Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST...
Transcript of Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST...
![Page 1: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/1.jpg)
J O S E P H I N E S . L A U , M D , M P HA D O L E S C E N T M E D I C I N E S P E C I A L I S TK A I S E R P E R M A N E N T E S A N L E A N D R OM E D I C A L C E N T E R
ADOLESCENT DEVELOPMENT
2017 Quality Parenting Initiative California Statewide Conference
![Page 2: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/2.jpg)
CASE
• 14 year-old male brought in by mother for routine physical
• In juvenile detention for 2 months last year• Failing school “all the teachers don’t care” “they
don’t want to help” “some just faking to be nice to get money”
• Constantly arguing with mom during the visit• Confidential portion:
• Just started having sex with a female partner—no condoms• Taking cough syrup once a week to feel good
![Page 3: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/3.jpg)
GROWTH AND DEVELOPMENT
• Physical• Cognitive• Emotional• Social/Moral• Summary & Key Points
![Page 4: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/4.jpg)
ENDPOINTS OF POSITIVE YOUTH DEVELOPMENT
ompetence in academic, social andvocational areas
onfidence or a positive self-identityonnections to family, peers, school
communityharacter or positive values,
integrity & moral commitment aring and compassion
![Page 5: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/5.jpg)
TYPICAL ADOLESCENT DEVELOPMENT
• Each teenager is an individual • Every teen faces a series of developmental
tasks• All adolescents display wide variability in
biological & emotional growth• Adolescence is not a continuous uniform
process - rather, it’s a constant process of change with progress and falling back
![Page 6: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/6.jpg)
STAGES OF ADOLESCENT DEVELOPMENT
• Early AdolescenceFemales: 9 - 13 yearsMales: 11 – 15
• Middle AdolescenceFemales: 13 - 16Males: 14 – 17
• Late AdolescenceFemales: 16 – 21+Males: 17 – 21+
![Page 7: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/7.jpg)
EARLY ADOLESCENCE
![Page 8: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/8.jpg)
EARLY ADOLESCENCE:PHYSICAL DEVELOPMENT
• Peak of pubertal changes in girls• Onset of pubertal changes in boys• Disruption of former body image
![Page 9: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/9.jpg)
EARLY ADOLESCENCE:COGNITIVE DEVELOPMENT
• Highly active period of brain development
• Transitional thinking: Biological basis• Concrete thinking transitioning
to abstract thinking
![Page 10: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/10.jpg)
BRAIN DEVELOPMENT 5-20
![Page 11: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/11.jpg)
PREFRONTAL LOBE
• “CEO of brain”: reasoning ability, goal setting/priorities
• Planning and decision-making, impulse control• last part of brain to myelinate
![Page 12: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/12.jpg)
CHARACTERISTICS OF CONCRETE THINKING
• Present orientation• Seeing is believing/my (my friend’s)
experience is what counts• Ability to project into future limited• Cannot perceive long-range implications of
current decisions
![Page 13: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/13.jpg)
CHARACTERISTICS OF ABSTRACT THINKING
• Ability to:• Envision alternatives• Evaluate alternatives• Engage in perspective taking• Reason about chance and probability• PRIORITIZE!
![Page 14: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/14.jpg)
EARLY ADOLESCENCE:EMOTIONAL DEVELOPMENT
• Wide mood swings common• Intense daydreaming• Preoccupation with “normalcy”-
particularly as relates to physical development/compares to peers
![Page 15: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/15.jpg)
EARLY ADOLESCENCE:SOCIAL DEVELOPMENT
• Increased interest in peers: seeks peer affiliation to counter instability
• Close idealized friendships with same-sex peers
• Strong desire to remain dependent on parents while simultaneously trying to detach
• Increase in“mild conflict” (bickering and squabbling) with parents
![Page 16: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/16.jpg)
EARLY ADOLESCENCE:MORAL DEVELOPMENT
• Conventional morality • oriented toward approval/pleasing
others• doing one’s duty and respecting
authority
![Page 17: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/17.jpg)
MIDDLE ADOLESCENCE
![Page 18: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/18.jpg)
MIDDLE ADOLESCENCEPHYSICAL DEVELOPMENT
• Deceleration of growth• Pubertal development almost completed• Preoccupation with appearance and
health issues which affect appearance• “Am I attractive?”
![Page 19: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/19.jpg)
MIDDLE ADOLESCENCECOGNITIVE DEVELOPMENT
• Need assistance applying general concepts to own context/behavior
• Increased abstract thinking ability, but difficulty applying information to decision-making
• More realistic about future plans/ personal goals
![Page 20: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/20.jpg)
MIDDLE ADOLESCENCEEMOTIONAL DEVELOPMENT
• Experimentation as a process to develop self-conceptions (pre-identity work)• Risk taking
• Development of ideals & selection of role models
• Significant mental health issues emerge (depression)
![Page 21: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/21.jpg)
MIDDLE ADOLESCENCESOCIAL DEVELOPMENT
• Greater independence and rejection of parental authority
• Strong desire for parental input and involvement, but in a less directive manner
• Emergence of peers (gender mixed) as primary affiliation
• Experimentation with relationships & sexual behaviors
![Page 22: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/22.jpg)
MIDDLE ADOLESCENCEMORAL DEVELOPMENT
• Principled morality• social contract/majority will and welfare• highly sensitive to “fairness”
![Page 23: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/23.jpg)
LATE ADOLESCENCE
![Page 24: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/24.jpg)
LATE ADOLESCENCEPHYSICAL DEVELOPMENT
• Pubertal process is complete/physically mature
• Acceptance of appearance vs. “extreme” behaviors to alter appearance
![Page 25: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/25.jpg)
LATE ADOLESCENCECOGNITIVE DEVELOPMENT
• Approaching cognitive maturity with established abstract thought and reasoning
• Future orientation with ability to act on long-range options
• Sense of perspective, abilities to delay, compromise and set limits
![Page 26: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/26.jpg)
BRAIN DEVELOPMENT DOESN’T END AT 18 (OR EVEN 21) !
• The part of the prefrontal lobe linked to the ability to inhibit impulses, weigh consequences, prioritize and strategize does not reach full development until the mid-to-late 20’s
![Page 27: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/27.jpg)
LATE ADOLESCENCEEMOTIONAL DEVELOPMENT
• Identity consolidation• More constancy of emotions• Sexual orientation solidifies
![Page 28: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/28.jpg)
LATE ADOLESCENCESOCIAL DEVELOPMENT
• Emancipation completed or progressing with separation from family
• Stable dyadic relationships take precedence over group
• Beginning shift from parent-child to adult-adult model in family relationships
![Page 29: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/29.jpg)
LATE ADOLESCENCEMORAL DEVELOPMENT
• Post-conventional morality• concept of conditionality/extenuating
circumstances• balancing of standards of society and
rights of the individual
![Page 30: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/30.jpg)
ENDPOINTS OF POSITIVE YOUTH DEVELOPMENT
ompetence in academic, social andvocational areas
onfidence or a positive self-identityonnections to family, peers, school
communityharacter or positive values,
integrity & moral commitment aring and compassion
![Page 31: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/31.jpg)
SUMMARY
• Biological basis to their behaviors• Maturation of the brain• Reaction to environment while attaining
developmental tasks
![Page 32: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/32.jpg)
KEY POINTS WORKING WITH ADOLESCENTS
• Building resilience helps• Self-respect• Social skills• Optimistic thinking• Self-confident and capable to get things
done
![Page 33: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/33.jpg)
KEY POINTS WORKING WITH ADOLESCENTS
• Every interaction contributes to their development
• No matter how brief each interaction is…• Be a good role model• Stay calm• Let them know that you care and you are
here to help
![Page 34: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/34.jpg)
CASE
• Social history• Mandated to live with paternal grandparents
• Family history• multiple family members have addiction problems,
including bio mom and dad
• Mental health• diagnosed with ODD and ADHD, currently receiving wrap
around services. Feels connected with therapist
![Page 35: Adolescent Development - QPI CaliforniaJOSEPHINE S. LAU, MD, MPH ADOLESCENT MEDICINE SPECIALIST KAISER PERMANENTE SAN LEANDRO MEDICAL CENTER ADOLESCENT DEVELOPMENT 2017 Quality Parenting](https://reader033.fdocuments.us/reader033/viewer/2022043001/5f79a2d7826564081c6aa02a/html5/thumbnails/35.jpg)
CASE
• Drug use counseling• Makes him feel good, but illegal to obtain• Gave feedback that he’s at higher risk of developing
addiction problem due to his family history• Asked him to try to quit cough syrup
• Safe sex counseling• “doesn’t want to be a father” “has no idea what he would
do”• Couldn’t afford condoms• Would return for more condoms and may bring his girlfriend
for contraception