Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 1 Chapter Thirteen: Psychosocial Problems in Adolescence

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 Problems in Adolescence Contrary to media portrayal, adolescents do not generally develop serious psychological or social problems,Contrary to media portrayal, adolescents do not generally develop serious psychological or social problems, Most problems reflect transitory experimentation, not enduring patterns of bad behaviorMost problems reflect transitory experimentation, not enduring patterns of bad behavior Not all problems begin in adolescence (some have their roots in childhood)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)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)Problems during adolescence are not biologically rooted or caused by the normative changes of adolescence (“raging hormones” do not cause problem behaviors)

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 3 Psychosocial Problems: Their Nature and Co-Variation Substance abuse – the maladaptive use of drugs (legal and illegal)Substance abuse – the maladaptive use of drugs (legal and illegal) Internalizing disorders – problems are turned inward (emotional and cognitive distress)Internalizing disorders – problems are turned inward (emotional and cognitive distress) Externalizing disorders – problems are turned outward (behavioral problems)Externalizing disorders – problems are turned outward (behavioral problems) Substance abuse problems are likely comorbidSubstance abuse problems are likely comorbid Insert DAL photo

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 4 Problem Behavior Syndrome Many adolescents with psychosocial problems have more than one type of problem at onceMany 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 SyndromeThe comorbidity of externalizing and substance abuse problems has led researchers to propose theoretical explanations for this phenomenon, sometimes called Problem Behavior Syndrome

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Externalizing Problems Problem behavior syndrome: Unconventionality in adolescents’ personality and social environment leads to risk-taking behaviors (Jessor)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)Problem clusters: Involvement in one problem behavior may lead to involvement in a second one (Kandel) –Cascading effects 5

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 6 Externalizing Problems Social control theorySocial 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

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 7 The Comorbidity of Internalizing Problems Although less research has studied comorbidity among internalizing problems, one underlying factor appears to be negative affectivityAlthough less research has studied comorbidity among internalizing problems, one underlying factor appears to be negative affectivity Negative affectivity refers to how easily someone becomes distressedNegative 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

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 8 Substance Use and Abuse in Adolescence Society sends mixed messages to youthSociety 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 dataAlcohol and nicotine are by far the most commonly used and abused substances, according to Monitoring the Future data

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 9 Prevalence of Substance Use and Abuse Most adolescents have experimented with alcohol, tobacco, and marijuana but not with other drugsMost adolescents have experimented with alcohol, tobacco, and marijuana but not with other drugs Only a very small number of adolescents use any substance dailyOnly a very small number of adolescents use any substance daily –10% smoke cigarettes every day; 3% use alcohol daily; 5% use marijuana daily

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 10 Earlier Age of Initiation Adolescents are experimenting with drugs at earlier ages than in the pastAdolescents 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 15The 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 adulthoodThe effects of alcohol and nicotine on brain functioning (especially memory) are worse in adolescence than in adulthood

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 11 Developmental Trajectories of Substance Abuse Gateway drugsGateway drugs –Alcohol and marijuana –Are typically used before harder drugs Studies have identified six patterns of substance use:Studies have identified six patterns of substance use: –Nonusers –Alcohol Experimenters –Low Escalators –Early Starters –Late Starters –High Escalators

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 12 Risk and Protective Factors For Substance Abuse Adolescents who use alcohol, tobacco, or other drugs frequently are usually exhibiting symptoms of prior psychological disturbanceAdolescents 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: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:Major protective factors are: –Positive mental health, high academic achievement, engagement in school, close family relationships, and involvement in religious activities

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 13 Prevention and Treatment of Substance Use and Abuse Efforts to prevent abuse target: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 environmentExperts believe it is more realistic to focus prevention efforts on adolescents’ motivation and environment

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 14 Prevention and Treatment of Substance Use and Abuse The most encouraging interventions are programs that combine: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 schoolThese kinds of programs have reduced the use of alcohol, drugs, and cigarettes, especially if started in late childhood and continued through high school

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Categories of Externalizing Disorders Conduct DisorderConduct Disorder AggressionAggression Juvenile OffendingJuvenile Offending 15

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 16 Externalizing Problems: Conduct Disorder Conduct Disorder (CD)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)If CD persists beyond age 18, may be diagnosed with antisocial personality disorder, characterized by a lack of regard for moral standards (psychopaths) Insert DAL photo

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 17 Externalizing Problems: Aggression Aggression – behavior that is done intentionally to hurt someoneAggression – behavior that is done intentionally to hurt someone –Physical fighting –Relational aggression –Intimidation Can be instrumental (planned) or reactive (unplanned)Can be instrumental (planned) or reactive (unplanned) Usually declines over the course of childhood and adolescenceUsually declines over the course of childhood and adolescence

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 18 Externalizing Problems: Juvenile Offending Juvenile offending is defined legallyJuvenile offending is defined legally Violent (e.g., assault, rape, robbery, and murder) and property crimes (e.g., burglary, theft arson)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 behaviorDelinquency v. criminal behavior Status offenses – behaviors that are not against the law for adults (truancy, running away, drinking)Status offenses – behaviors that are not against the law for adults (truancy, running away, drinking)

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 19 Externalizing Problems: Juvenile Offending Antisocial behavior takes the form of: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 16Onset of serious delinquency begins between ages 13 and 16

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Changes in Juvenile Offending Over time Juvenile crime rate has declined since its peak in the early 1990sJuvenile 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 girlsNot clear whether this change is mainly due to changes in actual offending or changes in arrest practices among girls 20

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 21 Two Types of Adolescent Offenders Life-course persistent offendersLife-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 offendersAdolescent-limited offenders –Engage in antisocial behavior only during adolescence These two types have very different causes and consequencesThese two types have very different causes and consequences

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 22 Life-Course Persistent Offenders Usually are poor, male, perform poorly in schoolUsually are poor, male, perform poorly in school From disorganized families with hostile or inept parentsFrom 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 regulationHave 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 retaliateExhibit hostile attributional bias – interpret ambiguous interactions with others as deliberately hostile and retaliate

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 23 Adolescent-Limited Offending Do not usually show signs of psychological problems or family pathologyDo not usually show signs of psychological problems or family pathology Still show more problems than teens who are not at all delinquentStill show more problems than teens who are not at all delinquent –More mental health, substance abuse, and financial problems Risk factors include:Risk factors include: –Poor parenting (especially poor monitoring) –Affiliation with antisocial peers

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 24 Internalizing Problems and Depression in Adolescence Depression is the most common psychological disturbance among adolescentsDepression 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 Insert DAL photo

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. Imprecise Use of the Word “Depression” Depressed moodDepressed mood –Feeling sad Depressive symptomsDepressive symptoms –Having multiple symptoms of depression Depressive disorderDepressive disorder –Having enough symptoms to be diagnosed with the illness 25

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 26 Sex Differences in Depression Before adolescence, boys are more likely to exhibit depressive symptomsBefore adolescence, boys are more likely to exhibit depressive symptoms After puberty, females are more likely to be depressed, possibly because of: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)

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 27 Adolescent Suicide ~20% of girls and 10% of boys think about killing themselves every year (suicidal ideation)~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:Risk factors include: –Having a psychiatric problem Especially depression or substance abuseEspecially depression or substance abuse –Having a family history of suicide in the family –Experiencing extreme family conflict Parental rejection, family disruptionParental rejection, family disruption –Being under intense stress Suicide rate is highest among American Indian and Alaskan Native adolescentsSuicide rate is highest among American Indian and Alaskan Native adolescents –Lowest among Black and White adolescents

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 28 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)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 DiathesisThe Diathesis –May be biological in origin (neuroendocrine or genetically linked), or because of cognitive style The StressThe Stress –Primarily from having a high-conflict and low cohesion family, being unpopular, or reporting more chronic and acute stressors

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 29 Treatment and Prevention of Internalizing Problems Treatment approaches: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 basisEvidence-based approaches are superior to approaches that do not have a scientific basis

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 30 Stress and Coping Stress responses vary, so some adolescents experience: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 outcomesStress does not always lead to negative outcomes –Resilience in the face of adversity Insert DAL photo

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 31 What Explains Stress Vulnerability? Multiple stressors have a much greater impact than single stressors (multiplicative)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 peersAdolescents 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 stressUsing 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)