1. Adolescent Mental Health
Oliver O’Connell
Psychiatrist

2. Adolescent Mental Health
Definition of Adolescence
Biopsychosocial development during adolescence
Biopsychosocial tasks of adolescence
Normal vs. abnormal adolescent behaviour
Resolution of Adolescence
Mental Illnesses arising in adolescence

3. Adolescent Mental Health
Definition:
Adolescence is the developmental phase that spans the transition period from the ending of the relatively complete childhood reliance on parents to the relatively complete reliance on oneself to manage one's own life. Thus the beginning and end dates vary greatly.

4. Adolescent Mental Health
Definition:
“adolescence begins in biology and ends in culture” longstanding definition of the onset of adolescence links it to puberty, when hormone activity produces the development of secondary sex characteristics (pubic hair and voice change in males; breast development and menarche in females). However, while these biological changes are evidence of the transition from childhood to adolescence, the transition out of adolescence is less well defined.
Age has changed with earlier onset due to better nutrition.

5. Adolescent Mental Health
Definition:
A hundred years ago, notions of adolescence were scarcely understood, since teens did not attend high school and most assumed adult roles of providing for their family and getting married at average ages of 14 and 15.
the time period of adolescence has been extended to include the ages of 10 through the mid twenties, with most researchers dividing the age span into early (10–13), middle (14–17) and late (18–mid twenties) adolescent

6. Adolescent Mental Health
Biopyschosocial tasks of adolescence:
(Physical, psychological and social development ). The problem is that these three domains may not keep up with each other. In the last 100 years the average age of puberty occurs 2 years earlier but there is no evidence that psychosocial developmental has kept pace.

7. Adolescent Mental Health
Physical development
A growth spurt precedes puberty by 1 year with girl's commencing about two years before boys and finishing at an earlier age. Emotional adjustment may be a problem for those whose pubertal level is out of synchrony with their peers. It is noted to be a problem for very early developing girls and late developing boys.

8. Adolescent Mental Health
Physical Development
Growth and maturation of the brain
This leads to new behaviours that irritate and frustrate parents including changes in
attention
motivation…………need reward
risk taking behaviour
Messy room, disobedient, reckless, careless………………need for instant gratification, impulsivity, novelty seeking and risk taking behaviour promoted

9. Adolescent Mental Health
Psychosocial Development through adolescence.
Early adolescence:
Growth spurt
Puberty commences
Social move away from family towards peers (peer group becomes an alternative for life advice)
Thinking is concrete

10. Adolescent Mental Health
Mid Adolescence: 14-17years
Ability to think abstractly
Metacognition
Beginning of consolidation of the sense of self
Scant empathy and lack of tolerance for views of others

11. Adolescent Mental Health
Late Adolescence: 18 to mid twenties
Abstract thinking and ability to consider the future, deductive reasoning
Idealism becomes more practical and less doctrinaire
Parental values less likely to be challenged automatically

12. Adolescent Mental Health
Biopyschosocial tasks of adolescence:
To come to terms with body/brain changes
To cope with sexual development and psychosexual drives
To establish and confirm sense of identity
To learn more about sex roles
To synthesize personality
To struggle for independence and emancipation from family

13. Adolescent Mental Health
Normal adolescent behaviour:
is it normal to be abnormal in adolescence?
What Is Normal?
Become Aware of the Attitudes and Behaviours of Adolescents Your Child's Age
How Often Does the Behaviour Occur?
Does the Behaviour Interfere with the Teenager's Ability to Function in the Environment?
Does the Behaviour Interfere with Others?
Consider Individual Differences
Use your intuition

14. Adolescent Mental Health
Normal Adolescent Behaviour
Risk taking
Impulsivity
Novelty seeking
Reckless behaviour
Disobedience

15. Adolescent Mental Health
Normal Adolescent Behaviour:
Inconsistent, unpredictable, and paradoxical behaviour
Exploration and experimentation with self and world
Eagerness for peer approval and relationships
Strong moral and ethical perceptions
Competitive in play; erratic work play patterns
Better use of language and other symbolic material
Critical of self and others
Alternates between anxiety over loss of parent nurturing and hostility to parents

16. Adolescent Mental Health
Abnormal Adolescent Behaviour:
Apprehensions, fears, guilt and anxiety about sex, health, education
Defiant, negative, impulsive or depressed behaviour
Frequent somatic or hypochondriacal complaints
Illness denying behaviour
Learning erratic or deficient
Sexual preoccupation
Poor or absent personal relationships with adults or peers
Immature or precocious behaviour
Unwillingness to assume greater autonomy
Complete inability to substitute or postpone gratifications

17. Adolescent Mental Health
Severely abnormal Adolescent Behaviour:
Complete withdrawal into self, extreme depression
Acts of delinquency, asceticism, ritualism, obsessions
Neuroses, especially phobias; persistent anxiety, compulsions, inhibitions,
Persistent hypochondriasis
Sexual deviance
Complete inability to socialize or study
Anorexia, Bulimia,
Psychoses:

18. Adolescent Mental Health
Resolution of Adolescence:
Separation from parents commensurate with being able to decide the course of one's own life
Attainment of a stable sexual identity
Ability to form a long-term sexual relationship
Attainment of a steady job or the preparation for a career
Attainment of a personal value system that respects both the needs of the self and the needs of others

19. Adolescent Mental Health
Mental Illnesses arising in adolescence
Epidemiology
1 in 4 have a mental disorder
9% are highly distressed
18-24year olds have the highest prevalence
Youth suicide is the leading cause of death in year olds

20. Adolescent Mental Health
Mental Illnesses arising in adolescence
Biology/Genetics
Risk factors:
Family history
Protective factors:
High Intelligence

21. Adolescent Mental Health
Mental Illnesses arising in adolescence
Social Environment
Risk Factors
Poverty
Discrimination based on race, religion etc.
Bullying, trauma, sexual abuse
Criminal opportunities

22. Adolescent Mental Health
Mental Illnesses arising in adolescence
Social Environment
Protective factors
Quality Schools
Cohesive Family
Neighbourhood Resources
Interested Adults

23. Adolescent Mental Health
Mental Illnesses arising in adolescence
Perceived Environment
Risk Factors
Models for deviant behaviour
Parent-friends conflict the norm

24. Adolescent Mental Health
Mental Illnesses arising in adolescence
Perceived Environment
Protective Factors
Models for conventional behaviour
High control against deviant behaviour

25. Adolescent Mental Health
Mental Illnesses arising in adolescence
Personality
Risk Factors
Low perceived life chances
Low Self-Esteem
Risk-Taking Propensity

26. Adolescent Mental Health
Mental Illnesses arising in adolescence
Personality
Protective Factors
Value on achievement
Value on health
Intolerance of deviance

27. Adolescent Mental Health
Mental Illnesses arising in adolescence
Alcohol and drug abuse
Anorexia, bulimia and other eating disorders
Anxiety disorders, OCD, Phobias, PTSD, PD
Attention Deficit Hyperactivity Disorder
Conduct Disorder
Bipolar Disorder/Depression

28. Adolescent Mental Health
Mental Illnesses arising in adolescence
Learning Disorders
Psychosis
Schizophrenia
Tourette’s

29. Adolescent Mental Health
Alcohol and drug abuse
Warning Signs
A drop in school performance
A change in group of friends
Delinquent behaviour
Deterioration in family relationships

30. Adolescent Mental Health
Alcohol and drug abuse
Warning Signs
Red eyes
Persistent cough
Changes in eating and sleeping patterns
Anxiety and depression

31. Adolescent Mental Health
Anorexia and Bulimia Warning signs
Preoccupation with body image or food
Bingeing, restricting, dieting
Rapid weight changes
Social withdrawal
Irritability
Moodiness

32. Adolescent Mental Health
Anxiety Disorders
Obsessive Compulsive Disorder
Phobias
Post Traumatic Stress Disorder
Panic Attacks and Panic Disorder

33. Adolescent Mental Health
Attention Deficit Hyperactivity Disorder
Normally begins in childood
Inattention
Daydreaming or hyperactive
Forgetfulness
Impulsivity
Inability to complete tasks
Interrupts others

34. Adolescent Mental Health
Conduct Disorder
Repetitive and persistent pattern of behaviour in which the basic human rights of others or major age-appropriate norms are violated

35. Adolescent Mental Health
Bipolar Disorder/Depression
Increased risk taking and recklessness
Impulsivity
Poor school performance
Low self-esteem
Insomnia or Hypersomnia
Changes in appetite or weight
Loss of emotional control

36. Adolescent Mental Health
Mental Illnesses arising in adolescence
Learning Disorders
Psychosis/Schizophrenia
Tourette’s

37. Adolescent Mental Health
Psychosis/Schizophrenia

38. Adolescent Mental Health
Tourettes
Co-occur with ADHD and OCD
Tic disorder