ADOLESCENCE

Prepared by: Gina M. Jumawan, RN, MBA ADOLESCENCE Stage of maturation between childhood and adulthood. The term denotes the period from the beginning of puberty to maturity It usually starts at about age 14 in males and age 12 in females. Typically refers to the socially defined period during which a person adjusts to the physical, emotional, and social changes associated with the transition from childhood to adulthood 3 SUBPHASES 1. Early adolescence- 11-14 years 2. Middle adolescence- 15-17 years 3. Late adolescence- 18-20 years TEENAGE YEARS Synonymous to adolescence- 13-19 years Pubescence time span during which reproductive function begin to mature it ends with the attainment of full maturity or reproductive capacity and is characterized by rapid growth of the body, full genital development and sexual awareness. PUBERTY refers to the point at which reproduction is possible Maturational, hormonal and growth process that occurs when the reproductive organs begin to function and the secondary sex characteristics develop 3 STAGES: 1. Prepubescence 2 years immediately before puberty when the child is developing preliminary physical changes that herald sexual maturity 2. Puberty sexual maturity is achieved, marked by the first menstrual flow in girls but by less indications by boys 3. Postpubescence 1-2 years following puberty during which skeletal growth is completed and reproductive functions become fairly well-established

BIOLOGIC DEVELOPMENT
Primary sex characteristics External and internal organs that carry out the reproductive functions Ovaries Uterus Breasts penis Secondary sex characteristics Changes that occur throughout the body as a result of hormonal changes but play no direct part in reproduction Voice alterations Development of facial & pubertal hair Fat depositions During adolescence physical growth is greatly influenced by a number of factors, such as Heredity Nutrition Medical care Illness Physical and emotional environment

 Family size Culture

HORMONAL CHANGES OF PUBERTY

Androgens (Gonadal and adrenal) Hair coarsens, darkens, lengthens at the sites related to secondary sex characteristics Testosterone Muscle development- lean body mass (more in boys than in girls) Estrogen Sebaceous gland extremely active especially in the genitals and flushed areas of the body (face, neck, shoulders, upper back, & chest) o Acne Eccrine sweat glands fully functional and respond to emotional and thermal stimulation Heavy sweating (more pronounced in boys than in girls) Apocrine glands functional(hair follicles in the axilla, areola of the breast, umbilicus, external auditory canal, genital and anal regions) o Secrete thick substance as a result of emotional stimulation o When acted on by surface bacteria- highly odoriferous

SEXUAL MATURATION IN GIRLS

Thelarche o appearance of breast buds o Occurs between 9 and 13.5 years Adrenarche o Approximately 2-6 months by growth of pubic hair on the mons pubis Menarche o Appearance of menstruation o Occurs about 2 years after the appearance of the first pubescent changes o Approximately 9 months after attainment of peak high velocity & 3 months after attainment of peak weight velocity o Related to critical gain in the body fat content (more fat content, earlier menarche)-controversial o Normal age range- 10.5 15 years o Ovulation and regular menstrual periods usually occur 6-14 months after menarche Pubertal delay o If breast development has not occurred by age 13 or if menarche has not occurred 4 years of the onset of breast development

SEXUAL MATURATION IN BOYS

1st pubescent changes o Testicular enlargement accompanied by thinning, reddening and increased looseness of the scrotum (9-14 years) Early puberty o Initial appearance of pubic hair o Penile enlargement o Testicular enlargement Mid-puberty o Continued hair growth o Increasing muscularity o Early voice changes o Associated with lengthening of the vocal chords and increase in the structure and mass of the vocal folds o Development of early facial hair o Gynecomastia-temporary breast enlargement and tenderness o Disappears within 2 years

o Spurts in height and weight (towards end of mid-puberty) Late puberty o Definite increase in length and width of the penis o Testicular enlargement continues o First ejaculation occurs o True reproductive maturity is attained when viable appear in the semen. o Ejaculation expulsion of semen occurs in boys. o Axillary hair develops o Facial hair extends to cover the anterior neck o Final voice changes occur secondary to the growth of the larynx Pubertal delay o No enlargement of testes or scrotal changes by 13.5- 14 years or if genital growth is not complete 4 years after the testicles begin to enlarge Sex-role identity o Achievement of sexual identity is enhanced by the physical changes of puberty o According to Freud these physiological changes of puberty stimulate the libido. o Libido is the energy source that fuels the sex drive. (E.g. the practice of masturbation) o Physical evidence of maturity encourages the development of masculine and feminine behaviors. o Peer begins to communicate expectations regarding heterosexual relationships and as development progresses, they encounter expectations for mature sex role behavior from both peers and adults o Expectations vary from culture to culture and among socioeconomic groups ADOLESCENCE Weight o With pubertal growth spurt o Females- 7-25 kg (15-55 lbs) average o Males- 7-30 kg (15-65 lbs) average Height o With pubertal growth spurt o Females- 5-20 cm (2-8 inches) average o Males- 10-30 cm (4-12 inches)average o Growth in height typically ceases 2-2.5 years after menarche in girls and 1820 years in boys o Both height and weight gains are large it is because o Gain is mostly in weight, leading to stocky, slightly obese appearance, then the thin appearance of late adolescence. o The skeletal system grows faster than the muscle-lack of coordination and poor posture. o Heart and lungs increase in size more slowly than activity then constant fatigue. o In the adolescence, fatigue is also due to protein depletion, with proteins being used up for body growth.

PSYCHOSOCIAL DEVELOPMENT
o o o o o According to Erikson (1963) the psychosocial task of the adolescent is the establishment of identity Erikson sees identity or role, confusion as the prime danger of this stage Suggest that the cliquishness and intolerance of differences seen in adolescent behavior are defenses against identity confusion. Adolescence need to develop their own ethical systems based on personal values. Adolescents may develop brief crushes.

GROUP IDENTITY VS ALIENATION o Essential to the development of a sense of personal identity o Teenagers find it essential to have a group to which they feel they can belong and that provides them status o Help them establish the differences between them and parents o They dress as a group, wear make up and hairstyles according to group criteria o Language, music and dancing- change when adults emulate it o They need esteem and acceptance o Popularity is major concern for teens o Popularity with opposite-sex and same-sex peers is important o Adolescent require close bonds with peers so that they can later achieve a sense of individuality. o Conformity with peers, nonconformity to adults-generation gap-display own assertion o To be different is to be unaccepted and alienated from the group Personal identity vs. role confusion o In their search for identity, adolescents consider the relationships that have developed between themselves and others in the past as well as the directions they hope to make in the future o Role diffusion results when an individual is unable to formulate a satisfactory identity from the multiplicity of aspirations, roles and identification Family Identity o Stronger relationship is contrasted with adolescent movements away from parents o Adolescence need to make choices, act independently, and experience the consequences of action o The family needs to allow independence while providing a haven in which adolescence can contemplate actions. Vocational Identity o Adolescent must be future oriented when making choices. Health Identity o This component is of specific interest to health care providers o Healthy adolescent evaluate their own health according to feelings of wellbeing, ability to function normally, and absence of symptoms. MORAL DEVELOPMENT o According to Kohlberg, the young adolescent is usually at the conventional level of moral development. o Adolescent examine their values, standards, and morals. o They may discard the values they have adopted from parents in favor of values they consider more suitable. o Adolescents consider the possibility of rationally changing the law and emphasize individual rights. o Not all adolescents or even adults proceed to this post conventional level. Moral identity o The development of moral judgment depends heavily on cognitive and communication skills and peer interaction o Adolescent who understand that rules are cooperative agreements that can be modified to fit the situation, rather than absolute. o Adolescent learn to use her own judgment rather than use the rules to avoid punishment as in earlier years. o Morality is derived from individual principles of conscience. Adolescence and Independence

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By 15 16 years, adolescence feels they should be treated as adults. Ambivalence: adolescent wants freedom but is not happy with corresponding responsibilities that come with it. Parental ambivalence is also present: they cry to give the adolescent freedom but continue or offer constructive guidance and enforce discipline.

COGNITIVE DEVELOPMENT
Adolescence develops the ability to o determine possibilities o rank possibilities o solve problems o Make decisions through logical operations. They can think abstractly and deal effectively with hypothetical problems. o

LANGUAGE SKILLS
o o o Language development is fairly complete by adolescence, although vocabulary continues to expand. Adolescents need to communicate thoughts, feelings, and facts to peers, parents, teachers and other persons of authority. Adolescent must select the person with whom to communicate, decide on the exact message, and choose the way to transmit the message.

HINTS FOR COMMUNICATING o Do not avoid discussing sensitive issues o Ask open-ended questions o Look for the meaning behind their words or actions o Be alert to clues to their emotional state o Involve other individuals and resources when necessary

SPIRITUAL DEVELOPMENT
o o o o o o According to Fowler, the adolescent or young adult reaches the syntheticconventional stage of spiritual development. Expose to a wide variety of opinions, beliefs, and behaviors regarding religious matter. They may reconcile the differences in one following ways: Deciding any differences are wrong Compartmentalizing the differences Obtaining advice from significant other, such as parent or a minister.

NURSING ACTIVITIES RELATIVE TO THIS STAGE OF SPIRITUAL DEVELOPMENT INCLUDE: o Presenting an open, accepting attitude to adolescents questions and statements regarding spiritual matters and their implications for health. o Arranging for adolescents to see a member of their religious faith if so desired, or talk with members of their church peer group for support. o Providing a comfortable environment in which adolescents can practice the rituals of their faith. PLAY (RECREATION AND LEISURE ACTIVITIES) Girls are more on social function o can relate in romantic TV shows, o interested in reading romance books, o can cook, o can sew clothes, o some are interested in art and poetry, o love outing with friends, o watch movies, o experiencing day dreaming, o telephone conversation are lengthy

Boys are more interested in group activities. o sports o can work with mechanical and electrical devices o fun with outings, movies, and parties. o Health Maintenance in the Adolescence Nutrition o Calories : 2200 in girls and 2700 in boys o Appetite increase with rapid growth o *Inadequate diet results to retarded growth and delay in sexual maturity. o Increased need for protein, calcium, iron and zinc for sexual maturation o WATER is the most important element in his diet and in the diet of all age group. o Health Maintenance in the Adolescence o Sports activities may increase nutritional requirement because food intake need to be balanced with energy expenditure. o Eating habits are influenced by peer group: usually with feeding problems: o Junk food o Overeating and inactivity=obesity o Fat diets and false dieting can lead to health problems like anorexia nervosa.

HEALTH RISK
Motor vehicle accidents o Pedestrian o Emphasize and encourage safe pedestrian behavior o At night, walk with a friend o If someone is following you, go to the nearest place with people o Do not walk in secluded areas; take well travelled walkways o Passenger o Promote appropriate behavior while riding in a motor vehicle o Driver o Provide competent driver education o Encourage judicious use of vehicle o Discourage drag racing, playing chicken o Maintain vehicle in proper condition (brakes, tires, etc.) o Teach and promote safety and maintenance of two-wheeled vehicles o Promote and encourage wearing of safety apparel such as helmet, long trousers o Reinforce the dangers of drugs, including alcohol, when operating a motor vehicle SUICIDE o The third leading cases of death in adolescent between 15 and 24 year of age o Derision and social isolation commonly precede a suicide attempt, but suicide probably results from a combination of several factors. o Often occur for at least a month for attempting suicide: o Decrease in school performance o Withdrawal o Loss of initiative o Loneliness, sadness and crying o Appetite and sleep disturbances o Verbalization of suicidal thought SUBSTANCE ABUSE o is in fact concern to those who work with adolescents. o All adolescent are at risk for experimental or recreational substance use. o Majority adolescence experiment with MARIJUANA o Some teens include steroids to enhance their athletic performance..

Tobacco use continues to be a problem of adolescent.

EATING ORDERS o The number of eating disorders is on the rise adolescent girls, and knowledge of growth progression may be away to discourage radical weight reduction activities. o Anorexia nervosa and bulimia are classified as separate disorders. o Bulimia Nervosa is most identified with binge eating and behaviors to prevent weight gain. o Anorexia Nervosa is considered a clinical syndrome with both physical and psychosocial component. SEXUALLY TRANSMITTED DISEASE (STD) o The annual physical examination of a sexually active adolescent should include a thorough sexual history and careful examination of the genitalia so that pubis (crab lice), primary syphilitic chancres, and other STDs are not missed. o Risk-taking behaviors of adolescent sexual activity and drug use make adolescents vulnerable to the threat of the disease. PREGNANCY o Adolescent pregnancy continues to be major social challenge for our nation. o Healthy People (2020) set as its objective: a) Reduce teen pregnancy, b.) decrease infant mortality, c.) encourage prenatal care o Adolescence pregnancy occurs across socio economic classes, in public and private schools, among all ethnic and religious background and in all parts of country.

GUIDANCE DURING ADOLESCENCE

ENCOURAGE PARENTS TO: o Accept adolescent as a unique individual o Respect adolescents ideas, likes and dislikes and wishes o Be involved with school functions and attend adolescents performances, whether it be a sporting event or school play o Listen and try to be open to teenagers views, even when they disagree with parental views o Avoid criticism about no-win topics o Provide opportunity for choosing options and accept natural consequences of these choices o Allow young persons to learn by doing, even when choices and methods differ from those of adults o Provide adolescent with clear reasonable limits o Clarify house rules and consequences for breaking them o Let societys rules and consequences teach them responsibility outside the home o Allow increasing independence within limitations of safety and well being o Be available but avoid pressing teenager too far. o Respect adolescents privacy. o Try to share adolescents feelings of joy or sorrow o Respond to feelings, as well as words o Be available to answer questions, give information and provide companionship o Try to make communication clear o Avoid comparisons with siblings o Assist adolescent in selecting appropriate career goals and preparing for adult role

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Welcome adolescents friends into the home and treat them with respect Provide unconditional love Be willing to apologize when mistaken

BE AWARE THAT ADOLESCENTS o Are subject to turbulent unpredictable behavior o Are struggling for independence o Are extremely sensitive to feelings and behavior that affect them o May receive a different message than what was sent o Consider friends extremely important o Have a strong need to belong GROWTH EARLY ADOLESCENCE 11-14 YEARS MIDDLE ADOLESCENCE 15-17 YEARS LATE ADOLESCENCE 18-20 YEARS

Rapidly accelerating growth Reaches peak velocity Secondary sex characteristic appear

Growth decelerating in girls Stature reaches 95% of adult height Secondary sex characteristic well advanced

Physically mature Structure and reproductive growth almost complete

COGNITION

Explores new found ability for limted abstract thought Clumsy groping for new values and energies Comparison of normality with peers of the same sex

Developing capacity for abstract thinking Enjoys intellectual powers, often in idealistic terms Concern with philosophic political and social problems

Established abstract thought Can perceive and act on long range options Able to view problems comprehensively Intellectual and functional identity established

IDENTITY

Pre-occupied with rapid body changes Trying out various roles Measurement of attractiveness by acceptance or rejection of peers Conformity to group norms

Modifies body image Very self-centered, increased narcissism Tendency toward inner experience and self discovery Has a rich fantasy life Idealistic Able to perceive future implications of current behavior and decisions; variable application

Body image and gender role definition nearly secured Mature sexual identity Phase of consolidation of identity Stability of self esteem Comfortable with physical growth Social roles defined and articulated

RELATIONSHIPS WITH PARENTS

Defining independencedependence boundaries Strong desire to remain dependent on parents while trying to detach No major conflicts over parental control

Major conflicts over independence and control Low point in parentchild relationship Greatest push for emancipation; disengagement Final and irreversible emotional detachment from parents; mourning

Emotional and physical separation from parents completed Independence from family with less conflict Emancipation nearly secured

RELATIONSHIPS WITH PEERS

Seeks peer affiliations to counter instability generated by rapid change Upsurge of close, idealized friendhips with members of the same sex Struggle for mastery takes place within peer group Self exploration and evaluation Limited dating, usually group Limited intimacy

Strong need for identity to affirm self image Behavioral standards set by peer group Acceptance by peers extremely important for feer of rejection Exploration ability to attract opposite sex

Peer group recedes in importancein favor of individual friendship Testing of romantic relationships against possibility of permanent alliance Relationships characterized by giving and sharing Forms stable relationships and attachment to another Growing capacity for mutuality aand reciprocity Dating as a romantic pair May publicly identify as gay, lesbian, or bisexual Intimacy involves commitment rather than exploration and romanticism More constancy of emotion Anger more apt to be concealed

SEXUALITY

PSYCHOLOGIC HEALTH

Multiple plural relationships Internal identification of heterosexual, homosexual, or bisexual attractions Exploration of self appeal Feeling of being in love Tentative establishment of relationships

Wide mood swings Intense daydreaming Anger outwardly expressed with moodiness, temper outbursts, and verbal insults and name-calling

Tendency toward inner experiences; more introspective Tendency to withdraw when upset or feelings are hurt Vacillation of emotions in time and range Feelings of inadequacy common; difficulty in asking for help

Freuds Stage of Development

stage G E N I T A L

age P U B E R T Y

Characteristics Energy is directed toward full sexual maturity and function and development of skills needed to cope with the environment.

Implications Encourage separation from parents, achievement of independence, and decision making.

USUAL SEQUENCE OF MATURATIONAL CHANGES GIRLS BOYS

Breast Changes Rapid increase in height and weight Growth of pubic hair Appearance of axillary hair Menstruation(usually begins 2 years after first signs) Abrupt deceleration of linear growth

Enlargement of testicles Growth of pubic hair, axillary hair, hair on upper lip, hair on face and elsewhere on body (facial hair usually appears about 2 years after appearance of pubic hair) Rapid increase in height Changes in the larynx and consequently the voice (usually take place along with the growth of the penis) Nocturnal emissions Abrupt deceleration of linear growth

ERIKSONS STAGE OF DEVELOPMENT STAGE AGE CENTRAL TASK INDICATIONS OF POSITIVE RESOLUTION INDICATIONS OF NEGATIVE RESOLUTION

A D O L E S C E N

12 to 20

Identity versus role confusion

Coherent sense Feelings of of self confusion, Plans to actualize indecisiveness. And ones abilities possible antisocial behavior

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HAVIGHURSTS AGE PERIOD AND DEVELOPMENTAL TASK ADOLESCENCE 1. Achieving new and more mature relations with age-mates of both sexes 2. Achieving a masculine or feminine social role 3. Accepting ones physique and using the body effectively 4. Achieving emotional independence from parents and other adults 5. Achieving assurance of economic independence 6. Selecting and preparing for an occupation 7. Preparing for marriage and family life 8. Developing intellectual skills and concepts necessary for civic competence 9. Desiring and achieving socially responsible behavior 10. Acquiring a set of values and an ethical system as a guide to behavior

PSYCHOSOCIAL DEVELOPMENT EARLY ADOLESCENCE MIDDLE ADOLESCENCE 11-14 YEARS 15-17 YEARS Starts with puberty. Physical body changes result in altered selfconcept Tends to compare own body to others. Early and late developers have anxiety regarding fear rejection. Fantasy life, daydreams, crushes are all normal, help in role play of varying social situations. Needs limits and consistent discipline. Can identify own values Can define self ( selfconcept, strengths, and weaknesses) Partakes in peer group; conforms to values/ fads. Has increase heterosexual interest; communicates with opposite sex; may form love relationship. Sex education continues.

LATE ADOLESCENCE 18-20 YEARS Achieves greater independence. Chooses a vocation. Participates in society. Find identity. Finds a mate. Develops own morality. Completes physical and emotional maturity.

KOHLBERGS STAGE OF MORAL DEVELOPMENT LEVEL STAGE AVERAGE AGE

II. Conventional Person is concerned in maintaining expectations and rules of the family, group, nation, or society. A sense of guilt has developed and affects behavior. The person values uses conformity, loyalty, and active maintenance of social order and control. Conformity means good behavior or what pleases or helps another and is approved.

Law-and-Order Adolescence and Orientation Adulthood The (most men are on this person wants stage) established rules from authorities, and the reason for decisions and behavior is that social and sexual rules and traditions demand the response.

PIAGETS PHASE OF COGNITIVE DEVELOPMENT Phase and Stage Formal operation Phase age 11 to 15 Significant Behavior Uses rational thinking, reasoning is deductive and futuristic.

WESTERHOFFS STAGE OF FAITH Stage Experienced Faith Affiliative stage Age Early Adolescence Late Adolescence Behavior Experiences faith through interaction with others who are living a particular faith tradition. Actively participates in activities that characterize a particular faith tradition; experiences awe and wonderment; feels a sense of belonging.