1. Adolescence 9th edition
Chapter Thirteen:
Psychosocial Problems in Adolescence
By Laurence Steinberg, Ph.D.

2. Chapter 13 Overview
What are some general principles about psychosocial problems in adolescence?
What is comorbidity?
What causes substance use and abuse in adolescence? How can it be treated or prevented?
What are the causes of antisocial and externalizing problems?
What factors lead to depression and other internalizing problems?
Why are girls at greater risk?
How do adolescents cope with stress? What explains vulnerability to stress?

3. Problems in Adolescence
Contrary to media portrayal, adolescents do not generally develop serious psychological or social problems,
Most problems reflect transitory experimentation, not enduring patterns of bad behavior
Not all problems begin in adolescence (some have their roots in childhood)
Most problems do not persist into adulthood (especially drug and alcohol use as well as delinquency)
Problems during adolescence are not biologically rooted or caused by the normative changes of adolescence (“raging hormones” do not cause problem behaviors)
Although the stereotype of adolescence is one of a developmental period riddled with difficulty, this is not an accurate portrayal. We should not gloss over the fact that many healthy adolescents at one time or another experience self-doubt, family squabbles, academic setbacks, or broken hearts, of course. But it is important to keep in mind as we look at psychosocial problems during adolescence that there is an important distinction between the normative, and usually transitory, difficulties encountered by many young people—and by many adults, for that matter—and the serious psychosocial problems experienced by a relatively small minority of youth.
First, we need to distinguish between occasional experimentation and enduring patterns of dangerous or troublesome behavior. Research shows that rates of occasional, usually harmless, experimentation far exceed rates of enduring problems.
Second, we need to distinguish between problems that have their origins and onset during adolescence, and those that have their roots during earlier periods of development.
Third, it is important to remember that many, although not all, of the problems experienced by adolescents are relatively transitory in nature and are resolved by the beginning of adulthood, with few long-term repercussions in most cases.
Finally, problem behavior during adolescence is virtually never a direct consequence of the normative changes of adolescence itself. Popular theories about “raging hormones” causing oppositional or deviant behavior have no scientific support whatsoever, for example, nor do the widely held beliefs that problem behaviors are manifestations of an inherent need to rebel against authority or that bizarre behavior results from an identity crisis

4. Psychosocial Problems: Their Nature and Co-Variation
Substance abuse – the maladaptive use of drugs (legal and illegal)
Internalizing disorders – problems are turned inward (emotional and cognitive distress)
Externalizing disorders – problems are turned outward (behavioral problems)
Substance abuse problems are likely comorbid
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While the distinction between internalizing disorders and externalizing disorders is useful for organizing information about psychosocial problems during adolescence, it is important to bear in mind that some adolescents experience problems in both domains simultaneously. That is, some adolescents who engage in delinquency or show other behavior problems also suffer from depression.

5. Problem Behavior Syndrome
Many adolescents with psychosocial problems have more than one type of problem at once
The comorbidity of externalizing and substance abuse problems has led researchers to propose theoretical explanations for this phenomenon, sometimes called Problem Behavior Syndrome

6. Externalizing Problems
Problem behavior syndrome: Unconventionality in adolescents’ personality and social environment leads to risk-taking behaviors (Jessor)
Tolerance of deviance
Not connected to school/religious institutions
Highly liberal views
Problem clusters: Involvement in one problem behavior may lead to involvement in a second one (Kandel)
Cascading effects

7. Externalizing Problems
Social control theory
Individuals who do not have strong bonds to societal institutions, (family, work, school) will be likely to deviate and behave unconventionally
Helps explain why behavior problems are far more prevalent among poor, inner-city, minority youths

8. The Comorbidity of Internalizing Problems
Although less research has studied comorbidity among internalizing problems, one underlying factor appears to be negative affectivity
Negative affectivity refers to how easily someone becomes distressed
Adolescents high in negative affectivity are more likely to suffer from depression, anxiety, and other symptoms of distress

9. Substance Use and Abuse in Adolescence
Society sends mixed messages to youth
TV programs “Just say NO”
TV football games and situation comedies “Having a good time is impossible without alcohol”
Alcohol and nicotine are by far the most commonly used and abused substances, according to Monitoring the Future data

10. Prevalence of Substance Use and Abuse
Most adolescents have experimented with alcohol, tobacco, and marijuana but not with other drugs
Only a very small number of adolescents use any substance daily
10% smoke cigarettes every day; 3% use alcohol daily; 5% use marijuana daily

11. Change in Substance Use over Time

12. Earlier Age of Initiation
Adolescents are experimenting with drugs at earlier ages than in the past
The chances of becoming addicted to alcohol or nicotine are increased when use begins before age 15
Drugs can affect dopamine production in the brain, possibly altering it permanently
The effects of alcohol and nicotine on brain functioning (especially memory) are worse in adolescence than in adulthood

13. Developmental Trajectories of Substance Abuse
Gateway drugs
Alcohol and marijuana
Are typically used before harder drugs
Studies have identified six patterns of substance use:
Nonusers
Alcohol Experimenters
Low Escalators
Early Starters
Late Starters
High Escalators

14. Risk and Protective Factors For Substance Abuse
Adolescents who use alcohol, tobacco, or other drugs frequently are usually exhibiting symptoms of prior psychological disturbance
More maladjusted as children and teenagers
Major risk factors are:
Personality – Anger, impulsivity, and inattentiveness
Family – Distant, hostile, or conflicted relationships
Socially – Friends who use and tolerate the use of drugs
Contextual – Live 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

15. Prevention and Treatment of Substance Use and Abuse
Efforts to prevent abuse target:
The supply of drugs (most government attention and money focused here)
The environment in which teens are exposed to drugs
Characteristics of the potential drug user
Experts believe it is more realistic to focus prevention efforts on adolescents’ motivation and environment

16. Prevention and Treatment of Substance Use and Abuse
The most encouraging interventions are programs that combine:
Social competence training for adolescents
Community-wide interventions aimed at adolescents, peers, parents, and teachers
These kinds of programs have reduced the use of alcohol, drugs, and cigarettes, especially if started in late childhood and continued through high school

17. Categories of Externalizing Disorders
Conduct Disorder
Aggression
Juvenile Offending

18. Externalizing Problems: Conduct Disorder
Conduct Disorder (CD)
Clinical diagnosis
A pattern of persistent antisocial behavior that routinely violates the rights of others and leads to problems in social relationships, school, or work
Related diagnosis is oppositional-defiant disorder (less aggressive)
If CD persists beyond age 18, may be diagnosed with antisocial personality disorder, characterized by a lack of regard for moral standards (psychopaths)
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Violations of the law are far more common among adolescents and young adults than among any other age segment of the population.
Individuals who have been diagnosed with conduct disorder and who persist in their antisocial behavior after age 18 may subsequently be diagnosed with antisocial personality disorder, which is characterized by a lack of regard for the moral or legal standards of the community and a marked inability to get along with others or abide by societal rules. Some individuals with antisocial personality disorder are called psychopaths, which refers to individuals who are not only antisocial in their behavior but manipulative, superficially charming, impulsive, and indifferent to the feelings of others (Hare, 1991). Because the terms “antisocial personality disorder” and “psychopath” imply a deep-seated personality problem that is unlikely to change, experts advise against applying them to people younger than 18, because, as you will read, most individuals who engage in antisocial behavior as teenagers do not continue to do so after their mid-20s.

19. Externalizing Problems: Aggression
Aggression – behavior that is done intentionally to hurt someone
Physical fighting
Relational aggression
Intimidation
Can be instrumental (planned) or reactive (unplanned)
Usually declines over the course of childhood and adolescence

20. Externalizing Problems: Juvenile Offending
Juvenile offending is defined legally
Violent (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)
Delinquency v. criminal behavior
Status offenses – behaviors that are not against the law for adults (truancy, running away, drinking)

21. Externalizing Problems: Juvenile Offending
Antisocial behavior takes the form of:
Authority conflicts (running away)
Covert antisocial behavior (stealing)
Overt antisocial behavior (attacking someone with a weapon)
Onset of serious delinquency begins between ages 13 and 16

22. Changes in Juvenile Offending Over time
Juvenile crime rate has declined since its peak in the early 1990s
However, adolescents still account for a disproportionately high number of crimes
Substantial decline in the gender gap in serious offending over the past several decades
Not clear whether this change is mainly due to changes in actual offending or changes in arrest practices among girls

23. Two Types of Adolescent Offenders
Life-course persistent offenders
Demonstrate antisocial behavior before adolescence
Are involved in delinquency during adolescence
Are at great risk for continuing criminal activity in adulthood
Adolescent-limited offenders
Engage in antisocial behavior only during adolescence
These two types have very different causes and consequences

24. Life-Course Persistent Offenders
Usually are poor, male, perform poorly in school
From disorganized families with hostile or inept parents
Harsh parenting may affect brain chemistry (serotonin)
Worse behavior elicits more bad parenting, leads to a vicious cycle
Have 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
Because antisocial behavior in the child typically provokes further parental ineffectiveness and association with other antisocial children, aggressive children often get caught up in a vicious cycle.

25. Life-Course Persistent Offenders

26. Adolescent-Limited Offending
Do not usually show signs of psychological problems or family pathology
Still show more problems than teens who are not at all delinquent
More mental health, substance abuse, and financial problems
Risk factors include:
Poor parenting (especially poor monitoring)
Affiliation with antisocial peers
Food for Thought: Given what we know about differences between life-course persistent offenders and adolescence-limited offenders, should we take this distinction into account when deciding how to treat violent juvenile offenders?

27. Internalizing Problems and Depression in Adolescence
Depression is the most common psychological disturbance among adolescents
Emotional 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
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Most individuals emerge from adolescence confident, with a healthy sense of who they are and where they are headed. But in some instances, the changes and demands of adolescence may leave a teenager feeling helpless, confused, and pessimistic about the future. Although minor fluctuations in self-esteem during early adolescence are commonplace, however, it is not normal for adolescents (or adults, for that matter) to feel a prolonged or intense sense of hopelessness or frustration. Such young people are likely to be psychologically depressed and in need of professional help. Depression is by far the most significant internalizing problem in adolescence.

28. Imprecise Use of the Word “Depression”
Depressed mood
Feeling sad
Depressive symptoms
Having multiple symptoms of depression
Depressive disorder
Having enough symptoms to be diagnosed with the illness

29. Sex Differences in Depression
Before 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, dependent, and fragile, heightened self-consciousness over physical appearance
Greater levels of stress during early adolescence
Ruminating more – turning feelings inward
Greater sensitivity to others (oxytocin)

30. Sex Differences in Depression

31. Adolescent Suicide
~20% of girls and 10% of boys think about killing themselves every year (suicidal ideation)
10% girls & 5% boys make attempts serious enough to require treatment
Risk factors include:
Having a psychiatric problem
Especially depression or substance abuse
Having a family history of suicide in the family
Experiencing extreme family conflict
Parental rejection, family disruption
Being under intense stress
Suicide rate is highest among American Indian and Alaskan Native adolescents
Lowest among Black and White adolescents

32. Adolescent Suicide

33. The Diathesis-Stress Model of Depression
Depression occurs when people with a predisposition (a diathesis) toward internalizing problems are exposed to chronic or acute stressors (a stress)
Those without the diathesis are able to withstand a great deal of stress without developing psychological problems
The Diathesis
May be biological in origin (neuroendocrine or genetically linked), or because of cognitive style
The Stress
Primarily from having a high-conflict and low cohesion family, being unpopular, or reporting more chronic and acute stressors

34. Treatment and Prevention of Internalizing Problems
Treatment approaches:
Biological therapies – Antidepressant medications (SSRIs) that address the neuroendocrine problems that may exist
Psychotherapies – Designed to help adolescents understand the roots of their depression or change their cognitions
Family therapy – Changing patterns of family relationships that contribute to symptoms
Evidence-based approaches are superior to approaches that do not have a scientific basis

35. 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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Nearly half of all adolescents report difficulty in coping with stressful situations at home or at school.

36. What Explains Stress Vulnerability?
Multiple stressors have a much greater impact than single stressors (multiplicative)
Adolescents who have internal and external resources are less likely to be affected by stress than their peers
Internal: high self-esteem, healthy identity development, high intelligence
External: social support from others
Using more effective coping strategies also buffers the effects of stress
Primary control: taking steps to change the source of stress (usually the best strategy)
Secondary control strategies: trying to adapt to the problem (better when situation is uncontrollable)