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Understanding the process of adolescent development is crucial to engendering good compliance. Successful outcomes can be achieved by approaching adolescents with respect and negotiating with them shared treatment goals. A few simple interventions can help make the issue of compliance in adolescents less problematic.
Primary care of girls between the ages of 10 and 20 presents some unique challenges. This article presents a review of normal adolescent development and explores preventive health issues and some of the more common acute medical problems of adolescent girls. Counseling on some behavioral and psychosocial issues also is discussed. Finally, anticipatory guidance topics to be discussed with parents are included.
This paper develops a general approach for dealing with parametric transformations of covariates for longitudinal data, where the responses are modeled marginally and generalized estimating equations (GEEs) are used for estimation of regression parameters. We propose an iterative algorithm for obtaining regression and transformation parameters from estimating equations, utilizing existing software for GEE problems. The algorithmic technique is closely related to that used in the Box-Tidwell transformation in classical linear regression, but we develop it under the GEE setting and for more general transformation functions. We provide supporting theorems for consistency and asymptotic Normality of the estimates. Inference between two nested models is also considered. This methodology is applied to two data sets. One consists of pill dissolution data, the other is taken from the Pittsburgh Youth Study (PYS). The PYS is a prospective longitudinal study of the development of delinquency, substance use, and mental health in male youth. We use the model-based parametric approach to examine the association between alcohol use at an early stage of adolescent development and delinquency over the course of adolescence.
OBJECTIVE: Recent research using the Shape and Weight-Based Self-Esteem (SAWBS) Inventory has shown that basing self-esteem on shape and weight is related to eating disorder and psychiatric symptoms. This study examined the relationship between other determinants of self-esteem assessed in the SAWBS Inventory (e.g., friendships, intimate relationships, school/work competence) and eating disorder and psychological health variables. METHOD: Female high school adolescents (N = 235) participated in this study. The relative contribution of the self-esteem dimensions to eating disorder and self-esteem was examined. RESULTS: In addition to shape and weight, basing self-esteem on intimate relationships was also related to higher eating disorder symptoms and lower body and global self-esteem. The only protective factors to emerge in this study were basing self-esteem on competence at school and other activities. DISCUSSION: Basing self-esteem on intimate relationships was associated with similar physical and health problems to basing self-esteem on shape and weight. The implications of these findings with regard to healthy adolescent development are addressed.
In the search for ever earlier determinants of adult pathology many ignore the transformative impact of adolescence. The authors suggest that the reality of adolescent development creates a vulnerability to being overwhelmed. Through deferred action childhood experiences may interact with adolescent realities and omnipotent beliefs to traumatize the adolescent. The authors suggest that trauma in adolescence can be independent both of the intensity of current external exposure or of earlier traumatic experiences.
Numerous adolescents are still undetected, unserved, and underserved by speech-language pathologists, resulting in astronomical financial and psychological costs to them and society. The purpose of this article is to provide an overview of past and present service delivery options for adolescents with language disorders. Before illustrating the authors' recommended model, the following background is provided: an overview of the three stages of adolescent development, characteristic expectations and problems for older students with language disorders, and a rationale for adolescent speech-language services. The comprehensive service delivery model for secondary-level speech-language students, designed and reported by the authors, consists of six components: information dissemination, identification, assessment, program planning, intervention, and follow-up. Some of the unique features of the comprehensive model are presenting services as a course for credit, providing grades, and using supportive course titles such as Individualized Communication Class.
Normal brain maturational and developmental processes, together with plastic reorganization of the brain in response to experiential demands, contribute to the acquisition of improved capacities for self-regulation and impulse control during adolescence. The frontal lobe is a main focus for these developmental and plastic processes during the transition from adolescence into adulthood. Tourette syndrome (TS), defined as the chronic presence of motor and vocal tics, has been increasingly conceptualized as a disorder of impaired self-regulatory control. This disordered control is thought to give rise to semicompulsory urges to perform the movements that constitute simple tics, complex tics, or compulsions. Neuroimaging studies suggest that the expression of the genetic diathesis to TS is influenced by genetic and nongenetic factors affecting activity-dependent reorganization of neuroregulatory systems, thereby influencing the phenotype, illness severity, and adult outcome of tic disorders. Similar developmental processes during adolescence likely determine the phenotype and natural history of a broad range of other complex neuropsychiatric disorders of childhood onset, and they likely contribute to the acquisition of improved self-regulatory capacities that characterize normal adolescent development.
Sexual victimization by adolescents is a serious problem of growing societal concern. As a result of such sexual offenses, family functioning and adolescent development may be compromised. Advanced practice psychiatric/mental health nurses can promote a healthier lifestyle for adolescent sexual offenders through assessment, early identification, and intervention to address the specific needs of the adolescents and their families and reduce the risk of sexual reoffense. The purpose of this paper is to explore the issues related to adolescent sexual offenders and their families, provide nurses with the knowledge to promote a healthier lifestyle for this population, and discuss implications for nursing practice, education, and research.
This study is based on interviews with four focus groups consisting of fourteen white, Latina, and black girls, ages 13 to 16 years, from diverse backgrounds. The objectives of the study are to gain insight into what forum girls use to learn about the adolescent experience and to examine teenage girls' views of their sexuality and femininity. The girls' discussion of their lives and perceptions of the teen magazine Seventeen reveal a displacement of female sexuality. The magazine's message to teenage girls of gaining self-worth through emphasized femininity seems to resonate with these girls regardless of class and race. We conclude that responsible adults need to challenge the distorted media images of adolescent development and teenage girls' sexuality.
Three types of ending in the analyses of adolescents have been discussed: the premature unilateral termination, the mutually agreed ending and the unilaterally interminable analysis. I have concentrated particularly on the third type, illustrating with clinical material the foreclosure in adolescent development. I have suggested that such foreclosure is preceded by developmental distortions from infancy onwards and that these distortions become organized in the breakdown during adolescence. If we return to the starting point of the Congress, Freud's paper 'Analysis terminable and interminable', it seems we still have to assess our potential adolescent patients carefully in terms of the constitutional/instinctual factors, the intensity and degree of internal and external traumata and the developmental strength of the ego which might effectively be mobilized within the analytic experience. But often it is only when we take such adolescents into analysis that we are really able to test their ego capacities for psychic change and for achieving separateness from the analyst and thus from their primary objects of infancy and early childhood.
Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.
There are several converging reasons to focus on sleep regulation in relation to healthy adolescent development: (a) Sleep appears to be particularly important during periods of brain maturation; (b) there are substantial biological and psychosocial changes in sleep and circadian regulation exist across pubertal development; (c) interactions between physical and psychosocial domains can lead to dramatic alterations in sleep patterns and habits during adolescence; (d) increasing evidence that many adolescents frequently obtain insufficient sleep exists; (e) there is mounting evidence that sleep deprivation has its greatest negative effects on the control of behavior, emotion, and attention, a regulatory interface that is critical in the development of social and academic competence, and psychiatric disorders; (f) the most obvious direct health consequences of insufficient sleep are high-risk behaviors associated with substance abuse and automobile accidents; (g) substantial evidence for bidirectional effects between sleep and behavioral/emotional regulation exists. Although the past decade has seen research progress in these areas, there continue to be major gaps in existing knowledge and a paucity of well-controlled studies to guide specific health policy decisions and recommendations regarding sleep in adolescence. In particular, there is need for improved understanding of the acute and chronic effects of inadequate sleep in adolescents, guidelines for defining adequate sleep in adolescents, and a better delineation of the links among sleep, behavior, and affect regulation. Finally, this paper briefly examines one specific application of this knowledge area regarding early starting times among some high schools.
Social interactions have been shown to be rewarding for adolescent and adult rats; however, there has been little emphasis on comparing the strength of the rewarding value of social stimuli across ontogeny. Since age differences in social interactions may vary with sex or housing circumstances, the present study assessed social conditioned place preference (CPP) in adolescent and adult male and female Sprague-Dawley rats housed either socially or in isolation and conditioned with either group-housed or isolate-housed partners. Isolated animals of both sexes and ages demonstrated social CPP, with the strongest preference emerging in adolescent males. Social CPP was not evident in group-housed adults whereas group-housed adolescents developed a preference for the compartment previously paired with similarly housed partners; however, when socially housed adolescents were conditioned with isolated partners, social CPP did not emerge. Age differences in social CPP may reflect age-related neural alterations in brain systems implicated in regulation of social behavior.
Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.
The cycle of tobacco dependence typically begins with the initiation of tobacco use during adolescence. Many teenagers try to quit smoking, fail and subsequently desire treatment for their tobacco dependence. Adolescents do not currently benefit from the same level of societal support for quit attempts as adults, and they may be less motivated for total cessation despite the short and long-term health consequences of smoking. Overall, the combination of low participation, high attrition and low complete cessation rates for adolescent smokers in treatment prompts the consideration of alternative treatment endpoints. It is likely that interactions among the processes of child and adolescent development, smoke exposure and trajectory influence patterns of tobacco use and treatment for tobacco dependence in adolescents. A rational framework is needed to integrate the study of these dynamic interactions to address tobacco dependence among youth from an exposure reduction, in addition to a cessation, perspective. This paper considers the issues and potential implications of tobacco exposure reduction therapy as an intermediate treatment goal for adolescent smokers who are dependent or dependence-prone, but for whom initial treatment interventions do not yield complete tobacco cessation.
Past research has suggested that white matter volume increases from childhood to adulthood; however, during adolescence, there is somewhat limited data to support this finding. In the present study, 65 typically developing adolescents underwent structural magnetic resonance imaging. Using magnetic resonance imaging, prefrontal white matter volumes were examined in relation to adolescent age and sex. Surprisingly, results suggested that prefrontal white matter volume decreased during late adolescence, particularly among the female sex. These findings are inconsistent with past research and suggest that perhaps some developmental processes in late adolescence are not yet fully explained. Possible methodological contributions and implications for the current findings are discussed.
Type 1 diabetes mellitus in adolescents presents diagnostic and management challenges. Diagnostically, the challenge is to distinguish type 1 from type 2 diabetes. A thin adolescent in diabetic ketoacidosis is easily recognized as having type 1 diabetes. However, since obesity does not negate the presence of type 1 diabetes, it is appropriate to measure diabetes-related antibody, C-peptide, and insulin levels in individuals who are thought to have type 2 diabetes to ensure that they do not have type 1 or a mixed type of diabetes. The goals for the management of type 1 diabetes in adolescents are to (i) prevent diabetic ketoacidosis; (ii) prevent severe hypoglycemia; (iii) maintain normal growth and development; and (iv) prevent long-term diabetic complications. To prevent diabetic ketoacidosis, patients must take their insulin appropriately. To ensure that this happens, increased parental supervision, psychological counseling, or placement in a different home environment may be necessary. All patients must be taught to appropriately manage sick days and test their urine for ketones when hyperglycemia is present. Prevention of severe hypoglycemia involves ensuring that the patient understands the symptoms of hypoglycemia and knows to test and treat it when the signs are present. Patients and families also need to know how to adjust insulin doses to prevent hypoglycemia and how to manage exercise appropriately. Patients with hypoglycemic unawareness need to meticulously avoid hypoglycemia. To maintain normal growth and development, adolescents with type 1 diabetes must have the appropriate tools to effectively match their meals to their lifestyle and to avoid the increased weight gain associated with improved glycemic control without intentionally manipulating their insulin dose to lose weight. The Diabetes Control and Complications Trial demonstrated that improved glycemic control decreased the risk of long-term diabetic complications. The goals of treatment in this study should be the goals for all adolescents with type 1 diabetes. To reach these goals, home glucose monitoring is critical. Patients need to know how to adjust insulin to maintain glucose levels in the range of 70-120 mg/dL (3.9-6.7 mmol/L) before meals. Insulin regimens need to be individually tailored to meet each patient's needs. Patients should be followed in a clinic using a multidisciplinary team approach at least every 3 months. Glycosylated hemoglobin should be measured at each visit. Regular eye exams, blood pressure monitoring, and urinary microalbumin measurements are critical. In this manner, the goals of management of type 1 diabetes in adolescents can be met.
BACKGROUND: Our psychiatric Objective Structured Clinical Examination (OSCE) group wishes to develop adolescent psychiatry OSCE stations. The literature regarding adolescent standardized patient (SP) selection methods and simulation effects, however, offered limited assurance that such adolescents would not experience adverse simulation effects. PURPOSE: Evaluation of adolescent SP selection methods and simulation effects for low- and high-stress roles. METHOD: A two-component (employment-psychological) SP selection method was used. Carefully selected SPs were assigned across three conditions: low-stress medical role, high-stress psychosocial role, and wait list control. Qualitative and quantitative measures were used to assess simulation effects. RESULTS: Our selection method excluded 21% (7% employment and 14% psychological) of SP applicants. For SP participants, beneficial effects included acquisition of job skills and satisfaction in making an important contribution to society. SP reactions of discomfort to roles were reported. Long-term adverse effects were not identified. CONCLUSIONS: A two-component adolescent SP selection method is recommended. Adolescent SP benefits outweigh risks.