Adolescent
Psychological
Development
Laura Kastner, Ph.D.
Clinical Associate Professor
Psychiatry and Behavioral Sciences
Why is it important for a adolescent health
clinicians to know the basics about adolescent
development?
• They are frequently asked the question by
parents, “Is this normal or a sign of pathology?”
(e.g. moodiness, withdrawal, rebelliousness,
defiance, irrationality, argumentativeness)
• They can be faced with teen emotions while
interviewing adolescent patients that impede
diagnosis and treatment.
Why is it important for a clinicians to know the
basics about adolescent development?
They may experience personal reactions that hinder effective
medical transactions if they don’t understand the dynamics of
adolescent development.
“My 15 year old son…
“ My 15 year old son, Randy, is rude, won’t talk at dinner, wants to just
hang out in his room, won’t share any information with us, cares more
about his electronics than anything, becomes irrational when we
confront him, hogs the bathroom, is highly emotionally reactive, and
has lied, snuck out and drank alcohol at a party and violated our
internet rules.”
“A website on drug abuse cited these warning signs:
• withdrawal
• moodiness
• increased family conflict
• argumentativeness
• over-reactivity to criticism
• sloppiness in appearance
• spending time isolating in room
• poor attitude
• disrespect
• loss of interest in family activities.”
“Does my son have a drug abuse problem?”
Adolescent Psychological
Development
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Physical development
Cognitive development
Social development
Identity development
Moral development
Physical development
• Pubertal development
• Bodily changes resulting in increased selfconsciousness, preoccupation and questions
of “Am I normal?’
• Alterations in sleep (and less!)
• Sexual interests and changes in social
responses
• Sexual identity development
Cognitive Development
(historical review)
• Shift from concrete to formal operations, allowing
for greater abstract thinking skills, symbolic
reasoning and hypothetical analysis (Jean Piaget)
• Cognitive style is characterized by egocentricism
• “magical thinking”; imaginary audience”; “myth
of immunity”; and “personal fable” (Elkind)
• And then the game-changer~ Brain imaging
research…
Emotion Brain-(limbic system)
• Amygdala-fear and anxiety center (fight,
flight, flood)
(this is an “amygdala
hijack” in action)
• Also hypocampus, ventral striatum,
hypothalamus, nucleus accumbens
Brain Maturation
• Recent research shows that much of which has
been attributed to hormones is probably related
also to changes in brain structure (Giedd, 1999).
• The prefrontal cortex (“CEO”) of the adolescent
(~13yo) becomes pruned, sloughing off up to 40%
of its neural branches, as it grows new
neural connections for more
sophisticated functioning.
• Greater refinements in neural connectivity and
extensive myelination continue through
adolescence; the brain does not fully mature until
the early 20’s.
Teen Brain
NASCAR
Metaphor
• Big engine—maturing bodies,
independence-striving
• Poor Driver—immature PFC and judgment
• Faulty Brake system—immature inhibitory
mechanisms in PFC
• High octane fuel—hormones
Put
simply…
…
• During adolescence, behavior is often
more governed by the emotional centers
than the thinking centers of the brain,
especially during high arousal situations
and in peer presence.
Adolescence:
“Storm and stress” theory
• Adolescent difficulties are neither inevitable or
universal
• Research on large populations of adolescents
indicates that teens experience more rapid mood
changes but no more depression/anxiety/pathology
than adult samples (Csikszentmihalyi & Larson)
• Surveys reveal that most adolescents describe
themselves as “mostly happy” and are adequately
adjusted (Offer)
Developmental research qualifiers:
• Marked changes in moodiness, emotional reactivity and
risk-taking among adolescents are neither universal or
inevitable (cultural and class differences exist)
• Although gender, culture and age differences among
adolescents can be important, temperament is a powerful
predictor of behavior
• Discussions with parents about their interpretations
regarding their teen’s behavior is tricky terrain
• What is interpreted as “normal” depends on the clinician’s
psychosocial assessment, sophistication of knowledge
about adolescence and personal “filters.”
Neuroendocrine system changes
• Testosterone in boys can increase by 100% by the
end of puberty, and 20 X more than girls of same
age.
• Amygdala has receptors for testosterone, which
probably contributes to increased novelty seeking,
territoriality and exploration for stimulation.
• Hormones have impact on neurotransmitters,
moods and symptoms: norepinephrine
(energizer); dopamine (pleasure); and serotonin
(mood stabilization, relaxation, confidence)
Sensitivity of the teen brain to
substances
• Alcohol stimulates the release of dopamine during the
“sensitive period” of adolescence, decreasing the natural
production.
• Heavy alcohol use interferes with memory and glutamate
functioning.
• Nicotine stimulates dopamine supply and affects other
neurotransmitters, allowing rapid addiction.
• Dopamine “squirts” result from computer games,
stimulating media, gambling and other high arousal
pursuits.
• Changes in circadian rhythms alter alert-fatigue signals,
affecting memory and biorhythms
In sum, the impact of brain changes on
adolescent reasoning, behavior and mood:
• Decision-making models don’t apply in high
arousal situations ( “cold” logic, as compared to
“hot” arousal situations)
• Impulse control reduction
• Poor risk assessment
• Executive functioning impairment
• Desire to escape boredom and negative affect by
“revving” up and seeking stimulation
• Parental disciplinary efforts at times of high
arousal can result in explosive conflict
Social Development
• Desire for increased independence
• Preference for spending time with peers, orienting
increasingly to peers for social influence and
values clarification
• Most teens are more “attached” to their parents,
but they prefer the company of their friends
• Individuation from the family
• Cultural context plays a large role in determining
diverse paths within these developmental and
universal trajectories.
Ethnic Diversity
• Developing a strong ethnic identity contributes to
high self-esteem among ethnic minority
adolescents (Carlson et al, 2000).
• Parents and role models are key for establishing
pride in shared values, traditions and practices of a
cultural group.
• Adolescence may be the first time they reflect on
the implications of their group identification.
Identity development
• Erik Erikson’s major task of adolescence was
constructed as “identity v. role confusion” (Who
am I uniquely?)
• Researchers have documented how teens explore
beliefs with various levels of “crisis and
commitment” (e.g. religion, politics, sexuality,
educational and vocational choices).
• By their twenties, they will have an integrated set
of values reflecting their experiences and parental,
generational and cultural influences.
Moral development theories focus on moral
reasoning (highly dependent on environment and
cognitive maturity)
• Lawrence Kohlberg’s theory demonstrates that
adolescents’ moral reasoning reflects a maturing
value on the rights of others, the importance of
law and justice and universal principles.
• Carol Gilligan pioneered the special value that
females place on responsibility and the caring of
others for moral reasoning.
• Jonathan Haidt and others emphasize that moral
reasoning doesn’t necessarily dictate moral action.
Kohlberg’s stages of moral
reasoning
Level 1
1.
Obedience and punishment orientation (How do I avoid punishment?)
2.
Self interest orientation (What’s in it for me?)
Level 2
3.
Interpersonal conformity orientation (I’ll be good to you if you are good to
me)
4.
Authority and social order orientation
(Law and order morality)
* ***
Level 3
5. Social contract orientation
(What makes a society run smoothly; concepts of liberty,
justice, democratic principles)
6. Universal principles
(principled conscience, e.g. Golden Rule,
civil disobedience)
Adolescence as a period of
normal risk-taking and behavioral
experimentation
• Adaptive identity development for most, but can
carry high risks and long term harm for others
• Early adolescence as a time of particular
vulnerability (school failure, STD’s, substance
use)
• Family cohesiveness and authoritative parenting
are significant predictors for successful and safe
adolescent outcome (Baumrind; Shedler and
Block; Blum)
Parenting strengths that predict optimal
adjustment in late adolescence
• Close relationship to caring parent figure
• Authoritative parenting: warmth, effective
communication, monitoring and structure.
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Socioeconomic advantages
Connections to extended supportive family networks
Bonds to prosocial adults outside the family
Connections to prosocial organizations
Attending effective schools
“My 15 year old son…
Remember Randy’s “warning signs”:
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withdrawal
moodiness
increased family conflict
argumentativeness
over-reactivity to criticism
sloppiness in appearance
spending time isolating in room
poor attitude
disrespect
loss of interest in family activities.”
In the context of positive reports about functioning in family, school,
extracurricular activities, emotional/social life, Randy is likely
experiencing normal adolescent development.
Take homes
• Remember your own teen vulnerabilities—it will enhance
your empathy
• Normal adolescent development is usually messy—so
you’ll hear about messy behaviors and see them too—even
when they are healthy!
• A comprehensive teen, parent, and social system review is
the only way to evaluate many of the problems you are
consulted about (e.g. drugs, depression, etc).
• Most morbidity and mortality among adolescents has
psychosocial/behavioral components, so focusing just on
“medical issues” is not an option.
• Because teens are vulnerable, fascinating and challenging,
they can be among your most rewarding patients when you
connect with them in a genuine way!
A clinician’s crash course in
adolescent development.
In summary,
• Assess the “big picture” of a teen’s life
• Appreciate that diversity includes many
domains
• Find something in the teen to appreciate
• Be curious
• Remember your own vulnerable teen
moments
• Be authentic, humble and sincere