Adolescence

Lecture Notes


Physical and Cognitive Development: Special Needs in Middle Childhood

  1. Special need types

    1. Sensory impairments

      1. Visual impairment: difficulty seeing which can include blindness or partial sightedness

      2. Auditory impairment: loss of hearing or some aspect of hearing

      3. Speech impairment: speech that deviates so much from speech of others that it calls attention to itself, interferes with communication, or produces maladjustment in the speaker

      4. Child-onset fluency disorder/stuttering: substantial disruption in the rhythm and fluency of speech; the most common speech impairment

    2. Learning disabilities - difficulty in acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities

      1. Diagnosis of specific learning disabilities are based on a discrepancy between children’s actual academic performance and their apparent potential to learn 

        1. Dyslexia

        2. Executive functioning

        3. Auditory processing 

      2. Public Law 94-142, the Education or All Handicapped Children Act: mid 1970s congress passed law for full inclusion and create least restrictive environment 

    3. Social-emotional OR behavioral impairments

  2. Autism Spectrum 

    1. Pervasive developmental delay - autism affects multiple areas of development (spreads throughout), not just one skill. It can influence communication, social interaction, behavior, emotional regulation, and sometimes learning or motor skills. 

    2. Apparent by age 3

      1. 3.2% of American children on spectrum 

        1. 4.9% in boys 

        2. 1.4% in girls

      2. Preserve sameness in environment - many autistic children prefer routines and predictability. Changes in schedule, environment, or expectations can feel stressful or overwhelming. This is why they may insist on doing things the same way each day. 

      3. Social isolation - some children with autism have difficulty forming social relationships or understanding social cues, which can lead to spending more time alone or struggling with peer interactions. 

      4. Severe language deficits

  3. Attention deficit hyperactivity disorder (ADHD/ADD)

    1. 1 in 9 US children diagnosed and 78% have co-occurring condition

    2. Higher incidence in boys

    3. Impulsivity, easily distracted, hard time concentrating, motivation difficulty, restless, fidgety

    4. ADD - primarily inattentive (more focus/attention without much hyperactivity)

    5. Treatment - medication from stimulants (adderall), or non stimulants, behavioral therapy (reward systems and positive reinforcement, breaking tasks into smaller steps, routine and time management) 

  4. Anxiety disorders 

    1. Internalizing disorder

    2. Generalized anxiety disorder

    3. Separation anxiety disorder 

    4. Obsessive compulsive disorder

    5. Post traumatic stress disorder

    6. → Symptoms →

      1. Shortness of breath

      2. Shallow breathing 

      3. Muscle tension

      4. More shortness of breath

      5. Tiredness

      6. Less energy for doing things

      7. Increased anxiety

  5. Depression

    1. Depressive symptoms different from Major depression

      1. MDD - diagnosis requires five or more depressive symptoms, including low mood or loss of interest, persisting nearly every day for at least two weeks 

    2. Depression affects 2% of children

      1. 8% of adolescents qualify for a diagnosis

    3. Somatic symptoms = fatigue, insomnia or hyperinsomnia (too much sleep), appetite changes (eating too much or too little), headaches, stomachaches, body aches/muscle pain, agitation and restlessness, low sex drive, brain fog

    4. Irritable mood and socially withdrawn

    5. Associated with a history of psychological adversity (stress, anxious attachment, physical or sexual abuse)

  6. Disruptive be\

  7. havior disorders - childhood and adolescent disorders characterized by ongoing patterns of uncooperative, hostile, aggressive, impulsive, or rule-breaking behaviors that interfere with daily life, relationships, school functioning, and social development. 

    1. Oppositional defiant disorder - usually occur for at least 6 months and are more extreme than typical childhood stubbornness 

      1. Negative, hostile, defiant behavior 

    2. Conduct disorder - more serious violations of rules and rights of others 

      1. Pattern of behavior that violates major age appropriate social norms (stealing, vandalism, lying, breaking the law)

      2. Early onset is more physical aggression, restlessness, subtle deficits in cognitive functioning 

        1. Often includes rejection by peers and limited social skills

        2. Can result from harsh parenting or parental rejection, abuse, avoidant attachment 

      3. Late onset occurs during puberty

        1. Better prognosis at this stage

        2. And there’s more peer context

    3. Other childhood disorders 

      1. Tourette Syndrome: A neurological disorder involving repeated, involuntary movements or vocalizations called tics, such as blinking, throat clearing, or sudden movements. Symptoms usually begin in childhood and may change over time.

      2. Enuresis and Encopresis: Enuresis refers to repeated urination in inappropriate places, such as bedwetting, beyond the expected developmental age. Encopresis involves repeated bowel movements in inappropriate places, often linked to constipation or difficulty with toilet training.

      3. Pica: A disorder in which a child repeatedly eats nonfood substances, such as dirt, chalk, paper, or paint, for at least one month. It can be dangerous because of poisoning or digestive problems.

      4. Developmental Language Disorder: Disorders involving difficulty understanding or using spoken language. Children may struggle with vocabulary, sentence structure, speaking clearly, or following conversations.

      5. Specific Learning Disorder: A disorder that affects a child’s ability to learn specific academic skills despite normal intelligence and educational opportunity. Common areas affected include reading (dyslexia), writing, and math.

      6. Selective Mutism: An anxiety-related disorder in which a child is able to speak normally in some settings (like at home) but consistently cannot speak in certain social situations, such as school.

      7. Reactive Attachment Disorder: A disorder that develops when infants or young children experience severe neglect, abuse, or inconsistent caregiving, leading to difficulty forming healthy emotional attachments and trusting relationships.

Middle Childhood: Social, Emotional, & Moral Development

  1. In response to family

    1. Middle childhood means more responsibilities

    2. Effective discipline = warmth, support, using reasoning

    3. Parents should monitor child’s behavior at this age

    4. Authoritative parenting leads to more agency

    5. Conflict should be resolved in a balanced way

  2. Sibling relationships 

    1. Compete for parents approval and attention 

    2. Social comparisons - looks, friends, talents

    3. Can act as facilitators, helpers, friends to each other

    4. Learn how to deal with conflict and anger through siblings

  3. School and out-of-school time contexts 

    1. In school - learn social behaviors

      1. Acquire mainstream cultural values and norms

      2. Influences child’s behavior and achievement

    2. Out-of-school Time

      1. Peers

      2. Clubs, lessons, sports

      3. TV, video games, computers

    3. Peer relations - major developments:

      1. Form loyal friendships

        1. Evaluate others in terms of personal traits 

        2. Best friends forever type of emotional connection formed

        3. Understand that conflict is natural and ok

        4. Fairness, equity, reciprocity

      2. Form peer groups

        1. Stable friendship networks

        2. Girls emphasize intimacy and sharing secrets

        3. Boys emphasize competition and joint building activities 

      3. Adhere to peer group norms

        1. Interpret rules rigidly and literally

      4. Maintain gender boundaries 

        1. Define and defend the borders of their gender group

        2. React negatively toward children who stray from gender lines

    4. Status and acceptance

      1. Sociometrics: used to measure children’s peer status by asking children who they like and don’t like - based on personal characteristics that are useful for achieving group goals and a predictor of adjustment in adolescence and mental health in adulthood

        1. Accepted: children are frequently named as liked

        2. Rejected: consistently named as disliked

        3. Neglected: rarely named as either liked or disliked

  4. Development of self

    1. Sense of gender:

      1. More flexible gender-role ideas

      2. Boys are more sex-typed than girls

      3. Parents continue to model and reinforce gender role behavior 

      4. Social factors influence flexibility of gender thinking 

    2. Gender development 

      1. Girls stop “knowing what they know” in order to maintain relationships

        1. girls may begin to hide their opinions, doubts, intelligence, or true feelings because they want to avoid conflict and keep friendships or relationships stable. During middle childhood, girls are often socialized to prioritize being “nice,” agreeable, and socially accepted. As a result, they may become less confident in expressing themselves openly if they think it could hurt relationships or make others dislike them.

      2. Boys socialized to decrease emotional expression, “tyranny of toughness”

        1. the pressure boys often experience to appear strong, tough, independent, and unemotional. The phrase “tyranny of toughness” means that society can almost “force” boys to suppress vulnerable emotions like sadness, fear, or anxiety because expressing them may be viewed as weak. In middle childhood, boys are commonly encouraged to “man up,” avoid crying, and focus on toughness or competitiveness instead. 

  5. Moral development - cognitive + social relationships + emotions = moral development

    1. Experience guilt

      1. Try to justify behavior

      2. Compensate for behavior

    2. Morals also depend on culture

    3. Younger kids do not understand motive so if Child A breaks 10 nice glasses from organizing kids will say they should be punished more than Child B who breaks only 1 nice glass from trying to steal a cookie

      1. But older kids evaluate motive more than number of nice things so they will say Child B should be punished more

  1. Carol Gilligan - challenged Kohlberg’s theory of moral development only from male viewpoint as women’s morality within relationships

    1. Kohlberg emphasized:

      1. Justice

      2. Rules

      3. Rights

      4. individual reasoning

      5. Abstract moral principles

      6. His research mainly studied boys and men.

    2. Gilligan argued:

      1. Women and girls may approach morality differently

      2. Morality is not only about justice and rules

      3. Relationships and care are also central to moral thinking

  2. Gilligan believed many females develop morality through:

    1. Relationships

    2. Responsibility to others

    3. Empathy

    4. Compassion

    5. Avoiding harm

  3. She called this the Ethic of Care.

Instead of asking:

“What is fair?”

Girls/women may also ask:

“How will this affect relationships and people’s feelings?”

  • Preconventional stage: women are focused on the self

  • Transition to responsibility

  • Conventional stage: women have come to focus on their responsibilities towards others

  • Transition from being good to being what’s true

  • Post-conventional stage: a woman has learned to see herself and others as interdependent 

Adolescent Physical Development

  1. Middle childhood - hormonal changes begin

    1. pituitary gland releases growth hormone

    2. Sex hormones released by adrenal glands - estrogens, andorgens

    3. Growth spurt: female bodies start first

      1. Girls age 10-16

      2. Boys age 12.5-17.5

      3. Both - add 10-11 inches and 50-75 lbs

  2. Puberty: biological

    1. Females

      1. Breast budding

      2. Height spurt

      3. Underarm and pubic hair

      4. Maturation of breast, uterus, and vagina

      5. Accumulation of body fat and change in body proportions

    2. Males

      1. Growth of penis and testes

      2. Body hair

      3. Ejeculation

      4. Voice changes

      5. Height spurt

      6. Facial hair

      7. Shoulders widen, muscle development, more muscle strength

  3. Puberty: sexual maturation

    1. Primary vs. secondary sex characteristics - help distinguish physically mature males and females

      1. Primary: physical changes directly related to reproductive organs and reproductive functioning

        1. Ovaries + uterus mature, menstruation, pregnancy capability

        2. Testes and penis grow, sperm produces, capable of fertilization

      2. Secondary: physical changes that signal sexual maturity but not directly involved in reproduction

        1. Breasts grow, wider hips, pubic and underarm hair, increased body fat distribution, growth spurt

        2. Facial hair, deeper voice, broader shoulders, increased muscle mass, pubic and underarm hair, growth spurt

    2. Menarche - a girl's first menstrual period (11-14 years on average)

    3. First ejaculation - signals beginning of sperm production (12-14 years on average)

    4. Individual differences in pubertal timing

  4. Puberty: brain development

    1. Neural connectivity and synaptic pruning

    2. Pruning of prefrontal cortex

    3. Increased sensitivity to excitatory neurotransmitters

    4. Increased sensitivity before cognitive control leads to increased risk-taking, impulsivity

    5. Sleep: shift in circadian rhythm 

  5. Prevention of teen pregnancy

    1. Sex ed does not encourage or increase early sex

    2. Sex ed programs that teach abstinence only are not effective

    3. Elements of effective Teen Pregnancy Prevention (TPP) programs

      1. Human development

      2. Puberty

      3. Reproduction

      4. Contraception

      5. STIs/STD prevention

      6. Healthy relationships

      7. Consent

      8. Communication skills

    4. Also need to build success in school, community, social skills, self-respect 

  6. Substance use and abuse

    1. Teen substance abuse has decreased since 1990s, except for marijuana use, which has increased steadily  - 10th-12th graders

    2. Prevention program elements - however high relapse rates

      1. Promote effective parenting including monitoring 

      2. Teach skills for resisting peer pressure

      3. Emphasize health and safety risk

      4. Decrease social acceptability of drug use

Adolescent Health Risk Behaviors

  1. Sex ed

    1. Only 15 states require sex ed to be medically accurate

    2. 37 states have laws requiring only abstinence is taught

    3. 18 states also require educators to educate about birth control

    4. 9 states require discussion of LGBTQ identities and relationships to be inclusive and affirming 

    5. 7 states either prohibit LGBTQ talk or require them to frame it negatively

    6. 37% of school districts require professional development for educators teaching human sexuality

  2. What educators should teach adolescents about sex

    1. Preventing teen pregnancy 

      1. Abstinence only education is ineffective so use effective TPP program topics

Adolescent Social and Emotional Development

  1. Major tasks during adolescence

    1. Establish a personal identity

    2. Achieve closeness and trust with peers

      1. Cognitive and psychological development helps produce capacity to have more intimate relationships - sharing feelings, events, emotions

      2. Romantic intimacy begins 

    3. Become more autonomous - novelty seeking drives a desire for independence even when it’s difficult

  2. 4 stages of identity development - James Marcia theory; yet not stages more like categories or statuses as they don’t have to go in this order

    1. Identity diffusion: not interested in figuring things out for themselves, not engaged in doing work to finding a life or who they want to be

    2. Identity foreclosure: acceptance of an identity somebody else gave, most often from a parent, but could be a faith leader or romantic partner — my parents want me to be a doctor so i’m doing that

      1. Typically see a midlife crisis in future 

    3. Identity moratorium: process of exploring and actively figuring yourself out

    4. Identity achievement: commitment to self-chosen values; as a student, son/daughter, friend, romantic partner, etc.

  3. Parent-child relationships

    1. Balance between connection and separation: parents feel massive rejection from children in adolescence, but they need to learn a balance 

      1. Consistent monitoring of activities

      2. Democratic decision making, as it shouldn’t be all the parents rulemaking like it used to be (but some are authoritarian)

        1. Asking kids what they should do when they’ve messed up

      3. Warmth and acceptance 

      4. Consistent discipline still necessary

    2. Quality of relationship is predictor of mental health

    3. Mild conflict is positive

  4. Psychological wellbeing

  5. Adolescent depression

    1. More than ¼ of high school students (~28%) say their mental health is not good most of the time

    2. Major depressive episode (MDE): physiological (disturbances in sleep or appetite) and psychological (persistent hopelessness, helplessness, social isolation, worthlessness sense) with these symptoms lasting many weeks

      1. Frequency of MDE = about 1 in 5 teens between 12 and 17 had an MDE in past year 

        1. Much higher among females than males

        2. Most experience impairment in functioning 

        3. 60% who had MDE didn’t receive treatment

      2. Combination of psychotherapy and medication is more effective than one alone to treat adolescent depression → but very difficult to access care for reasons:

        1. Lack of trusted parent/caregiver or 

        2. Cost (medication solely is commonly more cheaper than combination treatment)

        3. Concern of side effects 

          1. Paradoxical effect makes a younger adolescent experience worse symptoms on antidepressants as they can cause suicidal ideation

        4. Mental health stigma

    3. Group therapy with peers or family therapy are helpful modes of treatment 

  6. Adolescent suicide

    1. Second leading cause of death in American youth

    2. Rates of suicide completion is 4 times higher in boys than girls → despite rates of depression and suicide ideation being greater in females

      1. Girls are more likely to use pills or cutting while males are more likely to use guns or jump/hang themselves

    3. Prevention - most important thing to do when noticing signs is to ask them if they have been thinking about hurting or killing themselves 

      1. Misconception that you can put the idea into someone’s head by asking them if they’re not → suicide ideality is not cognitive

      2. Usually a relief to hear that question if they feel that way

      3. If they say yes you ask them to tell you more while expressing a degree of empathy and ask if they’ve thought about how they would do it and ask the plan if they have one, but also ask if they have the means to do so

      4. Hospitalization, close monitoring, and support for parents, friends, family, community