Psychosocial Problems of Adolescence
Chapter 13
Not all teens are well adjusted, but that is not necessarily about adolescence
We don’t need to overreact
 Teens do experiment, but that is not always a portent of problems
ahead
 Most problems are transitory & don’t persist into adulthood
 Most problems are not caused by adolescence itself
Major problems during adolescence
 Substance abuse
• Primarily alcohol, smoking, marijuana
 Internalizing disorders
• Depression, anxiety
 Externalizing disorders
• Delinquency, antisocial aggression, truancy
• Others- academic or peer problems
• Some can be comorbid- co-occurring
Comorbidity of externalizing problems
 There are different ways of acting out that display general lack of
impulse control
 Problem behavior syndrome- various behaviors, often linked to
substance abuse, displaying general unconventionality
• Tolerant of deviance
• Not connected to educational institutions
• Often in environments with others who engage in risk-taking,
experimentation, delinquency
Problem clusters
 Biological underpinnings of risk taking/ unconventionality
 Early family context may encourage or ignore deviant behavior
 Cascading effects:
• One behavior often connects to another- drugs to delinquency,
unsafe sex
• Problems in childhood may lead to problems in adolescence at
a higher level
 Risk taking behaviors differ in the clustering between girls and boys
 Girls are more likely to use nicotine; boys, pot
 Boys are more externalizing with fights
Social control theory
 People with weak bonds to social institutions (family, school, church)
are more likely to deviate
 One reason for so many more problems clustering in poor, inner-city
youth
 Even so, most youth are not having serious problems
Comorbidity of internalizing problems
 The common state is a subjective state of distress
 Internalizing relates to rumination- obsessional thinking about one’s
feelings, condition
 Negative affectivity- becoming distressed easily
Substance use vs. abuse
 Teens get mixed signals about drug use, a reflection of our society’s
ambiguity of values
 Monitoring the Future- longitudinal survey of youth drug use
• ¾ HS seniors tried alcohol
• ½ HS seniors- cigarettes
• 45% have tried pot
Problems seen in the survey
 Drug experimentation is starting earlier today
 1/5 eighth graders drink alcohol regularly
 1/10 smokes once a month or more
 1/6 tried inhalants, marijuana
 20% have been drunk once
 When drug use begins as early as 14, chances of addiction rise
dramatically
 Smoking has declined- due to 70% increase in price of cigarettes since
1997
Drugs and the Brain
 Drug exposure earlier in life is more damaging & increases life
potential for addiction
 Most drugs work by mimicking dopamine, the neurotransmitter of
pleasure
 The problem is that the brain’s dopamine system slacks off in the
presence of external sources
 Early experiences of drug use can permanently affect the dopamine
system
 This is the source of addiction- needing more of the substance to
achieve pleasure
Early use has varied long term effects
 People who begin drinking before 14 are 7 times more likely to binge
drink; 5 times more likely to develop a substance abuse disorder
 Those who begin smoking before 14 are at higher risk of dependence
in adulthood
 Early use of inhalants is associated with higher rates of drug abuse
 The part of the brain most affected is the hippocampus- memory site,
also reigns in impulsivity
 Alcohol seems to affect the planning & regulation of impulses
Animal studies show early exposure to nicotine increases likelihood of
addiction
Ethnic differences in use
 The longer a minority is acculturated, the more likely s/he is to use
drugs
 New immigrants use at half the rate of the same group who was born
in US
 White youth are more likely to use more drugs/ alcohol than
minorities
 Use is highest in Native Americans
Progression of use
 Beer & wine first
 Cigarettes & hard liquor
 Marijuana
 Other illegal drugs
 Those who haven’t experimented by their 20s are unlikely to ever use
 Gateway drugs- alcohol/ marijuana represent a gate through which
teens pass to use harder drugs, but progression is affected by many
things
Developmental trajectories
 Six groups of users have been identified
Occasional use has become normative for teens
 Substance abuse- drug use causes problems in living
 Substance dependence- physical addiction shows in withdrawal
 People use in different ways:
• Frequent drug users (1Xweek)
• Hard-drug users
• Experimenters (not regular use)
• Abstainers (rational & irrational)
 Rational abstainers show better adjustment than irrational
abstainers, as they are overcontrolled, narrow in interests,
anxious & inhibited
Predictors of substance abuse
 More likely to be maladjusted as children
 Drug use in adolescence is symptom of earlier emotional disturbance
 As early as 7 years old these issues show up:
• Peer problems
• Little concern for others or moral issues
• Not likely to plan ahead
• Not trustworthy
• Not dependable
• Not confident
 For 11 year olds:
• Deviant, emotionally unstable, stubborn, inattentive
Four risk factors
 Psychological
• Anger, impulsivity, inattentiveness, more tolerant attitudes
about deviance, beliefs that alcohol will solve problems
 Familial
• Distant, hostile, conflicted, another member uses drugs
 Social
• Friends who use & tolerate use; often use is at a friend’s house
 Contextual
• Availability of drugs, social norms, lax enforcement of laws,
attending a school with many drug users
Protective factors
 Positive mental health
• High self esteem
 High academic achievement
 Engagement in school
 Close family relationships
 Religious involvement
Prevention focused on:
 The supply of drugs
• An abysmal failure
 The environment where teens are exposed to drugs
• Increasing the cost has reduced use
 Characteristics of potential drug user
• Enhancing self esteem; social skills training
• Helping youth develop other interests
• DARE, informational tx- ineffective as a behavior change agent
• Working reduces drug use
Externalizing problems
 Conduct disorder
• Persistent pattern of antisocial behavior resulting in problems in
school, relationships or work
• Oppositional defiant disorder- less serious, but affects 6–
16%M, 2-9%F
 Aggression
• Behavior done to intentionally hurt another
 Delinquency
• Crimes dealt with by the juvenile justice system
Conduct disorder
 Youth may be diagnosed as antisocial personality disorder in
adulthood (sociopaths, psychopaths)
• Antisocial behavior as well as manipulative, charming,
impulsive, indifferent to others’ feelings
• Many of these behaviors are common for teens & don’t reflect
pathology
Aggression
 Aggression encompasses many forms: physical fighting, intimidation,
relational
• Most disturbing as it becomes more damaging to others
(greatest incidence of aggression is in preschool, but it doesn’t
hurt others much)
Juvenile offending
 Status offenses are violations of laws that only pertain to juvenilestruancy, running away
 Violent crimes & property crimes increase over adolescence &
decline during adulthood- the age-crime curve
• 1/3 of arrests for serious crimes involves suspect under 18
Developmental progression of antisocial behavior
Adolescents as crime victims
 We worry about teen perpetrators, but more teens are victims of crime
• 10% of population, but 25% of victims
• Victims can develop PTSD, depression, sleep disorders, school
problems, aggression/ antisocial
 Inner city youth are most likely to be victims
• 12-24 y.o.: homicide 42%
Why is poverty such an influence?
 Parents are less effective in monitoring/ nurturing
• Native American community before & after income from a
casino- drop in teen problems due to enhanced monitoring of
parents
 Poverty destroys social fabric of a community- difficult for groups to
provide guidance
 When unemployed, violence is used by males to display power
 Prevalence of guns ups the ante when teens fight
• Experiment: poor families with violent teens were relocated
into better neighborhoods- violence dropped
Types of offenders
 Life-course persistent offenders
• Antisocial behavior before, during, & after adolescence
• More males; poor; more often from divorced homes
• From disorganized homes with hostile or neglectful parents
who have mistreated children or failed to teach self-control
• Antisocial behavior by teens triggers worse behavior by parent,
links to antisocial peers, school problems
• History of antisocial behavior as early as 8
• Characteristics: impulsive, little self control of anger, more
likely to have ADHD
• Often have parents/siblings who have been in trouble with the
law- modeling/ acceptance of deviance
• More likely to score low on IQ tests, perform badly in school
 Many are born of poor, drug addicted mothers, often
suffered problems in birth
• Poor relations with peers- peer rejection
• Hostile attributional bias/ more likely to see aggression as
useful in solving problems
Types of offenders
 Adolescence-limited offenders
• Antisocial behavior simply during adolescence
• Have learned social norms, better socialized
• 10X more males, more likely to be loners
• More mental health, substance abuse problems than nonoffenders
• Risk factors- poor parenting, little monitoring, affiliation with
antisocial peers
• Most activity occurs in group situations, trying to impress one
another, feeling peer pressure
 Runaways
• Only 4 – 10% have run away
• ½ return within days; 75% within a week
• Concern is dangers of road: physical risks, crime, prostitution,
AIDS, STDs, drug use
• More likely to be delinquent, drop out of school, use aggression
• Risks: poverty, low IQ, family problems
Internalizing problems
 Depression: emotional, cognitive, motivational, & physical symptoms
• More prevalent due to more stressors, abstract thinking,
rumination, personal fable
• Symptoms increase during adolescence, then decrease in
adulthood
• Often accompanies by anxiety, phobias, psychosomatic issues
• May be missed by parents, as “normal moodiness”
• Twice as many females as males, somewhat concurrent with
puberty
 Increased self-consciousness over appearance, concern
for popularity with peers
• Genetic
• Poor body image & low masculinity scores
• Gender roles- traditional feminine role is passive, dependent,
fragile
• Girls are more likely to be sexually abused in childhood
• Problem solving is more internal, more helplessness (boys are
more likely to distract or act out or use drugs)
• Girls higher levels of sensitivity (due to oxytocin levels) leads
to relationships that can be more supportive, lead to greater
vulnerability
Suicide
 10%F & 6%M attempt suicide each year
 Suicidal ideation increases during early adolescence, peaks around 15,
then declines
 Suicide rate among 15 – 19 y.o. increased from 1950 – 1990,
declining in the 1990s with new Rx
 Most common method is firearms, then hanging, ODs, carbon
monoxide poison
 Rate is highest for Native Americans & Alaskan Natives, lowest with
African Americans
Risk factors for suicide
 Having a psychiatric problem (depression, substance abuse)
 History of suicide in family
 Under stress (especially in achievement or sexuality)
 Parental rejection, family disruption, conflict
 Those who have more than one risk factor are much more likely to
attempt
 One attempt puts a person at higher risk for life
Pubertal hormones increase sensitivity to stressors
 Those who have more than one risk factor are much more likely to
attempt
 One attempt puts a person at higher risk for life
Diathesis-stress model
 Depression occurs when people who are predisposed toward
internalizing problems face chronic/ acute stressors
• Teens with a depressed parent are 3X more likely to develop
depression
 Without the predisposition, people can handle a certain level of stress
 Predisposition is both genetic & neuroendocrine (hypothalamic,
pituitary) in regulation of emotion
 They are more biologically reactive to stress
 Cognitive style is more hopeless, pessimistic, self-blaming &
catastrophizing
Diathesis-stress model
 The stress factor:
 Depression is more common among teens in high conflict families,
with low cohesion
• Higher from divorced homes
 More prevalent among teens who are unpopular, poor peer relations
 These teens report more chronic & acute stress than nondepressed
 Academic problems are common
 Most common trigger is a romantic breakup
Treatment modalities
 Biological therapies- antidepressant Rx
• SSRIs, Prozac- also useful for anxieties
 Psychotherapies- cognitive reframing
 Finding reinforcement in daily life
 Family therapy to change patterns
Prevention methods
 Primary
• Teaching all teens social competencies & life skills
 Secondary
• Screening high schoolers to identify those most at risk
Major life stressors for teens
 Parental divorce, changing schools, loss of family members, poverty,
disabilities, daily hassles
 Many teens face these stressors, yet are protected by an inner
resilience
 Stress has a multiplier effect
 Some teens have other resources, internal & external
• Most important buffer is a close parent-adolescent relationship
 Some use better coping:
• Primary control- efforts to adapt to the problem
 Users are better adjusted, less depressed, less likely to act
out
• Secondary control- distraction