Adolescence: What Gives!

Adolescence

In contrast to puberty (a biological process universal to all children), adolescence is a period of "growing up"(a cultural phenomenon), unique to each civilization or society. According to 'Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents' (2008), Adolescence is the period from 11 to 21 years of age and is divided into three sections: Early Adolescence (11 to 14 years), Middle Adolescence (15 to 17 years), and Late Adolescence (18 to 21 years). These are very dynamic periods and often flow smoothly (but sometimes not) from one to the next. There are significant changes that occur during these periods which can be quite puzzling to the adolescent and their guardians. Among them are: physical, cognitive and psychological changes; development of social and sexual identity; formulation of educational and other long-range goals and plans; and development of an ideology and set of values.

Etiology of Adolescent Behaviors

Observing adolescent behaviors is easy. However, the more common and challenging question posed by caretakers and teens is "WHY?" There is no simple answer to this question because all human behavior is based on multiple factors including biology (gender, hormones), environment (cultural norms, media), social context (parents, peers), and personal (self-esteem, values). When there are disruptions in the sequence of normal adolescent growth and development, significant problems can arise and are often closely related. Delayed pubertal development in a boy, for example, can cause increased peer pressure leading to issues with self-esteem and ultimately depression. Severe acne or other common medical conditions associated with adolescence can similarly cause problems with peers and school performance.

Social expectations, family or personal issues, and poverty can all lead to unhealthy behaviors, especially during early adolescence when impulse control is still developing. The important concept for us to understand is that situations can trigger many different responses in adolescents. This is not excusing adolescent behavior but rather a recognition that we can try to understand the roots of that behavior while holding them accountable for the consequences of their actions.

Common Adolescent Issues

Many issues, both medical and non-medical confront adolescents and their families. In addition to acne, asthma, delayed puberty, musculoskeletal concerns, and weight problems (both over and under), adolescence is a period during which many psychosocial, psychological and psychiatric issues emerge. Peer and personal relationships are tested, concerns about sexual identity seem suddenly present, and more worrisome issues like mood and eating disorders, impulse control, and oppositional behaviors become more challenging to manage. Unhealthy, risky behaviors such as sexual activity, substance abuse, and violence test the limits of adolescent relationships with family, peers, and teachers alike. New issues confronting adolescents are related to excess or inappropriate use of electronic media such as the internet and social networking websites. When adults try to engage the adolescent in meaningful dialogue about these issues they are often met with the blanket statement, "you just dont understand me..."As a result caregivers become frustrated, and feel helpless and very much alone.

A Pound of Prevention

Completely anticipating and avoiding all potential adolescent issues is impossible. However, there are steps we can take to make this transition period less traumatic for many families. Anticipatory guidance and preventative healthcare are not only important for infants and young children, but are an essential part of caring for your adolescent. Helping families understand some of "what's ahead" as their grade school child becomes the adolescent is a key component of pediatric care. Adolescents should see their family doctor or pediatrician annually. In addition to a complete history and physical, their doctor will conduct recommended screenings and make sure immunizations are up-to-date.

It is common for your adolescent's doctor to spend a few minutes alone with her/him. Don't be alarmed! This is a time for them to discuss some sensitive topics that often make caregivers and adolescents uncomfortable, but that are essential to providing the best possible care to this age group. While confidentiality is sacred to the doctor-patient relationship, be assured, you will be informed of issues affecting your adolescent that can cause harm to themselves or others. These visits are also a time for your adolescent's doctor to offer you tips on dealing with your adolescent, including discussing what is "normal" adolescent growth and development, and areas for concern based on information gathered during the check-up. Treatment for any medical conditions discovered will be offered and necessary referral to specialists will be done.

Key Points

Some factors associated with helping to protect youth from engaging in unhealthy behaviors include close connection to home, extracurricular activities, school, and spirituality. In addition to counselors and teachers, your family doctor or pediatrician is an excellent source of information about many issues that confront you and your adolescent.

...And before you know it, she'll move on from arguing that she's responsible and skilled enough to drive (in Shanghai) and please get off her case, to planning a summer medical internship in Costa Rica...and you're the proud parents of a...Young Adult...

Additional Resources:

http://www.aap.org/parents.html
http://brightfutures.aap.org/pdfs/familypartnership.pdf

Written by Tyrone G. Bristol, MD, MPH, FAAP
Shanghai United Family Hospital
# 1139 Xian Xia Road, Changning District
Appointments Tel: (021) 2216 3922 or (021) 2216 3936

Dr. Bristol is from the United States of America but was born in Guyana, South America. He received his B.A. from Cornell University College of Arts and Sciences, his M.D. from the Albany Medical College, and his M.P.H. from the University at Albany School of Public Health. Dr. Bristol completed his pediatric internship and residency at the Children's Hospital of Philadelphia.

Dr. Bristol worked for many years as a general pediatrician in a community health center in Albany, New York. Before relocating to China, he was a General Academic Pediatrician and Associate Professor of Pediatrics at the Albany Medical Center.

Dr. Bristol is a Board Certified Pediatrician in the United States, and a Fellow of the American Academy of Pediatrics. He served as president of the New York Capital District Pediatric Society and the Albany Medical College Alumni Association. In addition to Health Administration, Dr. Bristol's clinical interests include Adolescent Medicine, Childhood Lead Poisoning, and Obesity.