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THE CONTEXT TO ADOLESCENCE

THE CONTEXT TO ADOLESCENCE. Professor Graham Martin OAM MD, FRANZCP, DPM g.martin@uq.edu.au. ADOLESCENCE. A transition period from immaturity to maturity Early 11-14yrs Middle 15-18yrs Late 19-21 yrs. There is no ‘one’ adolescence.

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THE CONTEXT TO ADOLESCENCE

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  1. THE CONTEXT TO ADOLESCENCE Professor Graham Martin OAM MD, FRANZCP, DPM g.martin@uq.edu.au

  2. ADOLESCENCE • A transition period from immaturity to maturity • Early 11-14yrs • Middle 15-18yrs • Late 19-21 yrs

  3. There is no ‘one’ adolescence • At last count there were over 190 different cultural backgrounds in Australia • Life is different for • Lebanese young people in Sydney compared with Asian kids in Cabramatta • Young People from Thursday Island compared with those from OAFS in Adelaide

  4. Adolescence used to have3 stages Based on physiological status • Early (from Puberty) - Identity Confusion • Middle - Working through • Late - Identity re-formation Now the variability is what is obvious

  5. Rites of Passage • Work • Keys to the door • Alcohol • Cars • Circumcision • Sex • Challenge

  6. TEENAGE LABOUR FORCE PARTICIPATION 1978-1997

  7. Case identification Indicated The Trajectory

  8. Cousin Michael The trajectory interrupted

  9. Growth of the Ego(after Erik H. Erikson) Ego Integrity vs Despair Generativity vs Stagnation Intimacy vs Isolation Identity vs Role Confusion Industry vs Inferiority Initiative vs Guilt Autonomy vs Shame & Doubt Basic Trust vs Mistrust

  10. Key Developmental Issues • Identity • Autonomy • Intimacy • Sexuality • Achievement

  11. Toward What? • Clear Identity • Body Image • Relative Autonomy • Task Orientation • Commitment • ‘Adult’ relationship development

  12. Hierarchy of Needs Need for Self-Actualisation Personal Growth and Fulfilment Basic Biological and Physiological Needs Air, Food, Water, Shelter, Warmth, Sex, Sleep Need for Self-Esteem Achievement, Affection, Responsibility, Reputation Social Needs - Belonging Family Affection, Relationships, Work, Group relationships Need for Safety and Security Protection, Security, Order, Law, Limits, Stability Abraham Maslow,‘Motivation and Personality’, 1954) eg McKelvey/Vietnam

  13. Development of Health

  14. Resilience “the ability to bounce back, recover from, or adjust to misfortune or change” Burns, 1996

  15. Resilience facing AdversityFergusson and Lynskey, 1996 • intelligence • problem solving ability • female gender ?? • external interests/affiliations • +ve parental attachment and bonding • easy early temperament • good peer relationships

  16. Profile of the Resilient ChildBenard 1991 Social Competence • responsiveness, flexibility, empathy, caring, communication skills, sense of humour; Problem Solving Skills • critical thinking, generating alternatives, planning, produces change;

  17. Profile of the Resilient ChildBenard 1991 Autonomy • self-esteem, self-efficacy, internal locus of control, independence, adaptive/healthy distancing; Sense of Purpose and Future • goal directedness, achievement orientation, high motivation, educational aspiration, persistence, hopefulness, coherence;

  18. INFLUENCES • Successful Ego Maturation • Family Parameters • Family Developmental Stage • Gender and Same Sex Peers • Education and Employment

  19. Factors Influencing Body Image • Puberty and Adolescence • Role Models - Parents, Family(heredity) Teachers, and Coaches • Peers • Society and the Media

  20. Influence of Puberty Girls • natural weight gain necessary for shifts away from society's ideal body shape Boys • natural weight gain shifts towards society's ideal body shape

  21. Influence of Peers • Influence of friends increases • Emphasis on fitting in and being alike • Self absorbed • Focus: girls - how they look boys - what they can do

  22. Body Image Dissatisfaction% of Respondents Who Do Not Like How Their Body Looks Halton Region - October 2001

  23. Fear of Fat% of Respondents Who are Afraid of Becoming Fat or Fatter Halton Region - October 2001

  24. Weight Control Behaviours% of Respondents Who Are Trying to Lose Weight Halton Region - October 2001

  25. Frequency of Exercise % of Frequency of Exercise Halton Region - October 2001

  26. Body Dissatisfaction USA 1972-97 Percent dissatisfied Sex / Body Part n of 4,000 refers to the 1997 survey only. Garner (1997).

  27. Body Image Dissatisfaction • 27% of girls 12 - 18 years reported disordered attitudes about food • 20% of these girls were 12 - 14 years • dieting was the most prevalent weight loss strategy • 12% of girls 12 - 14 report binge-eating and 5% report self-induced vomiting Jennifer Jones, Disordered eating attitudes and behaviours in teenaged girls: a school based study 2001

  28. Influence of the Media Media creates a distorted image of reality: • normalizes & glamorizes what is a abnormal • creates false impression that all women and men are the same • sends the message that one must continually improve and is never good enough • uses technology to alter and create an image

  29. CONTAGION

  30. CONTAGION2

  31. Bio Psycho Socio Cultural Bio-Psycho-Socio-Cultural Influences

  32. The Family Context Father Sig. other Mother Self Sibling

  33. PARAMETERS OF FAMILY FUNCTIONINGafter Epstein & Bishop (MCMASTER) • Roles • Problem Solving • Communication • Affective Involvement • Affective Responsiveness • Behaviour Control • General Functioning

  34. TRANSITION POINTS IN FAMILY DEVELOPMENTAfter Barnhill and Longo, 1978 • Creation of the Couple (Commitment) • Entry of the First Child (Development of Parenting Roles) • First Child Development (Acceptance of Child/New Marital Roles) • First Child enters the Wider World (Accepting other institutions as responsible)

  35. TRANSITION POINTS IN FAMILY DEVELOPMENT • Adolescence (Acceptance of changed physique, Sexuality, Social Roles toward leaving home) • First Child leaves the family (Accepting/Permitting/Encouraging Independence) • Separation of Parents (Continuation of Parenting without Marital Role)

  36. TRANSITION POINTS IN FAMILY DEVELOPMENT • Remarriage of Parent (Acceptance of Extended Adoptive Family) • Last Child leaves the family (Facing each other and the ‘Empty Nest’) • Retirement (Developing New Career/Grandparent Status) • Death of a Spouse (Acceptance of Single Status)

  37. Hannah The reconstituted family

  38. The Protective FamilyBenard 1991 Caring and Support • close relationship with one person, affection expressed physically and verbally; High Expectations • structure , order, discipline, values, explicit expectation, faith, hope for the future Participation • valued participant, domestic responsibility, independence encouraged, autonomy respected

  39. Development of Ill-Health

  40. THEORETICAL MODELS Vulnerability-Stress impairment becomes manifest when vulnerability and stress factors overwhelm biopsychosocial responses (Falloon, 1993)

  41. THEORETICAL MODELS Vulnerability-Stress social factors interact with prior maternal loss + current vulnerability factors to produce cognitive set of low self esteem, reducing the ability to work through current loss. This leads to hopelessness (Brown, 1987 & 1994)

  42. THEORETICAL MODELS Cognitive • Depression is based in the development of a negative sense of self from childhood loss reinforced over time and leading to cognitive distortions (Beck, 1973) • Helplessness is a learned maladaptive style (Seligman, 1975) • Attributions for failure are learned (Abramson, 1978)

  43. Cognitive Socioemotional Biological Representational THEORETICAL MODELS Ecological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998) depressotypic organization

  44. Micro Cognitive Socioemotional Biological Representational THEORETICAL MODELS Ecological Transactional adapted from (Cichetti & Tucker, 1994; (Cichetti & Toth, 1998) Macro depressotypic organization Exo Ontogenic DEPRESSION

  45. Hypothalamic-Pituitary Adrenal (HPA) axis • Stress related - fight or flight • Corticotrophin releasing factor (hypothalamus) • Adrenocortocotrophic hormone (anterior pituitary) • Glucocorticoids (Cortisol) (Adrenal Cortex) • Increases blood sugar, heart rate, and inhibits overreaction of the immune system • Serotonin modulates the threshold of stimulation

  46. Cortisol as a predictor • Depressed Adolescents followed 10 years • Suicide attempters had increased Cortisol in 4, 6, &12 hours prior to sleep, but reduced at 2-4 hours before sleep (ie dysregulation of HPA axis) Matthew et al. 2003 Columbia group

  47. Disorders: Mean Age of Onset • ADHD - symptoms prior to age 7 (by definition) • Anxiety - Different forms throughout childhood (Separation, GAD, Phobic, OCD) • Post-traumatic Stress Disorder throughout childhood • Oppositional Defiant Disorder from about 6yrs • Conduct Disorder from about 10yrs • Delinquency from about 12yrs • Depression from peak mean age of onset 15yrs • Psychosis from peak mean age of onset 18yrs

  48. Unipolar Major Depression Currently the 4th most costly illness in the world, but will be 2nd by the year 2020. WHO Global Burden of Disease Study Murray and Lopez, 1997

  49. Depression in Young People • Mood • Depressive Syndrome or Symptom Complex • Disorder or Illness

  50. So what is Depression ? • Sad Mood over time • Appetite Disturbance • Sleep Disturbance • Agitation or Retardation • Loss of Interest and Pleasure • Low Energy or Fatigue • Worthlessness or Guilt • Slow Cognition with poor Concentration and Memory

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