Psychosocial Problems in AdolescenceWhat can go wrong

Prevalence of Substance Prevalence of Substance Use and AbuseUse and Abuse

A large proportion of adolescents have A large proportion of adolescents have experimented with alcohol, tobacco, and experimented with alcohol, tobacco, and marijuana but not with other drugsmarijuana but not with other drugsout of high school seniors: 70% have tried alcohol; 46% have out of high school seniors: 70% have tried alcohol; 46% have

smoked marijuana, and 40% have smoked cigarettessmoked marijuana, and 40% have smoked cigarettesonly about 9% have used an illicit drug (other than marijuana) only about 9% have used an illicit drug (other than marijuana)

in the last monthin the last month

Earlier Age of InitiationEarlier Age of InitiationExperimentation with drugs is less common Experimentation with drugs is less common

among younger teens than in the pastamong younger teens than in the past

The chances of becoming addicted to The chances of becoming addicted to alcohol or nicotine are increased when use alcohol or nicotine are increased when use begins before age 15begins before age 15 drugs can affect normal maturation of the brain’s dopamine drugs can affect normal maturation of the brain’s dopamine

systemsystem

The effects of alcohol and nicotine on brain The effects of alcohol and nicotine on brain functioning (especially memory and impulse functioning (especially memory and impulse control) are worse in adolescence than in control) are worse in adolescence than in adulthoodadulthood

Ethnic Differences in Ethnic Differences in Substance UseSubstance Use

American Indian adolescents use the most American Indian adolescents use the most substancessubstances followed by Hispanic and White; then Black and Asian youthfollowed by Hispanic and White; then Black and Asian youth immigrant paradoximmigrant paradox

foreign-born and less Americanized foreign-born and less Americanized minority youth are less likely to use minority youth are less likely to use drugs, alcohol, and tobacco than their drugs, alcohol, and tobacco than their American-born counterpartsAmerican-born counterparts

Risk and Protective Factors For Substance Abuse

Adolescents who use alcohol, tobacco, or other drugs frequently are usually exhibiting symptoms of prior psychological disturbanceMore maladjusted as children and teenagers

Major risk factors are:Personality – Anger, impulsivity, and inattentivenessFamily – Distant, hostile, or conflicted relationshipsSocially – Friends who use and tolerate the use of drugs, living in

a context that makes drug use easy

Major protective factors are:Positive mental health, high academic achievement,

engagement in school, close family relationships, and involvement in religious activities

Prevention and Treatment of Prevention and Treatment of Substance Use and AbuseSubstance Use and Abuse

What works?What works?

http://youtu.be/ub_a2t0ZfTs

Efforts to prevent abuse target:Efforts to prevent abuse target: the supply of drugs (most government attention and money the supply of drugs (most government attention and money

focused here)focused here) the environment in which teens are exposed to drugsthe environment in which teens are exposed to drugs characteristics of the potential drug user characteristics of the potential drug user

WHY DO THEY FAIL??

Experts believe it is more realistic to focus Experts believe it is more realistic to focus prevention efforts on adolescents’ prevention efforts on adolescents’ motivation and environment motivation and environment

Prevention and Treatment of Prevention and Treatment of Substance Use and AbuseSubstance Use and Abuse

Most encouraging Most encouraging programs combine some programs combine some sort of social sort of social competence training competence training with a communitywide with a communitywide intervention (aimed at intervention (aimed at the adolescents, peers, the adolescents, peers, parents, and teachers)parents, and teachers)

Categories of Externalizing Categories of Externalizing DisordersDisorders

Conduct DisorderConduct Disorder

AggressionAggression

Juvenile OffendingJuvenile Offending

Externalizing Problems: Externalizing Problems: Conduct DisorderConduct Disorder

Conduct Disorder (CD)Conduct Disorder (CD)clinical diagnosisclinical diagnosisa pattern of persistent antisocial behavior that routinely a pattern of persistent antisocial behavior that routinely

violates the rights of others and leads to problems in violates the rights of others and leads to problems in social relationships, school, or worksocial relationships, school, or work

related diagnosis is oppositional-defiant disorder (less related diagnosis is oppositional-defiant disorder (less aggressive)aggressive)

If CD persists beyond age 18, may be If CD persists beyond age 18, may be diagnosed with antisocial personality disorder, diagnosed with antisocial personality disorder, characterized by a lack of regard for moral characterized by a lack of regard for moral standards (psychopaths)standards (psychopaths)

Externalizing Problems: Juvenile Offending

“Juvenile offending” is legal termViolent (e.g., assault, rape, robbery, and murder) and property

crimes (e.g., burglary, theft arson)increase in frequency between the preadolescent and adolescent

years peak during high school then declines in young adulthood (the age-

crime curve)

Status offenses – behaviors that are not against the law for adults (truancy, running away, drinking)

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Two Types of Adolescent Offenders

Life-course persistent offendersDemonstrate antisocial behavior before

adolescenceAre involved in delinquency during

adolescenceAre at great risk for continuing criminal

activity in adulthood

Adolescent-limited offendersEngage in antisocial behavior only during

adolescence

These two types have very different causes and consequences

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Life-Course Persistent Offenders

Usually are poor, male, perform poorly in schoolFrom disorganized families with hostile or inept

parentsHarsh parenting may affect brain chemistry (serotonin)Worse behavior elicits more bad parenting, leads to a

vicious cycleHave histories of aggression identifiable as early as

age 8

Have problems with self regulation More likely than peers to suffer from ADHD

Exhibit hostile attributional bias – interpret ambiguous interactions with others as deliberately hostile and retaliate

Adolescent-Limited OffendingDo not usually show signs of

psychological problems or family pathology

Still show more problems than teens who are not at all delinquentMore mental health, substance abuse, and

financial problems

Risk factors include:Poor parenting (especially poor monitoring)Affiliation with antisocial peers

Depression

A pervasive unhappy mood disorder more severe than the occasional blues or mood swings everyone gets from time to time The symptoms are so universal that it is

sometimes called “the common cold of psychopathology”

Children who are depressed can’t shake their sadness and it interferes with their daily routines, social relationships, school performance, and overall functioning often accompanied by anxiety or conduct

disorders often goes unrecognized and untreated

Internalizing Problems and Depression in Adolescence

Depression is the most common psychological disturbance among adolescentsEmotional symptoms – dejection,

decreased enjoyment of pleasurable activities, low self-esteem

Cognitive symptoms – pessimism and hopelessness

Motivational symptoms – apathy, boredom

Physical symptoms – loss of appetite, difficulty sleeping, loss of energy

http://www.youtube.com/watch?v=vUYPZOoL3Es

Sex Differences in DepressionBefore adolescence, boys

are more likely to exhibit depressive symptoms

After puberty, females are more likely to be depressed, possibly because of:Gender roles – pressure to

act passive, dependant, and fragile

Greater levels of stress during early adolescence

Ruminating more – turning feelings inward

Greater sensitivity to others (oxytocin)

Adolescent SuicideAdolescent Suicide~20% of girls and 10% of boys think about ~20% of girls and 10% of boys think about

killing themselves every year (suicidal killing themselves every year (suicidal ideation)ideation)10% girls and 6% boys make attempts serious enough to 10% girls and 6% boys make attempts serious enough to

require treatmentrequire treatment

Some adolescents commit acts of nonsuicidal Some adolescents commit acts of nonsuicidal self-injury (NSSI)self-injury (NSSI)such as deliberately burning or cutting oneselfsuch as deliberately burning or cutting oneself~25% of adolescents have done this at least once~25% of adolescents have done this at least once

Risks for Suicide

Having a psychiatric problemHaving a psychiatric problemespecially depression or substance abuseespecially depression or substance abuse

Having a family history of suicide Having a family history of suicide in the familyin the family

Experiencing extreme family Experiencing extreme family conflictconflictparental rejection, family disruptionparental rejection, family disruption

Being under intense stressBeing under intense stress

The Diathesis-Stress The Diathesis-Stress Model of DepressionModel of Depression

Depression occurs when people with a Depression occurs when people with a predisposition (a diathesis) toward predisposition (a diathesis) toward internalizing problems are exposed to chronic internalizing problems are exposed to chronic or acute stressors (a stress)or acute stressors (a stress)those without the diathesis are able to withstand a great those without the diathesis are able to withstand a great

deal of stress without developing psychological problemsdeal of stress without developing psychological problems

The Diathesis-Stress The Diathesis-Stress Model of DepressionModel of Depression

The Diathesis The Diathesis may be biological in origin (neuroendocrine or genetically may be biological in origin (neuroendocrine or genetically

linked), or because of cognitive stylelinked), or because of cognitive style

The StressThe Stressprimarily from having a high-conflict and low-cohesion primarily from having a high-conflict and low-cohesion

family, being unpopular, or reporting more chronic and family, being unpopular, or reporting more chronic and acute stressorsacute stressors

Stress and Coping Stress responses vary, so some

adolescents experience: Internalized disorders (anxiety,

depression, headaches, indigestion, immune system problems)

Externalized disorders (behavior and conduct problems)

Drug and alcohol abuse problems

Stress does not always lead to negative outcomes

Resilience in the face of adversity

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What Explains Stress Vulnerability?What Explains Stress Vulnerability?

Multiple stressors have a much greater Multiple stressors have a much greater impact than single stressors (multiplicative)impact than single stressors (multiplicative)

Adolescents who have internal and external Adolescents who have internal and external resources are less likely to be affected by resources are less likely to be affected by stress than their peersstress than their peers

internal: high self-esteem, healthy identity internal: high self-esteem, healthy identity development, high intelligencedevelopment, high intelligence

external: social support from othersexternal: social support from others

Coping StrategiesCoping Strategies

Using more effective coping strategies also Using more effective coping strategies also buffers the effects of stressbuffers the effects of stress primary control: taking steps to change the source primary control: taking steps to change the source

of stress (usually the best strategy)of stress (usually the best strategy) secondary control strategies: trying to adapt to the secondary control strategies: trying to adapt to the

problem (better when situation is uncontrollable)problem (better when situation is uncontrollable)