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DISCLOSURE
• I have nothing to disclose. I do not accept payments from anyone for speaking engagements
OBJECTIVES
• 1. Understanding the development and behavioral complexities of adolescents
• 2. Recognize roadblocks to adequately screen and counsel high risk behaviors
• 3. Discuss ways to effectively screen, educate and counsel adolescents
Are Teens Today Different than centuries ago?
“The son feels equal to his father.
He has no respect for his parents anymore.
All he wants is to be free. Students insult their teachers. And, on top of this situation,
in the name of liberty and equality,
sex is everywhere.”
Plato (427-347 BC) (The Republic):
“The son feels equal to his father.
He has no respect for his parents anymore.
All he wants is to be free. Students insult their teachers. And, on top of this situation,
in the name of liberty and equality,
sex is everywhere.”
▪Shakespeare (A Winter’s Tale) (1600 AD)
“I wish that there were no age between ten and three
and twenty or that youth would simply sleep out the
rest; for there is nothing in between but getting
wenches with child, wronging the ancestry, stealing
and fighting.”
YOUTH
Mark Twain Samuel Langhorne Clemens
(1835-1910)
"When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years"
STAGES OF ADOLESCENCE
Early Adolescence: 11-14 years old
Middle: 15-17 years old
Late: 18-21 years old
• Adolescence is a
period of profound
brain maturation.
• It was thought that
brain development
was complete by
adolescence
• It is now known
maturation is not
complete until about
age 24!!!
The Frontal Lobe of a Mature Brain
FUNCTIONS:1. CEO (Control center of the Brain)
a) Avoids impulsive behavior
b) Promotes discipline & Control
c) Avoids risk taking &
dangerous thrill-seeking
d) Controls Emotions
2. Higher intellect
3. Considers consequences of our
actions
The Frontal Lobe of an Adolescent Brain
FUNCTIONS:
▪ Control & regulation are not
developed
▪ Risk taking can occur
▪ Lack of discipline can occur
▪ Emotional chaos
▪ Thrill-seeking and not considering
consequences can occur
THREE PATHWAYS through adolescence
(sociology studies)
Based on brain chemistry, environment and maturity
Small, fairly smooth roller coaster riders
Small roller riders with occasional rides on
larger, more terrifying roller coasters
Those that continuously ride large,
terrifying roller coasters.
The Small Roller Coaster
▪ 20% of kids
▪ Well-adjusted; meet
demands of the
developmental stage
▪ Seem to always know
what to do
The Small Roller Coaster
with occasional rides on the
Large Roller Coaster▪ 35% of kids
▪ Reasonably well-adjusted
▪ May have difficulty coping with
unexpected trauma
(divorce, death, loss of pet,
bullying, etc.)
The Large Roller Coaster
▪ 42% of kids
▪ Adolescent turmoil
▪ Isolated; high risk
takers
▪ At increased risk for
alcohol and drugs
The Front of the Adolescent Brain
“BAD BRAKES !!!!”
…NOT FULLY DEVELOPED !!!!
The Front of the Adolescent Brain
“Go or Gas Pedal” unopposed
THRILL-SEEKING IMPULSIVE BEHAVIOR
Adolescent Identity
◼ Achieving a sense of identity is the major developmental task of teenagers. Without identities adolescents carry a “How am I doing?” attitude that is always focused on their concern about impressions they are making on others.
◼ Teens identify with people they admire
4 Fundamental Views of Self
◼ Subjective self: Adolescents private view of who she sees herself to be
◼ Object self: What others see when they view the adolescent
◼ Social Self: Adolescents perception of herself as she thinks others see her
◼ Ideal Self: Adolescents concept of who she would like to become; her ultimate goal.
How Adolescents Search for Identity
◼ Family relations
◼ Status symbols
◼ Grown up behavior
◼ Rebellion
◼ Opinions of others
◼ Idols
◼ Cliquish exclusion (excluding other on the basis of minor aspects, ex: dress)
Why adolescents Struggle
◼ Physical changes
◼ Sexual changes
◼ Social changes
◼ Religious changes
◼ Moral Changes (they are now responsible to replace forced childhood rules with their own moral principles).
Adolescent Development
◼ The adolescent’s perception of the world is different
◼ An overwhelming desire to be accepted, not wanting to feel different, and to be understood
◼ The focus is predominately on short-term, not long-term
◼ Risk taking is a part of it!
LEADING CAUSES OF DEATH AMONG PERSONS AGED 25 YEARS AND OLDER IN THE UNITED STATES, 2016
LEADING CAUSES OF DEATH AMONG PERSONS AGED 10 – 24 YEARS IN THE UNITED STATES, 2016
Adolescent Development
and Risk Behaviors
• What adults see as ‘problems’,
adolescents often experience as
‘solutions’
• and adolescents (and adults, for
that matter) do not give up their
‘solutions’ that easy.
WHAT HELPS A TEEN DO WELL?
Having a caring adult/adults
Safe place to interact with said adult
Something useful to do
Electronic Use
❖nearly all young adults (86%), the majority of teens (71%), and 25% of children ages 8 to 12 years have a Facebook account
❖teenagers send and receive 3,705 text messages per month
❖the majority of teens prefer to contact their friends via text messaging (54%) compared to talking to them on the telephone or seeing them in person (33 %)
Consequences
• Cyberbullying
• Sleep deprivation
• Sexting & Sexual victimization
• Internet addiction
• More widespread: inhalant use, choking
game, self mutilation, Vampire culture
• Digital stressors
Digital stressors
• • Impersonation
• Receiving mean and harassing personal
attacks
• Public shaming and humiliation
• Breaking and entering into accounts and
devices
• Pressure to comply -- digital peer pressure
• Feeling smothered -- the pressure of
keeping up with social media, especially with
texting• http://nms.sagepub.com/content/early/2014/07/21/1461444814543989
Percent Victimized x Grade
(Trolly, Hanel, & Shields, n.d.) and from isafe.org (survey from 2004)
Cyberbullying
• Talk with your kids about internet safety
• NEVER friend someone you don’t know
• NEVER meet someone in person you
met online
Digital Footprint
• EVERYTHING someone looks at or
posts online is recoverable, even if
deleted!!!
• Educate kids about this.
• Digital footprints are reviewed by
college admissions committees and
during job searches!!
Effects of Cyberbullying❖ academic problems, perception that school
is unsafe❖ skipping school, weapon carrying, and
detentions and expulsions are more frequently reported by youth harassed online
❖ depression, social anxiety, low self-esteem❖ headaches, recurrent abdominal pain, sleep
difficulties ❖warning signs include sadness or anger
during or after Internet use, withdrawal from friends and activities, school avoidance, declining grades, depression, anxiety
Adolescence and Sleep
• See reduced total night sleep from birth to teen
• There is a shift to later bedtime or sleep onset hour in teens.
• See 40% reduction in the REM sleep stage from ages 10 to 20 years
• Healthy Teens need approximately 9 hours of nocturnal sleep
Consequences of Excessive
Daytime Sleepiness
• Depression
• Irritability
• Academic Failure
• Impulsivity
• ADHD-like features
• Death from MVAs
New “Old” Risk Behaviors
• Huffing
• Choking
• Vampirism
INHALENTS (HUFFING)
• Any chemical around the house
• Mixing more than one
• Can cause severe brain, lung and liver
damage
• Can cause coma or death
anytime, including the first use
INHALENTS (HUFFING)
Percentage of High School Students Who Ever Used
Inhalants, by Sex† and Race/Ethnicity,
National Youth Risk Behavior Survey, 2011
* Sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or
more times during their life.† F > M§ H > W, B
PASSOUT
SPACE
MONKEY
Also known as:
The choking game
• First and foremost, IT IS NOT A
GAME!!!
• Essentially, it is cutting off the flow
of blood to the brain by choking,
hyperventilating, compressing the
chest, or hanging by a belt, towel,
rope, etc.
Who plays the choking game?
• Generally boys and girls between 9 and
16 years of age.
• usually high-achievers in athletics or
academics
Why are kids playing the choking game?
• Because it’s “cool”
• Because the high can be addictive
• Because they like the feeling
• Because they think it’s a safe alternative to drugs
Craig
Morse
16
Randall
Stamper
12
Blake
Edward
Conant
15
Tyler
Griffin
12
Jenny Morgan
17Uriah Martin
12
Alesa Beth
Somers
13
Kyle
O’Connor
12
George Barrera
14
Cody Willard-Joblonski
14
Sarah Beck 13 Justin Serrano 13
JD Reed 12
Fletcher Burfine 12
9
http://thedbfoundation.com/Choking_Game_Victims_Database.html
Vampire Clan 1998
Facebook for
Vampires?http://www.vampires.nu/pages/beginning.cfm/PageID/2
Eating Disorders and its
associating to Suicide
/Self Harming behavior
• Anorexia nervosa is associated with:
– Depression in 65 percent of cases
– Social phobia in 34 percent of cases
– Obsessive-compulsive disorder in 26
percent of cases.
Self Harm• “My body looks how I feel”
• May be cutting, scratching, burning,
rubbing to purposely injure skin
• Often a “coping” mechanism
• Ask about suicidal intent
• Kids who self harm are at higher risk of
suicide overall
• Addictive (releases endorphins)
Adolescents to college age
Female gender
Substance abuse
Personality disorder
History of self-mutilation
Conduct problems
Anxiety
Depression
Eating disorders
Childhood history family violence
family alcohol abuse
sexual and physical abuse
WHY?Psychodynamic/Interpersonal Factors
• A way to express or terminate emotional turmoil
• To stop suicidal ideations or attempts
• Becomes an addiction
– Urge to self-harm, tension or arousal before self-harming, and momentary pleasure or relief of tension after the act (similar to addictions or OCD).
• A way to punish themselves
– Ex. eating disorder patients
Escalation
1st 4 years now
Types of Self-Mutilation
• Stereotypical
– Most common in institutionalized patients
– Acts with fixed pattern of expression,
usually not symbolic
– Head banging is most common behavior
– Includes finger biting
Types of Self-Mutilation• Superficial/moderate
– Most common
– Acts of low lethality
– Sporadic, repetitive behaviors
– Skin cutting/carving/burning, self-punching, scratching
– Majority of cases occur in adolescents
Types of Self-Mutilation
• Major
- Infrequent acts in which a significant amount
of body tissue is destroyed.
- Associated with psychotic states and
intoxication.
- Eye-enucleation
- Castration
- Limb amputation
Prevention
◼ Cheaper
◼ More effective
◼ Relies on empowering youth (Positive Youth Development)
◼ Build up youth to solve their own problems and give them support system
DELAY OF ONSET
• Postponing the initiation of a
risk behavior to a time when
developmental need
(maturation) is greatly
diminished has the best chance
of success
It is desirable to communicate clearly:
Keys in Building a Trusting
Relationship: Active
Listening• Seek to understand what is being
said
• Pay attention to inconsistencies
between verbal & nonverbal
messages
• Listen for understanding rather than
“truth”
Keys in Building a Trusting
Relationship: Responding to
Emotions• Reflect the adolescent’s emotions
by expressing concern about
observed reactions
• Legitimate feelings the adolescent
shares
• Express support for the adolescent
Keys in Building a Trusting
Relationship: Demonstrating
Respect• Acknowledge potential issues
related to the adolescent’s…
-developmental stage
-cultural & religious beliefs, practices
-gender
-sexual preferences
-rights
Paths to Avoid
• Avoid being parent surrogate, especially use
of the words ‘why’ and ‘should’
• Avoid giving the impression that it is “all in
your head”
• Don’t threaten, admonish, lecture or diminish
• Don’t blame or blindly support family
members
• Don’t get caught in power struggles
Interview Process considerations
• Ensure privacy
• Discuss confidentiality
• Encourage the adolescent to share his/her concerns
• Offer non-threatening explanation for questions
• Give the adolescent some control
• Reveal hidden agendas
Interview Process considerations
• Be confident & comfortable
• Begin with open ended questions
• Follow by very specific & explicit questions
• Move from < sensitive to > sensitive topics
• Use language that is understood
• Check accuracy of information received
• Engage teen in decision-making process
Principles of One-on-One Intervention
• Based on teen’s level of risk
• Decrease risk factors; increase protective factors
• Possible foci to consider: environment, personality and behavior
• Intervention acceptable to the teen
• Intervention: Part of a comprehensive approach
Always ask simple questions to detect red flags regarding mental health/suicide risk:
1. What do you do for fun
2. Tell me something good about yourself
3. What would you like to be when you grow up
4. If you would divide last wk as happy and unhappy times, how would that look
Holistic Approach
• Recognize individuality of each patient
• Understand the complexity of adolescent development
• Explore quality of life from teen’s perspective
• Provide trust & understanding between patient & MD
• View the whole life picture & make the distinction between pure physical ailment (ex. Influenza) & one induced by psychosomatic issue or cry for help
Exploratory Prompts
• If I asked your best friend what you are like what would they say?
• What do you do when you are not in school?
• What does you mother and father do when you are not there?
• What do you do well?
• What are you going to do when you finish school?
• What do you see yourself doing in 5 years?
Creative Approaches
• “If you want to see what young people
can do, must stop giving them things”
(‘By giving you take away’ – the poverty
of affluence) - The Welfare Mentality
Youth - 2020
• Most youth are doing well despite environmental ‘toxicities’.
• Some youth have had limited developmental options and are struggling.
• All young people need a variety of experiences to develop their full potential (think neurobiology)
• Some have integrated poor developmental behaviors into identity and are at risk for significant bio-psychosocial sequelae.
Teens have a lot to offer!
They are resources to be developed not a problem to
be solved
FDR: 32nd president
“We can not build the future
for our youth, but we can
build our youth for the
future”
Thank you
