LS CH 10 Puberty and Adolescence PDF

7589_Ch10_149-166 30/08/17 11:54 AM Page 149 10 CHAPTER Puberty and Adolescence Key Words Chapter Outline adenohypophysis adolescence ambivalence anorexia nervosa apocrine glands bulimia depression ejaculation emotions estrogen gonads larynx menarche ova ovaries penis preadolescence primary sex...

7589_Ch10_149-166 30/08/17 11:54 AM Page 149 10 CHAPTER Puberty and Adolescence Key Words Chapter Outline adenohypophysis adolescence ambivalence anorexia nervosa apocrine glands bulimia depression ejaculation emotions estrogen gonads larynx menarche ova ovaries penis preadolescence primary sex characteristics progesterone puberty scrotum secondary sex characteristics sexually transmitted diseases sperm testes testosterone Physical Characteristics Puberty Height and Weight Development of Sex Characteristics Adolescence Height and Weight Muscle and Bone Development Development of Other Body Systems Vital Signs Developmental Milestones Motor Development Sexual Development Sexually Transmitted Diseases Teen Pregnancy Rape Psychosocial Development Puberty Adolescence Discipline Cognitive Development Moral Development Communication Nutrition Sleep and Rest Exercise and Leisure Safety Health Promotion Depression Substance Abuse Summary Critical Thinking Multiple-Choice Questions Learning Objectives A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: • • • • • • • • List four physical changes occurring in puberty. List four physical characteristics of adolescence. Describe three developmental milestones of the adolescent period. Describe the primary psychosocial task of adolescence as identified by Erikson. Describe the cognitive level of functioning during the teenage period of development. State how teens develop moral reasoning. List three factors that help to promote wellness in the teen. Describe three special concerns that may adversely affect adolescent health. 149 7589_Ch10_149-166 30/08/17 11:54 AM Page 150 150 Journey Across the Life Span The period known as puberty, or preadolescence, is a time of rapid growth normally commencing between ages 11 and 14 and taking an average of 2 years to complete. It is marked by the development of secondary sex characteristics. Puberty ends (and adolescence begins) with the onset of menses, or menarche, in girls and the production of sperm in boys. The growth patterns affecting the onset of puberty are influenced by factors that include heredity, climate, nutrition, gender, and socioeconomic status (Fig. 10.1). Four major changes associated with the pubescent period are as follows: 1. Rapid physical growth 2. Changes in body proportions 3. Development of primary sex characteristics (sex organs) 4. Development of secondary sex characteristics This phase of life witnesses major physical changes and opportunities for success in school, in relationships, and in life. Parents need to understand what children are feeling and struggling with developmentally. Understanding what is normal during this time is reassuring and empowering. Common frustrations include: • Wishing for independence while needing supervision at home and in school • Being concerned about appearance while undergoing major body changes FIGURE 10.1 The age of puberty varies with each individual. • Seeking peer acceptance while feeling anxious about or frustrated by those same peers • Struggling to achieve in school while accepting an increasing workload and more responsibility • Fluctuating between adultlike behavior and childlike impulses • Maintaining a demanding physical and social schedule while needing increased amounts of rest and sleep The term adolescence is from Latin and means “to grow and mature.” It refers to a transitional period that begins with sexual maturity and ends with cessation of growth and the movement toward emotional maturity. This period of development bridges the gap between dependence and independence, or childhood and adulthood. Adolescents need to accomplish the tasks that help prepare them for adulthood. The major characteristics of adolescence include: • • • • • Stormy emotions Feelings of insecurity Introspection Experimentation and learning Testing of values and beliefs PHYSICAL CHARACTERISTICS Puberty Height and Weight Puberty is second to the prenatal period as the phase of most rapid growth. This growth spurt occurs in girls earlier than in boys. The feet are usually the first part of the body that shows the effects of the growth spurt, followed by the legs and trunk. Height increases 20% to 25%. Boys grow 4 to 12 inches (10 to 30 cm) and girls grow 2 to 8 inches (5 to 20 cm) during this period. Increases in weight follow increases in height. These weight changes are related to increases in fat, bone, and muscle tissue. Boys gain between 15 and 65 pounds (7 and 30 kg), and girls gain 15 to 55 pounds (7 to 25 kg). Different parts of the body grow at different rates, making the whole body seem temporarily out of proportion. The bones grow longer and change shape. The trunk begins to broaden at the hips and shoulders. Development of Sex Characteristics Primary Sex Characteristics The primary sex characteristics are the gonads, or sex glands. The gonads are present at the time of birth but remain functionally inactive until the onset 7589_Ch10_149-166 30/08/17 11:54 AM Page 151 Puberty and Adolescence of puberty. The maturation of these glands is influenced by the adenohypophysis, or anterior lobe of the pituitary gland. The pituitary gland secretes a hormone that stimulates the gonads. In boys, the male gonads, or testes, are located in a sac called the scrotum, found outside of the body. The testes produce male sex cells, or sperm, and the male sex hormone testosterone. Ejaculation, the release of sperm, indicates that the testes are functionally mature. In addition, the penis, or male sex organ, grows in length and circumference. The female gonads or sex glands are the ovaries, located in the pelvic cavity. Their primary function is to produce the female sex cells (ova, or eggs) needed for reproduction and the female sex hormones estrogen and progesterone. The onset of the menstrual flow, which is called menarche, indicates that a girl is capable of reproduction. The menstrual flow is a monthly discharge of blood, mucus, and tissue from the uterus. It lasts from puberty until menopause. The usual monthly cycle is every 21 to 24 days, with each monthly period or discharge lasting an average of 5 days. Average blood loss with each period is 30 to 60 mL. Some girls and women experience headaches, cramps, swelling, and irritability before and at the onset of their periods. The whole menstrual process is an emotionally charged event. Attitudes toward menstruation are assimilated from cultural and personal experiences. Education regarding menarche should begin during the school-age period in the home setting. Adequate preparation leads to a more positive initial experience. The primary concerns of young girls are related to hygiene, preventing clothes from getting soiled, and embarrassment. In addition, girls at this stage need to be informed about restrictions, activities, and taboos. If any questions or misconceptions about menstruation exist, they will need to be openly explored with the teen. Secondary Sex Characteristics Secondary sex characteristics play no direct role in reproduction but appear at this time. Initially, pubic hair is sparse and lightly pigmented; it then becomes darker, coarse, and curly. In boys, axillary and facial hair appear after the pubic hair growth. Boys’ skin thickens, and hair appears on the arms, legs, shoulders, and chest. In boys, the larynx, or voice box, and the vocal cords increase in size, resulting in deepening of the voice. Changes in the distribution of fat and an increase in the width and roundness of the hip and pelvic bones are secondary sex characteristics occurring in girls. Breast development in girls follows an orderly sequence, resulting in the increase of fatty tissue and the maturation of the mammary glands. Hair also appears in the groin and the axillae. In both boys and girls, the sebaceous glands produce oil and become larger and more active. This increased activity may be related to the appearance of acne (pimples) seen in many adolescents at this time. The apocrine glands (sweat glands) in the armpits and groin become larger, producing a characteristic odorous secretion. See Table 10.1 for an overview of the physical and sexual developments of puberty. Adolescence Height and Weight The rate of physical growth slows down after puberty. In girls, growth in height ceases between 16 and 17 years of age. Boys continue to grow in height up to 18 to 20 years of age. During adolescence body proportions are similar to those of the adult. Muscle and Bone Development Muscle strength and endurance increase, as does muscle size. Some adolescents complain of muscle T A B L E 10.1 N or m al Pu b er t y an d A d ol escent Dev elo pment Boys Girls 11–12 years: growth of the testes, scrotum, and penis; appearance of pubic hair 10–11 years: rapid growth spurt, breast development, appearance of pubic hair 12–13 years: rapid growth spurt 11–14 years: first menstrual period 13–15 years: growth of underarm, body, and facial hair 12–13 years: appearance of underarm hair 13–14 years: ejaculation 14–15 years: deepening of voice 151 7589_Ch10_149-166 30/08/17 11:54 AM Page 152 152 Journey Across the Life Span soreness and fatigue with increased activity. Adolescents may at first be awkward as a result of the patterns of muscle growth. But by the end of this stage, they should have good muscle development and coordination. Motor capabilities improve with practice and training. Posture may be poor, evidenced by slouching. This may be further complicated by a common condition causing lateral curvature of the spine, known as scoliosis. As discussed in Chapter 9, this is more commonly seen in girls than in boys. Development of Other Body Systems The weight and volume of the lungs increase, causing a slowing down in the respiratory rate and an improvement in lung performance. Exercise helps to improve both cardiac and respiratory function. The stomach and intestines increase in size and capacity. Adolescents have increased appetites and therefore require an increase in their daily food intake. Adequate food intake helps to meet the demands of their bodies. A common observation in adolescents is that they are always hungry and can consume enormous amounts of food at one time. The typical teenager will devour groceries as soon as they are taken out of the shopping bags. At about 13 years of age, teens gain their second molars, and between 14 and 25 years their third molars, or wisdom teeth, appear. The jaw reaches adult size toward the end of adolescence. VITAL SIGNS Normal pulse range for this developmental stage is between 60 and 90 beats per minute. The respiratory rate of an adolescent is about the same as that of an adult. The normal respiratory rate for adolescents should be 16 to 24 breaths per minute. Exercise produces an improved physiological response. The changes in the circulatory system include an increase H E L P F U L H I N T S Concerns During Puberty • Your child appears too thin. • Your child exhibits sudden outbursts of anger. • Your child seems preoccupied with family problems. • Your child’s grades are not at the expected level of performance. • Your child avoids peer interactions. in the size of the heart and in the thickness of the walls of the blood vessels. These changes result in improved pumping ability of the heart. There is also an increase in blood volume. In boys, greater force is needed to help distribute blood to their larger body mass. This force, in turn, causes an increase in blood pressure. DEVELOPMENTAL MILESTONES Motor Development In the beginning of the adolescent stage, teens exhibit some clumsiness as a result of their rapid physical growth. The adolescent’s motor functions are comparable to those of the adult. Eye–hand coordination is markedly improved, allowing for good manual dexterity. Sexual Development At first, many teens gravitate toward individuals of the same sex and ridicule those of the opposite sex. As their bodies undergo the physical changes of puberty, they suffer from heightened emotions, increased worries, and lack of self-confidence (Table 10.2). They are sensitive about the sizes of their body parts and readily compare themselves to their peers. Many girls are preoccupied with the size of their breasts, and many boys are concerned about the size of their penises. These concerns continue into adolescence. From the time of sexual maturity, the teen can be sexually aroused to orgasm through self-stimulation. Masturbation is a normal part of sexual expression and has no harmful effects, but masturbation can result in feelings of anxiety and guilt if the adolescent is led to believe that it is shameful or unhealthy. Parents should respect adolescents’ needs for privacy and knock before entering their rooms. The extent and age of onset of sexual activity varies from individual to individual. Recent surveys indicate that sexual activity begins early in this country; some children are sexually active at age 10 or 11. Typical sexual behavior in the early dating period includes kissing, necking, and petting. Many teens engage in sexual intercourse. Studies indicate that girls sometimes become sexually active because of pressure or coercion and that the first sexual encounter may be a great disappointment. Boys may also become sexually active because it is expected of them. 7589_Ch10_149-166 30/08/17 11:54 AM Page 153 Puberty and Adolescence 153 T A B L E 10.2 T een ag er s ’ C on c er n s A b ou t Their Chang ing B o d ies Boys Girls Penis size. Most boys compare penis size with that of peers. Average length is 5–7 inches (12–17 cm) when erect. Breasts may not be exactly symmetrical. Size varies. Choose a well-fitting bra. Embarrassing erections may occur at any time. Try to think of something else to help it subside. Menstruation usually begins between 11 and 14 years of age, lasts about 5 days, and occurs every 28 days on average. Morning erections commonly occur during dreaming. Menstrual discomfort can often be relieved by using heat, taking Advil or Tylenol, and moderating your activity level. Wet dreams, or ejaculation while sleeping, may occur during dreaming. Pregnancy becomes possible with onset of menstruation. Voice changes occur as the voice box enlarges, causing the voice to gradually deepen. Hygiene is important especially during menstruation. Regularly bathe or shower. Perspiration increases because the apocrine sweat glands are highly active. Wash daily and use a deodorant. Concerns are the same. Acne and skin blemishes are more common. Cleanse daily. Topical skin-colored creams may help cover small blemishes. Concerns are the same. Sexual activity is given high priority at this time in adolescents’ lives. Girls traditionally set the limits on sexual interactions. A great deal of pressure to conform to the group’s behavioral standards exists. Sexual uncertainties and confusion often arise; many teens give in to peer pressure or lie to their friends about their sexual adventures. By conforming, the individual may find group acceptance. Successful resolution of the search for identity is necessary during the teen years for the young person to find emotional sharing and intimacy. Research indicates that teenagers acquire most of their information about sex from their peers rather than from more authoritative sources. This may result in transmission of incorrect information. Youngsters should receive sex education before they become teenagers. Young people need to be well informed about reproduction, their bodies, and the responsibilities of sexual behavior. Good sex education, which should include explicit information about the prevention of sexually transmitted diseases (STDs) and unwanted pregnancy, enables adolescents to make responsible choices about their own sexuality. Sexually Transmitted Diseases The incidence of STDs is increasing in this population. The best means of prevention is information. Every teenager should be taught safe sex practices, whether they choose to be sexually active or not. STDs include chlamydia, trichomoniasis, herpes genitalis, gonorrhea, syphilis, and AIDS. Each of these diseases has its own cause, signs and symptoms, and plan of treatment, but all are spread through vaginal, oral, and rectal intercourse. Table 10.3 summarizes information on STDs. Teen Pregnancy Teen pregnancy is both an individual and a social concern. The pregnant adolescent has twice the mortality rate of a nonadolescent pregnant woman. This increase in mortality is related to the fact that the adolescent is still herself growing and will compete with the developing fetus for the needed nutrients. Expected weight gain and the need for additional nutrients should be calculated on an individual basis. Teen pregnancy carries increased risks of complications for both mother and baby. Early recognition and medical supervision may help promote a more 7589_Ch10_149-166 30/08/17 11:54 AM Page 154 154 Journey Across the Life Span T A B L E 10.3 S e xu al l y T r an s m i t t ed Di s eas es Name Symptoms Chlamydia May be asymptomatic or may cause a yellowish vaginal discharge, painful or difficult urination, and spotting between menses or after intercourse; may spread to other pelvic organs Trichomoniasis Usually causes thin, frothy, yellow–green vaginal discharge; vaginal itching, tenderness; redness; painful urination and intercourse Herpes genitalis Usually causes genital blisters, pain, swollen glands, vaginal discharge and itching Gonorrhea May be asymptomatic or may cause a purulent yellow–green vaginal discharge; may cause painful urination and intercourse Syphilis Causes painless ulcer (chancre) on genitals, lips, or anus in early stage AIDS Causes lethargy, weight loss, skin lesions, and fungal infections positive outcome. Although teenagers may be physically mature, they may not yet be emotionally mature enough to handle parenthood. Pregnancy and parenthood during the teen years interrupt plans, education, and usual activities. Young teenagers who become pregnant may need additional counseling and time to choose between the various options of abortion, adoption, or parenting. Their decisions may have a serious impact on them for the rest of their lives. Rape Adolescent rape appears to be on the increase, and a large number of offenders are themselves adolescents. The exact number of rape cases is not clear because young women are the least likely to report these crimes. Not only are teens at risk for rape by strangers, but they also are at risk for date rape. Education for both male and female teens helps dispel myths about rape and provides preventive strategies. T A B L E 10.4 Teenag e B ehav io ral Issues Behavior Advice for Parents Rebelliousness, argumentativeness, or rudeness Overlook what you can. Avoid confrontation. Be as tolerant as possible. Avoid seeing behavior as a rejection of parental love. Need for privacy Make certain that teen has own space. Understand teen’s selfconscious behavior. Accept individual’s need for some privacy. Offer help, but step back if rejected. Keep lines of communication open. Dishonesty Avoid overreaction. Reinforce reality. Maintain consistent principles. Responsibility Listen attentively. Expect maturity to be uneven. Encourage decision making and acceptance of responsibility. Set reasonable rules. Curfews Allow for unexpected delays. Encourage frequent phone contact. Psychosocial Development Psychosocial development is rapid throughout puberty and adolescence. Table 10.4 reviews teenage behavioral issues and offers tips on how parents can deal with them. Puberty Several general behavioral characteristics are common during puberty. Individuals enter this stage happy and slowly become negative in their attitudes and interactions. The basis for some of this negativity is growing self-consciousness. This self-doubt 7589_Ch10_149-166 30/08/17 11:54 AM Page 155 Puberty and Adolescence T A B L E 10.4 Behavior Teenage Behavioral Issues—cont’d Advice for Parents Set good examples for teen. Allow social life to center around the home. Friends Accept friends without criticism. Try to get to know friends. Avoid showing disapproval. and worry are related to their changing bodies. Much of the behavior is influenced by an overall negative outlook. Youth at this age tend to spend more time by themselves and in their rooms than they did at earlier ages. Many move away from their earlier friendships and need to find their places in new group settings. Until this happens, they may be isolated and alone. Social antagonism is demonstrated best by their interactions with family, peers, and society. In the family setting preadolescents are argumentative with their parents and jealous of their siblings. Their desire for independence becomes the root of conflict with authority figures. They resent supervision and directions, viewing both as signs of their weakness and helplessness. This antagonism may extend into heterosexual interactions. Family relationships change dramatically during this stage of development. These changes produce turmoil and conflict. In the struggle for independence, the teen wishes to be free of restrictions and parental control. Chores, curfews, dating, telephone use, money, driving, schoolwork, and friendships are some of the issues that spark disagreements between parent and child. Parents want teens to listen and conform to their regulations. Teens complain about not feeling trusted. A common cry is, “Why can’t I go or do like everyone else can?” Teens are often argumentative and critical of their parents’ ways. Some teens withdraw and confide less in their parents, leaving the parents feeling shunned and removed. Teens often act as though they are embarrassed to be seen with their parents. Adolescence Erikson described the primary psychosocial task for adolescents as the search for identity. The individual must answer the question, “Who am I?” Identity begins with a separation of the individual from the family. As adolescents begin to separate, they start H E L P F U L 155 H I N T S Living With a Teenager • Allow teens to have privacy. Provide them with a room of their own whenever possible. • Recognize that teens are self-conscious and sensitive about their changing bodies. • Don’t expect to know everything about their thoughts and feelings because they may choose not to discuss everything with you. • Keep the lines of communication open despite their demands that you leave them alone. • Try not to be too critical. Listen carefully. • Recognize and praise their accomplishments. • Show interest in their activities. • Encourage them to bring their friends home. • Set reasonable limits. • Avoid arguments. Exercise compromise. to explore and then incorporate ideals and values that will become part of their own self-concepts. Before they can accomplish this fully, they test out and question these values and beliefs, comparing them to the beliefs of outsiders. Confusion, depression, and discouragement often accompany this period. Marked fluctuations appear in adolescents’ moods, ranging from low self-esteem to feelings of grandiosity. They are more likely to experience increased physical symptoms at this time. This is a difficult time for both adolescents and their families because teens tend to blame their parents for most of their problems. The movement away from the family expresses the teen’s need for freedom and independence. Complicating this need is their continuing desire for parental love, support, and guidance. These conflicting needs for independence and dependence create what is known as ambivalent feelings. Ambivalence is having two opposing feelings about the same person or object. Adolescents are truly ambivalent about many issues: loving and hating their families, wanting freedom and needing supervision, wanting to be part of a group of peers and wishing to be left alone. Besides feeling ambivalence, teens experience many different, sometimes conflicting emotions. Emotions are the expressed feelings that influence a person’s behavior. The charged emotions characteristic of this period are caused by both the physical and hormonal changes that are occurring. The increased social pressures placed on this age group further heighten adolescents’ emotional responses. Boredom is common during this development period. Individuals 7589_Ch10_149-166 30/08/17 11:54 AM Page 156 156 Journey Across the Life Span give up earlier forms of play activities, fearing that they represent babylike behavior. Daydreaming and fantasizing may occupy a great deal of their time alone. A sense of humor is generally present but often used at the expense of others. Name calling and teasing peers and others seem to give adolescents a sense of satisfaction. Although they are likely to tease others, they are usually not able to handle teasing that is directed toward them. Emotions cover a wide range of expressed feelings. Some commonly expressed emotions are anger, fear, worry, jealousy, envy, and happiness. Anger can be very disruptive and destructive to relationships. It is often expressed when teens are denied privileges. They angrily complain that they “are being treated like children.” Anger can also result when they are teased, criticized, or lectured. The manner in which they express anger varies from individual to individual. They may sulk, withdraw, or have an angry outburst. Fears may be imaginary or real and are usually related to social situations or inner feelings of inadequacy. Worries stem from issues related to school performance, vocational choices, relationships, appearance, and group acceptance. Jealousy may arise in their relationships, whereas envy is mainly related to social status and material possessions. Happiness occurs when the individual succeeds and feels at ease. Many teens find part-time employment. Work has many benefits for this age group. Work helps the individual develop knowledge and skills that can be applied in adult life. Work gives the adolescent a sense of belonging in the adult world. Furthermore, work teaches responsibility and provides a source of income. This teaches money management and principles of saving. Ages 13 to 14 Years Young teenagers may hide their feelings from others and sulk instead of opening up and discussing what is bothering them. They become openly more negative and hostile. Issues are seen mostly from their own points of view. This narrow perspective creates an attitude of intolerance toward others. Compromise is something that 14-year-old children find hard to do. Friends are very important at this time, with teenagers identifying more with their friends than with their families. Boys tend to have small groups of friends, whereas girls usually have one or two best friends. Friendships create a much needed sense of belonging. Experimentation with clothing and hairstyles begins at this time. Door slamming and harsh verbal outbursts are typical ways in which a 14-year-old teenager deals with stress. Sense of humor for most teens is based on their negative outlooks. They readily insult or tease parents and siblings and may show disrespect to their teachers. Ages 15 to 16 Years By this age teenagers are less self-absorbed and better at compromising. They are now more tolerant of others’ views. They can now think more independently and make more of their own decisions. Their curiosity and interests increase, allowing them to further develop specific skills relating to math, science, music, or sports. Thinking is abstract, and they can more readily discuss and debate issues. They are likely to continue to experiment with clothing, hairstyles, and attitudes. This experimentation helps them to shape their self-image. Teens at this age often test their boundaries, pushing them to the limit. Risks are taken because they see themselves as impervious to danger. In fact, some teenagers believe that they are immortal. Socially, many teens are less shy and more adventurous. Many show an interest in traveling with clubs or other organizations. Dating begins around 15 to 16 years of age. “Crushes” are typical of the early dating period. Crushes are distinguished by strong feelings of attachment and what the individual believes to be love. These crushes usually last 1 to 6 months. Physical attraction to an individual of the opposite sex is the immediate factor that draws the teen’s attention. Dating is the major source of fun and recreation for the teenager. It helps establish social status and recognition within the peer group. It also provides the individual with personal and social growth. Teens who begin dating later than others or who are less popular often feel pressure that leads to feelings of inadequacy and rejection. Depression or a profound feeling of unworthiness may result and must be closely monitored. At first, dating may be characterized by short-lived sexual relationships. Some teens are secretive about their dating and feelings, whereas others share their innermost thoughts with their closest friends. Ages 17 to 19 Years At this point in development a sense of seriousness becomes more evident. Teens are now very involved with their own activities in school, at work, or with friends. Regardless of which activities they choose, the one common denominator is that the activity is based outside the home, keeping them away from family for longer periods of time. At 17 to 19 years, teens are idealistic. They like to work for a cause and follow the ideals they hold important and right. 7589_Ch10_149-166 30/08/17 11:54 AM Page 157 Puberty and Adolescence Stress increases for this age group, related to the many uncertainties about the future. As the stress level increases, so do temper outbursts. Difficulties continue between the teenager and parents. Usually teens believe that they know more and are more in touch with the real world than are their parents. This leads to frequent discord and disharmony. By this age many teens have established more stable sexual relationships. They may have one serious boyfriend or girlfriend with whom they spend a great deal of time. Usually at this age, teenagers focus relationships on deeper traits such as honesty, reliability, and a sense of humor. Sexual behavior varies with individuals based on earlier teachings and peer pressures. Peer relationships are very important at this stage. Peers share the same age, feelings, experiences, goals, and doubts in ways that parents can’t. Friendships tend to develop among those of similar social classes and with similar interests. Peers offer social and emotional fulfillment. Teens wish to have their peers recognized and accepted by their parents. Development of a self-concept is further influenced by teenagers comparing their own perceived appearances to those of their peers. Real or imagined differences threaten self-esteem. The significance of a slight blemish or defect will be magnified and weaken confidence. Box 10.1 offers suggestions for ways parents can promote self-esteem in their adolescent children. Socialization further develops through peer relationships. The social behavior of the adolescent changes from earlier patterns to resemble those of the social group to which he or she belongs. The influence of the group on individuals depends on the amount of shared intimacy and contact. Teens may form cliques, crowds, and gangs. An important feature of these groups is that the individual must conform to the patterns or rules B O 10.1 • • • • • • • • • X 157 determined to be socially acceptable by the group. One of the strongest needs for a teen is to feel accepted by the group members. Perceived acceptance or the lack of it will influence the teen’s behavior and attitude. Different personality traits emerge at this stage. The popular teenager feels secure, happy, and confident. The unpopular teen feels alienated, resentful, and antagonistic. The role of a leader falls to the person having the most admired qualities. Many demands are placed on adolescents at this stage of development. Society expects them to select vocations and think seriously about their futures. Impending graduation from high school causes teens to wonder if they should continue with their schooling or begin jobs (Fig. 10.2). This question is of great magnitude for teenagers, who are often unable to simply decide what to wear in the morning or whether to go out on a date or with a group of friends. Those who are unable to select a career may develop fear and self-doubt. Other demands placed on this age group include development of a value system and demonstration of socially responsible behavior. At the end of this stage the individual should have moved toward becoming more economically independent. Toward the end of this stage many adolescents are able to bridge the generation gap by establishing close relationships with their grandparents (Fig. 10.3). P r omot i n g P os i t i ve Sel f - Es teem i n A d ol es c en t s Be positive. Recognize achievements. Be genuinely interested. Be sensitive. Encourage self-expression. Value opinions. Avoid belittling. Show respect. Encourage decision making. FIGURE 10.2 Graduation from high school is a key event. 7589_Ch10_149-166 30/08/17 11:54 AM Page 158 158 Journey Across the Life Span Cognitive Development FIGURE 10.3 Adolescents and older adults bridge the generation gap. Discipline Discipline during adolescence is important. Many of the conflicts between parents and teens are based on choice of friends and issues surrounding dating. Different family patterns and parenting styles have different effects on the developing teenager (discussed in Chapter 3). The democratic style of parenting encourages youth to make decisions. Parents always have the right to approve or disapprove of expressed beliefs. This style of parenting best supports the child’s developing sense of self. In the autocratic style of parenting, the youth is not permitted free expression of feelings or views. Parents make decisions based on their own feelings and judgments. The teen is then expected to follow along with what the parents decide for him or her with little input from the teen. This style of discipline may hinder or slow the teen’s growth process and moral development. In the laissez-faire parenting style, the adolescent is left to decide what he or she wants or believes is best. Although most teens say that they want most to be free to decide, in this set of circumstances they feel ignored and unloved. It appears that feelings of independence and strength come easiest to adolescents whose parents listen, explain, and make clear what is expected of them. The use of “grounding” is appropriate for serious offenses by adolescents. This technique provides them with an opportunity to learn the consequences of their behavior. When a child or teenager is grounded, parents should give specific jobs or household chores to be completed within a certain time frame. Parents must evaluate and praise the completed tasks. Grounding is effective when a teen generally follows the rules and shows an understanding of the consequences of the offenses. During adolescence, maturation of the central nervous system may lead to a shift from a concrete thinking style to formal operational thought processes. Training and studies help the adolescent progress from concrete thinking to more formal ways of reasoning. However, without proper training or motivation, adolescents may not move beyond the level of concrete thinking. Formal operational thinking is conducted in a more logical manner than concrete thinking. Some scientific reasoning and problem solving can be mastered at this point. Individuals are capable of looking at all possibilities. They can think abstractly beyond the present and imagine a sequence of events that might occur and the consequences of those events (or of their actions). This operational thinking does not guarantee that a teenager will make the right choices, however. Other factors such as peer pressure, the need to be accepted by the group, or the desire to look cool often have a greater impact than reason and judgment. Adolescents are able to analyze a problem, set up a hypothesis, collect evidence, and come up with possible solutions. In addition, they are conversant on many topics. Topics that hold their interest include politics, religion, justice, and other social issues. School is at the center of teens’ development. Most of their time is spent at school or in activities related to their schooling. Social skills, friendships, and peer interactions are of utmost importance to teenagers. Currently, the law in most states requires teens to remain in school until the age of 16. Transition from middle school to high school may be both exciting and stressful for the teenager. Several factors complicate the stress of high school. Teens must come to terms with their changing appearance and developing self-image. Self-doubt may serve to complicate their ability to enter new relationships. New friends are sought out, and many new groups and clubs may be joined. In high school teens are expected to be more independent and responsible for the learning process. This places more challenges and demands on them. Instead of having only one teacher for all subjects, they now have a teacher for each subject. Many differences exist in the performances and academic achievements of today’s teenagers. Several factors may determine an individual’s success in high school, including socioeconomic background, family relationships, and peer and social pressures. Life after high school may include college near home or away, work, marriage and parenting, or some combination of these. 7589_Ch10_149-166 30/08/17 11:54 AM Page 159 Puberty and Adolescence Moral Development Cognitive development is a prerequisite for moral reasoning. Moral judgment is based on earlier learned principles of right and wrong. Parents directly and indirectly influence the moral judgments of their children. Positive listening and empathy enable families to foster moral development. Teenagers must learn to make decisions for themselves and guide their own behavior according to learned standards. Society has determined that adolescents can no longer expect adults to guide all of their decisions. During early adolescence teens are usually at the conventional level of moral development. They can follow rules and show concern for others. They express a strong wish to be trusted by their parents. Following this stage of development, they progress to the transitional phase of moral development—that is, they begin to question everything and everyone. This questioning places them in direct conflict with any person of authority, but it also helps them to gain autonomy from adults and begin to substitute and try out their own codes of ethics. Teens look at rules, see many injustices, and feel that they have the right to change these rules. They believe that they can make a difference, and they often want to get involved in social issues. They are usually ready to take a stand on what they believe. Slowly, they gain responsibility and show an understanding of duty and obligation. Adolescents are further developing their spiritual awareness. They begin to question and compare religions. They can philosophize and think logically about religious doctrines. They speculate, search, and think about conflicting ideologies. During this period of awakening, they may reject formal or traditional religious practices in favor of their own styles of practice. Some move completely away from their family practices and may gravitate toward other, less traditional ideologies. A small number of teens may gravitate toward certain groups or cults. cultures. Having their own slang creates a sense of belonging for teens and sets them apart from others. The lives of today’s adolescents revolve around the use of media and technology. Cell phones, tablets, computers, and the Web are part of every aspect of their lives, and the amount of time adolescents spend using technology has increased in the last decade (Fig. 10.4). Technology can be a powerful educational tool, expanding knowledge and bringing education to their fingertips. However, technology can also be used as a powerful social tool for adolescents. Teens are now multitasking: watching TV, texting, or using cell phones while eating, driving, or doing other tasks. The use of cell phones while driving has increased the number of motor vehicle accidents and deaths. Television has a great impact on individuals, and its highly persuasive effect can be educational or potentially detrimental depending upon the program and amount of viewing. Other interests include social platforms like Facebook, messaging, chat rooms, Twitter, and photo streaming. These are just a few of the technological media forms popular with today’s teenager. Parents must be aware of their teen’s use of all technology and social media. The sites should be carefully monitored for appropriateness, and time spent using this technology should be closely monitored. NUTRITION Because of the rapid growth that occurs during the adolescent period, teens need an increase in calories, protein, minerals, and vitamins. The average caloric need for teenage girls is 2,600 calories per day; for teenage boys it is 3,600 calories per day. These Communication Language skills and vocabulary increase during adolescence. Verbal communication is the means by which adolescents make their thoughts and beliefs known. They verbally argue or defend their ideas. Adults need to encourage their free expression and should listen to and exchange opinions with them. This give-and-take type of relationship helps to foster a teen’s growth and sense of self. In peer settings adolescents frequently develop a common language typical of their groups, times, and 159 FIGURE 10.4 Technology drives the teen’s activities. 7589_Ch10_149-166 30/08/17 11:54 AM Page 160 160 Journey Across the Life Span needs are easily filled because the teen’s appetite increases, allowing increased intake of food. Boys never seem to get enough food to keep them from feeling hungry. This age group also seems to enjoy food more than they did as children. The teenager’s protein intake should be between 12% and 16% of the daily dietary intake. The increased need for calcium is necessary for skeletal and muscle growth and for the increased amount of total blood volume. Iron intake must be monitored after menarche because girls at that time may be more susceptible to iron-deficiency anemia. The American Academy of Pediatrics recommends that adolescents with a family history of high cholesterol be tested and screened for high blood pressure. Dietary management may be instituted for those individuals with familial hypercholesterolemia, elevated test results, or hypertension. Eating habits are affected by time, pressures, and peer influence. Fruits and vegetables are often passed over for other favorites such as meats and potatoes. Snacks are generally chosen for their accessibility and taste with little regard for nutritional value. Some youth favor milk, and others move away from it toward carbonated drinks. Teens are likely to consume large amounts of soda or carbonated beverages. Some favor regular colas with high caffeine and sugar contents. Diet colas are not any healthier because they contain artificial sweeteners, which have been the subject of much medical controversy. Studies have shown that large consumption of sugary sodas can lead to both obesity and dental caries. In comparison to previous generations, there may be a slight increase in the number of teens who are vegetarians. Some teenagers choose a vegetarian diet for moral or health reasons; others give little reason for their decisions. The practice of vegetarianism varies greatly. Some individuals simply eliminate meat from their diets; others avoid all animal products, including dairy. Vegetarians need to include cereals, legumes, and vegetables in their daily diets. These substances are needed to provide the essential amino acids for growth and tissue repair. Dieting has become a national pastime. Hundreds of fads and quick weight-loss gimmicks are advertised. Current fashion trends may have added to the increased number of eating disorders. Anorexia nervosa, which affects a large number of adolescent girls and an increasing number of boys, is willful starvation that can result in weight loss of as much as 25% or more of a teen’s body weight. The average age for the onset of anorexia used to be 13 to 17 years; now it is 9 to 12 years. This is more than an eating disorder: it is a complex emotional disorder that requires immediate medical attention. Anorexia accounts for a large number of deaths among adolescent girls. Bulimia, another eating disorder, is characterized by a series of eating binges followed by periods of purging or self-induced vomiting. This condition also warrants intense medical treatment. Obesity may also be listed as an eating disorder. Some teens are unable to maintain their desired weight and are in need of nutritional supervision to promote healthy weight loss. Many teenagers today have unhealthy eating habits or unhealthy concepts of dieting. Studies have indicated that 42% of young children wish they were thinner. A majority of children in early school years state that they feel they should be on a diet. These trends highlight how media and commercialism affect young peoples’ beliefs and choices. SLEEP AND REST The growth spurt that occurs during puberty and early adolescence causes an increased need for sleep. Adequate sleep and rest are needed to help maintain optimal health during this stage of development. In this stage a teen requires about 8 hours of sleep to be fully rested. Teens have a tendency to stay up late to watch television, send text messages, or talk on the telephone. Staying up late causes them to be too tired to wake up in the morning or, when awakened, to be irritable. There also seems to be a direct correlation between lack of sleep and poor performance in school. Some teens are merely too tired during school to concentrate and learn (Fig. 10.5). FIGURE 10.5 Naps allow the teen to catch up on lost sleep. 7589_Ch10_149-166 30/08/17 11:54 AM Page 161 Puberty and Adolescence 161 EXERCISE AND LEISURE Exercise is another important factor in helping teens maintain good health. It is one area in which many teens actively participate without much prodding. A teen’s ability to perform skillfully and compete determines popularity and group acceptance. Some teens choose not to participate in sporting activities. Their reasons for avoiding these activities are either lacking skills or having sedentary natures and personalities. The activities that they may be interested in often challenge thinking rather than muscle coordination and skill. The patterns of exercise established during adolescence are likely to continue into the adult years. Many teens take on part-time jobs in addition to school and extracurricular activities. These teens must learn to balance their time and other activities. Part-time employment offers an adolescent spending money and exposure to the work world. Adolescents involved in athletics must increase their caloric intake of carbohydrates and proteins. In addition, they need to make certain that they drink enough fluid to maintain hydration before, during, and after engaging in strenuous exercise. SAFETY The leading cause of death in adolescence is accidents related to teens’ increased motor abilities and strength, combined with lack of judgment. This combination puts them at great risk for harm. Although driving represents independence for the adolescent now (Fig. 10.6), motor vehicle accidents are responsible for a majority of deaths during this developmental stage. Poor judgment, lack of driving skills, failure to follow rules and use seat belts, and texting while driving contribute to the high number of motor vehicle accidents involving teens. Driver education courses and defensive driving programs can help reduce the number of accidents. Teens must be strongly encouraged not to drink and drive. Those who drink must be told to appoint a designated driver. Parents need to model proper behavior to help instill these values in their teens. The second leading cause of death among all adolescents and young adults is homicide. Risk factors include race and socioeconomic status. Half of all homicides are associated with alcohol use. Both alcohol and drug use have further complicated vehicle-related injuries and deaths. FIGURE 10.6 Driving is an important milestone. Sporting activities also account for many injuries during this stage. Teens often exercise little caution when competing in athletic activities. Proper physical examinations must be done before a teen engages in any sporting event. Teens must adhere to the use of proper protective equipment when participating in contact sports. It has been shown that protective clothing can reduce the number of sporting injuries. Boys tend to have more injuries related to contact sports such as football and hockey, whereas girls have more injuries related to gymnastics. Some sport injuries have a seasonal pattern. The incidence of injuries and deaths related to firearms is steadily on the increase for children and adolescents in this country. Many of these accidents could be prevented with proper storage of and training in the use of firearms. An alarming number of the accidents involving firearms occur in or around the home. Parents need to take responsibility for proper education about and supervision of firearms. Some toy items have been found to cause injuries and lethal damage in the hands of children and teens. Many manufacturers have stopped producing toy guns that may be mistaken for real firearms and could result in devastation and harm. HEALTH PROMOTION In general, a teen’s state of health is reflective of his or her habits and nutritional patterns. The number of acute illnesses decreases during this stage of development. A yearly medical checkup is suggested for this age group. The examination should include vision and hearing screening. Problems with eyesight should be promptly corrected with glasses or contact lenses. Teens must be instructed to avoid using stereo headphones at high volume, as frequent exposure to excessively loud noise has been proven 7589_Ch10_149-166 30/08/17 11:54 AM Page 162 162 Journey Across the Life Span to cause nerve damage and lead to hearing loss. Some teens have even shown significant hearing loss as a result of frequent attendance at loud concerts. Weight and height measurements and nutritional guidance should be a part of each health visit. Dental examinations must be scheduled every 6 months or more frequently if there is dental decay or problems with malocclusion. Blood pressure recordings must be monitored during the teen years to help detect any signs of abnormalities so that preventive measures and treatment may be promptly instituted. Blood cholesterol levels are examined and dietary interventions are offered to those individuals who appear to be candidates for high blood cholesterol. Girls are prone to anemia; therefore, a complete blood cell count should be done at least yearly or more often. Symptoms such as fatigue, weakness, or excessive menstrual flow may be indicative of anemia. Generally teenagers have high resistance to early childhood illnesses. The well-functioning immune system still needs the support of booster immunizations at ages 14 through 16 years for the prevention of diphtheria and tetanus. Proper nutrition and other healthy living practices help determine the teenager’s overall health. Teenagers should continue to be assessed for any signs of spinal abnormalities such as scoliosis, discussed in Chapter 9. Many teens need reminders about the importance of good posture to prevent musculoskeletal pain and deformity in later years. Teens also have many concerns and questions about skin care and hygiene. Teens are generally very sensitive about the appearance and the condition of their skin, so much so that even the appearance of a small blemish will cause them to become distressed (Fig. 10.7). They should be instructed in the basics of proper skin care. If they develop an acute case of acne, further medical treatment is necessary. Depression Depression, a prolonged feeling of sadness and unworthiness, is a serious problem affecting many teens. Stress from school, family, and personal relationships may overwhelm a teenager and lead to this mood disorder. Teens are more prone to this condition because they spend more time in selfreflection, which may lead them to disappointment and despair. Signs of depression may go unnoticed by family and friends. The risk of suicide increases for depressed persons. Suicide is the third leading cause of death in the 15- to 24-year-old age group. FIGURE 10.7 Appearance is very important at this stage. Young men are the most affected by violence and suicide. Many factors may contribute to adolescent suicide. Depression, low self-esteem, poor impulse control, substance abuse, and emotional isolation are some of the common contributing factors leading to suicide. The common signs of depression are listed in Box 10.2. Health care workers should assess depressed persons for possible clues to impending suicide. They should listen carefully and try to understand the person’s feelings in addition to the actual words spoken. Be sure not to undervalue what emotions the person is expressing. It is important to openly ask if the individual is contemplating suicide. Individuals with suicidal plans are at great risk for carrying out their plans. Be sure to report any suggestion or suicidal inclinations to others so that necessary preventative measures may be instituted. Constant close supervision helps maintain the individual’s safety until other interventions reduce the threat of self-destruction. B O 10.2 • • • • • • • • • X Sig ns o f Depressio n and Suicid al Tho ug hts Crying spells Insomnia Eating disorders Social isolation or withdrawal Acting-out behaviors: school phobias, underachievement, truancy, temper outbursts, substance abuse Feelings of hopelessness Unexplained physical symptoms Loss of interest in appearance Giving away of possessions 7589_Ch10_149-166 30/08/17 11:54 AM Page 163 Puberty and Adolescence Substance Abuse Substance abuse refers to out-of-control use of tobacco, alcohol, and other drugs. The need to be accepted often causes teenagers to smoke cigarettes. Even with the current legislation curtailing the sale of tobacco to minors, many easily obtain cigarettes. Antismoking campaigns have been instituted with minimal success. The need for early parental education and positive role modeling may be the best deterrent to the use of tobacco. Experimentation with alcohol is considered to be another teenage rite of passage. Most teens begin drinking before the legal age. Drinking may occur at home, in school, or in other social settings. Some teens may feel that drinking helps them to deal with their feelings or avoid facing certain realities. Both tobacco and alcohol are used in the movies as a prop to portray sexuality. This greatly influences children and adolescents. Alcohol abuse occurs when the intake of alcohol interferes with day-to-day activities. Intense counseling and support groups may help the teen who has a substance problem. 163 Drug experimentation can begin at any age but most often occurs during adolescence. Any drug, prescription or nonprescription, may be abused. Research indicates that the most common offender is marijuana. Starting with occasional use, some teens may become habitual users. This behavior may then extend to the use of other drugs. Drug use has been shown to lead to other social problems, including sexual promiscuity, diseases, and pregnancy. Refer to Box 10.3 for signs of possible drug use. B O 10.3 X Sig ns o f Drug Abuse • Altered sleep patterns: drowsiness, sleepiness, lethargy, or hyperactivity • Mood swings • Change in appetite • Marked irritability • Loss of interest in friends, school, and other activities • Secretiveness • Loss of property or money • Impaired judgment • Change in hygiene or appearance SUMMARY 1. Puberty or preadolescence is a period of rapid growth ending with reproductive maturity. In girls puberty ends with the onset of menarche; in boys puberty ends with the production of sperm. 2. The major changes associated with puberty include rapid physical growth, changes in body proportions, and the development of primary and secondary sex characteristics. 3. Primary sex characteristics affect the growth and maturation of the gonads, or sex glands. 4. The male gonads are the testes, which, when mature, produce sperm and the male sex hormone. The release of sperm, known as ejaculation, indicates functional maturity. 5. The female gonads are the ovaries. The production of ova and female hormones signals maturity. 6. Menarche is the first menstrual period. Menstruation will occur monthly from puberty until menopause. 7. Secondary sex characteristics refer to all the changes that have no direct role in reproduction. These changes include hair growth, increased activity of the sweat glands, voice changes in boys, and widening of the hips and pelvis in girls. 8. Youth of this age tend to spend more time by themselves and move away from earlier friendships. In many settings teens are argumentative, causing their family relationships to change. 9. Adolescence is a transitional period that begins with sexual maturity and ends with physical maturity. This stage bridges the gap between dependence and independence, childhood and adulthood. 10. Dating begins at about 15 to 16 years of age. It helps establish social status and recognition and provides a means of recreation with the peer group. 11. Sex is given high priority at this time. Teens usually experience a great deal of pressure to 7589_Ch10_149-166 30/08/17 11:54 AM Page 164 164 Journey Across the Life Span conform to the group’s standards. Many teens engage in sexual intercourse during the adolescent period. 12. Sex education must be provided in the home and further reinforced in school. 13. Masturbation is considered to be a normal part of sexual expression. 14. Sex education needs to be provided before the teenage period of development. Teens continue to need advice about prevention of STDs and pregnancy. 15. The major characteristics of adolescence include stormy emotions, feelings of insecurity, introspection, interest in experimentation and learning, and testing of values and beliefs. 16. According to Erikson, the psychosocial task for this stage is the search for identity. Identity begins with the separation of the individual from the family. The movement away from the family expresses the teen’s need for freedom and independence. 17. Adolescents are ambivalent about many issues, including loving and hating their families, wanting freedom and needing supervision, or wanting to be part of a group and wishing to be alone. Some of the commonly expressed emotions are anger, fear, worry, jealousy, envy, and happiness. 18. Peer relationships are very important at this stage. Peers share the same age, feelings, experiences, goals, and doubts in w