Debunking the Myths of Adolescence PDF

# SPECIAL ARTICLE ## Debunking the Myths of Adolescence: Findings from Recent Research DANIEL OFFER, M.D., AND KIMBERLY A. SCHONERT-REICHL, PH.D. **Abstract.** This review summarizes some of the important research findings on adolescence that have accumulated during the past two decades. Current u...

# SPECIAL ARTICLE ## Debunking the Myths of Adolescence: Findings from Recent Research DANIEL OFFER, M.D., AND KIMBERLY A. SCHONERT-REICHL, PH.D. **Abstract.** This review summarizes some of the important research findings on adolescence that have accumulated during the past two decades. Current understanding of the adolescent age-period is first discussed with particular attention to the previously held myths about adolescence. Second, a review of existing studies that have examined the problems and help-seeking behaviors of adolescents is presented. Overall, the majority of recent research findings suggest adolescence should not be characterized as a time of severe emotional upheaval and turmoil because the majority (80%) of adolescents manage this transition quite well. Nevertheless, a sizable proportion of youth (20%) do not fare so well, with many not receiving the help they may need. *J. Am. Acad. Child Adolesc. Psychiatry, 1992, 31, 6:1003-1014.* **Key Words:** adolescence, normal development, epidemiology, help seeking. During the past decade, interest in the scientific study of adolescence has increased dramatically (Dornbusch, 1989; Dornbusch et al., 1991; Lerner et al., 1991; Petersen, 1988; Petersen and Epstein, 1991). Indeed, a flurry of new research has emerged as a result of the identification of the adolescent age as an interesting and worthy area of investigation. As a consequence of this recent upsurge of adolescent research, researchers now possess a more thorough and in-depth understanding of this time of development than they had in previous decades. Adolescents have been written about since the thirteenth century (Aries, 1962), and adolescence was first identified by Hall in 1904. However, it has been only in the last two decades that empirical investigations examining adolescence have flourished. Rigorous scientific investigation of the adolescent period was circumvented, in part, by strongly held beliefs put forth by psychoanalytic theorists who purported that normative adolescent development was tumultuous (Blos, 1962; A. Freud, 1958). Why have researchers suddenly become cognizant of adolescents? Three reasons are considered here. First, researchers have come to the conclusion that the early years of life are no longer considered to be the most important ones (Brim and Kagan, 1980). Second, the youth movements of the 1960s and 1970s spurred researchers to more closely examine this age period (Petersen, 1988). Finally, in light of rapidly changing social circumstances, many more adolescents today than in previous generations are confronted with stressors that put them at risk for adverse outcomes (Elliott and Feldman, 1990; Schorr, 1988). Therefore, there is growing concern for the need to more fully understand the problems that today's adolescents face to devise effective preventive and interventional efforts that will be successful in facilitating the healthy development of youth. This review highlights some of the recent research findings on adolescence that have emerged during the past two decades. First, a discussion of the myths regarding adolescence that have impeded conceptualizations of "normal" adolescent development and then a review and discussion of the main findings from studies that have examined the problems and help-seeking behaviors of adolescents. This review cannot hope to be exhaustive because of the dramatic increase of research on adolescence that has accumulated during the past several years. Instead, the review is focused on areas of study where there is important new work providing a sample of current adolescent research. Several excellent reviews of recent research on adolescence have appeared in the past few years, and the reader is urged to read further on topics not covered here (e.g., Dornbusch, 1989; Feldman and Elliott, 1990; Lerner et al., 1991; Petersen, 1988). ## The Myths of Adolescence Despite the increased accumulation of knowledge regarding the adolescent period, research on adolescence has been somewhat disabled because of the strongly held beliefs about adolescents (Petersen, 1988). Misconceptions about adolescence continue to flourish, and many people, unreceptive to research findings that dispel their beliefs about adolescents, continue to believe many of the myths about adolescence (Brooks-Gunn and Petersen, 1984). According to many, adolescents are portrayed as troubled with fluctuating emotions and hormones over which they have little control. The "typical" adolescent is assumed to be out of control, in constant conflict with his or her family, and incapable of rational thought. Herein, several of the "myths" of adolescence are put forth, and their incongruence with current empirical study is discussed. ### Myth 1: Normal Adolescent Development is Tumultuous Historically, many researchers and clinicians have described adolescence as a tumultuous developmental period, a time of physical and emotional upheaval, and various authors have indicated that mental disorders and deviant behaviors appear more frequently during this time than in any other period of life (Blos, 1962; Erikson, 1968; Freud, 1958; Rabichow and Sklansky, 1980). These authors have written that if adolescents do not go through a serious and prolonged identity crisis, they will ultimately become very disturbed. Surprisingly, many adults today hold the same view (Hechinger and Hechinger, 1963). The ubiquity and stability of this characterization of adolescence was bolstered by clinicians' primary contacts with disturbed adolescents who were patients or with adult patients who recalled a disruptive and tumultuous adolescence. Indeed, assumptions about "normative" adolescent development have been based on the clinical experiences of psychiatrists and psychoanalysts working with emotionally disturbed youth (e.g., A. Freud, 1958). During the past two decades, psychiatrists and others have begun to study nonclinical samples and have found that the developmental theories, although still true for some, were, for the most part, not applicable to the new subjects studied (Csikzentmihalyi and Larson, 1984; Douvan and Adelson, 1966; Grinker et al., 1962; Offer, 1969; Offer and Offer, 1975; Petersen, 1981). These new studies of nonpatient samples have demonstrated that adolescence is not a time of severe disturbance for all adolescents. Moreover, many showed that a significant percentage of adolescents (80%) do not experience adolescent turmoil, relate well to their families and peers, and are comfortable with their social and cultural values (Douvan and Adelson, 1966; Offer and Offer, 1975, Rutter et al., 1976). Although most child and adolescent psychiatrists accept the fact that adolescent turmoil is not a universal phenomenon, in our culture, adolescence is still seen as "the terrible teens," and parents, teachers, as well as some mental health professionals, believe it to be true (Offer et al., 1981). In summary, the new generation of studies of nondis-turbed adolescents clearly demonstrates that teenagers who exhibit little disequilibrium are normal. This new research also supports the concept that adolescence is a period of development that can be traversed without turmoil and that the transition to adulthood is accomplished gradually and without undue upheaval. ### Myth 2: Adolescence is a Time of Increased Emotionality This myth is a subordinate of Myth 1. That is, the view that all adolescents experience turmoil led to the view that normal adolescents display frequent changes in mood and that these moods are more extreme than those experienced by children and adults. This characterization of adolescent emotionality and moodiness is hypothesized to result from the psychological, physiological, and social changes that occur during this period of development. The description of adolescence as a time of extreme emotionality and moodiness has been formulated by persons from a variety of fields (e.g., Benedict, 1938; Blos, 1962; Freud, 1958, Hall, 1904; Mead, 1928). As shall be seen, however, findings from recent research refute their conceptualization of adolescence. Larson and Lampman-Petraitis (1989) recently addressed the aforementioned hypothesis that the onset of adolescence is characterized by greater emotionality by examining the emotional states of both children and adolescents. These researchers employed an interesting and creative new research method designated the "Experience Sampling Method," which entails subjects carrying electronic pagers for one week and filling out self-report forms when signaled randomly during the course of each day. This method allows for the collection of information on the "hour-to-hour" mood changes that preadolescents and adolescents experience rather than gathering data retrospectively and helps provide a richer picture of adolescent life (Elliott and Feldman, 1990). Findings from this study indicated that adolescents' mood changes were no different than were those of preadolescents. Larson and Lampman-Petraitis (1989) contend: "These findings suggest that the onset of adolescence is not associated with appreciable differences in the variability of emotional states experienced during daily life" (p. 1257). However, although these researchers did not find elevated emotionality at the onset of adolescence, they did uncover a linear relationship between age and average mood states. Specifically, they found that older adolescents reported more negative mood states than did preadolescents and younger adolescents, thereby suggesting that adolescents become more unhappy with age. Larson and Lampman-Petraitis (1989) hypothesize that the increase in negative affect during adolescence may be a result of changes in the adolescent's life that cause more unhappiness. For example, one change often perceived as stressful for the adolescent is puberty. ### Myth 3: Puberty is a Negative Event for Adolescents Pubertal hormones frequently have been portrayed as the impetus for adolescent turmoil, and relatedly, moodiness and emotionality (Hall, 1904). Current research findings, however, contradict this relationship between puberty and disturbance, and instead suggest that the effects of pubertal hormones are neither potent nor pervasive (Brooks-Gunn and Reiter, 1990). Cultural definitions of what is desirable or expectable have a significant impact on the adolescent's psychological experience of puberty (Boxer et al., 1989; Petersen and Taylor, 1980; Tobin-Richards et al., 1983). For example, the normal increase in weight associated with pubertal development has been found to be a significant contributor to adolescent females' dissatisfaction with their bodies (e.g., Blyth et al., 1985). Another important factor contributing to adolescents' experience of puberty is whether they are on- or off-time relative to their peers (Simmons and Blyth, 1987). In a recent overview of puberty research, Brooks-Gunn and Reiter (1990) remarked that, until the 1980s, scant research existed on the meaning or the effects of puberty for adolescents. Although much research has examined the biological aspects of puberty, few research studies have explored the psychological effects of puberty. Thus, one of the current issues in pubertal research is to more fully understand what the pubertal experience is like for teenagers today compared with adolescents in the past. For example, heretofore little was known about how adolescent girls perceive the onset of menstruation. This is, in part, because previous research on adolescent girls' perceptions of the experience of menarche has been based on retrospective reports of adults rather than on prospective reports with the adolescents themselves. Previous reports of menarche frequently have portrayed the onset of menstruation as a time of crisis for the adolescent girl and have emphasized her negative feelings associated with the event. Current researchers (Ruble and Brooks-Gunn, 1982), however, have found in interviews with adolescent girls, that few young women perceive menarche as entirely negative and, for the majority of young women today, menarche is a time characterized by both positive and negative feelings. With regard to the meaning of pubertal changes to adolescent boys, much less is known. It appears little research has examined adolescent boys' feelings about the occurrence of first éjaculation (i.e., spermarche). Researchers do suggest, however, that this occurrence is as significant to boys as menarche is to girls. In one investigation (Gaddis and Brooks-Gunn, 1985), adolescent boys were interviewed about how they felt about the occurrence of spermarche. Findings revealed that, in general, adolescent boys did not have negative reactions to ejaculation. Two-thirds of the sample, however, did report feeling somewhat frightened by the event. Overall, responses to spermarche for the young men were positive. Most of the adolescent boys felt prepared for the event, although few reported their sources of information. In summary, it appears that puberty is not an entirely negative event for adolescent boys and girls. Most adolescents' experience of puberty is somewhat ambivalent, with both positive and negative feelings. Little is known about how parents perceive pubertal changes in their children, although most adolescents report feeling uncomfortable discussing puberty with their parents (Brooks-Gunn and Reiter, 1990). More research is needed on these topics to foster a better understanding of these events and their repercussions for the adolescent. ### Myth 4: Adolescence is a Time of Increased Risk for Suicide The demographic studies of adolescence have become far more accurate in the past two decades and, as a consequence, have aided in the understanding of certain aspects of adolescent psychopathology. Adolescent suicide is a case in point. During the past decade, a number of studies on adolescent suicide have emerged, culminating in a recent book by Holinger and Offer (in press). These authors examined the relationship between suicide rate and the size of the adolescent population in the society at large and found that the dramatic increase of youth suicide (15 to 24 years of age) between 1956 and 1976 followed the proportion of youth in the US population. With the end of the "baby boom," a small but definite decrease in adolescent suicide was seen until the year 1983. After 1983, the suicide rate stabilized and has not returned to the high rate of 1978. The only exception to this was the younger generation of white, middle-class males (ages 15 to 19 years). The suicide rate of this group continued to climb, but the slope of the curve did not climb as rapidly in the 1980s as in the 1960s and 1970s. Remembering that suicide is a most tragic but nevertheless extremely rare event, note that the adolescent suicide rate, with the exception of children, is the lowest in the life cycle. The current suicide rates of adolescents in the United States are as follows (latest available figures are from 1988) (Holinger and Offer, in press): young males (15 to 19 years) 18.0, older males (20 to 24 years) 25.8, young females (15 to 19 years) 4.4, and older females (20 to 24 years) 4.1. The rate is per 100,000. These epidemiologic data appear to be consistent with self-image data from questionnaires and interviews with samples of normal adolescents. In studying the self-image of thousands of adolescents across three decades, Offer et al. (1989) found that the self-image of adolescents in the early 1960s was better than that of adolescents in the late 1970s. These differences corresponded closely to the smaller numbers of adolescents in the population in the early 1960s and the larger number of adolescents in the late 1970s. Offer et al. (1989) also noted that the self-image of adolescents in the 1980s was better than that of adolescents in the 1970s. This increase in the self-image of adolescents corresponded with the decrease in the number of adolescents in the population at large in the early 1980s. One way of explaining these findings has to do with the cohort theory; that is, the higher the ratio of adolescents in the total population, the more difficulties the adolescents have. They have more difficulty in obtaining jobs and in being admitted to good colleges. Called "baby-boom-baby-bust theory," this theory, based on the thinking of Easterlin (1980) and Brenner (1971, 1979), offers a useful framework with which to understand fluctuations in adolescent self-image and suicide rates across the decades. Because suicide is such an extremely rare phenomenon, it is most difficult to study events that give rise to increases in suicide among adolescent or to discover preventive approaches that might lower the risk of suicide. For example, Gould and Shaffer (1986) examined the impact of a television movie on the suicide rate of teenagers. Although some effects were discovered, attempts to replicate their findings were not successful (Phillips and Carstensen, 1986). Other research by Shaffer and his colleagues (1990) examining the effects of suicide prevention programs in high schools indicated these programs were not successful in achieving their professional goals. Specifically, the programs failed to change adolescents' attitudes or to encourage suicidal adolescents to seek help. ### Myth 5: Adolescent Thought is Childlike Lawmakers, as well as many others, have had difficulty in deciding at what age the adolescent is capable of adult thinking (Offer, 1987). Although in the past researchers have characterized the thinking of adolescents as similar to that of children, current research and theory does not support this contention. Indeed, recent findings suggest that adolescence is characterized by the emergence of new mental capabilities that allow the adolescent to consider possibilities and alternatives (Keating, 1990). According to Jean Piaget, adolescence is characterized as a period when formal operations emerge, a time when the person is able to generate hypotheses and possible solutions (Inhelder and Piaget, 1958). Beside influencing adolescents' perceptions in the cognitive realm, these changes in mental capabilities have repercussions for adolescents' perceptions in the social realm. That is, adolescents' ability to think more abstractly, to consider possibilities, and to hypothesize in matters of scientific problems or physical objects also allows them to use more sophisticated thinking about their social world. ### Myth 6: Adolescents are Less Emotionally Mature While many theories portray adolescents as highly emotional, research suggests that there is no significant change in emotionality between adolescence and preadolescence. Further, studies show that adolescents are able to manage and control their emotions efficiently. Social cognition refers to the processes by which persons learn and interpret their social world and apply cognitive skills to social situations (Flavell, 1981, 1985; Kohlberg, 1969, 1976; Lapsley, 1990). The theory of social cognitive development supplies researchers with a theoretical framework with which to answer questions regarding adolescents' growing ability to understand how others feel and think about one another's behavior as well as how the adolescent conceptualizes other people's thinking. The capability to use recursive thinking is said to emerge during adolescence, such as "He thinks that I think that she wants..." (Santrock, 1990, p. 148). Cognitive developmental theory also has implications for adolescents' conceptions of emotional disturbance. Previous research has found that as children become older they gain increasing sophistication in their ability to understand both the internal and external factors that impinge on mental illness (Coie and Pennington, 1976; Dollinger et al., 1980; Kalter and Marsden, 1977; Kazdin et al., 1984; Marsden and Kalter, 1976; Whiteman, 1967). These earlier investigations indicate that the ability to think in more complex and abstract ways about aspects of mental illness increases with advancing age in late childhood and early adolescence (Coie and Pennington, 1976; Messenger and McGuire, 1981). Undoubtedly, this growing complexity in their conceptions about mental illness would have an influence on adolescents' willingness to participate in treatment. That is, Piaget's theory of cognitive development also would suggest that adolescents might be more capable of the kind of hypothetical-deductive reasoning necessary for reflecting about possible courses of action for seeking help. In addition, these more sophisticated cognitive abilities would allow the adolescent the opportunity to benefit from psychotherapeutic interventions. It should be noted, however, that these growing cognitive abilities have been hypothesized to contribute to depression and social withdrawal of adolescents with disabilities (Elkind, 1985). Elkind posits that these new mental constructions give the adolescent the ability "to reconstruct their childhood and to see it in a very different light from the way they perceived as children" (p. 84). Elkind suggests these new capabilities can exacerbate existing disabilities. For example, an adolescent who had experienced the death of a parent as a young child may not have really experienced the death because children do not perceive death as the cessation of life. In adolescence, however, as a result of his or her new cognitive abilities, the adolescent experiences the death and may begin to think about all the possibilities of "what might have been" if the parent had lived. Gender differences with regard to social cognitive ability exist in adolescence. For example, it appears that emotionally disturbed adolescent girls score higher on measures assessing different aspects of social cognitive ability, such as moral reasoning (Schonert, 1992) and ego development (Paget et al., 1990). Other research has indicated that females, in general, score higher in domains theoretically related to social cognitive ability, such as empathy (Hoffman, 1977), altruism (Krebs, 1975), and the decoding of visual and auditory cues (Hall, 1978). Thus, adolescent girls might be more able than adolescent boys to benefit from the more traditional insight-oriented treatment approaches. ## Problems and Help-Seeking Behaviors of Adolescents Many of the aforementioned myths regarding adolescence continue to prevail (Offer et al., 1981). For example, mental health professionals, pediatricians, as well as adults in general, continue to believe that adolescence is a time of "storm and stress" (Hechinger and Hechinger, 1963; Offer et al., 1981; Swedo and Offer, 1989). It is particularly unfortunate that many of these beliefs about adolescents have endured for so long because they have undoubtedly hindered the progress of research on adolescent disturbance and coping. That is, believing the typical adolescent is in constant turmoil, many clinicians and researchers have overlooked the study of adolescent psychopathology. Although considerable evidence in the literature has now accumulated suggesting that the vast majority of adolescents have positive feelings toward their parents (Douvan and Adelson, 1966; Mitchell, 1980; Offer, 1969; Offer and Offer, 1975; Offer et al., 1981, 1984) and, in fact, adopt beliefs compatible with those of their parents (Bealer et al., 1971; Elkin and Westley, 1955; Kandel and Lesser, 1972; Steinberg, 1990; Thurnher et al., 1974; Yankelovich and Clark, 1974; Youniss and Smollar, 1985), there still remains the finding that approximately 20% of adolescents in the population have mental health problems and need help. Scarce research exists, however, that has examined adolescent disturbance and help-seeking behaviors. A review of some recent research findings regarding adolescent disturbance and help-seeking is presented to provide a flavor of work on adolescent psychopathology. Specifically, recent research addressing prevalence rates of disturbance in adolescence, gender differences in rates of disturbance, adolescents' self-reported problems, and adolescent assessment issues are reviewed and discussed. Finally, a brief review of studies examining the help-seeking behaviors of adolescents is put forth. ### Prevalence Rates of Disturbance during Adolescence Although there is a burgeoning literature on the prevalence rates of emotional disturbance among the general population of adults (e.g., Myers, et al., 1984), relatively few researchers have systematically examined the frequency or character of emotional disturbance in the general population of adolescents. The dearth of reliable estimates of frequency and severity of emotional disturbance during adolescence is particularly unfortunate when so many disturbed adolescents may go unnoticed. Existing epidemiological research suggests that approximately one in five or 20% of adolescents in the general population have mental health problems (Bernstein et al., unpublished manuscript; Bird et al., 1988; Bjornesson, 1974; Esser et al., 1990; Graham and Rutter, 1973; Kashani et al., 1987; Krupinski et al., 1967; McGee et al., 1990; Offord et al., 1986, 1987; Rutter et al., 1976; Weyerer et al., 1988; Whitaker et al., 1990). Studies of adults show a mental disorder prevalence rate that is almost identical to that shown by adolescents (e.g., Burnam et al., 1987; Klerman and Weissman, 1984; Uhlenhuth et al., 1983). Until recently, many of the epidemiological studies of adolescent disturbance have been carried out in countries other than the United States. Research conducted by Rutter et al. (1976), for example, indicated that the prevalence of psychiatric disorder among 14 and 15 year olds was 13% when only parent interviews were taken into account and increased to 21% based on interviews with the adolescents themselves (Graham and Rutter, 1973; Rutter et al., 1976). The findings from other epidemiological investigations examining rates of disturbance among children and adolescents conducted outside of the United States are in agreement with findings of Rutter et al. (1976) suggesting a prevalence rate of disturbance in adolescence to be about 20% (e.g., Bird et al., 1988; Bjornesson, 1974; Esser et al., 1990; Krupinski et al., 1967; McGee et al., 1990; Offord et al., 1987; Weyerer et al., 1988). Although in the United States relatively few studies have attempted to ascertain the prevalence of emotional disturbance among adolescents, findings are in agreement with those of studies conducted in other countries. For example, Kashani et al. (1987) examined the prevalence of psychiatric disorders in a school-based sample of adolescents in Columbia, Missouri and found a prevalence rate of disturbance to be 18.7%. Whitaker et al. (1990), examined a countywide population of adolescents aged 14 to 17 years and found an overall prevalence rate of 17.9% in New York, and Bernstein et al. (1990), also in New York, found that 17.0% of their adolescent sample qualified for an DSM-III Axis II diagnosis. Brandenburg, Friedman, and Silver (1990) reviewed the recent prevalence findings from eight epidemiological investigations of childhood psychiatric disorders conducted in five Western developed nations during the last decade. Although adolescence was not included as a separate age grouping for the review, Brandenburg et al. report the prevalence estimates from several of the studies that examined children and adolescents. (Several of these studies have been presented in the current review because they included adolescents in their sample [i.e., Bird et al., 1988; Cohen et al., 1987. Kashani et al., 1987; Offord et al., 1987; Verhulst et al., 1990]. Those studies reviewed by Brandenburg et al. that reported only prevalence estimates on children younger than 12 years old have been excluded from the present review.) Based on their review of these recent investigations, the authors conclude that the overall prevalence estimates of disturbance range from 14% to 20% for children aged 4 to 19 years and go on to mention that it is important for future researchers to report age-specific prevalence estimates because of the importance of age in estimating the prevalence of most chronic diseases. Despite the agreement among research findings regarding prevalence rates of adolescent disturbance, several methodological problems exist in these investigations that limit their generalizability to a wide population of adolescents. One salient limitation evident in many studies is that very few investigators have distinguished rates of mental illness of children from those of adolescents. For example, findings of Offord et al. (1987) suggest an increase in rate of disturbance from childhood to adolescence and, consequently, underline the importance of signifying adolescents as a separate and unique group with which to conduct psychiatric investigations. Examining prevalence of disturbance in children and adolescents aged 4 to 16 years, Offord et al. found a rate of 15.8% in the 4 to 11 year old group and a rate of disturbance of 20.2% in the 12 to 16 year old group. In addition, the rate of disturbance was related to both age and gender. For children ranging in age from 4 to 11 years, the rate of disorders was higher for boys than for girls (19.5% versus 13.5%). This pattern reversed for the 12 to 16 year olds and indicated a greater preponderance of disturbance among the girls in comparison with the boys (21.8% versus 18.8%). It is important to note that this change in rate of disorder for the genders would have been obscured if Offord et al. (1987) had not separated the younger group from the adolescents. A second limitation of the research available on prevalence rates of disturbance during adolescence is that the majority of studies have been carried out on school-based samples and therefore cannot be generalized to adolescents not in school. This second limitation most likely leads to an underestimate in the prevalence rates of adolescent psychopathology because it excludes adolescents who, because they are emotionally disturbed or delinquent, drop out of school. Third, with a few exceptions (Bird et al., 1988; Langner et al., 1976), the adolescents in the previous prevalence rate studies were non-Hispanic whites. Whether the findings from these studies are applicable to adolescents from other racial and ethnic backgrounds is unknown. This is a problem that exists in much of the available research on adolescence (Petersen and Epstein, 1991). Finally, different measures as well as different methods were employed in the matter of case definition, diagnostic criteria, and classification of data. As pointed out by Brandenburg et al. (1990): "Those investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples" (p. 76). To be addressed, however, is the assessment procedures that are most appropriate for adolescents. ### Gender Differences in Rates of Disturbance in Adolescence The research findings of Offord et al. (1987) suggest it is important to examine gender differences in addition to examining age differences when investigating prevalence rates of disturbance during adolescence. Indeed, previous research suggests that the many changes occurring during adolescence are accompanied by changes in the distribution of disturbance between the genders (Petersen et al., 1991). Before adolescence, girls are mentally healthier, whereas after adolescence, an opposite pattern emerges. These changes in the prevalence of mental illness between the genders may be linked to the increase in the prevalence of depression that occurs from childhood to adolescence (e.g., Rutter, 1989). Although it appears that in childhood there is an equal distribution of depression between the genders (Fleming et al., 1989; Kashani et al., 1983; Velez et al., 1989), in adolescence a preponderance of adolescent girls is diagnosed with depression (e.g., Garrison et al., 1990; Kandel and Davies, 1982; Petersen et al., 1991; Reinherz et al., 1989; Rutter, 1986). The research studies indicating a higher incidence of depression among adolescent girls are in accord with the research findings on adult depression indicating that depression is more prevalent in adult women than in men (Weissman and Klerman, 1979). ### Self-Reported Problems and Concerns of Adolescents: Differences between Adolescent Boys and Girls Because of the gender differences that exist with regard to adolescent disturbance, researchers have begun to more specifically examine differences in the self-reported problems of adolescent boys and girls. Several studies have been conducted to obtain much-needed information about the concerns and problems of adolescents to design and implement specific interventions to meet the needs of adolescents. For example, Sternlieb and Munan (1972) conducted a study assessing 1,408 adolescents' (ages 15 to 21) perceptions of their own health and personal problems. Findings revealed that females indicated greater concerns for problems than did males in the areas of nervousness, headaches, and sexual relationships. Males expressed more concerns than did females on issues relating to acne, adaptation to work, and drug and alcohol problems. As might be expected from the above findings, when these same adolescents were queried about their interests in obtaining information regarding a number of health-related topics, girls more frequently indicated an interest in obtaining information about birth control whereas boys indicated a greater interest in obtaining information about dealing with drugs, venereal disease, and alcohol. Health appears to be more of a concern to adolescent females than to adolescent males. More females than males perceive themselves as vulnerable to illness and express concerns about their health and about becoming sick (Radius et al., 1980). Adolescent boys, however, (particularly those 16 years old and older) describe themselves as frequently doing things that are not good for their health. Adolescent girls more frequently report physical problems than do adolescent boys. For example, Dubow et al. (1990) reported that girls were significantly more likely to report headaches, frequent colds and coughs, fatigue, stomach aches, muscle and bone aches, nail biting, visual problems, chest pains, dizziness, sleeping problems, and vomiting than were adolescent boys. In addition, these researchers found that adolescent girls predominated with regard to psychological problems such as moodiness, anxiety, irritability, depression, loss of appetite, and suicidal ideation. Research has suggested that adolescent girls are more likely than are adolescent boys to associate emotional problems with poor health. Alexander (1989), in a study examining gender differences in adolescent health concerns found that whereas emotional and social concerns were associated with poorer perceived health among 13-year-old girls, physical concerns were associated with poor health for same aged boys. Further, Alexander found that girls health concerns were related to body image and social relationships. This relationship between somatic complaints and psychological well-being among adolescent females has been found by others. For example, Garrick et al., (1988) found that adolescent girls with many physical complaints displayed specific disturbance in their psychological functioning. This was not the case for adolescent boys. It appears that adolescent boys and adolescent girls have different concerns in general that, in turn, relate to their psychological health. Adolescent girls express more frequent concerns than do adolescent boys on areas relating to personal appearance (e.g., weight), relationships with parents, emotional stress, and sex-related problems (House et al., 1979). In contrast, adolescent boys express more frequent concerns than do girls on problems relating to substance abuse. Research findings from studies carried out by Feldman et al. (1986) and Marks et al. (1983) are in agreement with these findings indicating that adolescent girls are concerned about being overweight, feeling depressed, and having nervous and emotional problems whereas adolescent boys are more concerned about drug and alcohol abuse. Body image and weight appear to be frequent concerns of adolescent girls. Dubow et al. (1990) found that adolescent girls report more distress on issues relating to weight. Specifically, these researchers found that although only 16% of the adolescent boys indicated they were concerned about feeling overweight, over half (53%) the adolescent girls reported such. Casper and Offer (1990) found similar results indicating that female adolescents are preoccupied with weight and dieting as opposed to male adolescents and go on to suggest that the fairly common thoughts and concerns about weight and dieting among adolescent girls are reflective of society's greater emphasis on thinness for women. Casper and Offer (1990), however, note that both adolescent girls and boys who possess substantial either weight or dieting concerns are most likely manifesting psychological problems. In addition to concerns about weight, other researchers have found that adolescent girls are more likely than boys to report concerns relating to grades and future schooling (Eme et al., 1979). As can be surmised from the above review, a number of differences exist regarding the perceived problems of adolescent males and females. On the one hand, troubled adolescent boys are likely to express their disturbance through acting-out behavior, such as substance abuse. On the other hand, adolescent girls express their disturbance through inwardly turned symptomatology, such as somatic complaints. These differences should be taken into account when devising programs and determining whether gender-specific interventions are required. ### Assessment Issues Three major assessment methods have been used to assess symptomatology and disturbance in adolescents. These include the clinical interview, the reports of teachers and parents, and the self-report of the adolescent. Currently, it appears that a self-report of the adolescent is necessary to obtain a "complete picture" of symptomatology. Although problems with recall and accuracy may arise when relying on the report of the adolescent, relying on the adolescent's self-report has a number of advantages. First, the report is from the adolescent's perspective. Second, there is lower cost because of not having to collect data from multiple sources. Finally, researchers have