental traits
Simon Gowers
• In the UK, there has been a rapid increase in the number of young people staying in full-time education (and remaining financially dependent) into their early twenties • Young people in the UK now drink more alcohol and at an earlier age than in any other country
Adolescence is a complex stage of development spanning the gap between childhood and adulthood. It starts with the biological changes of puberty and ends with full maturity but its timing, length and experience is highly culture dependent. In the developing world, where childhood is brief, adolescence barely exists as a developmental stage and children of 12 or 13 years of age will often be in full-time work and expected to take on adult roles. Indeed, some cultures ritually mark entry into adulthood in what would be considered early adolescence in Western society. In developed cultures, however, adolescence has come to be seen as a developmental stage spanning several years and leading to independence from the family of origin. Defining the start and end of adolescence is, therefore, problematic. Physical maturation (i.e. puberty), often taken as a marker for entry into adolescence, may occur at very different ages. The end of adolescence is even more difficult to define. Full maturity and independence are influenced by socioeconomic and other culturally defined factors. Western definitions of adolescence have changed markedly since the Industrial Revolution, and recent educational initiatives have significantly raised the age that most young people become financially independent. Legally, the age at which an individual can be deemed responsible for a criminal act, purchase cigarettes or alcohol, get married, vote, join the armed forces or become a justice of the peace varies widely within and among different countries, reflecting inconsistency about the concept of maturity. For more than a century, much work has been preoccupied with the problems associated with adolescence, referred to variously as ‘sturm und drang’ (storm and stress), or ‘adolescent turmoil’, terms that indicate the complexity of adolescent development. However, only some (up to 15%) adolescents experience severe psychological disturbance. A high percentage of troubled teenagers will have had difficulties earlier in childhood, suggesting that the experience of adolescence is not the sole or even major cause.
families on one another and the role of adolescents themselves in producing and shaping their environment. Rutter and Rutter set out a number of principles and concepts that are central to the consideration of development across the lifespan.2 They note the importance of genetic and biological factors – the changes in body shape and hormonal activity that precede and continue through puberty. They emphasize the degree to which people are active, rather than passive participants in their own development and refer to the importance of transitions and the existence of chain and strand effects, in which there is carry-over from childhood into adolescence and then into adulthood. The developmental tasks of adolescence: adolescence presents the young person with a number of tasks, the successful accomplishment of which is important for mental health. The tasks change over time, and there are clear cultural and gender differences which become more marked with increasing age. • The main task of this stage is generally viewed as the achievement of an independent identity. While younger children seek to identify with others who follow the same sports team or idolize the same pop group, for example, by the end of adolescence individuality is prized more highly and successful individuals have greater self-confidence to stand out from the crowd. Developing one’s identity is set in the context of movement from small, familiar settings to those that are larger and more impersonal (e.g. from primary to secondary school), and the exploration of new possibilities in relationships, leisure and – later – work settings. • Subsidiary tasks include the achievement of greater independence, the formation of successful intimate relationships and the achievement of a secure sexual identity. • The final tasks of this stage are considered to be gaining employment and leaving home. Throughout adolescence, although the peer group is of major importance, development takes place against the background of relationships within the family. The wider cultural context and prevailing socio-economic conditions also have an important bearing on development.
Adolescent development in the context of the lifespan: Coleman and Hendry have summarized the main principles of lifespan developmental psychology which are of relevance to adolescent development.1 They emphasize the geographical, historical, social and political context as well as the influence of the family. They also draw attention to the reciprocal influence of individuals and
Development in adolescence Physical development: puberty involves rapid physical change and development of the reproductive and neuroendocrine systems. It is a time of tremendous growth, with a typical spurt at 11 years of age in girls and 13 years of age in boys although there is considerable individual variation (Figure 1). Strength and endurance increase
Simon Gowers is Professor of Adolescent Psychiatry at the University of Liverpool and Consultant to the Young People’s Centre, Chester, UK. His research interests include the treatment of eating disorders and outcome measurement in child mental health services.
PSYCHIATRY 4:6
6
© 2005 The Medicine Publishing Company Ltd
NORMAL DEVELOPMENT
markedly, particularly in boys. Physical changes have different, culturally determined meanings for males and females, and their timing – relative to peers – has a significant impact on self-esteem. Girls – in the developed world, menarche generally occurs between the ages of 10 and 16 years, later in less developed societies. Age at puberty tends to follow dietary, workload and morbidity patterns, decreasing as these improve. Social context may also be a factor; girls who grow up in households with family conflict and where the father is absent have an early menarche. Such girls tend to start dating, drinking and smoking earlier, showing that biological and behavioural developments are closely linked. Boys – the sequence of sexual maturation of boys occurs approximately 18–24 months later than in girls and the growth spurt is more marked, peaking at about 10 cm/year at 14 years of age. As well as skeletal growth, there are changes in many organs: • the heart almost doubles in weight • the number of red blood cells increases • systolic blood pressure rises. These changes are much more marked in boys than girls.
boys tend not to discuss sexual development with their fathers. For girls at least, preparation for puberty is associated with better adjustment. Sexual behaviour: the development of sexual awareness is an important accompaniment to the physical changes of adolescence. Recent figures for the UK collected by the Brook Advisory Service show that 20% of young people report having intercourse before their 16th birthday; most have their first experience at 17 years of age.3 The age of first intercourse for boys is related to early physical maturity, antisocial behaviour and substance use. The rate of teenage pregnancy in the UK has fallen since the introduction of freely available contraception in 1975, but rates in Britain and the USA are the highest in the developed world and approximately five times those in the Netherlands and Sweden. Teenage pregnancy is associated with a number of adversities including: • dropping out of education • unemployment • emotional difficulties, including depression. The rate of abortion for pregnant teenagers is related to socioeconomic status – girls from deprived areas are more likely to continue with a pregnancy. In the UK, 9.4 girls per 1000 aged 13–15 years became pregnant in 2002, just over 50% ending in abortion. There were also 31 births per 1000 girls aged 15–19 years in this year.4 Parents are generally more concerned about the emerging sexuality of their daughters than sons, though the value of female chastity varies markedly across cultures. First intercourse for males is a highly regarded event, while reports from girls are typically more anxious. Prevailing attitudes and behaviour may be changing however, with the gap between males and females narrowing. Homosexuality tends to cause parents considerable concern. There are great differences in attitudes and prevalence between societies and cultures, and between generations. A recent study estimated that 30–40% of men will have had some sort of homosexual experience (mostly in adolescence), but only 1–3% of men describe themselves as having a stable homosexual identity. Young lesbian women often report an inconsistent pattern of sexual attraction through adolescence. A critical factor in the mental health of homosexual adolescents appears to be the anticipated responses of others, particularly the mother’s acceptance. Fear of rejection, ridicule and physical assault is especially important.
The experience of puberty: puberty is experienced very differently between the sexes. Early pubertal onset appears to be a mixed blessing for girls. Although there might be some social prestige, girls who develop early are not generally popular among their (female) peers and are more likely to mix with older, deviant teenagers. Early maturity is associated with greater psychological distress, particularly negative body image. Late menarche appears to carry far less risk of associated disturbance. For boys, there seems to be a strong association between physical maturation and peer-group status. Boys who mature early are perceived more positively by peers and develop better self-image. Late maturation is associated with anxiety and boys who mature late are less popular with peers and adults. There are probably considerable differences in the ways parents talk to boys and girls about puberty and communicate expectations about changes at this time. While girls generally have some discussion of menstruation with their mother or another confidante,
Growth and development in adolescence (UK) Female
Male
Mean age at height spurt (yr)
10.3
12.3
Age at menarche (yr)
12.9
–
At 12 years: Weight (kg) Height (m) Body mass index (BMI)
40.3 1.50 17.9
38.0 1.48 17.4
At 15 years: Weight (kg) Height (m) BMI
53.3 1.62 20.3
55.0 1.69 19.2
At 18 years: Weight (kg) Height (m) BMI
57.8 1.64 21.5
66.8 1.77 21.3
Cognitive development: the teenage years are a time of major shift in thinking and reasoning abilities. Piaget suggested that adolescence is characterized by the ability to perform formal operations, and engage in abstract reasoning. The increasing capacity for logical and scientific reasoning is reflected in the problems that adolescents are able to solve in mathematics and science. The ability to think in hypothetical terms and to consider a range of possibilities helps in the formulation of arguments and counter-arguments. Abstract ability also enables adolescents to use logical processes to think about issues such as morality, friendships and responsibility. There is likely to be increased self-consciousness and a degree of preoccupation with the self (egocentrism). Teachers, social workers and health-care professionals should appreciate that self-centredness is a normal part of development when assessing adolescents.
1
PSYCHIATRY 4:6
7
© 2005 The Medicine Publishing Company Ltd
NORMAL DEVELOPMENT
Drugs and alcohol Drug and alcohol use in the UK are now so prevalent as to be a feature of normal adolescence. Goddard showed that about 45% of boys and 35% of girls drink alcohol at least weekly by the age of 15.6 In the UK (unlike North America), buying alcohol under age is relatively easy; one study reported that a quarter of 15-yearolds said they had bought alcohol from a shop in the previous week. Drinking is related to availability and acceptability within the peer group. Young people give the same reasons for drinking as adults: • sociability • relaxation • companionship • excitement. They tend to learn their limits from experience; drunkenness is a common feature of late adolescence. Illicit drug use has increased in the last decade in all Western countries. Cannabis is by far the commonest drug, with 40% of British 14–16-year-olds reporting having used it.7 Use of all drugs increases with age, up to 18 years, apart from solvent use which peaks at 14–15 years. Most drug use among teenagers is experimental and short term, with no evidence of long-term harm. However, early and increased use of cannabis is related to greater subsequent psychological and emotional problems. The UK Government Research Development & Statistics Directorate reported a significant growth in recreational drug use associated with the UK dance culture, with Ecstasy, cannabis and cocaine the most frequently used drugs.8 Recently there has also been an increase in the use of ketamine and gamma-hydroxybutyrate (GHB), and much media publicity around their use as ‘date rape’ drugs.
Social cognition – at the core of good peer relations is the ability to think about people and social relationships. Conceptions of morality and social convention become appreciated more fully, and the moral principles of fairness, justice and equality are considered in more abstract ways. Through the development of these principles, adolescents begin to see that social conventions serve a functional purpose in regulating and co-ordinating actions between people. Research suggests that boys and girls use different moral conventions, and that both sexes use moral arguments that are less mature when addressing dilemmas that are practical or personal rather than abstract. Identity: although achievement of a stable identity is vital in adolescence, identity development is a life-long process that continues through adulthood. Erikson discussed the concept of an ‘identity crisis’ in adolescence, as the young person struggles to decide who he or she is and wants to become. Cultural factors may protect against identity confusion; Islamic culture, for example, provides a strong sense of place within the extended family and community and within Islam, which may lead to a clear sense of identity.5 The development of personality traits involves an interplay between the environment and a number of genes. Many traits are familial due to the combination of genes and shared environment. Shared environment is largely responsible for things such as religious belief, career choice and vulnerability to trajectories linked to social deprivation. Peer relationships become increasingly important in adolescence, as young people pursue a range of activities outside the parental home. As well as providing social support, these relationships provide an alternative set of values and an arena for the development of social skills. Social support buffers adolescents against stress and helps with the development of autonomy. Conformity to culturally valued norms is a characteristic of peer-group relationships. While conformity to prosocial pressure is greatest at 11–12 years old, response to antisocial suggestion peaks at 14–15 years old, probably reflecting the struggle for autonomy from parents. Identification with the peer group and the family are not mutually exclusive; adolescents who strongly identify with their peers are usually committed to their family. While the significance of peers increases with age, family members are rated as the most significant people and remain an important source of advice on major decisions. It is notable that young people often choose friends with views similar to their parents (though they would never admit such similarities). During late adolescence, the peer group weakens and is replaced by loosely associated pairs or couples, enabling experimentation with intimate relationships. Peer acceptance, popularity and rejection – adolescents are often preoccupied with peer-group acceptance. Popular adolescents are good-natured, humorous and intelligent, though popularity is not necessarily associated with leadership. Social rejection is associated with poor social skills, tactlessness or aggressive behaviour. As friendship and social acceptance are so important in adolescence, those who are isolated or rejected are especially vulnerable to depression, substance misuse or eating disorders. Anorexia nervosa in particular can be viewed as a disorder that results from a belief that one is unacceptable and the consequent changes in behaviour.
PSYCHIATRY 4:6
Adolescent development and the family There is little empirical evidence for a ‘generation gap’. While there are likely to be numerous arguments over the setting of limits, families that function well can usually agree on such issues, and adolescents generally accept parental values. Conflict: several studies show that parent–child conflict does increase in adolescence, and this is not surprising given the many changes that the young person is going through. Most conflicts involve mothers, siblings, friends, fathers and other adults, in descending order of frequency. Adolescents tend to argue with parents over autonomy, authority and responsibility. With peers, interpersonal behaviour and relationship difficulties are the focus. The sibling relationship is distinguished by the degree of conflict – adolescents argue more with siblings than they do with anyone else. Adolescent development and the family life cycle: middle adulthood can be a time of difficulty for parents, with anxieties over changes in their physical state and attractiveness. At the time when the adolescent child is beginning to explore possibilities for the future, the parents may feel increasingly trapped or be concerned for their own ageing parents. Parenting styles: social concern about increasing adolescent antisocial behaviour has led a number of researchers to consider the role of parenting practice. Hess has drawn attention to a growing uncertainty among Western parents regarding their authority and responsibility; little consensus exists about what is expected of 8
© 2005 The Medicine Publishing Company Ltd
NORMAL DEVELOPMENT
them in terms of monitoring and supervision or setting of limits for their children.9 Baumrind suggested that two relatively independent aspects of parenting can be described; parental responsiveness and parental ‘demandingness’, leading to a four-way classification: • indulgent (high responsiveness, low demand) • authoritative (high responsiveness, high demand) • authoritarian (low responsiveness, high demand) • indifferent (low responsiveness, low demand).10 Subsequent studies have shown these styles of parenting are associated with different adolescent outcomes (Figure 2).
home with parents who value education and who agree with the school’s values is associated with better outcome. From education to employment: educational attainment is directly linked to attainment at work, and chain effects are very apparent, with links observed from childhood behaviour through to educational success, occupational status and success in marriage and parenting. Clearly, children whose attainment declines in adolescence or who leave school at times of economic recession and high unemployment can be disadvantaged throughout life. Moving towards adulthood: active planning for the future can protect mental health. Adolescents who show a ‘future time perspective’ are aware of the future and the relationship between their current activities and later outcomes. This is, in turn, associated with family factors: when parents express interest, adolescents develop clearer and more positive plans. Peer relationships are also important; as they get older, adolescents come to share a view of the future and their part in it. Adolescence is characterized by the movement from the family into the wider world. It is a time when the young person matures rapidly and undergoes a number of transformations in their physical state, thinking and behaviour, which are a preparation for adult life. The course of development can be greatly influenced by family, peers and the wider social context, while the adolescent as an individual makes a substantial contribution to the course of their own development and relationships.
School The school environment: adolescents actively choose the extent to which they fit in with the demands of school, and the school environment is an important factor. Adolescents value being treated as intelligent, responsive individuals, and their motivation to work needs careful management and understanding by teachers and the school system. Good schools will: • work towards keeping school organizational structures small • ensure that adults are accessible • promote healthy peer relations • allow authentic experiences of success and self-responsibility. Educational attainment – family and school environments both contribute to academic attainment: a stable, affluent, stimulating
Styles of parenting and their effects REFERENCES 1 Coleman J C, Hendry L The nature of adolescence. 3rd edition. London: Routledge, 1998. 2 Rutter M, Rutter M. Developing minds: challenge and continuity across the life span. Harmondsworth, UK: Penguin, 1992. 3 Brook Advisory Service. Young people’s sex advice services; delays, triggers and contraceptive use. London: Brook Publications, 2000. 4 Department for Education and Skills. 2nd Annual Report of the Independent Advisory Group on Teenage Pregnancy. London: DfES, 2003. 5 Erikson E. Identity and the life cycle. Psychological Issues 1959; 1: 1–171. 6 Goddard E. Teenage drinking in 1994. London: HMSO, 1996. 7 Parker H, Aldridge J, Measham F. Illegal leisure: the normalisation of adolescent recreational drug use. London: Routledge, 1998. 8 Home Office. Calculating the risk; recreational drug use amongst clubbers in South East England. London: Home Office report 43/03, 2003. 9 Hess L. Changing family patterns in Western Europe: opportunity and risk factors for adolescent development. In: Rutter M, Smith D, eds. Psychosocial disorders in young people. Chichester: John Wiley, 1995. 10 Baumrind D. Parental disciplinary patterns and social competence in children. Youth and Society 1987; 9: 239–76.
Authoritative Parents are ‘warm and firm’: they value autonomy, but take ultimate responsibility. Adolescents tend to be more responsible, self-assured, adaptive, creative, curious and socially skilled. They are also more successful in school. Authoritarian Parents value obedience and conformity, and are more punitive and more absolute in their demands. The child is expected to accept rules without question, and autonomy is restricted. Adolescents tend to be dependent and passive, less socially skilled and assured, and less curious. Indulgent Parents are accepting and benign, making little demand on the child. The imposition of rules or control is seen as an infringement of the child’s rights. They are more likely to see themselves as available resources for the child to use. Adolescents are more irresponsible and less mature. Indifferent Parents minimize the demands of the child on themselves. They are possibly neglectful and take little interest in the child’s school work or other activities. Adolescents are more likely to be impulsive and to engage in delinquent behaviour and precocious experimentation with drugs, sex and alcohol.
FURTHER READING Calam R. Normal development in adolescence. In: Gowers S, ed. Adolescent psychiatry in clinical practice. London: Arnold, 2001. Christie D, Viner R. Adolescent development. BMJ 2005; 330: 301–4. Piaget J. The principles of genetic epistemology. London: Routledge and Kegan Paul, 1972.
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PSYCHIATRY 4:6
9
© 2005 The Medicine Publishing Company Ltd
Development in adolescence
What’s new? • The recent growth in molecular genetic research has focused attention on the contribution of genetics to normal developmental traits
Simon Gowers
• In the UK, there has been a rapid increase in the number of young people staying in full-time education (and remaining financially dependent) into their early twenties • Young people in the UK now drink more alcohol and at an earlier age than in any other country
Adolescence is a complex stage of development spanning the gap between childhood and adulthood. It starts with the biological changes of puberty and ends with full maturity but its timing, length and experience is highly culture dependent. In the developing world, where childhood is brief, adolescence barely exists as a developmental stage and children of 12 or 13 years of age will often be in full-time work and expected to take on adult roles. Indeed, some cultures ritually mark entry into adulthood in what would be considered early adolescence in Western society. In developed cultures, however, adolescence has come to be seen as a developmental stage spanning several years and leading to independence from the family of origin. Defining the start and end of adolescence is, therefore, problematic. Physical maturation (i.e. puberty), often taken as a marker for entry into adolescence, may occur at very different ages. The end of adolescence is even more difficult to define. Full maturity and independence are influenced by socioeconomic and other culturally defined factors. Western definitions of adolescence have changed markedly since the Industrial Revolution, and recent educational initiatives have significantly raised the age that most young people become financially independent. Legally, the age at which an individual can be deemed responsible for a criminal act, purchase cigarettes or alcohol, get married, vote, join the armed forces or become a justice of the peace varies widely within and among different countries, reflecting inconsistency about the concept of maturity. For more than a century, much work has been preoccupied with the problems associated with adolescence, referred to variously as ‘sturm und drang’ (storm and stress), or ‘adolescent turmoil’, terms that indicate the complexity of adolescent development. However, only some (up to 15%) adolescents experience severe psychological disturbance. A high percentage of troubled teenagers will have had difficulties earlier in childhood, suggesting that the experience of adolescence is not the sole or even major cause.
families on one another and the role of adolescents themselves in producing and shaping their environment. Rutter and Rutter set out a number of principles and concepts that are central to the consideration of development across the lifespan.2 They note the importance of genetic and biological factors – the changes in body shape and hormonal activity that precede and continue through puberty. They emphasize the degree to which people are active, rather than passive participants in their own development and refer to the importance of transitions and the existence of chain and strand effects, in which there is carry-over from childhood into adolescence and then into adulthood. The developmental tasks of adolescence: adolescence presents the young person with a number of tasks, the successful accomplishment of which is important for mental health. The tasks change over time, and there are clear cultural and gender differences which become more marked with increasing age. • The main task of this stage is generally viewed as the achievement of an independent identity. While younger children seek to identify with others who follow the same sports team or idolize the same pop group, for example, by the end of adolescence individuality is prized more highly and successful individuals have greater self-confidence to stand out from the crowd. Developing one’s identity is set in the context of movement from small, familiar settings to those that are larger and more impersonal (e.g. from primary to secondary school), and the exploration of new possibilities in relationships, leisure and – later – work settings. • Subsidiary tasks include the achievement of greater independence, the formation of successful intimate relationships and the achievement of a secure sexual identity. • The final tasks of this stage are considered to be gaining employment and leaving home. Throughout adolescence, although the peer group is of major importance, development takes place against the background of relationships within the family. The wider cultural context and prevailing socio-economic conditions also have an important bearing on development.
Adolescent development in the context of the lifespan: Coleman and Hendry have summarized the main principles of lifespan developmental psychology which are of relevance to adolescent development.1 They emphasize the geographical, historical, social and political context as well as the influence of the family. They also draw attention to the reciprocal influence of individuals and
Development in adolescence Physical development: puberty involves rapid physical change and development of the reproductive and neuroendocrine systems. It is a time of tremendous growth, with a typical spurt at 11 years of age in girls and 13 years of age in boys although there is considerable individual variation (Figure 1). Strength and endurance increase
Simon Gowers is Professor of Adolescent Psychiatry at the University of Liverpool and Consultant to the Young People’s Centre, Chester, UK. His research interests include the treatment of eating disorders and outcome measurement in child mental health services.
PSYCHIATRY 4:6
6
© 2005 The Medicine Publishing Company Ltd
NORMAL DEVELOPMENT
markedly, particularly in boys. Physical changes have different, culturally determined meanings for males and females, and their timing – relative to peers – has a significant impact on self-esteem. Girls – in the developed world, menarche generally occurs between the ages of 10 and 16 years, later in less developed societies. Age at puberty tends to follow dietary, workload and morbidity patterns, decreasing as these improve. Social context may also be a factor; girls who grow up in households with family conflict and where the father is absent have an early menarche. Such girls tend to start dating, drinking and smoking earlier, showing that biological and behavioural developments are closely linked. Boys – the sequence of sexual maturation of boys occurs approximately 18–24 months later than in girls and the growth spurt is more marked, peaking at about 10 cm/year at 14 years of age. As well as skeletal growth, there are changes in many organs: • the heart almost doubles in weight • the number of red blood cells increases • systolic blood pressure rises. These changes are much more marked in boys than girls.
boys tend not to discuss sexual development with their fathers. For girls at least, preparation for puberty is associated with better adjustment. Sexual behaviour: the development of sexual awareness is an important accompaniment to the physical changes of adolescence. Recent figures for the UK collected by the Brook Advisory Service show that 20% of young people report having intercourse before their 16th birthday; most have their first experience at 17 years of age.3 The age of first intercourse for boys is related to early physical maturity, antisocial behaviour and substance use. The rate of teenage pregnancy in the UK has fallen since the introduction of freely available contraception in 1975, but rates in Britain and the USA are the highest in the developed world and approximately five times those in the Netherlands and Sweden. Teenage pregnancy is associated with a number of adversities including: • dropping out of education • unemployment • emotional difficulties, including depression. The rate of abortion for pregnant teenagers is related to socioeconomic status – girls from deprived areas are more likely to continue with a pregnancy. In the UK, 9.4 girls per 1000 aged 13–15 years became pregnant in 2002, just over 50% ending in abortion. There were also 31 births per 1000 girls aged 15–19 years in this year.4 Parents are generally more concerned about the emerging sexuality of their daughters than sons, though the value of female chastity varies markedly across cultures. First intercourse for males is a highly regarded event, while reports from girls are typically more anxious. Prevailing attitudes and behaviour may be changing however, with the gap between males and females narrowing. Homosexuality tends to cause parents considerable concern. There are great differences in attitudes and prevalence between societies and cultures, and between generations. A recent study estimated that 30–40% of men will have had some sort of homosexual experience (mostly in adolescence), but only 1–3% of men describe themselves as having a stable homosexual identity. Young lesbian women often report an inconsistent pattern of sexual attraction through adolescence. A critical factor in the mental health of homosexual adolescents appears to be the anticipated responses of others, particularly the mother’s acceptance. Fear of rejection, ridicule and physical assault is especially important.
The experience of puberty: puberty is experienced very differently between the sexes. Early pubertal onset appears to be a mixed blessing for girls. Although there might be some social prestige, girls who develop early are not generally popular among their (female) peers and are more likely to mix with older, deviant teenagers. Early maturity is associated with greater psychological distress, particularly negative body image. Late menarche appears to carry far less risk of associated disturbance. For boys, there seems to be a strong association between physical maturation and peer-group status. Boys who mature early are perceived more positively by peers and develop better self-image. Late maturation is associated with anxiety and boys who mature late are less popular with peers and adults. There are probably considerable differences in the ways parents talk to boys and girls about puberty and communicate expectations about changes at this time. While girls generally have some discussion of menstruation with their mother or another confidante,
Growth and development in adolescence (UK) Female
Male
Mean age at height spurt (yr)
10.3
12.3
Age at menarche (yr)
12.9
–
At 12 years: Weight (kg) Height (m) Body mass index (BMI)
40.3 1.50 17.9
38.0 1.48 17.4
At 15 years: Weight (kg) Height (m) BMI
53.3 1.62 20.3
55.0 1.69 19.2
At 18 years: Weight (kg) Height (m) BMI
57.8 1.64 21.5
66.8 1.77 21.3
Cognitive development: the teenage years are a time of major shift in thinking and reasoning abilities. Piaget suggested that adolescence is characterized by the ability to perform formal operations, and engage in abstract reasoning. The increasing capacity for logical and scientific reasoning is reflected in the problems that adolescents are able to solve in mathematics and science. The ability to think in hypothetical terms and to consider a range of possibilities helps in the formulation of arguments and counter-arguments. Abstract ability also enables adolescents to use logical processes to think about issues such as morality, friendships and responsibility. There is likely to be increased self-consciousness and a degree of preoccupation with the self (egocentrism). Teachers, social workers and health-care professionals should appreciate that self-centredness is a normal part of development when assessing adolescents.
1
PSYCHIATRY 4:6
7
© 2005 The Medicine Publishing Company Ltd
NORMAL DEVELOPMENT
Drugs and alcohol Drug and alcohol use in the UK are now so prevalent as to be a feature of normal adolescence. Goddard showed that about 45% of boys and 35% of girls drink alcohol at least weekly by the age of 15.6 In the UK (unlike North America), buying alcohol under age is relatively easy; one study reported that a quarter of 15-yearolds said they had bought alcohol from a shop in the previous week. Drinking is related to availability and acceptability within the peer group. Young people give the same reasons for drinking as adults: • sociability • relaxation • companionship • excitement. They tend to learn their limits from experience; drunkenness is a common feature of late adolescence. Illicit drug use has increased in the last decade in all Western countries. Cannabis is by far the commonest drug, with 40% of British 14–16-year-olds reporting having used it.7 Use of all drugs increases with age, up to 18 years, apart from solvent use which peaks at 14–15 years. Most drug use among teenagers is experimental and short term, with no evidence of long-term harm. However, early and increased use of cannabis is related to greater subsequent psychological and emotional problems. The UK Government Research Development & Statistics Directorate reported a significant growth in recreational drug use associated with the UK dance culture, with Ecstasy, cannabis and cocaine the most frequently used drugs.8 Recently there has also been an increase in the use of ketamine and gamma-hydroxybutyrate (GHB), and much media publicity around their use as ‘date rape’ drugs.
Social cognition – at the core of good peer relations is the ability to think about people and social relationships. Conceptions of morality and social convention become appreciated more fully, and the moral principles of fairness, justice and equality are considered in more abstract ways. Through the development of these principles, adolescents begin to see that social conventions serve a functional purpose in regulating and co-ordinating actions between people. Research suggests that boys and girls use different moral conventions, and that both sexes use moral arguments that are less mature when addressing dilemmas that are practical or personal rather than abstract. Identity: although achievement of a stable identity is vital in adolescence, identity development is a life-long process that continues through adulthood. Erikson discussed the concept of an ‘identity crisis’ in adolescence, as the young person struggles to decide who he or she is and wants to become. Cultural factors may protect against identity confusion; Islamic culture, for example, provides a strong sense of place within the extended family and community and within Islam, which may lead to a clear sense of identity.5 The development of personality traits involves an interplay between the environment and a number of genes. Many traits are familial due to the combination of genes and shared environment. Shared environment is largely responsible for things such as religious belief, career choice and vulnerability to trajectories linked to social deprivation. Peer relationships become increasingly important in adolescence, as young people pursue a range of activities outside the parental home. As well as providing social support, these relationships provide an alternative set of values and an arena for the development of social skills. Social support buffers adolescents against stress and helps with the development of autonomy. Conformity to culturally valued norms is a characteristic of peer-group relationships. While conformity to prosocial pressure is greatest at 11–12 years old, response to antisocial suggestion peaks at 14–15 years old, probably reflecting the struggle for autonomy from parents. Identification with the peer group and the family are not mutually exclusive; adolescents who strongly identify with their peers are usually committed to their family. While the significance of peers increases with age, family members are rated as the most significant people and remain an important source of advice on major decisions. It is notable that young people often choose friends with views similar to their parents (though they would never admit such similarities). During late adolescence, the peer group weakens and is replaced by loosely associated pairs or couples, enabling experimentation with intimate relationships. Peer acceptance, popularity and rejection – adolescents are often preoccupied with peer-group acceptance. Popular adolescents are good-natured, humorous and intelligent, though popularity is not necessarily associated with leadership. Social rejection is associated with poor social skills, tactlessness or aggressive behaviour. As friendship and social acceptance are so important in adolescence, those who are isolated or rejected are especially vulnerable to depression, substance misuse or eating disorders. Anorexia nervosa in particular can be viewed as a disorder that results from a belief that one is unacceptable and the consequent changes in behaviour.
PSYCHIATRY 4:6
Adolescent development and the family There is little empirical evidence for a ‘generation gap’. While there are likely to be numerous arguments over the setting of limits, families that function well can usually agree on such issues, and adolescents generally accept parental values. Conflict: several studies show that parent–child conflict does increase in adolescence, and this is not surprising given the many changes that the young person is going through. Most conflicts involve mothers, siblings, friends, fathers and other adults, in descending order of frequency. Adolescents tend to argue with parents over autonomy, authority and responsibility. With peers, interpersonal behaviour and relationship difficulties are the focus. The sibling relationship is distinguished by the degree of conflict – adolescents argue more with siblings than they do with anyone else. Adolescent development and the family life cycle: middle adulthood can be a time of difficulty for parents, with anxieties over changes in their physical state and attractiveness. At the time when the adolescent child is beginning to explore possibilities for the future, the parents may feel increasingly trapped or be concerned for their own ageing parents. Parenting styles: social concern about increasing adolescent antisocial behaviour has led a number of researchers to consider the role of parenting practice. Hess has drawn attention to a growing uncertainty among Western parents regarding their authority and responsibility; little consensus exists about what is expected of 8
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NORMAL DEVELOPMENT
them in terms of monitoring and supervision or setting of limits for their children.9 Baumrind suggested that two relatively independent aspects of parenting can be described; parental responsiveness and parental ‘demandingness’, leading to a four-way classification: • indulgent (high responsiveness, low demand) • authoritative (high responsiveness, high demand) • authoritarian (low responsiveness, high demand) • indifferent (low responsiveness, low demand).10 Subsequent studies have shown these styles of parenting are associated with different adolescent outcomes (Figure 2).
home with parents who value education and who agree with the school’s values is associated with better outcome. From education to employment: educational attainment is directly linked to attainment at work, and chain effects are very apparent, with links observed from childhood behaviour through to educational success, occupational status and success in marriage and parenting. Clearly, children whose attainment declines in adolescence or who leave school at times of economic recession and high unemployment can be disadvantaged throughout life. Moving towards adulthood: active planning for the future can protect mental health. Adolescents who show a ‘future time perspective’ are aware of the future and the relationship between their current activities and later outcomes. This is, in turn, associated with family factors: when parents express interest, adolescents develop clearer and more positive plans. Peer relationships are also important; as they get older, adolescents come to share a view of the future and their part in it. Adolescence is characterized by the movement from the family into the wider world. It is a time when the young person matures rapidly and undergoes a number of transformations in their physical state, thinking and behaviour, which are a preparation for adult life. The course of development can be greatly influenced by family, peers and the wider social context, while the adolescent as an individual makes a substantial contribution to the course of their own development and relationships.
School The school environment: adolescents actively choose the extent to which they fit in with the demands of school, and the school environment is an important factor. Adolescents value being treated as intelligent, responsive individuals, and their motivation to work needs careful management and understanding by teachers and the school system. Good schools will: • work towards keeping school organizational structures small • ensure that adults are accessible • promote healthy peer relations • allow authentic experiences of success and self-responsibility. Educational attainment – family and school environments both contribute to academic attainment: a stable, affluent, stimulating
Styles of parenting and their effects REFERENCES 1 Coleman J C, Hendry L The nature of adolescence. 3rd edition. London: Routledge, 1998. 2 Rutter M, Rutter M. Developing minds: challenge and continuity across the life span. Harmondsworth, UK: Penguin, 1992. 3 Brook Advisory Service. Young people’s sex advice services; delays, triggers and contraceptive use. London: Brook Publications, 2000. 4 Department for Education and Skills. 2nd Annual Report of the Independent Advisory Group on Teenage Pregnancy. London: DfES, 2003. 5 Erikson E. Identity and the life cycle. Psychological Issues 1959; 1: 1–171. 6 Goddard E. Teenage drinking in 1994. London: HMSO, 1996. 7 Parker H, Aldridge J, Measham F. Illegal leisure: the normalisation of adolescent recreational drug use. London: Routledge, 1998. 8 Home Office. Calculating the risk; recreational drug use amongst clubbers in South East England. London: Home Office report 43/03, 2003. 9 Hess L. Changing family patterns in Western Europe: opportunity and risk factors for adolescent development. In: Rutter M, Smith D, eds. Psychosocial disorders in young people. Chichester: John Wiley, 1995. 10 Baumrind D. Parental disciplinary patterns and social competence in children. Youth and Society 1987; 9: 239–76.
Authoritative Parents are ‘warm and firm’: they value autonomy, but take ultimate responsibility. Adolescents tend to be more responsible, self-assured, adaptive, creative, curious and socially skilled. They are also more successful in school. Authoritarian Parents value obedience and conformity, and are more punitive and more absolute in their demands. The child is expected to accept rules without question, and autonomy is restricted. Adolescents tend to be dependent and passive, less socially skilled and assured, and less curious. Indulgent Parents are accepting and benign, making little demand on the child. The imposition of rules or control is seen as an infringement of the child’s rights. They are more likely to see themselves as available resources for the child to use. Adolescents are more irresponsible and less mature. Indifferent Parents minimize the demands of the child on themselves. They are possibly neglectful and take little interest in the child’s school work or other activities. Adolescents are more likely to be impulsive and to engage in delinquent behaviour and precocious experimentation with drugs, sex and alcohol.
FURTHER READING Calam R. Normal development in adolescence. In: Gowers S, ed. Adolescent psychiatry in clinical practice. London: Arnold, 2001. Christie D, Viner R. Adolescent development. BMJ 2005; 330: 301–4. Piaget J. The principles of genetic epistemology. London: Routledge and Kegan Paul, 1972.
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