Lawrence S. Neinstein
No brief manual can hope to fully illuminate the complicated psychosocial developmental process of adolescence. This chapter offers an elementary framework from which to approach the study of this developmental process and discusses ways to enhance interactions between health care providers and adolescents.
In terms of physical development, adolescence can be described as the period of life beginning with the appearance of secondary sexual characteristics and terminating with the cessation of somatic growth. In modern Western culture, the behavioral aspects of this developmental period have become equally important. Adolescence is, in fact, a biopsychosocial process that may start before the onset of puberty and last well beyond the termination of growth. The events and problems that arise during this period are often perplexing to parents, health care providers, and adolescents. It is a time in which, for example, a previously obedient, calm child may become emotionally labile and act out.
It is vital that health care providers who provide comprehensive care for adolescents understand the adolescent psychosocial developmental process. Such an understanding is not only beneficial in routine adolescent health care but can also help adolescents and their families through problem periods involving, for example, failure in school, depression, suicidal tendencies, and out-of-control behavior. This chapter examines the phases and tasks of normal adolescent psychosocial growth and development, beginning with some general comments about the process of adolescence.
The Process of Adolescence
First, it is important to keep in mind that no outline of psychosocial development can adequately describe every adolescent. Adolescents are not a homogeneous group, but display wide variability in biological, psychological, and emotional growth. Each adolescent responds to life's demands and opportunities in a unique and personal way. Further, adolescents must meet the challenges that arise from their own high-risk behaviors as well as the many social factors that impact their lives (Atav and Spencer, 2002; Galambos and Leadbeater, 2000; Gutgesell and Payne, 2004; Lerner and Galambos, 1998).
Second, the transition from childhood to adulthood does not occur by a continuous, uniform synchronous process. In fact, biological, social, emotional, and intellectual growth may be totally asynchronous (Steinberg, 2005). In addition, growth may be accented by frequent periods of regression. It must be remembered that all of life, from birth to death, is a constant process of change and that adolescence is not the only challenging period.
Third, whereas adolescence has historically been described as a period of extreme instability or “normal psychosis,” most adolescents survive with no lasting difficulties, and many are unperturbed by the process (Freud, 1958). This ability to cope is a resiliency that is often overlooked, as the behaviors of adolescents are often the primary focus of attention (Olsson et al., 2003). In actuality, approximately 80% of adolescents cope well with the developmental process. Of these 80%, approximately 30% have an easy continual growth process, 40% have periods of stress intermingled with periods of calm, and 30% have tumultuous development marked by bouts of intense storm and stress. In a national survey, approximately 90% of 16-year-old boys and girls reported that they got along well with their mothers and 75% reported getting along well with their fathers (Rutter, 1980). Only one in five families reported difficult parent–child relationships. Overall, intractable and major conflict between parents and their adolescent children is not a “normal” part of adolescence (Steinberg, 1990; Laursen et al., 1998).
Phases and Tasks of Adolescence
Adolescence can be conceptualized by dividing the process into three psychosocial developmental phases:
These stages overlap among different adolescents. By the end of adolescence, emerging adults (Arnett, 2000) have become emancipated from parents and other adults and have attained a psychosexual identity and sufficient resources from family, education, and community to begin to support themselves in an emotionally, socially, and
financially satisfying way. In addition, they have learned how to appropriately seek support from other individuals when needed.
Several tasks characterize the development of the adolescent and are discussed in the next several sections in conjunction with the various phases of adolescence. These tasks include the following:
Early Adolescence (Approximate Ages 10 to 13)
Early adolescent psychosocial development is heralded by rapid physical changes with the onset of puberty. These physical changes engender self-absorption and initiate the adolescent's struggle for independence. The onset of puberty occurs 1 to 2 years earlier for girls than for boys. Concomitantly, the psychosocial and emotional changes also occur 1 to 2 years earlier in girls. Recent studies have provided evidence for an earlier age at onset of pubertal development in girls.
Early adolescence is characterized by the beginning of the shift from dependence on parents to independent behavior. Common events at this time include:
Body Image Concerns
Rapid physical changes lead the adolescent to be increasingly preoccupied with body image and the question of, “Am I normal?” The early adolescent's concern with body image is characterized by the following four factors:
Peer Group Involvement
With the beginning of movement away from the family, the adolescent becomes more dependent on friends as a source of comfort (Pugh, 1999; Eccles, 1999). The early adolescent's peer group is characterized by the following:
At the same time that the rapid physical changes occur, the adolescent's cognitive abilities are improving markedly. According to Piaget's (1969) cognitive theory, this corresponds to the evolution from concrete thinking (concrete operational thoughts) to abstract thinking (formal operational thoughts). During this time, the adolescent is expected to achieve academically and to prepare for the future. This period of identity development is characterized by the following:
Middle Adolescence (Approximate Ages 14 to 16)
Middle adolescence is characterized by an increased scope and intensity of feelings and by the rise in importance of peer group values.
Conflicts become more prevalent as the adolescent exhibits less interest in parents and devotes more of his or her time to peers.
Body Image Concerns
Most middle adolescents, having experienced most of their pubertal changes, are less preoccupied with these changes. Although there is greater acceptance and comfort with the body, much time is spent trying to make it more attractive. Clothes and makeup may become all important. Because of the societal emphasis on youthful body image, eating disorders may become established during this developmental phase.
Peer Group Involvement
The powerful role of peer groups is most apparent during middle adolescence (Pugh, 1999; Eccles, 1999). Characteristics of this involvement include the following:
Evidence suggests that friends are the primary source of influence on youths' behavior, but estimates of peer pressure are often overstated (Aseltine, 1995). Adolescents' reactions to peer pressure are extremely varied and peer pressures can also involve a desire to excel in school, sports, or other positive activities.
The abilities to abstract and to reason continue to increase in middle adolescence, along with a new sense of individuality. The middle adolescent's ego development is characterized by the following:
Late Adolescence (Approximate Ages 17 to 21)
Late adolescence is the final phase of the adolescent's struggle for identity and separation. If all has proceeded well in early and middle adolescence, including the presence of a supportive family and peer group, the adolescent will be well on his or her way to handling the tasks and responsibilities of adulthood. If the previously mentioned tasks have not been completed, then problems such as depression, suicidal tendencies, or other emotional disorders may develop with the increasing independence and responsibilities of young adulthood. A new conceptualization of the period from late adolescence through the twenties (specifically the period from 18–25 years of age) is referred to as the “emergent adult” period (Arnett, 2000). These new young adults have begun to accept responsibility for their behaviors, formulate their own decisions, and make an effort to be financially independent.
For most, late adolescence is a time of reduced restlessness and increased integration. The adolescent has become a separate entity from his or her family and may better appreciate the importance of his or her parents' values. Such an understanding may make it possible for the adolescent to seek and accept parental advice and guidance. However, it is not uncommon for some adolescents to be hesitant to accept the responsibilities of adulthood and to remain dependent on family and peers. Characteristics include the following:
Body Image Concerns
The late adolescent has completed pubertal growth and development, and is typically less concerned with this process, unless an abnormality has occurred.
Peer Group Involvement
Peer group values become less important to late adolescents as they become more comfortable with their own values and identity. More time is spent in a relationship with one person. Such relationships involve less exploitation and experimentation and more sharing. The selection of a partner is based more on mutual understanding and enjoyment than on peer acceptance.
Ego development during the late adolescent phase/stage is characterized by the following:
Most adolescents follow the general psychosocial developmental phases as outlined above. An understanding of this general pattern helps health care providers evaluate an adolescent's behavior. Table 2.1 summarizes the developmental tasks for each phase of adolescence.
http://www.My.webmd.com. Web MD Health, search under “growth and development”.
http://www.Connectforkids.org. For adults—parents, grandparents, educators, policy makers and others who want to become more actively involved with youth.
http://www.apahelpcenter.org/. The American Psychological Association's online resource center.
http://www.Generalpediatrics.com. The General Pediatrician's view of the Internet.
http://www.Parent-teen.com. An online magazine for families with teens.
http://www.cpyu.org. Center for Parent Youth Understanding.
http://www.aacap.org/publications/factsfam/develop.htm. American Academy of Child and Adolescent Psychiatry.
References and Additional Readings
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Coleman JC. Understanding adolescence today: a review. Child Soc 1993;7:137.
Eccles J. The development of children ages 6 to 14. Future Child 1999;9(2):30.
Freud A. Adolescence. Psychoanal Study Child 1958;13:255.
Galambos NL, Leadbeater BJ. Trends in adolescent research for the new millennium. Int J Behav Dev 2000;24(3):289.
Gutgesell ME, Payne N. Issues of adolescent psychological development in the 21st century. Pediatr Rev 2004;25:79.
Hill JP. Understanding early adolescence: a framework. Carrboro, North Carolina: Center for Early Adolescence, 1980.
Laursen B, Coy KC, Collins WA. Reconsidering changes in parent-child conflict across adolescence: a meta-analysis. Child Dev 1998;69(13):817.
Lerner RM, Galambos NL. Adolescent development: challenges and opportunities for research, programs, and policies. Annu Rev Psychol 1998;49:413.
Lipsitz JS. Sexual development of young adolescents. Chapel Hill: University of North Carolina, Center for Early Adolescence, 1980.
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Olsson CA, Bond L, Burns JM, et al. Adolescent resiliency: a concept analysis. J Adolesc 2003;26:1.
Piaget J. The intellectual development of the adolescent. In: Caplan G, Lebovici S, eds. Adolescence: psychological perspectives. New York: Basic Books, 1969.
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Steinberg L. Autonomy, conflict and harmony in the family relationship. In: S Feldman, G Eliot eds. At the threshold: the developing adolescent. Cambridge, MA: Harvard University Press, 1989:255.
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