Summary

This document discusses the biological perspective of adolescence, including the storm-and-stress view, contemporary research, and the timing, signs, and sequence of puberty. It also covers individual differences in pubertal growth and related factors. This document is suitable for undergraduate level study.

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❖ The Biological Perspective The storm-and-stress view of adolescence, based on G. Stanley Hall's theory of evolution, describes the turbulent period adolescents experience during puberty, transitioning from childhood to adulthood. This stage involves sexual impulses reawakening in the genital...

❖ The Biological Perspective The storm-and-stress view of adolescence, based on G. Stanley Hall's theory of evolution, describes the turbulent period adolescents experience during puberty, transitioning from childhood to adulthood. This stage involves sexual impulses reawakening in the genital stage, leading to psychological conflict and volatile behavior. As adolescents find intimate partners, inner forces gradually achieve a new, mature harmony, and the stage concludes with marriage, birth, and child rearing. Contemporary research suggests that the storm-and-stress notion of adolescence is exaggerated. While certain problems, such as eating disorders, depression, suicide, and lawbreaking, do occur more often than earlier, the overall rate of serious psychological disturbance rises only slightly from childhood to adolescence, reaching 15 to 20 percent. Emotional turbulence is not a routine feature of the teenage years. Anthropologist Margaret Mead (1928) first pointed out the wide variability in adolescent adjustment, stating that the social environment is entirely responsible for the range of teenage experiences. Later researchers found that Samoan adolescence was not as untroubled as Mead had assumed. Erikson believed that successful resolution of intimacy versus isolation prepares individuals for the middle adulthood stage, which focuses on generativity—caring for the next generation and helping to improve society. Adolescence is a period of significant growth and development, often divided into three phases: early adolescence (11-14 years), middle adolescence (14-16 years), and late adolescence (16-18 years). Physical development during puberty involves rapid growth in height and weight, changes in body proportions and form, and sexual maturity. DHEA plays a part in the growth of pubic, axillary, and facial hair, as well as in faster body growth, oilier skin, and the development of body odor. Studies suggest that an accumulation of leptin, a hormone in the bloodstream identified as having a role in obesity, may stimulate the hypothalamus to signal the pituitary gland, which in turn may signal the sex glands to increase their secretion of hormones. ❖ Timing, Signs, and Sequence of Puberty and Sexual Maturity Puberty is a period of growth and maturation that typically begins at age 8 in girls and 9 in boys. Primary sex characteristics include the organs necessary for reproduction, such as the ovaries, fallopian tubes, uterus, clitoris, and vagina, while secondary sex characteristics include physiological signs of sexual maturation that do not directly involve the sex organs. The adolescent growth spurt, a rapid increase in height, weight, and muscle and bone growth, generally begins in girls between ages 9½ and 14½ and in boys between 10½ and 16 (usually at 12 or 13). It typically lasts about two years and soon after it ends, the young person reaches sexual maturity. Both growth hormone and sex hormones contribute to this normal pubertal growth pattern. Girls between ages 11 and 13 tend to be taller, heavier, and stronger than boys the same age. After their growth spurt, boys are again larger, reaching full height at age 15 and boys at age 17. The rate of muscular growth peaks at age 12½ for girls and 14½ for boys. Boys and girls grow differently in terms of rates of growth, form, and shape. The maturation of reproductive organs brings the beginning of menstruation in girls and the production of sperm in boys. The principal sign of sexual maturity in boys is the adolescent growth spurt, which is a sharp increase in height and weight that precedes sexual maturity. Most girls experience a growth spurt two years earlier than most boys, so between ages 11 and 13 girls tend to be taller, heavier, and stronger. Menarche, a monthly shedding of tissue from the lining of the womb, is the principal sign of sexual maturity in girls. ❖ Individual differences in Pubertal Growth Heredity significantly influences the timing of pubertal changes, with identical twins being more similar than fraternal twins in attaining most pubertal milestones. Nutrition and exercise also play a role, with a sharp rise in body weight and fat potentially hastening sexual maturation in females. Fat cells release a protein called leptin, which signals the brain that energy stores are sufficient for puberty, causing breast and pubic hair growth and menarche to occur earlier for heavier and obese girls. Girls who start rigorous athletic training early or eat very little usually experience later puberty. A secular trend in the onset of puberty, which includes increases in adult height and weight, began about 100 years ago and has occurred across several generations. Variations in pubertal growth also exist among regions, SES, and ethnic groups. Physical health plays a major role, with menarche being delayed in poverty-stricken regions and higher-income girls reaching menarche 6 to 18 months earlier than those in economically disadvantaged homes. ❖ Family Experiences Early family experiences can influence pubertal timing, as humans are sensitive to the emotional quality of their childhood environments. Research shows that girls and boys with a history of conflict, harsh parenting, parental separation, or single mothers tend to reach puberty early, while those with warm, stable family ties reach puberty relatively late. This chain of influence from adverse childhood environments to earlier pubertal timing and increased adolescent sexual risk taking is confirmed in longitudinal studies for girls. ❖ The Adolescent Brain The adolescent brain is a work in progress, with dramatic changes in brain structures involved in emotions, judgment, behavior organization, and self-control taking place between puberty and young adulthood. This immaturity raises questions about the extent to which adolescents can reasonably be held legally responsible for their actions, prompting the U.S. Supreme Court to rule the death penalty unconstitutional for a convicted murderer who was 17 or younger when the crime was committed. ❖ Risk taking and research Risk taking appears to result from the interaction of two brain networks: (1) a socioemotional network that is sensitive to social and emotional stimuli, such as peer influence, and (2) a cognitive-control network that regulates responses to stimuli. The socioemotional network becomes more active at puberty, whereas the cognitive-control network matures more gradually into early adulthood. These findings may help explain teenagers' tendency toward emotional outbursts and risky behavior and why risk taking often occurs in groups. Research has shown that early adolescents (aged 11 to 13) predominantly relied on the amygdala, a small structure located deep within the temporal lobe that plays a crucial role in emotional and instinctual responses. On the other hand, older adolescents (aged 14 to 17) exhibited patterns more similar to adults, utilizing the frontal lobes responsible for functions such as planning, reasoning, judgment, emotional regulation, and impulse control. This contrast may elucidate why early adolescents often make imprudent decisions such as engaging in substance abuse and risky sexual behaviors. To understand the immaturity of the adolescent brain, we also need to look at changes in the structure and composition of the frontal cortex. The increase in white matter typical of childhood brain development continues in the frontal lobes, while the pruning of unused dendritic connections during childhood results in a reduction in the density of gray matter (nerve cells), increasing the brain's efficiency. By mid- to late adolescence, young people have fewer but stronger, smoother, and more effective neuronal connections, making cognitive processing more efficient. ❖ COGNITIVE DEVELOPMENT: Teenagers emerge with mature bodies and a zest for life, and their cognitive development continues. They differ in appearance, thinking, and communication, but are capable of abstract reasoning, sophisticated moral judgments, and realistic planning for the future. Piaget's Stage of Formal Operations is the highest level of cognitive development, where adolescents develop the capacity for abstract thought. This stage, usually around age 11, allows them to manipulate information more flexibly, understand historical time and extraterrestrial space, use symbols to represent other symbols, learn algebra and calculus, appreciate metaphor and allegory, and think in terms of what might be rather than what is. 1. Hypothetical-Deductive Reasoning is a crucial aspect of formal reasoning. Adam, a typical child, experiences the preoperational stage of reasoning when faced with a pendulum problem. At age 10, he tries random methods to solve the problem, making it difficult for him to understand or report what has happened. At age 15, Adam systematically tests all possible hypotheses, varying one factor at a time, to determine that only the length of the string determines how fast the pendulum swings. This shift to formal reasoning is attributed to brain maturation and expanding environmental opportunities. Piaget attributed this shift to a combination of brain maturation and expanding environmental opportunities. Schooling and culture play a role in the development of formal reasoning, as seen in children in New Guinea and Rwanda. Chinese children in Hong Kong, who had been to British schools, did at least as well as U.S. or European children. Knowing what questions to ask and what strategies work are keys to hypothetical deductive reasoning. When 30 low-performing urban sixth graders were asked to investigate factors in earthquake risk, those who received a suggestion to focus on one variable at a time made more valid inferences than those who were not given the suggestion. Propositional thought is another important characteristic of Piaget's formal operational stage. Adolescents' ability to evaluate the logic of propositions without referring to real-world circumstances is another important characteristic of this stage. Formal operations require language-based and other symbolic systems that do not stand for real things, such as those in higher mathematics. Secondary school students use such systems in algebra and geometry. ❖ An Information Processing View of Adolescent Cognitive Development Information-processing theorists identify several mechanisms, including executive function components, as underlying cognitive gains in adolescence. These mechanisms promote advances in working memory, inhibition, attention, reasoning, planning, strategy effectiveness, knowledge, metacognition, and cognitive self-regulation. Piaget's followers suggest that adolescents develop two distorted images of the relation between self and other: the imaginary audience, which leads to extreme self-consciousness and sensitivity to public criticism, and the personal fable, which leads to an inflated opinion of their own importance. As children attain higher cognitive levels, they become capable of more complex reasoning about moral issues. Their tendencies toward altruism and empathy increase, and they are better able to take another person's perspective, solve social problems, deal with interpersonal relationships, and see themselves as social beings. All of these tendencies foster moral development. ❖ Kohlberg's model of reasoning Lawrence Kohlberg's groundbreaking theory of moral reasoning, which is based on hypothetical dilemmas posed to 75 boys aged 10, 13, and 16, is a significant example of moral development. Kohlberg (1969) described three levels of moral reasoning, each divided into two stages: Level I: Preconventional morality (people act under external controls, obey rules to avoid punishment or reap rewards, or act out of self interest). This level is typical of children ages 4 to 10. Level II: Conventional morality (or morality of conventional role conformity), where people have internalized the standards of authority figures and are concerned about being "good," pleasing others, and maintaining the social order. This level is typically reached after age 10; many people never move beyond it, even in adulthood. Level III: Postconventional morality (or morality of autonomous moral principles), where people recognize conflicts between moral standards and make their own judgments on the basis of principles of right, fairness, and justice. People generally do not reach this level of moral reasoning until at least early adolescence, or more commonly in young adulthood, if ever. In conclusion, information-processing theorists highlight the importance of cognitive changes in adolescence, particularly in terms of working memory, inhibition, attention, planning, strategy effectiveness, knowledge, metacognition, and cognitive self-regulation. Kohlberg's moral development theory suggests that individuals progress through different stages of moral development, with some adolescents and adults remaining at level I, where they seek to avoid punishment or satisfy their needs. Most adolescents and adults are at stage II, usually in stage 3, where they conform to social conventions, support the status quo, and "do the right thing" to please others or obey the law. Stage 4 reasoning (upholding social norms) is less common but increases from early adolescence into adulthood. Kohlberg proposed a transitional level between Level II and Level III of moral development, where individuals no longer feel bound by society's moral standards but have not yet reasoned out their own principles of justice. At this stage, moral decisions are based on personal feelings rather than principled reasoning. Before reaching Level III, individuals must recognize the relativity of moral standards. Moral identity, the degree to which morality is central to self-concept, also affects moral behavior. In a study of low-SES African-American and Hispanic teenagers, those who emphasized moral traits and goals in their self descriptions displayed exceptional levels of community service. When 10- to 18-year-olds rated moral traits on the basis of whether each reflected the kind of person they wanted to be, those with a stronger moral ideal self were viewed by their parents as more ethical and altruistic. Kohlberg's theory inaugurated a profound shift in the way we look at moral development. Instead of viewing morality solely as the attainment of control over self-gratifying impulses, investigators now study how children and adults base moral judgments on their growing understanding of the social world. Initial research supported Kohlberg's theory, with American boys who progressed through Kohlberg's stages in sequence, and none skipped a stage. However, more recent research has cast doubt on the delineation of some of Kohlberg's stages. There is not always a clear relationship between moral reasoning and moral behavior. People at postconventional levels of reasoning do not necessarily act more morally than those at lower levels. Other factors, such as specific situations, conceptions of virtue, and concern for others, contribute to moral behavior. The influence of parents, peers, and culture on moral reasoning is also important. Adolescents with supportive, authoritative parents who stimulate them to question and expand on their moral reasoning tend to reason at higher levels. Peers also affect moral reasoning by talking with each other about moral conflicts, having more close friends, spending quality time with them, and being perceived as a leader are associated with higher moral reasoning. Kohlberg's system does not seem to represent moral reasoning as accurately in non-Western cultures as it was originally developed. Research indicates that pubertal events significantly impact adolescents' self-image, mood, and interaction with parents and peers. Some outcomes are a response to dramatic physical change, while others have to do with pubertal timing. Girls often react with surprise due to the sudden onset of menarche, while boys typically report mixed feelings. However, wide individual differences exist that depend on prior knowledge and support from family members, which in turn are influenced by cultural attitudes toward puberty and sexuality. For girls who have no advance information, menarche can be shocking and disturbing. Cultural or religious views of menstruation as unclean, embarrassing, or a source of weakness requiring restriction of activities also promote distressed reactions. Unlike European-American families, few girls in developed countries are uninformed, likely due to parents' greater willingness to discuss sexual matters and the spread of health education classes. Almost all girls get some information from their mothers. Boys' responses to spermarche reflect mixed feelings. Most boys know about ejaculation ahead of time, but many say that no one spoke to them before or during puberty about physical changes. They usually get their information from reading material or websites. Even boys who had advance information often say that their first ejaculation occurred earlier than they expected and that they were unprepared for it. In contrast, Western societies grant little formal recognition to movement from childhood to adolescence or from adolescence to adulthood. Western adolescents are granted partial adult status at many different ages, making the process of becoming an adult more confusing. Higher pubertal hormone levels are linked to greater moodiness, but only modestly so. Factors contributing to this include situational changes, such as high points spent with peers and self-chosen leisure activities, low points occurring in adult-structured settings, and emotional highs coincided with Friday and Saturday evenings, especially in high school. Going out with friends and romantic partners increases so dramatically during adolescence that it becomes a "cultural script" for what is supposed to happen. Adolescents who spend weekend evenings at home often experience a deep sense of loneliness, but studies show that negative moods tend to stabilize during late adolescence, providing hope. ❖ The Role of Physical Attractiveness Society often views attractive females as thin and long-legged, while attractive males are tall, broad-shouldered, and muscular. Gender-specific ideals of body image are prevalent, with the female ideal favoring a girlish shape for late developers and the male ideal fitting early-maturing boys. Early-maturing European-American girls often have less positive body image compared to their peers, as they internalize the cultural ideal of a thin female body. Body image significantly influences young people's self-esteem, and negative effects on body image and emotional adjustment can be intensified when combined with other stressors. ❖ The Importance of Fitting in with Peer Early-maturing adolescents often feel unfit physically with their peers, leading them to seek out older companions who may expose them to activities they are not yet ready to handle. The hormonal influences of puberty on the brain's emotional and social network are stronger for early maturers, making them more susceptible to engaging in sexual activity, drug and alcohol use, and delinquent behaviors. Consequently, early maturers, both male and female, are more likely to experience emotional stress and a decline in academic performance. Long-term effects of pubertal timing are also evident, with early-maturing girls at risk for lasting difficulties. In one study, depression and frequently changing sexual partners persisted into early adulthood among early-maturing girls, with depression evident mainly in those who had displayed the severest adolescent conduct problems. In another study, early maturing boys showed good adjustment, but early maturing girls reported poorer-quality relationships with family and friends, smaller social networks, and lower life satisfaction in early adulthood than did their on-time counterparts. Psychosocial factors play a significant role in identity formation, as Erikson (1950, 1968) recognized it as the major personality attainment of adolescence and a crucial step toward becoming a productive, content adult. Identity formation involves defining who you are, what you value, and the directions you choose to pursue in life. In complex societies, young people often experience an identity crisis, a temporary period of distress as they experiment with alternatives before settling on values and goals. Current theorists agree that questioning of values, plans, and priorities is necessary for a mature identity, but they no longer describe this process as a "crisis." For most young people, identity development is not traumatic and disturbing but rather a process of exploration followed by commitment. As young people try out life possibilities, they gather important information about themselves and their environment and move toward making enduring decisions. By the end of middle childhood, children describe themselves in terms of personality traits, with early adolescence unifying separate traits into abstract descriptors like "intelligent." However, these generalizations are often contradictory, as adolescents expand their social world and display different selves in different relationships. As awareness of these inconsistencies grows, they often agonize over "which is the real me." By late adolescence, cognitive changes enable teenagers to combine their traits into an organized system, using qualifiers to reveal that psychological qualities can vary from one situation to the next. Older adolescents also add integrating principles that make sense of formerly troublesome contradictions. Teenagers place more emphasis on social virtues, such as being friendly, considerate, kind, and cooperative, reflecting their increasing concern with being viewed positively by others. Personal and moral values also appear as key themes among older adolescents. As young people revise their views of themselves to include enduring beliefs and plans, they move toward the unity of self that is central to identity development. ❖ Self esteem Self-esteem, the evaluative side of self-concept, continues to differentiate in adolescence, with teenagers adding several new dimensions of self-evaluation to those of middle childhood. The level of general self-esteem also changes, with most young people reporting feeling especially good about their peer relationships, physical appearance, and athletic capabilities from mid- to late adolescence. Identity development in adolescents is influenced by their well-organized self-descriptions and differentiated sense of self-esteem. Researchers evaluate progress in identity development using two key criteria: exploration and commitment. Identity achievement and moratorium are psychologically healthy routes to mature self-definition, while long-term foreclosure and diffusion are maladaptive. Identity-achieved individuals tend to have higher self-esteem, are more open to alternative ideas and values, feel more in control of their lives, and are more advanced in moral reasoning and concerned with social justice. However, if exploration becomes ruminative, it can lead to distress and poor adjustment. Long-term foreclosure involves commitment, offering a sense of security in the face of important life choices. Foreclosed individuals display a dogmatic, inflexible cognitive style, internalizing the values and beliefs of parents and others without deliberate evaluation and resisting information that threatens their position. They often fear rejection by people on whom they depend for affection and self-esteem, and may join cults or other extremist groups uncritically adopting a way of life different from their past. Long-term diffused individuals are the least mature in identity development, using a diffuse-avoidant cognitive style that avoids dealing with personal decisions and problems and allows situational pressures to dictate their reactions. They often experience time management and academic difficulties, are low in self-esteem and prone to depression, and are the most likely to commit antisocial acts and use and abuse drugs. Adolescent identity formation begins a lifelong, dynamic process, with various factors influencing it. Identity status is both cause and consequence of personality characteristics. Adolescents who assume absolute truth is always attainable tend to be foreclosed, while those who doubt that they will ever feel certain about anything are more often identity-diffused. Young people who are curious, open-minded, and persistent in the face of obstacles are likely to be in a state of moratorium or identity achievement. ❖ Peer relations Family serves as a "secure base" from which adolescents can confidently move out into the wider world. Young people who feel attached to their parents but also free to voice their opinions tend to have committed to values and goals and are on their way to identity achievement. Foreclosed teenagers often have close bonds with parents but lack opportunities for healthy separation. They report the lowest levels of parental support and warm, open communication. Interaction with diverse peers through school and community activities encourages adolescents to explore values and role possibilities. Close friends can act as a secure base, providing emotional support and models of identity development. Identity development depends on schools and communities that offer rich and varied opportunities for exploration. Culture strongly influences mature identity, as it influences constructing a sense of self-continuity despite significant personal changes. Native Canadian youths take an interdependent approach, focusing on constantly transforming self resulting from new roles and relationships. They typically construct a coherent narrative linking various time slices of their life with a thread explaining how they had changed in meaningful ways. Eating disorders during puberty include the "Vacuum Cleaner Effect," which refers to increased appetite and frequent eating, similar to a vacuum cleaner picking up debris. Rapid body growth during puberty leads to significant increase in nutritional requirements due to substantial physical changes. Poor adolescent diets are also common during this critical period. Skipping breakfast, eating on the run, and consuming empty calories are common health issues among adolescents. Fast-food restaurants and schools have started offering healthier menu options to address unhealthy eating among adolescents. However, adolescents still need guidance in making nutritious food choices, as they may not always opt for these alternatives. Iron deficiency is a risk for adolescents, especially during growth spurts, and girls often experience iron loss during menstruation. Other nutritional deficiencies include inadequate calcium intake, riboflavin (vitamin B2), and magnesium deficiencies. It is crucial to guide adolescents toward making nutritious choices, given the prevalence of less healthy options in their diets. Anorexia nervosa is a tragic eating disorder where young people starve themselves due to a compulsive fear of getting fat. About 1% of North American and Western European teenage girls are affected, with cases increasing sharply over the past half-century due to cultural admiration of female thinness. Boys account for 10 to 15% of anorexia cases, with up to half of them being gay or bisexual young people. Individuals with anorexia have an extremely distorted body image and often go on self-imposed diets so strict that they struggle to avoid eating in response to hunger. The severe physical consequences of anorexia include extreme weight loss, menstrual disruption, physical signs of malnutrition, severe health complications, and mortality. Multiple factors contribute to anorexia nervosa, including genetic influence, neurotransmitter abnormalities in the brain, psychological characteristics of individuals with anorexia, and parent-adolescent interactions. Genetic influence is suggested by the higher prevalence of the disorder among identical twins compared to fraternal twins, and neurotransmitter abnormalities in the brain linked to anxiety and impulse control. Psychological characteristics of individuals with anorexia include setting unrealistically high standards for behavior and performance, emotional inhibition, and avoiding intimate relationships outside the family. Societal pressures, particularly the idealization of thinness, contribute to poor body image, particularly affecting early-maturing girls. Parental factors also play a role, with mothers often having high expectations for physical appearance, achievement, and social acceptance while being overprotective and controlling. These parental attributes may contribute to the anxiety and pursuit of perfection observed in affected individuals. It remains uncertain whether maladaptive parent-child relationships precede the disorder, result from it, or are intertwined with it. ❖ Treatment Challenges Anorexia treatment is challenging due to individuals often denying its seriousness, and hospitalization may be required to address life-threatening malnutrition. Effective treatment often involves family therapy and medication to reduce anxiety and address neurotransmitter imbalances. However, less than 50% of young people with anorexia achieve full recovery, and many continue to experience eating problems in less extreme forms. A subset may develop a related disorder called bulimia nervosa, which is less severe but still debilitating. Bulimia nervosa primarily affects young people, mainly girls, but can also impact gay and bisexual boys. It is characterized by recurrent episodes of binge eating, followed by compensatory behaviors aimed at avoiding weight gain. It typically emerges in late adolescence and affects approximately 2 to 4 percent of teenage girls. Only a small percentage (5%) of those with bulimia had previously suffered from anorexia. Heredity plays a role in the development of bulimia, similar to anorexia, with overweight and early menarche increasing the risk. Some adolescents with bulimia exhibit perfectionistic tendencies, while most are impulsive and sensation-seeking, often engaging in risky behaviors like shoplifting and alcohol abuse when distressed. Family dynamics may also play a role in the development of bulimia, as girls with bulimia may have experienced their parents as emotionally disengaged and unavailable. Binge-eating disorder, which occurs between 2 and 3 percent of adolescent girls and close to 1 percent of boys, is unrelated to ethnicity and typically leads to overweight and obesity. It is associated with social adjustment difficulties, severe emotional distress, and suicidal thoughts. Effective treatments resemble those used for bulimia. Teenagers are influenced by their natural inclination for sensation seeking during adolescence, living in cultures where adults often rely on substances like caffeine, alcohol, and cigarettes to manage daily stress and discomfort. Media, including TV, movies, and advertisements, often depict high rates of substance use, potentially leading adolescents to "self-medicate" when stressed. While many teenagers who try alcohol, tobacco, or marijuana do not develop addiction problems, it is essential not to underestimate the risks associated with adolescent drug experimentation. Most drugs can impair perception and cognitive function, even in a single heavy dose, potentially resulting in permanent harm or death. A concerning minority of teenagers transition from substance use to abuse, with escalating use that interferes with daily responsibilities. The correlates and consequences of adolescent substance abuse include serious behavioral issues characterized by impulsivity, disruptiveness, and hostility, which may manifest in early childhood. Drug abuse tends to start at an earlier age among these individuals, possibly due to a genetic predisposition involved. Longitudinal studies have shown that a significant imbalance between the brain's cognitive-control network and its emotional/social network predicts a rapid increase in alcohol, tobacco, and marijuana use during mid-adolescence. Environmental factors contributing to substance abuse include low socioeconomic status (SES), family mental health problems, a history of drug abuse in parents and older siblings, lack of parental warmth and involvement, experiences of physical and sexual abuse, and poor school performance. Teenagers facing family difficulties are particularly susceptible to substance abuse, especially when influenced by friends who use and provide drugs. The significant and lasting consequences of introducing drugs to the developing adolescent brain include impairments in neural development and a lack of essential life skills. This can result in a range of adjustment problems, contributing to chronic anxiety, depression, antisocial behavior, and difficulties in managing adult responsibilities, all of which can perpetuate a cycle of addictive behavior.

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