1. + Dr Amy Robinson Adolescent Health Specialist Children’s Hospital of Eastern Ontario Assistant Professor, University of Ottawa “Downside… up”

2. + Objectives Outline the normal developmental tasks for an adolescent Discuss how difficulties attaining adolescent developmental milestones can lead to maladaptive coping skills Recognize the impact of teenage pregnancy on adolescent development Outline risk factors for youth homelessness

3. + Disclosure You may only access and use this PowerPoint presentation for educational purposes. You may not post this presentation online or distribute it without the permission of the author.

4. + Adolescence Time of intense change: Physical changes Gain 50% of their adult body weight during this period Puberty – become capable of reproducing Cognitive changes “Pruning” occurring at rate similar to infancy Advance reasoning skills (multiple options, “what if”, logic) Abstract thinking skills (love, faith, trust, beliefs) “Meta-cognition” – think about thinking Emotional & social development “Emotional intelligence” – self-awareness, social awareness, self-management, ability to get along with others and make friends McNeely, Clea. The Teenage Years Explained: A Guide to Healthy Adolescent Development, 2010.

5. + Developmental milestones Identity Autonomy Relationships Vocation

6. + Developmental milestones Identity Autonomy Relationships Vocation “Who am I?” Own individuation, including moral, religious and sexual identities

7. + Developmental milestones Identity Autonomy Relationships Vocation ‘Ability to think and act independently’ Becoming a self-governing person  Physical autonomy  Psychological autonomy

8. + Developmental milestones Identity Autonomy Relationships Vocation Intimacy Friendships & romantic relationships

9. + Developmental milestones Identity Autonomy Relationships Vocation From idealistic to realistic goals School, employment, future planning

10. + Adolescent development “Adolescent behaviours” occur because of difficulties traversing the developmental milestones Some “behaviours” are in fact maladaptive coping skills for the real issue at hand

11. + Clips from Pregnancy Pact Notice: Relationship between the difficulties reaching developmental milestones (i.e. identity, autonomy, relationships, vocation) and teen pregnancy Impact of teen pregnancy on adolescent development

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20. + Pregnancy Pact questions What milestones (i.e. identity, autonomy, relationships, vocation) were some of the teens having difficulty with pre- pregnancy? How do you think teen pregnancy will impact their development?

21. + Developmental milestones Identity Autonomy Relationships Vocation

22. + Teenage pregnancy & adolescent development Identity Autonomy Relationships Vocation

23. + Teenage pregnancy & adolescent development Identity Autonomy Relationships Vocation New identity as ‘mother’, while experimenting with own identities

24. + Teenage pregnancy & adolescent development Identity Autonomy Relationships Vocation Struggling with own emerging independence, while now has own dependent

25. + Teenage pregnancy & adolescent development Identity Autonomy Relationships Vocation Difficult relating to peers; strained relationship with baby’s father

26. + Teenage pregnancy & adolescent development Identity Autonomy Relationships Vocation Higher risk of school drop-out/lower educational attainment, unemployment, reliance on social assistance

27. + Questions? Comments?

28. + Clips from Downside…Up Notice: Relationship between the difficulties reaching developmental milestones (ie. identity, vocation, autonomy) and youth homelessness Identify risk factors for youth homelessness

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37. + Homelessness & adolescent development Identity Autonomy Relationships Vocation

38. + Risk factors for youth homelessness Adversity in childhood Family dysfunction Physical, sexual, emotional abuse Neglect/abandonment Parental drug abuse Social services involvement Foster care Socioeconomic situation Reliance on social assistance Expulsion/school failure Mental health, addiction problems Criminal behaviour and violence Sexual minority youth

39. + Conclusion Adolescence is a period of intense change, with a series of developmental milestones that adolescents need to accomplish ‘Teenage behaviours’ are often maladaptive coping strategies to difficulties accomplishing these milestones Understanding the difficulties themselves, rather than focusing on the resultant high risk behaviours, will allow the provider to be of most benefit to the adolescent patient

40. + Questions? Comments?

41. + Adolescent History H E A D S “HEEADSSS” assessment

42. + Adolescent History Home environment Education & Employment Eating Activities Drugs Sexuality Suicide/Depression Safety “HEEADSSS” assessment