1. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 1 Chapter 14 Problems of Adolescence

2. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Learning Objectives Describe three common problems of adolescence. Discuss three problems faced by adolescents with troubled family lives. Identify the diagnostic criteria for behavioral disorders. Explain how the signs and symptoms of adolescent depression differ from those seen in adult depression. Define two eating disorders, and describe the associated signs and symptoms and behaviors.

3. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Learning Objectives Describe the stages of chemical dependency in adolescence. List four signs or symptoms indicating a potentially suicidal teen. Identify four therapeutic interventions designed specifically for adolescent clients. Explain how health care providers help adolescents develop effective coping skills.

4. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Adolescent Growth and Development Adolescents undergo great changes in the physical, intellectual, emotional, social, and spiritual areas of their lives. Care providers should understand how adolescents grow and change if they are to assist them through this important developmental stage. Many adult problems find their roots in adolescence.

5. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Physical Development Maturation –Process of attaining complete development Puberty –Stage during which an individual becomes physically capable of reproduction –Sexual development Menarche in girls usually is established at around 12 years of age. The male growth spurt begins at age 11 years and continues until about 14 years. –Puberty lasts until about 18 years of age.

6. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Psychosocial Development Refers to the nonphysical realms of functioning Developmental tasks for each psychosocial area of functioning: –Intellectual changes –Emotional development –Social development –Spiritual development

7. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Common Problems of Adolescence Internal development problems –Most difficulties of early adolescence arise from within the individual. –An important developmental problem of adolescence is defining oneself. –Problems that threaten self-esteem or confidence routinely arise during the journey to adulthood.

8. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Common Problems of Adolescence External (environmental) problems –Problems that arise outside the teen –Family problems change as the adolescent develops independence. Many adolescents must cope with physical violence, sexual abuse, neglect, or parents who abuse alcohol or drugs. –Adolescents also are challenged by numerous social problems: Gangs Peer groups Intimacy –Problems in the environment can threaten basic needs.

9. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Mental Health Problems of Adolescence Mental health services for adolescents focus on promoting –Positive life skills –Prevention –Treatment of dysfunction Nursing interventions focus on promoting –Health education –Assisting with group therapy –Individual therapy –Medication management –Setting of limits –Provision of emotional support

10. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Behavioral Disorders Teens with behavioral disorders exhibit behaviors that begin to disrupt –Their families –Social interactions –Performance at school Disruptive behavioral disorders consist of two basic diagnoses: –Attention-deficit/hyperactivity disorder –Conduct disorder

11. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Emotional Disorders When moods or feelings disrupt the teen’s daily activities, mental health care may be needed. Problems that affect the emotional realm of human functioning include the following: –Anxiety disorders The adolescent’s ability to adapt is overwhelmed. –Mood disorders Wide range of behaviors from profound depression to racing hyperactivity Depression in adolescence is characterized by irritable moods and acting-out behaviors.

12. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Eating Disorders “Severe disturbances in eating behavior” Obesity –Body weight that is 20% or more above the average weight for a person of the same height and build Anorexia nervosa –Prolonged refusal to eat to keep body weight at a minimum Bulimia –A cycle of binge eating followed by purging

13. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Eating Disorders Treatment for eating disorders has three goals: –To manage the medical dangers –To restore normal nutrition and eating patterns –To meet the psychiatric treatment needs of the client and the family

14. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Chemical Dependency Problems associated with substance abuse: –Accidents caused by lack of judgment –Interpersonal violence –Depression –Worsening relationships with others Chemical dependency is a state in which one physically and psychologically requires a drug. Treatment focuses on helping the teen replace the use of chemicals with more effective coping skills.

15. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Personality Disorders Personality –Combination of behavioral patterns that each of us develops to cope with living Teens with history of inappropriate or maladaptive behaviors may be given the diagnosis of personality disorder. –A major characteristic of a personality disorder is impulsivity.

16. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Personality Disorders Treatment for teens with personality disorders: –Psychotherapy –Treatment with medications, such as selective serotonin reuptake inhibitors (SSRIs) Fluoxetine (Prozac)

17. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Sexual Disorders Characterized by significant distress and impaired ability to function –Gender identity disorders –Sexually acting out is common for teens Many sexual problems faced by adolescents can be solved with the use of good communication skills. Replacing ignorance with accurate knowledge can assist a teen along the road toward healthy sexual maturity.

18. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Psychosis Adolescent with schizophrenia is typically a good child who begins to develop a whole new set of behaviors and activities. The major characteristic of adolescent psychosis is loss of contact with reality. Treatment for psychosis includes a combination of –Psychotherapy –Medications Antipsychotics Antidepressants Lithium

19. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Suicide Adolescent girls attempt suicide three times more often than their male counterparts. –Boys are more successful because they choose more lethal methods. Teenagers who attempt suicide fall into three groups: –Teens with depression –Teens who are trying to influence others –Teens with a serious mental health problem

20. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Suicide Goals of treatment –Protect them from harm. –Build trusting therapeutic relationships. –Assist them in developing self-awareness and alternate coping skills.

21. Mosby items and derived items © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Therapeutic Interventions Therapeutic interventions: –Building self-esteem –Facilitating skill development –Setting limits –Providing surveillance