Adolescent Problems - DSM – IV Adolescent Problems - DSM – IV Disorders Disorders usuallyusually first diagnosed in first diagnosed in

infancy, childhood, or adolescenceinfancy, childhood, or adolescence Mental RetardationMental Retardation Learning DisordersLearning Disorders Developmental Coordination Disorder Developmental Coordination Disorder

(motor coordination)(motor coordination) Expressive Language Disorder Expressive Language Disorder

(standardized tests of expressive language)(standardized tests of expressive language) Phonological Disorder (speech sounds)Phonological Disorder (speech sounds) StutteringStuttering Autistic Disorder (social interaction deficits)Autistic Disorder (social interaction deficits)

Rett’s Disorder (head size, hand Rett’s Disorder (head size, hand movement, social engagement – movement, social engagement – deficits after early normality)deficits after early normality)

Childhood Disintegrative Disorder Childhood Disintegrative Disorder (after normal development, (after normal development, progressive deterioration of progressive deterioration of language, social, physical skills)language, social, physical skills)

Asperger’s Disorder (nonverbal Asperger’s Disorder (nonverbal behaviors, peer skills, peer behaviors, peer skills, peer enjoyment, emotional reciprocity)enjoyment, emotional reciprocity)

ADHDADHD Pica (eating objects)Pica (eating objects)

Rumination (regurgitation, rechewing)Rumination (regurgitation, rechewing) Feeding Disorder (failure to eat adequate Feeding Disorder (failure to eat adequate

amount)amount) Tourette’s Disorder (motor, vocal outbursts)Tourette’s Disorder (motor, vocal outbursts) Encopresis (feces)Encopresis (feces) Enuresis (wetting)Enuresis (wetting) Separation Anxiety Disorder (excessive Separation Anxiety Disorder (excessive

anxiety)anxiety) Selective MutismSelective Mutism Reactive Attachment Disorder (hypervigilant or Reactive Attachment Disorder (hypervigilant or

diffuse attachments)diffuse attachments) Stereotypic Movement Disorder (repetitive and Stereotypic Movement Disorder (repetitive and

non-functional motor behavior)non-functional motor behavior)

Conduct DisorderConduct Disorder (rights of others (rights of others are violated) – as early as 5-6, are violated) – as early as 5-6, usually in late childhood or early usually in late childhood or early adolescence, rarely after 16adolescence, rarely after 16

Oppositional Defiant DisorderOppositional Defiant Disorder (negativistic, defiant, disobedient, (negativistic, defiant, disobedient, hostile behavior toward authority hostile behavior toward authority figures) – usually before age 8figures) – usually before age 8

Externalizing problemsExternalizing problems• Problem behavior theoryProblem behavior theory• Risky automobile drivingRisky automobile driving• Substance useSubstance use• Delinquency and crimeDelinquency and crime• Factors involved in risk behaviorFactors involved in risk behavior

Internalizing problemsInternalizing problems• DepressionDepression• Eating disordersEating disorders

Two Broad Problem TypesTwo Broad Problem Types1.1. ExternalizingExternalizing Problems – create difficulties in a person’s Problems – create difficulties in a person’s

external world (a.k.a. “undercontrolled”)external world (a.k.a. “undercontrolled”) Tend to go together (a person that fights is also more likely Tend to go together (a person that fights is also more likely

to commit other crimes)to commit other crimes) More common among malesMore common among males Often motivated by desire for excitement, not necessarily Often motivated by desire for excitement, not necessarily

underlying unhappiness or psychopathologyunderlying unhappiness or psychopathology

2.2. InternalizingInternalizing Problems – primarily affect a person’s internal Problems – primarily affect a person’s internal world (A.k.a. “overcontrolled”)world (A.k.a. “overcontrolled”)

Tend to go together (a person who is depressed is also more Tend to go together (a person who is depressed is also more likely to have an anxiety disorder)likely to have an anxiety disorder)

More common in femalesMore common in females Associated with experiencing distressAssociated with experiencing distress

Problem Behavior TheoryProblem Behavior Theory

Problem Behavior Problem Behavior SyndromeSyndrome = Pattern of = Pattern of correlations between externalizing correlations between externalizing problemsproblems

Theory: Problems have common origins Theory: Problems have common origins • BackgroundBackground factors – e.g., family income factors – e.g., family income• PersonalityPersonality factors – e.g., self-esteem factors – e.g., self-esteem• SocialSocial factors – e.g., parental control factors – e.g., parental control

Monitoring Monitoring the Future, the Future,

20062006

Any illicit Any illicit drug usedrug use

CigarettesCigarettes

AlcoholAlcohol

LSDLSD

CocaineCocaine

Other Other narcotics, narcotics, including including

OxyContin, OxyContin, VicodinVicodin

Increase in 2002 due Increase in 2002 due to inclusion of more to inclusion of more types of drugs in the types of drugs in the

survey questionsurvey question

EcstasyEcstasy

Shope’s Model of Young Driver

Crash Risks (2002)

Driver Crash Involvement: Driver Crash Involvement: Property DamageProperty Damage

Rates per 100,000: 1997

Driver Crash Involvement: Driver Crash Involvement: InjuryInjury

Rates per 100,000: 1997

Driver Crash Involvement: Driver Crash Involvement: FatalityFatality

Rates per 100,000: 1997

Prevention: Two ApproachesPrevention: Two Approaches1.1. Driver EducationDriver Education

• Generally hasn’t worked too well…Generally hasn’t worked too well…• Get your license faster…you’re out Get your license faster…you’re out

there driving and getting into there driving and getting into accidents!accidents!

2.2. Graduated Driver Licensing (GDL)Graduated Driver Licensing (GDL)• More effectiveMore effective• Address a variety of risk factorsAddress a variety of risk factors• Restrict the conditions under which Restrict the conditions under which

novices can drivenovices can drive

Graduated Licensing StrategyGraduated Licensing Strategy Three Stages to a Three Stages to a GDL GDL program:program:

1.1. LearningLearning License – getting driving License – getting driving experience under supervision of experience under supervision of experienced driverexperienced driver

2.2. RestrictedRestricted License – can drive License – can drive unsupervised, but with restrictions unsupervised, but with restrictions designed to reduce crashes (e.g., designed to reduce crashes (e.g., driving curfews)driving curfews)

3.3. Full Full License – after 1 year restrictedLicense – after 1 year restricted

N

L

Substance UseSubstance Use

AlcoholAlcohol

CigarettesCigarettes

Illegal drugs (e.g., marijuana, Illegal drugs (e.g., marijuana, cocaine, LSD, ecstasy…)cocaine, LSD, ecstasy…)

Adolescent substance use became target of a great deal of political attention,

public policy programs and researchIn the 1980s and beyond….

Substance Use, 1975-1999Substance Use, 1975-1999

Source: Monitoring the Future, 2000

Alcohol & Marijuana Use by AgeAlcohol & Marijuana Use by Age

Notice the higher levels of use during

age when unstructured socializing is

most prevalent

Sequence of Substance UseSequence of Substance Use

1.1. Drinking beer and wineDrinking beer and wine

2.2. Smoking cigarettes and drinking hard Smoking cigarettes and drinking hard liquorliquor

3.3. Smoking marijuanaSmoking marijuana

4.4. Using “hard” drugsUsing “hard” drugs

Adolescents use in different ways…Adolescents use in different ways…ExperimentalExperimental curiosity “to see what it’s like”curiosity “to see what it’s like”

Once or twiceOnce or twice

SocialSocial Use during social activities with one Use during social activities with one or more friendsor more friends

MedicinalMedicinal To relieve unpleasant emotional To relieve unpleasant emotional state such as sadness or anxietystate such as sadness or anxiety

AddictiveAddictive Dependency either physical or Dependency either physical or psychologicalpsychological

Delinquency and Crime: DefinitionsDelinquency and Crime: Definitions Delinquency – when “juveniles” commit Delinquency – when “juveniles” commit

crimes:crimes:

1.1. StatusStatus Offences – only a violation of the law Offences – only a violation of the law because committed by juvenilebecause committed by juvenile

2.2. IndexIndex Crimes – serious crimes at any age Crimes – serious crimes at any age Violent CrimesViolent Crimes

Property CrimesProperty Crimes

3.3. Nonindex Nonindex Crimes – less serious offenses Crimes – less serious offenses such as gambling, disorderly conductsuch as gambling, disorderly conduct

Age and CrimeAge and Crime

1842 1977

Two Types of DelinquencyTwo Types of Delinquency

Life-course-persistentLife-course-persistent delinquents delinquents Pattern of problems from birth on upPattern of problems from birth on up

Originate in neuropsychological deficits (difficult Originate in neuropsychological deficits (difficult temperament, LD)temperament, LD)

Likely to grow up in high risk environmentLikely to grow up in high risk environment

Adolescent-delimitedAdolescent-delimited delinquents delinquents No signs of problems in infancy or childhoodNo signs of problems in infancy or childhood

Period of occasional criminal activity between ages of Period of occasional criminal activity between ages of 12-25 (e.g., vandalism, illegal drug use)12-25 (e.g., vandalism, illegal drug use)

(Moffit, 1993)

Preventing Crime & DelinquencyPreventing Crime & Delinquency

Prevention programs for children who Prevention programs for children who show signs of risk for LCPD and for show signs of risk for LCPD and for adolescents engaging in serious adolescents engaging in serious delinquencydelinquency

Varied Strategies:Varied Strategies:• Individual therapyIndividual therapy• Group therapyGroup therapy• Vocational trainingVocational training• Outward Bound type programsOutward Bound type programs• Scared Straight “Boot Camp” type programsScared Straight “Boot Camp” type programs

Preventing Crime & DelinquencyPreventing Crime & Delinquency

Two problems with prevention programs:Two problems with prevention programs:

1.1. Participation is typically non-voluntary or Participation is typically non-voluntary or against one’s willagainst one’s will

2.2. Prevention comes too late (in adolescence) Prevention comes too late (in adolescence) after behavior patterns have been establishedafter behavior patterns have been established

• The Multisystemic Approach has been met with some success

• MST includes parent training, job training, vocational counseling, development of neighborhood activities and centers – directing the energy of delinquents in positive directions.

Preventing Crime & DelinquencyPreventing Crime & DelinquencyMultisytemic therapy (MST) vs. usual Juvenile Justice Multisytemic therapy (MST) vs. usual Juvenile Justice Services for serious adolescent offendersServices for serious adolescent offenders

Note: Lower is better!

Factors involved in Risk Behavior

Socialization and DelinquencySocialization and Delinquency

What is a “socialized delinquent”? What is a “socialized delinquent”? An “unsocialized delinquent”?An “unsocialized delinquent”?

Culture and Risk BehaviorCulture and Risk Behavior In traditional cultures, Schlegel and Barry In traditional cultures, Schlegel and Barry

(1991) found that boys and not girls tend to (1991) found that boys and not girls tend to engage in risk behavior during adolescenceengage in risk behavior during adolescence

Evidence of antisocial behavior in less than half Evidence of antisocial behavior in less than half of the cultures studiedof the cultures studied

In Western countries other than the USA, In Western countries other than the USA, engage in less risky driving behaviorengage in less risky driving behavior

USA has highest rates of violent crimesUSA has highest rates of violent crimes

Deaths from Suicide & HomicideDeaths from Suicide & HomicideThe USA has the highest

homicide rate; Canada the highest suicide rate

15-year olds Who Report Smoking Daily 15-year olds Who Report Smoking Daily

Levels of DepressionLevels of Depression Depression is an enduring period Depression is an enduring period

of sadness:of sadness:

• Depressed moodDepressed mood: enduring period of : enduring period of sadness without any related sadness without any related symptomssymptoms

• Depressive syndromeDepressive syndrome: addition of : addition of symptoms such as frequent crying, symptoms such as frequent crying, feeling guilty, lonely or worriedfeeling guilty, lonely or worried

• Major Depressive DisorderMajor Depressive Disorder: Episode : Episode includes five or more symptoms includes five or more symptoms during a two-week period and disrupt during a two-week period and disrupt functioningfunctioning

Major Depressive DisorderMajor Depressive Disorder1.1. Depressed or irritable mood for most of the day, Depressed or irritable mood for most of the day,

nearly every day.nearly every day.

2.2. Reduced interest or pleasure in all or almost all Reduced interest or pleasure in all or almost all activities, nearly every day.activities, nearly every day.

3.3. Significant weight loss or gain, or decrease in Significant weight loss or gain, or decrease in appetite.appetite.

4.4. Insomnia or oversleeping.Insomnia or oversleeping.

5.5. Psychomotor agitation or retardation, observable by Psychomotor agitation or retardation, observable by others.others.

6.6. Low energy or fatigue.Low energy or fatigue.

7.7. Feelings of worthlessness or inappropriate guilt.Feelings of worthlessness or inappropriate guilt.

8.8. Diminished ability to think or concentrate.Diminished ability to think or concentrate.

9.9. Recurrent thoughts of death, recurrent suicidal Recurrent thoughts of death, recurrent suicidal thoughts.thoughts.

Cognitive Behavior Therapy (CBT) recognizes

that depression is characterized by

negative attributions, and a belief that the

situation is permanent and uncontrollable

The goal of CBT is to help the young person recognize the cognitive habits that are promoting depression and

work to change those habits. Strategies include

discussion, role play, practicing new ways of

interacting

Treating Depression with CBT…

Relapse is less likely after CBT treatment than drug treatment

Suicide: Risk Factors and FactsSuicide: Risk Factors and Facts RiskRisk factors: factors:

• DepressionDepression• Family disruptionFamily disruption• Substance abuse problemsSubstance abuse problems• Relationship problems outside familyRelationship problems outside family• Result of series of difficulties over timeResult of series of difficulties over time

Females 4 times more likely than males to attempt suicideFemales 4 times more likely than males to attempt suicide

Males 4 times more likely than females to complete suicideMales 4 times more likely than females to complete suicide

Rates are highest where guns are most availableRates are highest where guns are most available

Third most Third most common cause of common cause of death ages 15-19death ages 15-19

Higher rates among White than Black youthHigher rates among White than Black youth

Rates highest among Native American youthRates highest among Native American youth

Eating DisordersEating Disorders Anorexia Nervosa – Anorexia Nervosa –

intentional self-starvingintentional self-starving Bulimia – binge eating and Bulimia – binge eating and

purgingpurging

Cultural ideal of thinnessCultural ideal of thinness Puberty and body changesPuberty and body changes

More common among upper and middle socioeconomic classesMore common among upper and middle socioeconomic classes

Girls who read magazines like “Seventeen” are moreGirls who read magazines like “Seventeen” are morelikely to strive for thinnesslikely to strive for thinness

Occurs most often among females in teens and early 20sOccurs most often among females in teens and early 20s

Warm and controlling parentsWarm and controlling parents