Children and Adolescents

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Children and Adolescents

• John Sargent, MD

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• Learning Objectives
• 1) Understand the process and context of the
  development of children
• 2) Learn the process of adolescent development
  through early, middle and late adolescence

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Development in Infancy

• A.) Dependent upon health and capacities
  including motor skills, sensory abilities
• B.) Dependent upon availability of attuned,
  available, caring adults
• C.) Consistency of adult involvement is most
  important

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• Importance of learning to communicate and to
  obtain consistent reinforcement of communicating
  wants and needs

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• Importance of parental affiliation parental
  caring for child as he or she is

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• Early motor development enhances relating
  capacity and mobility rolling over, sitting,
  crawling, walking, climbing, running

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• Motor development both builds autonomy and the
  capacity for exploration but also increases the
  need for social interaction, supervision and
  limit setting

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• Language development begins before age 1 with
  babbling, proceeds to single words, putting words
  together by age 2 and greater vocabulary and
  complexity of syntax through age 5

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• Language development furthers modulation of
  emotions and impulses through prefrontal
  cortical modulation of arousal

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• Language development also furthers
  preoperational, egocentric thinking and capacity
  for solitary and peer play

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• Preschool programs require capacity for
  nurturance, adult availability, physical play,
  routines, rest, use of language

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• Importance of alternatives to language for
  developmentally delayed, deaf and autistic
  children

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• School aged children engage increasingly in group
  experiences (teams, classes and clubs)

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• Through progression to concrete reasoning school
  aged children require consistency, challenge and
  reinforcement and clear support for and standards
  for success

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• Differences in cultural background, size, gender
  and skills become increasingly more important
  leading to in groups and out groups

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• Specific vulnerabilities in preschool children
  include parental loss, parental neglect and
  domestic violence

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• Specific vulnerabilities among school aged
  children include ADHD, learning disabilities and
  conflictual parental relationship

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• Adolescence is the journey between childhood and
  adulthood

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• Physiologic
• Cognitive
• Emotional
• Behavioral
• change occurs, often asynchronously

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Goals of Adolescence

• 1.) Learn skills necessary to be prepared for
  occupational and relationship competency in
  adulthood

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Goals of Adolescence, cont.

• 2.) Gain the capacities for self-direction and
  decision making

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Goals of Adolescence, cont.

• 3.) Have memorable and meaningful experiences
  that represent contributions and lead to belonging

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Goals of Adolescence, cont.

• 4.) Avoid problems that have long-term
  consequences and a life of their own

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Goals of Adolescence, cont.

• 5.) Build the capacity for autonomy upon a
  foundation of connections and a set of personal
  values

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Some challenges which can persist into adulthood
that frequently have inception in adolescence
include

• A.) eating disorders
• B.) substance abuse
• C.) incarceration and persistent unlawful behavior

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Some challenges, cont.

• D.) handicap following injury/accident
• E.) school failure/dropout
• F.) HIV
• G.) teen pregnancy(ies)

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Some challenges, cont.

• Frequently these risk factors occur together and
  have exponential effects

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Family and community factors can exacerbate risk

• A.) Parental substance abuse, psychopathology, or
  criminality
• B.) Conflictual parental relationship or
  post-divorce conflict
• C.) Parental job loss or moving
• D.) Poverty

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Family and community factors, cont.

• E.) Poor schools
• F.) Community violence/school bullying
• G.) Exposure to gangs and antisocial peers

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Family and community factors, cont.

• H.) Lack of access to resources and adult role
  models
• I.) Lack of opportunity to develop and refine
  unique skills
• J.) Inadequate or poor information
• K.) A rejecting or unsupportive community

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Role of cultural and ethnic/racial difference

• A.) Differing views about American culture
• B.) Pressure to maintain culture of origin
• C.) Confusion about being true to ones own
  culture
• D.) Defining a unique cultural adaptation

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Sexual Orientation Issues

• A.) Concerns about being different
• B.) Family responses
• C.) Peer acceptance and support

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Sources of resiliency among adolescents

• A.) Adult/parental support
• B.) Intelligence
• C.) Attractiveness
• D.) Even/easy personality
• E.) A unique talent or ability

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Other sources of resiliency

• A.) Positive framing of contribution and
  circumstances by others
• B.) Experience of competent problem-solving
• C.) Experience of regard and an expectation of
  honesty and integrity

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Course of Development

• A.) Generally successful 60 continuous growth
• B.) Staggered but progressive growth 20
• C.) Challenged development 20 of youth at
  risk for varied poor outcomes

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Characteristics of successful growth

• A.) Decreasing age of onset of puberty (earlier
  for girls)
• B.) Consistent age of brain maturation with
  completion of frontal lobe maturation at age 25

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Characteristics of successful growth, cont.

• C.) Supervision and support synchronous with and
  consistent with fluctuating skills
• D.) Opportunities for negotiation, communication
  and exploration of concerns through language

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Challenges to successful development

• A.) Arbitrary and excessive efforts at external
  control
• B.) Lack of appreciation of adolescent ambivalence

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Challenges to successful development, cont.

• C.) Fluctuation between absent supervision and
  authoritarian control
• D.) Parental helplessness and abandonment

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Community problems that impact youth development

• A.) Lack of after school or extracurricular
  opportunities
• B.) Lack of work opportunities

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Community problems that impact youth development,
cont.

• C.) Negative views about teenagers
• D.) Confusion between recognition of physical
  maturity and awareness of slow psychosocial/emotio
  n regulation development

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Characteristics of Positive Youth Development

• Confidence
• Competence
• Caring
• Connection
• Character

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Youth who do well

• A.) Have a positive connection with their school
• B.) Have positive relationships with youth who
  have a positive relationship with school
• C.) Are engaged positively with adults who care
  about them

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Adolescence can be divided into 3 sections

• A.) Early ages 11-14
• B.) Mid ages 14-16
• C.) Late ages 17-19
• Many aspects of adolescence persist into 20s

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Early Adolescence

• A.) Focus upon physical changes
• B.) Developing interests which may change rapidly
• C.) Need adult supervision
• D.) Need structure and monitored expectations

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Early Adolescence, cont.

• E.) Want greater privacy
• F.) More aware of emotional experience
• G.) Beginning to reflect on self and experience
• H.) Impulse control can be a challenge

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Mid Adolescence

• A.) More time with peers
• B.) Strong desire to belong, activities based on
  belonging
• C.) Beginning partnering

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Mid Adolescence, cont.

• D.) Abstract reasoning, problem solving used more
  frequently
• E.) Wants and utilizes more independence in
  decision making
• F.) Expects competence and expects to make
  contributions to social groups

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Late Adolescence

• A.) Greater self-direction, self-monitoring
• B.) Greater capacity for judgment and impulse
  control

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Late Adolescence, cont.

• C.) More independent decision making
• D.) More involvement in longer term relationships
• E.) Parents/adults more in the role of advisor/
  mentor
• F.) More consistent values and beliefs