7 Adolescence: 12-21 Years

Be yourself. Besides, everyone else is taken.

– unknown

TABLE OF CONTENTS (TOC)

• Neurodevelopmental disorders
• Peers and understanding others
• Romantic relationships and sexuality
• Identity and self-esteem
• Behavioral health

Neurodevelopmental Disorders

Disorders or diseases that affect the development of the brain as well as the central nervous system resulting in deficits or delays in cognition, emotion, sociality, learning, and self-control and often appear in childhood or adolescence.

1. Intellectual disability (ID) is defined as having a psychometric intelligence (IQ) under 70 as well as two (2) deficits in adaptive behaviors. Adaptive behaviors reflect an individual’s social and practical competence in meeting the demands of everyday living. So, for instance, a blind adolescent, may need to learn braille or become adept in the use of technology to overcome their limitations.

2. Learning disorders (LD) include dyslexia, dysgraphia, and dyscalculia, and students are entitled to 504 accommodations such as extra time on an exam or a quiet room.

Dyslexia can be thought of as a verbal coding deficit. The most consistent research finding is that there appear to be deficits in memory for words and the ability to segment the basic sounds of language, known as phonemes.

Dysgraphia is a deficiency in the ability to write, primarily handwriting. It is a writing disorder associated with impaired handwriting, orthographic coding–conventions for writing, including spelling, hyphenation, capitalization, word breaks, emphasis, and punctuation– and finger sequencing (the movement of muscles involved in writing).

Dyscalculia is a difficulty in learning or comprehending arithmetic such as difficulty in understanding numbers, learning how to manipulate numbers, performing mathematical calculations, and learning facts in mathematics.

3. Autism spectrum disorders (ASD) including include autism, Rett’s syndrome, and childhood disintegrative disorder.

Autism, a rare but devastating disorder of childhood, was originally defined by the physician, Leo Kanner, M.D., in 1943, as a constitutional inability to make emotional contact with others. More than a decade later, it was widely agreed that the two central deficits in autism were profound social impairment and insistence by the child on sameness in behavioral routines (behavioral stereotypies). Currently, the received view designates a triad of symptoms as central to the autistic syndrome: (1) social impairment, (2) deficits in verbal and nonverbal communication, and (3) behavioral stereotypies (e.g., hand-flapping, repetitive play behaviors).

4. Developmental motor disorders including congenital injuries resulting in movement disorders leading to forms of cerebral palsy, a group of movement disorders, and neuromuscular diseases such as variants of muscular dystrophy.

5. Tic disorders including focal tics, Tourette syndrome, Sydenham’s chorea, and Huntington’s disease (juvenile).

The ability to shift from one activity (e.g., doing one’s taxes) to another (e.g., answering the phone) involves inhibiting the first activity to pursue a second activity and results in the production of new sequences of behavior. Repetitive stereotyped activities, such as obsessive-compulsive behavior and Gilles de Tourette syndrome, indicate the malfunctioning of this system.

6. Traumatic brain injury (TBI) includes concussions.

A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. It can be classified based on severity, mechanism (closed or penetrating head injury) or other features (e.g., occurring in a specific location or over a widespread area). Head injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social, emotional and behavioral symptoms, and outcomes can range from complete recovery to permanent disability or death.

7. Speech and language disorders including, specific language impairments (SLI), developmental phonological disorder (DPD), and stuttering.

Development phonological disorders result in failure to use developmentally expected speech sounds that are appropriate for a child’s or adolescent’s age and dialect such that the resulting speech difficulties interfere with academic or occupational achievement and social communication.

8. Neurotoxicants that cause various disorders including fetal alcohol spectrum and conduct disorders, methylmercury poisoning, and exposure to organophosphate pesticides, lead, arsenic, toluene, polybrominated diphenyl ethers, phthalates, and polychlorinated biphenyls (PCBs).

Children and adolescents from 8-15 years of age with higher urinary levels of organophosphate metabolites were more likely to meet the diagnostic criteria for attention deficit hyperactivity disorder (ADHD). Why is ADHD associated with organophosphates? Organophosphates inhibit the action of acetylcholinesterase and disruption of cholinergic signaling is one mechanism proposed for ADHD.

9. Genetic disorders such as Fragile-X syndrome, Down syndrome, Williams syndrome, attention deficit hyperactivity disorder (ADHD), schizophrenia-related disorders, and hypogonadotropic hypogonadal syndromes.

Neurodevelopmental disorders are the quantitative extreme of a continuum of normal variation; 50% begin by age 14.

Physical Activity and Mental Health

A very recent study found that total physical activity dropped between ages 12 and 16 years of age, mostly because of decreases in light activity (active movement) and increases in sedentary behavior. Activity levels when kids were younger were linked to their mental health later on; the depression scores at 18 were lower for every additional 60 minutes per day of light activity at 12, 14 and 16 years of age, and higher for every additional sedentary hour.

Peers and Understanding Others

As children mature into adolescence their brains undergo development that makes their reward system particularly responsive to peer influence and especially accommodating to various kinds of social situations. Adolescents, navigating this new social world, are very curious about other people’s behavior and values and are easily influenced by these new ways of being and interacting in the world. And this curiosity partakes of both non-risky and risky behaviors like smoking, sex, driving a car, and other adolescent interests.

A sense of wanting to be included or being excluded by other adolescents can also have an outsize influence on these behaviors. Other factors can include families, friends, schools, neighborhoods, and communities.

But peer influence can help adolescents thrive if they get more involved with their communities or learn how to cooperate or be empathetic with others.

Romantic Relationships and Sexuality

Although romance and dating are relatively common in adolescents, they are not universal. Of adolescents, 13 to 17 years of age, about a third have had a romantic relationship including a more casual or a more serious relationship.

Indeed, a recent survey found that 14% of adolescents are currently in a relationship that they consider to be serious with a boyfriend, girlfriend, or significant other. 5% of adolescents are in a current romantic relationship but do not consider it to be serious and 16% of adolescents are not currently dating but have had some sort of romantic relationship in the past.

On the other hand, about 64% of adolescents indicate that they have never been in a romantic relationship. Of the remaining adolescents (35%), they report having had a romantic partner or have dated in the past. Nonetheless, most adolescents are not sexually active or have never had sex, about 66%. Only about 30% have had some type of sexual activity.

Age is the primary demographic dividing line when it comes to dating and romance. Teens ages 15 to 17 are around twice as likely as those ages 13 to 14 to have ever had some type of romantic relationship experience (44% vs. 20%). These older teens also are significantly more likely to say they are currently in an active relationship, serious or otherwise (18% vs. 6% of younger teens).

Older teens also are more likely to be sexually active, as 36% of 15- to 17-year-olds with romantic relationship experience have had sex, compared with 12% of 13- to 14-year-olds with relationship experience.

Besides age, there are relatively few demographic differences when it comes to teens’ experiences with dating and romantic relationships. Boys and girls, and those with different racial, ethnic and economic backgrounds are equally likely to have been in such relationships.

Identity and Self-Esteem

The development of the self-concept in adolescence is an ongoing achievement. Indeed, the ability to think in possibilities and reason abstractly furthers this sense of themselves. However, the adolescent’s understanding of the self is often contradictory. They may feel withdrawn at certain times but at other times are outgoing, or feel intelligent one moment but unintelligent in another. Research has demonstrated that these contradictions begin to become an overarching concern as they begin to recognize that their personality and behavior morph depending on where they are or who they are interacting with. Nonetheless, given adolescents’ increasing concern about how they appear to others, they are more likely to emphasize traits such as considerateness or friendliness.

As self-concept differentiates, however, so too does self-esteem. This self-esteem emanates from their increasing understanding of their academic, social, physical, and athletic accomplishments in the light of others as well as their increasing competency in handling interpersonal (friends) and romantic relationships, and employment situations. But self-esteem may temporarily drop when making school transitions or moving to another city along with additional stressors such as family disruptions and parental conflict. Self-esteem rises again in late adolescence with increasing competence in adolescent peer relations, appearance, and athletic prowess.

Behavioral Health

• Globally, one in seven 10- to 19-year-olds experiences a mental disorder of one kind or another accounting for about 13% of the global burden of disease in this age group.
• Depression, anxiety, and behavioral disorders are among the leading causes of illness and disability among adolescents.
• Suicide is the fourth leading cause of death among 15-29 year-olds.
• Moreover, the consequences of failing to address adolescent mental health conditions extend into adulthood, impairing both physical and mental health and limiting opportunities to lead fulfilling lives as adults.

Anxiety disorders such as panic or excessive worry are the most prevalent in this age group and are more common among older than younger adolescents. Indeed, 3.6% of 10-14 year-olds and 4.6% of 15-19 year-olds experience an anxiety disorder. On the other hand, depression is estimated to occur among 1.1% of adolescents aged 10-14 years, and 2.8% of 15-19-year-olds. Depression and anxiety share some of the same symptoms, including rapid and unexpected changes in mood. Moreover, anxiety and depressive disorders can profoundly affect school attendance and academic work. And social withdrawal can exacerbate isolation and loneliness whereas depression can lead to suicide.

Many risk-taking behaviors, such as substance use or risky sex start during adolescence. Risk-taking behaviors can be a dangerous strategy to cope with emotional difficulties and can severely impact an adolescent’s mental and physical well-being.

• Worldwide, the prevalence of heavy binge drinking among adolescents aged 15­-19 years was 13.6% in 2016, with males most at risk.
• The use of tobacco and cannabis is also a concern. Many adult smokers have their first cigarette prior to the age of 18 years and get addicted to tobacco in less than 72 hours. Cannabis is the most widely used drug among young people with about 4.7% of 15-16 years-olds using it at least once in 2018.
• Interpersonal violence is a risk-taking behavior that can increase the likelihood of low educational attainment, injury, as well as involvement in a crime. Interpersonal violence was ranked among the leading causes of death of older adolescent males in 2019.