Presentation on theme: "Behavioral problems in adolescents"— Presentation transcript:
1 Behavioral problems in adolescents Doç Dr Müjgan Alikaşifoğlu
2 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.
3 Threats to healthy youth devolopment Personal and familial characteristicsQuality of the schools they attendCommunities in which they live
4 Greatest risk to healthy development of adolescents Their behavior (i.e. Risky behaviors)
5 Adolescent risk behaviors Behaviors that can directly or indirectly compromise the well-being, the health and even the life course of young people
6 They can result in negative outcomes or adverse consequences. I.e.,drug use can lead to trouble with parents or the lawEarly sexual activity can lead to unintended child bearing; school dropout can result in chronic unemployment.
7 Risk behaviors can be considered, therefore, as risk factors for personally or socially or developmentally undesirable outcomes.
8 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 adulthoodOne third became competent and successful adults
9 Why some who are reared under adverse circumstances become competent adults while others do not appear to overcome the adversities experienced in early life?
10 ResiliencyThe process in which individuals show positive outcomes despite adversityIs not a trait, it is a pattern of behaviorIt represent an interaction between the individual and the environment
11 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.
12 Resiliency Resiliency is interactive with risk. Resiliency refers to the process of overcoming the negative effects of risk exposureA key requirement of resiliency is the presence of both risks and promotive (protective) factors
13 Risk factorsElements and experiences in a child or adolescent’s life that increase the likelihood of negative outcomes and decrease the likelihood of positive outcomes
14 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.
15 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.
16 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.
17 Protective factorsProtective 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.
18 Protective factors Assets Positive factors that reside within the individualCompetence, coping skills, self-efficacyResourcesPositive factors that are external to theParental support, adult mentoring,community organizations
19 Risk- protective factors Effects not uniform across social groupsMay operate in different ways at different stages of development or at different exposure levels
20 Risky behaviors Significant public health problem Substance use Violent behaviorUnsafe sexual practices
21 Three behaviors Pose considerable health risks to adolescents Play significant role in adolescent developmentAmenable to public health intervention
22 Increasing public health concerns related to adolescents Mental health disordersObesity
23 Sexual behavior Initiation of sex Level of sexual activity Risky sexual behavior
24 Adolescent sexualityHuman 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.
25 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.
26 Biological factors such as genotype and its phenotypic expression begin to affect sexuality from the moment of conception. Other influences begin at birth.
27 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.
28 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.
29 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.
30 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.
31 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.
32 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.
33 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.
34 Cultural ambiguity regarding sexual behavior leaves the adolescent with many options but little guidance.Similarly, how sexual feelings are expressed can be culturally dictated.
35 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.
36 Negative consequences of adolescent sexuality Premature sexual activityPregnancySexually transmitted diseasesSexual preferencesGender identity issues
37 Substance use is an individual-level risk factor for adolescent sexual behavior This risk factor is compensated for by:a) Personal assetsb) Resources
38 Personal assets compensating for the risk of substance use for sexual behavior Self-esteemParticipation in extracurricular activitiesSchool achievement and attachmentReligiosityHIV and reproductive health knowledgePositive attitudes towards condomsSafer sex intentionsSeeing sex as nonnormativeSelf-efficacy to refuse drugs and use condoms
39 Resources compensating for the risk of substance use for sexual behaviors Father’s educationTeacher supportResidence with both parentsPeer norms for sexual behaviorsFamily socioeconomic status
40 Other risk factors for adolescent sexual behavior Peer sexual behaviorMother having had a child before 20 (sexual intercourse before 16)Neighborhood poverty
41 Peer sexual behavior compensated by Family socioeconomic statusParental monitoringOpen parental communication
42 Mother having had a child before 20 compensated by School attachmentSelf-easteem
43 Neighborhood poverty counteracted by Participation in extracurricular activities and community organizations
44 Substance use in adolescents Adolescents use drugs as:An escape from environmental chaosA way to mirror an adult lifestyleA rite of passage into pubertyA way to cope with adolescent issuesA result of other dysfunctional processesA result of pervasive influence of the media and their peers
45 A way of challenging authority A way of fitting into a social situation at school, at work, at social clubs (gang)Media influencesComorbid conditions (eg, depression or anxiety) also contribute to the development and maintenance of drug abuse
46 Risk factors for substance abuse in adolescents Genetics:Alcoholism among first or second degree relativesMale genderIndividualAbuseAntisocial behaviorParental rejectionAggressive temparamentLack of self controlEarly sexual activityDepressionLow self-esteemAttention-deficit disordersPoor self-imageBody modificationLearning disorders
47 Family:Disfunctional family dinamicsPermissivenessAuthoritarianismParental conflict, divorce, separationPoor supervision, lack of supervisionPoor parental role modeling
48 Community/environmental/societal: Easy availability of drugs and alcoholCultural and religious sanctionAcceptance of drug use behaviorUnemploymentPoor general quality of life in the neighborhoodMedia influenceCriminal activities in neighborhoodLow religiosityIncreased use of drugs and alcohol in certain culture
49 Peer group influenceDrug using friendsCuriosityRebellionDesire to belongIndependenceRisk taking behavior
50 School/academicPoor school performancePoor school environmentTruancy
51 Factors protective of substance abuse in adolescents Good communication within familySupportive parentsIntact familyAppropriate adult supervisionPositive self-esteemSocial competenceAcademic successGood schoolGood general healthHigh intelligencePositive adult role modelsPeer group with positive personal attributesReligious involvementA personal sense of morality
52 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
53 Stage of substance use Stage 1: experimentation Usually begins in elementary or junior highOften involves “gateway” drugsUsed in context of exploring new behaviors and experiencesUsed in setting of home or party, or while “hanging out”Used in response to peer norms or to feel grown-upSmall amounts used withhout a definite patternHelps adolescent to cope with demands of development
54 Stage 2: ExplorationProgression in frequency of use,Stronger drugs usedEpisodes of use may be justified as “handling stress”Patterned use apparent and often integrated into social situationsUsed during the week in conflict with regular activities (eg., school)Problems related to drug use occur (decreased performance)Often dissociates from non-drug using friendsDeceptive behaviors to obtain drugsMood swings become apparent to family and friendsDenial often predominates
55 Stage 3:EncapsulationTolerance develops to particular drug of choiseMore and more time spent ascertaining the drug experienceDrug use to maintain function and moodDrops out of other activities, drug use dominates lifeOther problem behaviors manifested (stealing, lying, violence)Physical withdrawal may occurHealth problems may be manifested
56 Stage 4: DependenceIncreasing negative feelings toward selfDeterioration of social relationshipsSocial contacts limited to drug-using friendsDenial of drug use as a problem predominatesInvolvement in illegal activity to maintain drug habitLife is chaotic in all domains (physical, social, psychologic, personal)Often shame, guilt and self destructive behaviorDrug use not to feel “high” but to feel normal
57 ViolenceGlobally, youth violence has been identified as a major health problemViolence 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
58 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.
59 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
60 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.
61 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.
62 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.
63 Definition of violence WHOThreatening or using power against oneself, another person or against a group or community that-Results in-Has a high likelihood of resulting inİnjuryDeathPsychological harmMaldevelopmentDeprivation
64 Form of violencePhysical intimationCorporal punishmentPhysical abusePhysical fightingSuicidePhysical assultsRapeSexual assaultSexual abuseGunshot woundsConflicts between oramong:ParentsSiblingsRelativesCare providersTeachersFriendsAcquaintancesOther peersIntimate partnersSpouses
65 Five factors have a major impact on the incidence and prevalence of physicalAggression and violence in the lives ofchildren and adolescence:Exposure to media violenceBullyingWeapon carryingBelonging to a gangAbusing substances
66 Individual risk factors If the child or adolescent is/has/:Congenital abnormalitiesLow birth weighLow self-esteemBeeing male (except sexual violence)Between the ages of 15-19A member of a violent familyDatingAngry after experiencing a violent traumaA member of a gang groupA runaway from homeHomeless
67 Abusing drugsHistory of early aggressive behaviorA comorbid psychiatric diagnosis of: Attention deficit hyperactivity disorder, Conduct disorderA low IQPoor academic performanceA learning disabilityA history of physical or sexual abusePeers who are violentAccess to a weapon
68 If the child or adolescents: Believes violence is effective for resolving conflictsAccepts that violence or aggression is normalCarries a weponEngages in antisocial behavior and hostile talk with others
69 Familial risk factors If the child or adolescent has: Antisocial parentsPhysically aggressive parentsParents who use harsh physical punishment to disciplinePoor supervision by parentsA mother was parent at an early ageA family with low socieconomic statusA parent who abuses alcohol or other substances
70 If the child or adolescent experiences: Parental conflict in early childhoodA low level of attachment with parentsParental separation or divorce at a younger ageA low level of family cohesion
71 Environmental and cultural risk factors If the adolescent:Lives in an urban areaAttends a large urban school that serves the very poorHigh density and overcrowdingHigh crime rateEasy access to drugs and alcoholLack of community cohesion and neigborhood commitmentLack of supportive services such as child care and recreation
72 If adolescent lives in area where there is: Income inequalityRapid demographic changes in the youth population, urbanizationA culture does not provide nonviolent alternative for resolving conflicts
73 Individual protective factor Ability to respond quickly to threatening eventsPleasure and satisfaction in helping othersMaintaining positive expectations about the future
74 Family level protective factors A warm familyLess crowded and clean homesDiscipline styleStrong parental supervisionUnderstanding and supportClosenessRespect for individual autonomyGood communication
75 Community level protective factors Gun controlLegal regulation
76 Physicians rolePhysicians can be involved in helping prevent/reduce risk behaviors1-Personal level2-Practice level3-Patient level4-Parent level5-School level6-Community/society level
77 Historical approachAdolescent: Problem to be solvedRisk reduction strategy and treatment (Outcome isimportant)Contemporary approachAdolescent: Resource to be developedAdolescent development approach(Resiliency based approach)
78 Resiliency- based approach Builds on individual strengthsAims at addressing those factors that predispose an individual to one or multiple risks
79 Pregnancy prevention program (risk redaction) To develop resistance skills among adolescents at risk for early onset of sexual activity and unprotected intercourse
80 Adolescent development program Focuses on issues related to school failure, vocational options, adult mentorshipImproving life outcomesReduction of unwanted pregnancy