PSYCHOLOGICAL CHANGES DURING ADOLESCENCE

ADOLESCENT: derived from latin word adolescence meaning to grow mature (GHAI 6th) DEF : period from onset of puberty to termination of growth Attainment of adult pattern of hieght and characterstics Characteristics:

Characteristics:
Rapid physical growth Significant physical, emotional, psychological spiritual changes involving personal relations

WHO DEF 10- 19 YRS

STAGES OF ADOLESENCE GHAI NELSON EARLY ADOELECENCE 9-13 YRS 10-13 YRS

MID ADOLESCENCE

14-15 YRS

14-16 YRS

LATE ADOLESCENCE

16-19 YRS

17- 20 YRS

CHANGES DURING ADOLESCENCE

   

Biological changes Cognitive changes Emotional changes Social changes

Environmental Settings
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Peer s

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School YOUTH

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Media/ Internet

Co m m un

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DEVELOPMENTAL CHARACTERSTIC OF THREE PHASES OF ADOLESCENCE

CHARACHTERISTIC S AGE SMR COGNITIVE & MOTOR SELF CONCEPT EARLY ADOLESCENCE 10-13 1-2 Concrete operation Conventional morality Pre-occupation with changing body Self consciousness Stuggles for independence Same sex groups Middle school adjustment MID ADOLESCENCE 14-16 3-5 Abstract thought Self centred Questioning Cocern with attractiveness introspection Struggle for acceptance & autonomy Dating Peergroup less imp. G? Skills & oppurtunity LATE ADOLESCENCE 17-20 5 Idealism Absolutism Stable body image

FAMILY

Practical independence Family secure base Intimacy Career decision

PEERS RELATIONSHIP WITH SOCIETY

SELF ESTEEM: Adolescent personal evaluation of self

Plays role in:
Motivation School and sports performance Peer relation Drug abuse Teen age pregnancy Willingness to preserve, resillience Capacity to bounce back from failure

FORMATION OF IDENTITY CRISIS: Physical appearance Encompasses

Feeling about self & sexuality Cognition Communication Value system Social status Independence

RELATION WITH PARENTS : i t t s ci t tsi flicts wit p r ts ft

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Growing identity and independence Question authority Different levels of morality

REALTION WITH PEERS:

Try to be popular Tendency to join peer group Peer pressure

BODY IMAGE: defined as the way a person defines his own body
AFFECTIVE/ COGNITIVE PERCEPTUAL

Higher level of body satisfaction asso. With higher SELFESTEEM Body image concerns:
GIRLS
1. 2. 3. 4. 5. Body wieght Breast size Acne Complexion attractiveness

BOYS
1. 2. 3. 4. 5. 6. Over all build Hairs Hands Hieght Weight muscle

DEPRESSION: not uncommon

1. 2. 3. 4.

Growing conflict with parents Confusion of identity establishment Stress of academic achievement Need to peer popularity

strain
Pers eeli l l sses f elpless ess

Indicates poor self esteem -ve self image and identity

SUICIDAL ATTEMPT & SUICIDE:

  

Depression preceeds suicidal behaviour Indicates failure of psychosocial defense mechanism Last attempt to gain control over a situation in which one is powerless/helpless & lost

SCHOOL PROBLEMS:  Absentism  Academic failure  Behavioural problems

Challe ge #2
Cog itive Developme t
Nor al adolesce t behavior?
t r e f r t e s ke f r i t e self- centered t c nst ntl find f lt in dults p siti n t e verl dr tic

YES!

Cog itive Developme t differe t arrow

19 ears

10 ears

ilit t t ink str ctl ilit t nal ze situati ns l icall abilit t t ink realisticall about t e future, oal setting oral reasoning Entertain pot etical situations, use of etap ors eed guidance for rational decision aking

Brai Research Fi di gs
The brain continues to develop during adolescence. Areas under construction:
Prefrontal cortex responsible for organizing,

setting priorities, strategizing, controlling i pulses Brain functions that help plan and adapt to the social environment Brain functions that help put situations into context; retrieve memories to connect with gut reactions

INDIVIDUATION AND IDENTITY DEVELOPMENT

INDIVIDUATION: Process by which adolescent develops a unique personal identity or sense of self, distinct and separate from all others

DIFFERENTIATION (early adolescence): Recognizes psychological difference between self and parents PRACTICE AND EXPERIMENTATION (14- 15 YRS.): Feels all-knowing, self(14allselfsufficient;actively challenges parents and seeks approval of peers RAPPROCHEMENT (mid-adolescence): After achieving a fair degree of (midseparateness from parents, returns to home base and conditionally and partially reaccepts parents' authority CONSOLIDATION OF SELF (until end of adolescence): Develops a sense of personal identity, which serves as the basis for self-understanding and for selfmaintaining a sense of autonomy, independence, and individuality

NORMAL BEHAVIORAL CHANGES IN ADOLESCENTS

i.

Aggresive & disruptive behavior towards parents, teachers, siblings, friends Thumb sucking Nail biting Masturbation Tics Stammering Hyper kinesis feeding problems Experiment with alcohol, drugs, smoking Avoiding family activities Demanding privacy Increased argumentativeness

ii. iii. iv. v. vi. vii. viii. ix. x. xi. xii.

BEHAVIORAL DISORDER

Distinction between disturbance and normality of psychosocial disorder is imprecise Disturbance is characterised by number frequency severity and duration of symptoms rather than type of symptomatology

HABIT PROBLEM:
Thumb sucking Nail biting Tics Enuresis Encopresis Trichotilomania

EATING PROBLEMS:
ood fads ood refusal/ over eating Aerophagia Anorexia

SLEEP PROBLEMS:
I. Night terrors II. Nightmares III. Somnabulism IV. Insomnia V. Hypersomnolence VI. Sleep talking VII. Narcolepsy/ cataplexy

SPEECH PROBLEMS:

I. Stammering II. Mutism III. Phonation and articulation defects

SCHOLASTIC PROBLEMS:
Reading Writing/ mathematical disability Absenteesim Truancy School phobia aggressiveness

SEXUAL PROBLEMS:
A. B. C. D. E. Masturbation Homosexuality Incest Precocious sexuality Hypersexuality

PERSONAL PROBLEMS:
Shyness timidity Fear Anger Jealousy

ANTISOCIAL PROBLEMS:
Juvenile delinquncy in the form of Stealing Lying Destructiveness Cruelty Gang activity Gambler Sex offence

ETIOLOGY (NIMS/GUPTE)
FAULTY EMOTIONAL ENVIRONMENT
Parental attitude Siblings Neighbourhood School Mass media T.V radio

FAULTY PARENTAL ATTITUDES

Rejection Overprotection Dominance Unrealistic expectation Discrimination Unfavorable comparision Over/under discipline Marital disharmony  availibility of parents Poor communication

CHANGES IN PEER RELATION

Loss of boyfriend /girl friend

POOR SELF IMAGE/ POOR SELF ESTEEM PHYSICAL ILLNESS/ HANDICAP

WHEN TO SUSPECT? (NIMS)

RECURRENT SOMATIC COMPLAINT
Headache Chestpain Abdominal pain Back pain

CHANGING EATING HABITS/ SLEEP PATTERN MOOD SWINGS

Restlessness Withdrawl from peers and family

DECREASE SCHOOL PERFORMANCE APATHY SELF DESTRUCTIVE BEHAVIOR SUBSTANCE ABUSE &RECKLESS DRIVING RISK TAKING BEHAVIOR

ATTEMPT AT SUICIDE
I wish I were dead what is there to live for

STATEMENTS LIKE:

INQUIRY ABOUT:

PSYCHOLOGICAL ASSESMENT
Psychosocial Hist. Brief mental status examination Determine content, duration,
context, intensity, freq. situation, persons involved, impact of problem

(IAP/ITPH)

Determine external factors Level of risk to the problem Involve parents and parents identify outcome

Determine if problem can be managed at office Determine if pt. needs referral Request referral sorce remain in contact and provide feedback Information, explanation, support to adolescents and parents Remain involved

FEW QUESTIONS FOR ASSESMENT

DIFFICULTY IN PEER RELATION
Do you have a best friend in whom you can share the most personal secerets

SELF IMAGE
is there anything you would like to change about yourself

DEPRESSION
What do you see yourself doing 5yrs from now

SCHOOL
How are your grades this year as compared to last year

PERSONAL DECISION
Are you feeling pressured to engage in any behavior for which you are not prepared

EATING DISORDER
Do you feel food controls you rather than vice-versa

PROTECTIVE FACTORS AGAINST RISKY BEHAVIOR (GHAI)

Caring & meaningful relationship Positive school environment Structures and boundaries fo behavior having spiritual beliefs Encouragement of self expression Oppurtunity for participation & contribution Work in three ways:
Encourage and sustain positive behavior Reduce risk of negative health beahvior & health Diminsh effect of and support recovery from negative health outcome

COUNSELLING TO PARENTS:
  

    

Understand impending identity crisis Show love to children & spend time with them Gain their faith that you will stand by them in period of crisis Use physical touch, kissing, hugging suitably Reinforce desirable behavior Getting familiar with friends of their children Help them pursue their hobbies Make other parents aware of ideal ways of parenting

ROLE AS A PEDIATRICIAN:
 

Interrogate parent and adolescent individually Choice if the parent should be present when adolescent is being interviewed is left to adolescent Establish a trusting relation with adolescent and parents Take help of other disciplines psychology, child psychiatry Counselling of the parents

THANK YOU