Presentation on theme: "Behavioral problems in adolescents Doç Dr Müjgan Alikaşifoğlu."— Presentation transcript:
Behavioral problems in adolescents Doç Dr Müjgan Alikaşifoğlu
Adolescence, is a period of transition that for the most part are culturally determined and personally defined. Most morbidity and mortality in this age group is atributable to preventable risk factors.
Threats to healthy youth devolopment Personal and familial characteristics Quality of the schools they attend Communities in which they live
Greatest risk to healthy development of adolescents Their behavior (i.e. Risky behaviors)
Adolescent risk behaviors Behaviors that can directly or indirectly compromise the well-being, the health and even the life course of young people
They can result in negative outcomes or adverse consequences. I.e.,drug use can lead to trouble with parents or the law Early sexual activity can lead to unintended child bearing; school dropout can result in chronic unemployment.
Risk behaviors can be considered, therefore, as risk factors for personally or socially or developmentally undesirable outcomes.
Adolescent risk behaviors Werner and Smith (1992) Children at risk for negative outcomes (poverty, family instability, health problems) Many of the children experienced negative outcomes as they entered adolescence and adulthood One third became competent and successful adults
Why some who are reared under adverse circumstances become competent adults while others do not appear to overcome the adversities experienced in early life?
Resiliency The process in which individuals show positive outcomes despite adversity Is not a trait, it is a pattern of behavior It represent an interaction between the individual and the environment
Resiliency Resilient individuals are: -Flexible -Not invulnerable* -Not unable to be defeated** *Resilience refers to avoiding the problems associated with being vulnerable. ** Cumulative risk can defeat the most resilient individual.
Resiliency Resiliency is interactive with risk. Resiliency refers to the process of overcoming the negative effects of risk exposure A key requirement of resiliency is the presence of both risks and promotive (protective) factors
Risk factors Elements and experiences in a child or adolescent’s life that increase the likelihood of negative outcomes and decrease the likelihood of positive outcomes
Risk factors Effects of risk are cumulative Multiple risk factors at a single point in time or over time increases the likelihood of negative outcomes.
There is great heterogeneicity in the linkage between involvement in risk behaviors and the likelihood of adverse outcomes. There is also great heterogeneicity in the linkage between exposure to risk factors and likelihood of involvement in risk behaviors.
It is this heterogenecity or variability on both the antecedent and the consequent sides of engaging in risk behavior that has led to an important new focus of inquary concerning adolescent risk behavior, namely, the identification and assessment of protective factors.
Protective factors Protective factors have both direct and indirect effects; they lessen the likelihood of engaging in risk behaviors, or of adverse outcomes from having engaged in them, but they also can serve as moderators of or buffer against exposure to risk factors or actual involvement in risk behaviors themselves.
Protective factors Assets Positive factors that reside within the individual Competence, coping skills, self-efficacy Resources Positive factors that are external to the individual Parental support, adult mentoring, community organizations
Risk- protective factors Effects not uniform across social groups May operate in different ways at different stages of development or at different exposure levels
Risky behaviors Significant public health problem Substance use Violent behavior Unsafe sexual practices
Three behaviors Pose considerable health risks to adolescents Play significant role in adolescent development Amenable to public health intervention
Increasing public health concerns related to adolescents Mental health disorders Obesity
Sexual behavior Initiation of sex Level of sexual activity Risky sexual behavior
Adolescent sexuality Human sexuality can be defined as including the physical characteristics of and capasities for specific sexual behaviors, together with psychosocial values, norms, attitudes and learning processes that influence these behaviors.
It also includes a sense of gender identity and related concepts, behaviors, and attitudes about the self and others as women or men in the context of one’s society.
Biological factors such as genotype and its phenotypic expression begin to affect sexuality from the moment of conception. Other influences begin at birth.
First, the family’s attitudes and expression of femaleness and maleness, rooted in the family’s culture and influenced by society as a whole, is expressed to the infant from birth onwards.
From the moment the newborn’s genitalia are seen at birth, a whole set of expectations and gender-specific attitudes are elicited from the family members. These expectations and attitudes are largely a result of the parents’ cultural dictated norms.
Family: A chid’s first sense of its gender and what that means is conveyed by the parents early in childhood. As the child developes, it withnesses how the mother behaves as a woman, how the father expresses his masculanity, and how they behave with each other.
Since children learn best from the examples set by the most significant adults in their lives, these impressions are instrumental in helping the child define what a man or a woman should be, and how they will express themselves as members of their gender.
Absence of someone who fills the parental role can make it difficult for the child to understand the ways in which men and women behave with each other. Girls “test” how to behave as women with their father or other men serving in the parental role. Without this opportunity to “test out” in a safe relationship, girls may start “looking for daddy” and may engage in considerable risk taking behavior toward that end.
Inappropriate behavior on the part of the girl’s male parental figure may also negatively color her views of how to express her sexuality. A girl or boy who is reared in a home in which the parents are caring, lowing, supportive, and affectionate toward each other most likely will be able to enter into mature, positive relationships when tehy reach adulthood.
Culture: The adolescent’s expression of sexuality is greatly influenced by the culture in which she or he lives. Culture assings very specific or less than clearly specific roles to men and to women. When these roles are clearly defined, the choices open to the adolescent to express manhood or womanhood a few.
Cultural ambiguity regarding sexual behavior leaves the adolescent with many options but little guidance. Similarly, how sexual feelings are expressed can be culturally dictated.
Society: The media exerts a powerfull influence on adolescents by exposing them to an adult world of which they were unaware. Many parents abdicate their responsibilities in teaching their children about sex and sexuality, leaving to peers and the media to be the major sources of information and role modeling in this area.
Negative consequences of adolescent sexuality Premature sexual activity Pregnancy Sexually transmitted diseases Sexual preferences Gender identity issues
Substance use is an individual-level risk factor for adolescent sexual behavior This risk factor is compensated for by: a) Personal assets b) Resources
Personal assets compensating for the risk of substance use for sexual behavior Self-esteem Participation in extracurricular activities School achievement and attachment Religiosity HIV and reproductive health knowledge Positive attitudes towards condoms Safer sex intentions Seeing sex as nonnormative Self-efficacy to refuse drugs and use condoms
Resources compensating for the risk of substance use for sexual behaviors Father’s education Teacher support Residence with both parents Peer norms for sexual behaviors Family socioeconomic status
Other risk factors for adolescent sexual behavior Peer sexual behavior Mother having had a child before 20 (sexual intercourse before 16) Neighborhood poverty
Peer sexual behavior compensated by Family socioeconomic status Parental monitoring Open parental communication
Mother having had a child before 20 compensated by School attachment Self-easteem
Neighborhood poverty counteracted by Participation in extracurricular activities and community organizations
Substance use in adolescents Adolescents use drugs as : An escape from environmental chaos A way to mirror an adult lifestyle A rite of passage into puberty A way to cope with adolescent issues A result of other dysfunctional processes A result of pervasive influence of the media and their peers
A way of challenging authority A way of fitting into a social situation at school, at work, at social clubs (gang) Media influences Comorbid conditions (eg, depression or anxiety) also contribute to the development and maintenance of drug abuse
Risk factors for substance abuse in adolescents Genetics: Alcoholism among first or second degree relatives Male gender Individual Abuse Antisocial behavior Parental rejection Aggressive temparament Lack of self control Early sexual activity Depression Low self-esteem Attention-deficit disorders Poor self-image Body modification Learning disorders
Family: Disfunctional family dinamics Permissiveness Authoritarianism Parental conflict, divorce, separation Poor supervision, lack of supervision Poor parental role modeling
Community/environmental/societal: Easy availability of drugs and alcohol Cultural and religious sanction Acceptance of drug use behavior Unemployment Poor general quality of life in the neighborhood Media influence Criminal activities in neighborhood Low religiosity Increased use of drugs and alcohol in certain culture
Peer group influence Drug using friends Curiosity Rebellion Desire to belong Independence Risk taking behavior
School/academic Poor school performance Poor school environment Truancy
Factors protective of substance abuse in adolescents Good communication within family Supportive parents Intact family Appropriate adult supervision Positive self-esteem Social competence Academic success Good school Good general health High intelligence Positive adult role models Peer group with positive personal attributes Religious involvement A personal sense of morality
Some drugs (eg., tobacco, alcohol, and marijuana) are called gateway drugs, in that they are the launching pad for more serious drug experimentation and abuse
Stage of substance use Stage 1: experimentation Usually begins in elementary or junior high Often involves “gateway” drugs Used in context of exploring new behaviors and experiences Used in setting of home or party, or while “hanging out” Used in response to peer norms or to feel grown-up Small amounts used withhout a definite pattern Helps adolescent to cope with demands of development
Stage 2: Exploration Progression in frequency of use, Stronger drugs used Episodes of use may be justified as “handling stress” Patterned use apparent and often integrated into social situations Used during the week in conflict with regular activities (eg., school) Problems related to drug use occur (decreased performance) Often dissociates from non-drug using friends Deceptive behaviors to obtain drugs Mood swings become apparent to family and friends Denial often predominates
Stage 3:Encapsulation Tolerance develops to particular drug of choise More and more time spent ascertaining the drug experience Drug use to maintain function and mood Drops out of other activities, drug use dominates life Other problem behaviors manifested (stealing, lying, violence) Physical withdrawal may occur Health problems may be manifested
Stage 4: Dependence Increasing negative feelings toward self Deterioration of social relationships Social contacts limited to drug-using friends Denial of drug use as a problem predominates Involvement in illegal activity to maintain drug habit Life is chaotic in all domains (physical, social, psychologic, personal) Often shame, guilt and self destructive behavior Drug use not to feel “high” but to feel normal
Violence Globally, youth violence has been identified as a major health problem Violence in the lives of infants, children, and adolescents can produce debilitating effects on their growth and development. Exposure to violence increases the risk of morbidity and mortality for all youth
There are various factors, including the influence of genetics, hormone production, the combination of cultural and environmental conditions, and specific form of mental illness. In recent years the impact of exposure to violence on children and adolescents has been recognized as a major contributor to the epidemic of children’s and adolescents’ violence.
Children are witnessing violence at home, in their communities, at schools, and in the media. This continuous exposure combined with easy access to firearms, alcohol, and drugs has contributed to the sudden surge of violence
Most violent youth do not suffer from mental illness during childhood or adolescence and these with neurological impairements, psychosis or head trauma. These adolescents are greater risk of becoming violent, because they have psychological events that interfere with their ability to correctly interpret reality and to appropriately interact with others.
Most adolescents who engage in violent behavior engage in transient violence and are not violent after they become adults. Most violent youth will never be arrested for a violent crime. There are two general onset trajectories for youth violence. The first onset trajectory begin before puberty, and the second begins during adolescence.
Those youth who become violent before age 13 generally commit crimes more often; their crimes are more serious, occur over a greater duration of time, and more frequently extend into adulthood. Adolescents who engage in late onset violence usually are looking for excitement and are typically violent in the company of friends.
Definition of violence WHO Threatening or using power against oneself, another person or against a group or community that -Results in -Has a high likelihood of resulting in İnjury Death Psychological harm Maldevelopment Deprivation
Form of violence Physical intimation Corporal punishment Physical abuse Physical fighting Suicide Physical assults Rape Sexual assault Sexual abuse Gunshot wounds Conflicts between or among: Parents Siblings Relatives Care providers Teachers Friends Acquaintances Other peers Intimate partners Spouses
Five factors have a major impact on the incidence and prevalence of physical Aggression and violence in the lives of children and adolescence: Exposure to media violence Bullying Weapon carrying Belonging to a gang Abusing substances
Individual risk factors If the child or adolescent is/has/: Congenital abnormalities Low birth weigh Low self-esteem Beeing male (except sexual violence) Between the ages of 15-19 A member of a violent family Dating Angry after experiencing a violent trauma A member of a gang group A runaway from home Homeless
Abusing drugs History of early aggressive behavior A comorbid psychiatric diagnosis of: Attention deficit hyperactivity disorder, Conduct disorder A low IQ Poor academic performance A learning disability A history of physical or sexual abuse Peers who are violent Access to a weapon
If the child or adolescents: Believes violence is effective for resolving conflicts Accepts that violence or aggression is normal Carries a wepon Engages in antisocial behavior and hostile talk with others
Familial risk factors If the child or adolescent has: Antisocial parents Physically aggressive parents Parents who use harsh physical punishment to discipline Poor supervision by parents A mother was parent at an early age A family with low socieconomic status A parent who abuses alcohol or other substances
If the child or adolescent experiences: Parental conflict in early childhood A low level of attachment with parents Parental separation or divorce at a younger age A low level of family cohesion
Environmental and cultural risk factors If the adolescent: Lives in an urban area Attends a large urban school that serves the very poor High density and overcrowding High crime rate Easy access to drugs and alcohol Lack of community cohesion and neigborhood commitment Lack of supportive services such as child care and recreation
If adolescent lives in area where there is: Income inequality Rapid demographic changes in the youth population, urbanization A culture does not provide nonviolent alternative for resolving conflicts
Individual protective factor Ability to respond quickly to threatening events Pleasure and satisfaction in helping others Maintaining positive expectations about the future
Family level protective factors A warm family Less crowded and clean homes Discipline style Strong parental supervision Understanding and support Closeness Respect for individual autonomy Good communication
Community level protective factors Gun control Legal regulation
Physicians role Physicians can be involved in helping prevent/reduce risk behaviors 1-Personal level 2-Practice level 3-Patient level 4-Parent level 5-School level 6-Community/society level
Historical approach Adolescent: Problem to be solved Risk reduction strategy and treatment (Outcome is important) Contemporary approach Adolescent: Resource to be developed Adolescent development approach (Resiliency based approach)
Resiliency- based approach Builds on individual strengths Aims at addressing those factors that predispose an individual to one or multiple risks
Pregnancy prevention program (risk redaction) To develop resistance skills among adolescents at risk for early onset of sexual activity and unprotected intercourse
Adolescent development program Focuses on issues related to school failure, vocational options, adult mentorship Improving life outcomes Reduction of unwanted pregnancy