Adolescent Maladaptive Behaviors

1
Adolescent Maladaptive Behaviors

• Madeline Gervase RN,MSN,CCRN,FNP
• Advanced Practice Nurse

2
Maladaptive Behavior

• What is it?
• Behavior that is deviant, maladaptive and
  personally distressful.
• Results in Discouraging well-being, growth and
  fulfillment.
• Presents itself by Addiction to drugs, eating
  disorders, non-compliance, etc

3
Causes of Abnormal Behavior

• 3. Sociocultural
• Factors
• 4. Biopsychological
• Factors
• (Interactionist approach)

• 1. Biological
• Factors
• 2. Psychological
• Factors

4
Biological Factors

• Malfunctioning of the persons body, specifically
  brain processes and genetic factors

5
Psychological Factors

• Distorted thoughts, emotional turmoil,
  inappropriate learning, and troubled relationships

6
Sociocultural Factors

• Frequency and intensity varies from culture to
  culture, and is based on social, economic,
  technological and religious aspects

7
Biopsychosocial The
Interactionist Approach

• Biological, psychological and sociocultural
  factors may interact

8
Characteristics of Adolescent Disorders

• Vary in severity based on developmental level,
  sex, and socioecomomic status
• Duration short-term to long-term which could
  be for many years
• Younger adolescents fighting, arguing and being
  loud
• Older adolescents depression, drug abuse and
  skipping school

9
Gender Comparison on Behavior

• Boys
• Under-controlled, externalized behaviors.
• - fighting, destroying property

10
Gender Comparison on Behavior

• Girls
• Over-controlled and internalized behavior
• Anxiety
• Depression

11
Abnormal Behavior Associated With

• Increase of problems with fewer related adults in
  home
• Biological parents unmarried
• Separated or divorced parents
• Families that receive public assistance
• Family members who receive mental health services

12
Drugs and Alcohol.

• Why?
• Reduce tension frustration
• Relieve boredom, curiosity
• Escape realities of the world
• Social reasons make you feel comfortable and
  relaxed
• Drugs provide relaxation, skewed perceptions and
  a pleasurable high

13
Definitions

• Tolerance More of the drug is needed to produce
  the original effect
• Physical Dependence Physical need for a drug,
  symptoms of withdrawel when drug is stopped
• Psychological Dependence Strong craving to keep
  using the drug for emotional needs such as to
  reduce stress

14
Alcohol

• Most widely used drug by U.S. adolescents
• Effects depressant, slows brain activity
• - reduces inhibition and impairs
• judgement
• - excess, can damage or kill
  biological tissues like muscle and brain cells
• - extreme intoxication can result in
  coma

15
Alcohol Effects

• Vary according to weight, amount drunk, persons
  alcohol tolerance
• More males binge drink than females
• Alcoholism is the 3rd leading killer in the U.S.
• 13 million people are alcoholics

16
Statistics..

• In 1999, more than 50 of HS seniors drank every
  month.
• Marijuana ( Cannabis sativa) is the most common
  illicit drug used by children and adolescents in
  the US

17
Risk Factors

• Heredity more evidence of alcoholism related to
  genetic factors with an influence on
  environmental
• Family influences
• Peer Relations
• Personality Characteristics
• A strong family support system reduces alcohol
  abuse in adolescents

18
Cloningers Personality Characteristics

• Four inherited temperments
• - novelty seeking
• - ha avoidance
• - reward
• dependence
• - persistence
• Three learned characters
• - self-directedness
• - cooperativeness
• - self-transcendence

19
DRUGS.DRUGS.DRUGS

• Hallucinogens
• LSD and Marijuana
• -mind altering drugs that produce
  hallucinations.
• Increased use by adolescents
• Experimental and peer influence

20
LSD

• Is powerful in low doses
• Objects glow and change shape
• Kaleidoscope images
• Pleasant and frightening images
• Dizziness, nausea, tremors
• Rapid mood swings, impaired attention span and
  memory

21
Marijuana

• More mild than LSD active ingredient THC
• Increases heart rate and blood pressure
• Combined excitation, depression and hallucinatory
  characteristics
• Distorted perceptions of time and place
• Changes in verbal behavior
• Can effect reproduction system and cause birth
  defects

22
STIMULANTS

• Increase CNS activity
• Caffeine, nicotine, amphetamines and cocaine
• Increase heart rate, respirations and temperature
• Increases energy, decrease fatigue
• Lifts mood and self-confidence
• After effects wear off, become tired, irritable,
  depressed
• Can be physically and psychologically addictive

23
CIGARETTES

• Onset 7-9 grades
• In 1999, nearly 20 of 8th graders had smoked
• Male Female
• Smoking in adolescents causes permanent genetic
  changes in lungs
• Increases risk of lung cancer.

24
Cocaine

• Coca plant
• Exhilerated feelings followed by depressive
  feelings and lethargy
• Insomnia irritability
• Can result in Heart attack, stroke and seizures
• Crack Cocaine Inexpensive, purified, smokable
  form .

25
Amphetamine

• Widely prescribed stimulant sometimes in the
  form of diet pills
• OTC over-the-counter stay awake pills.
  Sharp increase in use
• Overall, amphetamine use has decreased
• OTC diet pills has decreased, however, fairly
  common among women

26
Depressants

• Slow down central nervous system bodily functions
  and behavior
• Medically reduce anxiety, induce sleep
• Most widely used alcohol, barbituates and
  tranquilizers

27
Depressants

• Barbituates
• Induce sleep, reduce anxiety
• Decreased use since 1975

• Tranquilizers
• Reduce anxiety and induce relaxation

• Opiates
• Opium and its derivative
• Effects last for several hours- depress CNS
  activity
• Euphoria
• Pain relief, increased appetite for food sex
• Physically addictive drug

• Heroin
• Opiate
• Body craves
• Withdrawel is very painful physically mentally
• Heroine rates low but, recent use increased

28
Anabolic Steroids

• Female Changes
• Acne
• Weaening tendons
• Decrease HDL ( The good cholesterol
• High blood pressure

• Male changes
• Shrinking testicles
• Reduced sperm count
• Impotence
• Premature baldness
• Enlarged prostate
• Breast enlargement

29
Psychological Effects of Anabolic Steroids

• Irritability and uncontrollable bursts of anger
• Severe mood swings
• May result in depression during withdrawel and
  when stopped
• Impaired judgement
• Feelings of invincibility
• Paranoid jealousy
• Increase use 1999, 1.7 of 8th 9th graders
  used steroids

30
Roles of DevelopmentParents, Peers Schools in
Adolescent Drug Abuse

• Most adolescents use drugs at some point in their
  development
• When using drugs to cope with stress, it can
  interfere with competent coping skills and
  responsible decision making
• Parents, peers social support play important
  roles in preventing drug abuse

31
Steps to Reduce Drug Use

• Early intervention
• Peer led programs
• Community-wide prevention efforts
• Teacher support and training
• Alternative physical activities to keep the body
  as well as mind occupied and challenged

32
Major Adolescent Problems

• Depression
• Suicide
• Eating Disorders
• Juvenile Delinquency
• Substance Abuse
• Adolescents are at most risk to have more than
  one problem.
• Problem behaviors in adolescents are interrelated.

33
Depression Signs Symptoms

• Depressed mood most of the day.
• Reduced interest or pleasure in all/most
  activities.
• Significant weight loss or weight gain ,
  significant increase or decrease in appetite.
• Trouble sleeping or sleeping too much.
• Psychomotor agitation or retardation.

34
Depression Signs Symptoms

• Persistent sad or irritable mood.
• Fatigue or loss of energy.
• Feeling worthless or guilty in an excessive or
  inappropriate manner.
• Problems n thinking, concentration, or making
  decisions.
• Recurrent thoughts of death or suicide.

35
Depression

• 5 or more of these symptoms must be persist for 2
  or more weeks before the diagnosis is made.
• The way symptoms are expressed varies with the
  developmental stage of the child.
• Children have difficulty in identifying
  describing their internal emotional or mood
  states.

36
Associated Signs Symptoms of
Depression

• Frequent vague, non-specific physical complaints
  such as headache, muscle aches, stomach aches or
  tiredness.
• Frequent absences form school or poor
  performance.
• Talk of efforts to run away from home
• Outburst of shouting, complaining, unexplained
  irritability, or crying.
• Being bored.
• Lack of interest in playing with friends.

37
Associated Signs Symptoms of
Depression

• Social isolation, poor communication.
• Alcohol or substance abuse.
• Fear of death.
• Extreme sensitivity to rejection of failure.
• Increased irritability, anger or hostility.
• Reckless behavior.
• Difficulty with relationships.

38
Risk Factors for Depression

• Family history of the disorder.
• Stress
• Cigarette smoking.
• A loss of a parent or loved one.
• Break-up of a romantic relationship.
• Attentional, conduct or learning disorders.
• Chronic illness, such as diabetes.
• Abuse or neglect.

39
Risk Factors for Depression

• Previous depressive episode
• Family conflict.
• Parents who are emotionally unavailable. Immersed
  in marital conflict, and economic problems.
• Parental divorce.
• Period of puberty.
• Uncertainty regarding sexual orientation.
• Poor peer relationships (friends).

40
Is Depression a serious problem?

• 1/3 of adolescents who for to a mental health
  clinic suffer from depression.
• Depression increases in the adolescent years, and
  being twice as common as in the elementary years.
• In childhood, boys girls appear ot be at equal
  risk for depressive disorders.
• Adolescent girls are twice as boys . likely to
  develop depression

41
Suicide

• Rate has tripled in the past 30 years in the US.
  11.3 per 100,000 or 30,575 Americans completed
  suicide in 1998.
• The third leading cause of death in 10-24 year
  olds.
• Males are 5x as likely to commit suicide as
  females are.

42
Males vs. Females

• Commit suicide more frequently
• Active methods for attempting suicide
• Shooting

• Attempt suicide more frequently
• Passive methods
• Sleeping pills

43
Why Suicide?

• Loss of boyfriend/girlfriend.
• Poor grades at school.
• Unmated pregnancy.
• Drugs.
• Family history of instability/unhappiness.
• Lack of affection, emotional support, friendship.
• Pressure for achievement by parents.

44
Why Suicide?

• Mental illness.
• Family discord.
• Absence of biological parents.
• Physical abuse.
• Unemployment.
• Interpersonal Stress.
• Residential transience.
• Chronic behavioral problems.

45
Eating Disorders

• Increasing problem in adolescent girls who feel
  negative about their bodies I early adolescence
  were more likely to develop eating disorders
  later in adolescent.
• Adolescent girls with a positive relationship
  with their parents tended to have healthier
  eating habits.
• Girls who are both sexually active and in
  pubertal transition are morel likely to be
  dieting or engaging in an eating disorder.
• 5 million Americans are affectd by an eating
  disorder each year.

46
Three most commonEating Disorders

• Obesity
• Anorexia Nervosa
• Bulimia

47
Obesity

• Children born in the USA today have a 50 chance
  of becoming overweight at some point in their
  lifetime.
• 25 of today's adolescent are obese.
• 80 of obese adolescents become obese adults.
• 10 of children who DO NOT have obese parents
  become obese themselves.
• 40 of children who become obese have 1 obese
  parent.
• 70 of children who become obese have 2 obese
  parents.

48
Obesity

• Identical twins have similar weights even when
  reared apart.
• The dramatic increase in obesity is likely due to
  greater availability of food, energy saving
  devices, and declining physical activity,
• American adolescents are more obese than European
  adolescents from other parts of the world.

49
Anorexia Nervosa

• An eating disorder that involves the relentless
  pursuit of thinness through starvation. Self is
  viewed as Fat. Intense fear of gaining weight
• Primarily affects females during adolescence and
  early adulthood.
• 5 anorexics are male.
• Most adolescents with this disorder are white
  from well educated middle upper class homes.

50
Anorexics

• Avoid eating but have an intense interest in
  food.
• Distorted body image perceiving they will only be
  attractive when they are skeletal appearance.
• Repeatedly check body wieght.
• As starvation continues the fat content of their
  bodies drops to a bare minimum menstruation
  stops behavior is hyperactive.

51
Common findings in Patients with Anorexia Nervosa

• Bradycardia
• Orthostatic changes in pulse or blood pressure
• Hypothermia
• Cardiac murmur
• Dull, thinning hair
• Sunken cheeks, sallow skin

• Atrophic breasts (post pubertal)
• Atrophic vaginitis (post pubertal)
• Pitting edema of extremities
• Emaciation
• Flat affeft
• Cold extremities, acrocyanosis

52
Causes of anorexia nervosa

• Societal current fashion image of thinness.
• Psychological
• -Motivation for attention
• -Desire for individuality
• -Denial of sexuality
• -Way to cope with over controlling parents
• Physiological- Hypothalamus functions abnormally
  when an adolescent becomes anorexic.

53
Bulimia

• An eating disorder in which the individual
  consistently follows a binge-and-purge eating
  pattern.
• Eating an excessive amount of food within a
  discrete period of time with a sense of lack of
  control during the episode.
• Inappropriate behavior to prevent weight gain,
  self induced vomiting, misuse of laxatives,
  diuretics, enemas, fasting, excessive exercise.

54
Bulimics

• Binge and then purge by self-induced vomiting or
  by using a laxative.
• May alternate binges with fasting or normal
  eating
• Female
• Depression is common
• Bulimia can cause gastric and chemical imbalance.
• Many of the causes offered for anorexia are also
  offered for bulimia.

55
Common findings in patients with Bulimia

• Sinus bradycardia
• Cardiac arrhythmias
• Orthostatic changes in pulse or blood pressure
• Cardiac murmur
• Hair without shine
• Parotitis

• Russells sign -
• (callus on knuckles from self induced emesis)
• Mouth sores
• Palatal scathes
• Dental enamel erosions
• Possible normal appearance

56
Juvenile Delinquency

• Refers to a broad range of behaviors from
  socially unacceptable behavior,
• i.e. acting out in school, to status offenses,
  i.e. running away, and criminal acts, i.e.
  burglary.

57
Index Offenses

• Criminal acts, whether committed by juveniles or
  adults.
• Robbery, aggravated assault, rape , homicide.

58
Status Offenses

• Performed by youths under specific age, these are
  not as serious as index offenses.
• Acts of drinking under age, truancy, and sexual
  promiscuity.

59
Conduct Disorder

• The psychiatric diagnostic category for the
  occurrence of multiple delinquent activities over
  a 6 month period.
• Truancy, running away , fire setting , cruelty to
  animals, breaking entering, excessive
  fighting.

60
Antecedents of Delinquency

• Negative identity
• Low degree of self control
• Early initiation
• Males
• Low expectations low grades
• Low parental monitoring, supporting,
  disciplining

61
Factors often present

• Early involvement with drugs alcohol.
• Easy access to weapons, especially handguns.
• Association with antisocial, deviant peer group.
• Pervasive exposure to violence in the media.