1. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 1 Chapter 13: Problems in Adolescence and Emerging Adulthood Outline EXPLORING ADOLESCENT AND EMERGING ADULT PROBLEMS –The Biopsychosocial Approach –The Developmental Psychopathology Approach –Characteristics of Adolescent and Emerging Adult Problems –Stress and Coping –Resilience

2. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 2 Chapter 13: Problems in Adolescence and Emerging Adulthood Outline PROBLEMS AND DISORDERS –Drug Use –Juvenile Delinquency –Depression and Suicide –Eating Disorders

3. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 3 Chapter 13: Problems in Adolescence and Emerging Adulthood Outline INTERRELATION OF PROBLEMS AND PREVENTION/INTERVENTION –Adolescents with Multiple Problems –Prevention and Intervention

4. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 4 Exploring Adolescent and Emerging Adult Problems The biopsychosocial approach –Emphasizes that biological, psychological, and social factors interact to produce the problems that adolescents, emerging adults, and people of other ages develop.

5. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 5 Exploring Adolescent and Emerging Adult Problems Biological Factors: –Adolescent and emerging adult problems are believed to be caused by a malfunctioning of the body. –Focus on the brain and genetic factors as causes of adolescent and emerging adult problems. –Drug therapy is frequently used to treat problems.

6. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 6 Exploring Adolescent and Emerging Adult Problems Psychological Factors: –Distorted thoughts –Emotional turmoil –Inappropriate learning –Troubled relationships –Family and peer influences

7. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 7 Exploring Adolescent and Emerging Adult Problems Social Factors: –Socioeconomic status (SES) –Neighborhood quality (Leventhal, Dupere, & Brooks, 2009; McLoyd & others, 2009).

8. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 8 Exploring Adolescent and Emerging Adult Problems The Developmental Psychopathology Approach –Focuses on describing and exploring the developmental pathways of problems. –Adolescent and emerging adult problems can be categorized as internalizing or externalizing. Internalizing problems Externalizing problems

9. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 9 Exploring Adolescent and Emerging Adult Problems The Developmental Psychopathology Approach (Continued) –Internalizing problems Occur when individuals turn their problems inward. –Examples: anxiety and depression. –Externalizing problems Occur when problems are turned outward. –An example: juvenile delinquency.

10. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 10 Exploring Adolescent and Emerging Adult Problems Characteristics of Adolescent and Emerging Adult Problems –The spectrum is wide. –The problems vary in their severity and in how common they are for females and males, and for different socioeconomic groups. –Some problems are short-lived; others can persist over many years. –Some problems are more likely to appear at one developmental level than at another. –SES background differences. –Internal versus external assets.

11. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 11 Exploring Adolescent and Emerging Adult Problems The Two Items Most Likely to Differentiate Clinically Referred and Nonreferred Children and Adolescents Fig. 13.1

12. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 12 Exploring Adolescent and Emerging Adult Problems Stress and Coping –Stress is the response of individuals to stressors, which are circumstances and events that threaten them and tax their coping abilities. –Some stressors are acute. –Some stressors are chronic. –Stress may come from many different sources (Compas & Reeslund, 2009; Greenberg, 2009; Mash & Wolfe, 2009).

13. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 13 Exploring Adolescent and Emerging Adult Problems Life events, daily hassles –Individuals who have had major life changes (loss of a close relative, the divorce of parents) have a higher incidence of cardiovascular disease and early death than those who do not (Taylor, 2009). –Researchers have found that, when several stressors are simultaneously experienced, the effects may be compounded (Rutter & Garmezy, 1983). –The most frequent daily hassles of college students were wasting time, being lonely, and worrying about meeting high achievement standards (Kanner & others, 1981).

14. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 14 Exploring Adolescent and Emerging Adult Problems Socio-cultural Factors –Help to determine: Which stressors individuals are likely to encounter. Whether they are likely to perceive events as stressful or not. How they believe stressors should be confronted. (Matsumoto & Juang, 2008). Acculturative stress –Refers to the negative consequences that result from contact between two distinctive cultural groups.

15. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 15 Exploring Adolescent and Emerging Adult Problems Acculturative stress (Continued) –Many individuals who have immigrated to the United States have experienced acculturative stress (Liu & others, 2009; Wong & others, 2009). –Poverty can cause considerable stress for individuals and families (Healey, 2009; Leon-Guerrero, 2009). –Adolescents are more likely to experience threatening and uncontrollable life events if they live in low-income contexts than if they live in more economically robust contexts (Conger & Conger, 2008).

16. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 16 Exploring Adolescent and Emerging Adult Problems Coping –Coping involves managing taxing circumstances, expending effort to solve life’s problems, and seeking to master or reduce stress. –Success in coping has been linked with several characteristics: A sense of personal control Positive emotions Personal resources The strategies used The context

17. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 17 Exploring Adolescent and Emerging Adult Problems Problem-focused coping –The strategy of squarely facing one’s troubles and trying to solve them. –Problem-focused coping was associated with positive change following trauma and adversity (Linley & Joseph, 2004). Emotion-focused coping –Responding to stress in an emotional manner, especially by using defensive mechanisms. –Coping includes avoiding a problem, rationalizing what has happened, denying it is occurring, laughing it off, or calling on our religious faith for support.

18. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 18 Exploring Adolescent and Emerging Adult Problems Thinking Positively –Thinking positively and avoiding negative thoughts is a good strategy when trying to handle stress in just about any circumstance (Greenberg, 2009). –A positive mood improves our ability to process information efficiently and enhances self-esteem. –An optimistic attitude is superior to a pessimistic one. It gives us a sense that we are controlling our environment.

19. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 19 Exploring Adolescent and Emerging Adult Problems Support –An important aspect of being able to cope with stress (Mash & Wolfe, 2009; Taylor, 2009). –Close, positive attachments to others consistently act as buffers to stress. Contexts and Coping –Coping is not a stand-alone process. –Coping is influenced by the demands and resources of the environment. –Coping flexibility Modify coping strategies to match the demands of the situation.

20. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 20 Exploring Adolescent and Emerging Adult Problems Resilience –Masten (2001, 2006, 2007) analyzed the research literature on resilience and concluded that a number of factors were involved: Individual factors (such as good intellectual functioning) Family factors (close relationship to a caring parent figure) Extrafamilial factors (bonds to prosocial adults outside the family)

21. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 21 Exploring Adolescent and Emerging Adult Problems Characteristics of Resilient Children and Adolescents Fig. 13.2

22. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 22 Problems and Disorders Trends in Overall Drug Use –The 1960s and 1970s were a time of marked increases in the use of illicit drugs. –Many youth turned to marijuana, stimulants, and hallucinogens. –Increases in adolescent and emerging adult alcohol consumption during this period were also noted (Robinson & Greene, 1988). –In the late 1990s and early part of the 21 st century, the proportion of secondary school students reporting the use of any illicit drug has been declining.

23. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 23 Problems and Disorders Trends in Overall Drug Use (Continued) –Marijuana is the illicit drug most widely used in the United States and Europe (Hibell & others, 2004; Johnston & others, 2009). –The recent downturn in drug use by U.S. adolescents has been attributed to an increase in the perceived dangers of drug use on youth (Johnston & others, 2007). –In the United States, drug use increases in emerging adulthood (Park & others, 2006).

24. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 24 Problems and Disorders Trends in Drug Use by U.S. 8 th -, 10 th -, and 12 th -Grade Students Fig. 13.3

25. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 25 Problems and Disorders Alcohol –An extremely potent drug. –Acts on the body as a depressant and slows down the brain’s activities. –If used in sufficient quantities, it will damage or even kill biological tissues, including muscle and brain cells.

26. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 26 Problems and Disorders Alcohol (Continued) –The mental and behavioral effects of alcohol include reduced inhibition and impaired judgment. Initially, adolescents feel more talkative and more confident when they use alcohol. –Most widely used by U.S. adolescents and emerging adults. –The third-leading killer in the United States. –A special concern is the increase in binge drinking by females during emerging adulthood (Young & others, 2005).

27. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 27 Problems and Disorders Risk Factors in Alcohol Abuse: –Heredity. –Family influences. –Peer relations. –Certain personality and motivational characteristics ( Pinger & others, 2009). –Genetic predisposition (Hart, Ksir, & Ray, 2009).

28. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 28 Problems and Disorders Hallucinogens –Also called psychedelic (mind-altering) drugs. –Modify an individual’s perceptual experiences and produce hallucinations. –LSD (lysergic acid diethylamide). –Marijuana, comes from the hemp plant Cannabis sativa. –Stimulants are drugs that increase the activity of the central nervous system.

29. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 29 Problems and Disorders Trends in Annual Prevalence of Marijuana Use by U.S. 8 th -, 10 th -, and 12 th -Graders Fig. 13.4

30. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 30 Problems and Disorders Cigarette Smoking –The active drug is nicotine is one of the most serious yet preventable health problems (Mathers & others, 2006). –Approximately 20 percent of adolescents in more than 130 countries use a tobacco product (Centers for Disease Control and Prevention, 2006). –The peer group especially plays an important role in smoking (Picotte & others, 2006).

31. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 31 Problems and Disorders Trends in Cigarette Smoking by U.S. Secondary School Students Fig. 13.5

32. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 32 Problems and Disorders Cigarette Smoking (Continued) –Engaging in risk-taking behavior is also linked to cigarette smoking in adolescence. –Smoking in the adolescent years causes permanent genetic changes in the lungs and forever increases the risk of lung cancer, even if the smoker quits (Weineke & others, 1999).

33. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 33 Problems and Disorders Cocaine –A stimulant that comes from the coca plant, native to Bolivia and Peru. –Either heated and the fumes inhaled or it is injected in the form of crystals or powder. –The effect is a rush of euphoric feelings, which eventually wear off, followed by depressive feelings, lethargy, insomnia, and irritability. –Can have a number of seriously damaging effects on the body, including heart attacks, strokes, and brain seizures.

34. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 34 Problems and Disorders Amphetamines –Often called “pep pills” and “uppers.” –Are widely prescribed stimulants, sometimes appearing in the form of diet pills. –Use among high school seniors has decreased significantly. –Although use of over-the-counter diet pills has decreased in recent years, 40 percent of today’s females have tried using diet pills by the time they graduate from high school.

35. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 35 Problems and Disorders Ecstasy –The street name for the synthetic drug MDMA. –Has stimulant and hallucinogenic effects. –Similar to methamphetamines. –Usually comes in a pill form. –Tolerance builds up rapidly. –Produces euphoric feelings and heightened sensations (especially touch and sight). –Users often become hyperactive and sleepless. –Can lead to dangerous increases in blood pressure, as well as stroke or a heart attack.

36. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 36 Problems and Disorders Depressants –Drugs that slow down the central nervous system, bodily functions, and behavior. –Medically, depressants have been used to reduce anxiety and to induce sleep. Alcohol Barbiturates Tranquilizers

37. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 37 Problems and Disorders Psychoactive Drugs: Depressants, Stimulants, and Hallucinogens Fig. 13.6

38. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 38 Problems and Disorders Anabolic Steroids –Drugs derived from the male sex hormone, testosterone. –Promote muscle growth and increase lean body mass. –Abused by some athletes and others who hope to improve their sports performance and physical attractiveness. –Nonmedical uses of these drugs carry a number of physical and psychological health risks (National Clearinghouse for Alcohol and Drug Information, 1999).

39. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 39 Problems and Disorders Anabolic Steroids (Continued) –Users who take large doses of anabolic steroids usually experience changes in sexual characteristics. –In males: a shrinking of the testicles, reduced sperm count, impotence, premature baldness, enlargement of the prostate gland, breast enlargement, and difficulty or pain in urinating. –In females: can trigger severe acne on the face and body, a weakening of tendons (which can result in rupturing or tearing), reduction in HDL (the “good” cholesterol), and high blood pressure.

40. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 40 Problems and Disorders Inhalants –Ordinary household products that are inhaled or sniffed by children and adolescents to get high. Examples include: –Model airplane glue –Nail polish remover –Cleaning fluid –Short-term use can cause intoxicating effects. –Long-term use can lead to heart failure and even death. –Use of inhalants is higher among younger than older adolescents.

41. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 41 Problems and Disorders Factors in Adolescent and Emerging Adult Drug Abuse –Being born into a high-risk family (especially a poor, single, or teenage mother). –An increase in harsh parenting in childhood. –Child has conduct problems in school and gets rejected by peers. –Increased conflict with parents in early adolescence. –Low parental monitoring by parents. –Young adolescent hangs out with deviant peers and increases substance use.

42. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 42 Problems and Disorders Binge Drinking in the Transition from Adolescence to Adulthood Fig. 13.7

43. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 43 Problems and Disorders Juvenile Delinquency –Refers to a broad range of behaviors, from socially unacceptable behavior (such as acting out in school) to status offenses (such as running away) to criminal acts (such as burglary).

44. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 44 Problems and Disorders Juvenile Delinquency (Continued) –For legal purposes, a distinction is made between index offenses and status offenses: Index offenses are criminal acts, whether they are committed by juveniles or adults. –They include such acts as robbery, aggravated assault, rape, and homicide. Status offenses, such as running away, truancy, underage drinking, sexual promiscuity, and uncontrollability, are less serious acts. –They are performed by youth under a specified age, which classifies them as juvenile offenses.

45. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 45 Problems and Disorders Juvenile Delinquency (Continued) –Conduct disorder is the psychiatric diagnostic category used when multiple behaviors occur over a six-month period. –These behaviors include truancy, running away, fire setting, cruelty to animals, breaking and entering, excessive fighting, and others. –If these behaviors result in illegal acts by juveniles, society labels them as delinquents.

46. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 46 Problems and Disorders Number of U.S. Juvenile Court Delinquency Caseloads from 1960 to 2005 Fig. 13.8

47. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 47 Antecedents of Juvenile Delinquency (Continued on next slide) Fig. 13.9

48. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 48 Antecedents of Juvenile Delinquency (Continued from previous slide)

49. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 49 Problems and Disorders Effective Prevention and Intervention Programs –The most successful programs are those that prevent juvenile delinquency from occurring in the first place. Examples include: –Home-visiting programs that provide services to pregnant adolescents and their at-risk infants. –Quality preschool education that involves home visits and working with parents. –Improving family interactions and providing skills to adults who supervise and train the adolescent. The least effective programs for reducing juvenile delinquency are those that emphasize punishment or attempt to scare youth.

50. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 50 Problems and Disorders Violence and Youth –An increasing concern is the high rate of adolescent violence (Specter, 2008). Gangs –It is estimated that there are more than 750,000 gang members in more than 24,000 gangs in the United States (Egley, 2002). –Most gang members are 12 to 26 years of age. –Average age of 17 to 18 years of age. –More likely to be male than female.

51. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 51 Problems and Disorders Gangs (Continued) –Often composed of adolescents from low-income and ethnic minority backgrounds. –It is estimated that approximately one-fourth of U.S. gang members are made up of non-Latino whites. –Often engage in violent and criminal activities. –Criminal activities are used as an indication of gang identity and loyalty.

52. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 52 Problems and Disorders Gangs (Continued) –Risk factors that increase the likelihood an adolescent will become a gang member are: Disorganized neighborhoods characterized by economic hardship. Having other family members involved in a gang. Drug use. Lack of family support. Peer pressure from gang members to join their gang (Lauber, Marshall, & Meyers, 2005).

53. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 53 Problems and Disorders School Violence and Shootings –An issue of national concern in the United States. –A 2005 national survey revealed a decline in violence-related behaviors in schools. From 1991 to 2005 physical fighting declined from 16 percent to 13.6 percent. Weapon carrying in schools declined from 12 percent of students to 6.5 percent. –The violent youth are overwhelmingly male and many are driven by feelings of powerlessness.

54. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 54 Problems and Disorders School Violence and Shootings (Continued) –Violence seems to infuse these youth with a sense of power (Fritzon & Brun, 2005). –Youth violence is far greater in poverty-infested areas of inner cities. –Factors often present in at-risk youths: Disorganized neighborhoods characterized by economic hardship. Family members who are involved in a gang. Drug use. Lack of family support. Peer pressure from gang members to join their gang. (Lauber, Marshall, & Meyers, 2005).

55. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 55 Problems and Disorders Depression and Suicide –The most frequent characteristics of adolescents referred for psychological treatment is sadness or depression, especially among girls. Depression –Major depressive disorder An individual experiences lethargy and hopelessness, for at least two weeks or longer and daily functioning becomes impaired.

56. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 56 Problems and Disorders According to the DSM-IV classification of mental disorders (American Psychiatric Association, 1994), nine symptoms define a major depressive episode.

57. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 57 Problems and Disorders To be classified as having major depressive disorder, at least five of these must be present during a two- week period: 1. Depressed mood most of the day. 2. Reduced interest or pleasure in all or most activities. 3. Significant weight loss or gain, or significant decrease or increase in appetite. 4. Trouble sleeping or sleeping too much. 5. Psychomotor agitation or retardation. 6. Fatigue or loss of energy. 7. Feeling worthless or guilty in an excessive or inappropriate manner. 8. Problems in thinking, concentrating, or making decisions. 9. Recurrent thoughts of death and suicide.

58. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 58 Problems and Disorders In adolescence, pervasive depressive symptoms might be manifested in such ways as: –Tending to dress in black clothes. –Writing poetry with morbid themes. –A preoccupation with music that has depressive themes. –Sleep problems can appear as all-night television watching. –Difficulty in getting up for school. –Sleeping during the day. –Withdrawal from friends. –Adolescent depression also can occur in conjunction with conduct disorder, substance abuse, or an eating disorder.

59. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 59 Problems and Disorders How serious a problem is depression in adolescence? –One-third of adolescents who go to a mental health clinic suffer from depression (Fleming, Boyle, & Offord, 1993). –Depression is more common in the adolescent years than the elementary school years. –By about age 15, adolescent females have a rate of depression that is twice that of adolescent males.

60. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 60 Problems and Disorders How serious a problem is depression in adolescence? (Continued) –Some of the reasons for the sex difference that have been proposed: Females tend to ruminate in their depressed mood and amplify it. Females’ self-images, especially their body images, are more negative than males’. Females face more discrimination than males do. Hormonal changes alter vulnerability to depression in adolescence, especially among girls.

61. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 61 Problems and Disorders How serious a problem is depression in adolescence? (Continued) –Mental health professionals note that depression often goes undiagnosed in adolescence. –Family factors are involved in adolescent depression (Graber & Sontag, 2009). –Poor peer relationships also are associated with adolescent depression (Starr & Davila, 2008). What type of treatment is most likely to reduce depression in adolescence? –Adolescents recovered faster when they took an antidepressant and received cognitive behavior therapy that involved improving their coping skills (Tads, 2007).

62. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 62 Problems and Disorders Suicide –Depression is linked to an increase in suicidal ideation and suicide attempts in adolescence (Werth, 2004). –Suicide behavior is rare in childhood but escalates in adolescence and then increases further in emerging adulthood (Park & others, 2006).

63. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 63 Problems and Disorders Suicide (Continued) –Suicide is the third-leading cause of death in 10- to 19-year-olds today in the United States (National Center for Health Statistics, 2007). –A suicide threat should always be taken seriously. –Far more adolescents contemplate or attempt it unsuccessfully than actually commit it (Miranda & others, 2008).

64. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 64 Problems and Disorders Percentage of U.S. 9th to 12th-Grade Students Who Seriously Considered Attempting Suicide in the Previous 12 Months from 1991 to 2005 Fig. 13.10

65. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 65 Problems and Disorders Suicide (Continued) –Females were more likely to attempt suicide than males, but males were more likely to succeed in committing suicide. –Males use more lethal means, such as guns, in their suicide attempts, whereas adolescent females are more likely to cut their wrists or take an overdose of sleeping pills—methods less likely to result in death.

66. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 66 Problems and Disorders Suicide Attempts by U.S. Adolescents from Different Ethnic Groups Fig. 13.11

67. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 67 Problems and Disorders Suicide (Continued) –Both early and later experiences may be involved in suicide attempts. –The adolescent might have: A long-standing history of family instability and unhappiness. Lack of affection and emotional support. High control. Pressure for achievement by parents during childhood are likely to show up as factors in suicide attempts.

68. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 68 Problems and Disorders Suicide (Continued) –Genetic factors are also associated with suicide. –In some instances, suicides in adolescence occur in clusters. “Copycat” suicide

69. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 69 Problems and Disorders What is the psychological profile of the suicidal adolescent? –Depressive symptoms. –Overly self-critical. –A sense of hopelessness. –Low self-esteem. –High self-blame. –A perception of being a burden on others. –Thwarted belongingness.

70. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 70 Problems and Disorders What to Do and What Not to Do When You Suspect Someone Is Likely to Attempt Suicide Fig. 13.12

71. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 71 Problems and Disorders Eating Disorders –Eating disorders have become increasingly common problems in adolescence (Schiff, 2009; Wardlaw & Smith, 2009). What research reveals about adolescent eating disorders: Body Image Adolescence were dissatisfied with their bodies, with males desiring to increase their upper body and females wanting to decrease the overall size of their body (Ata, Luden, & Layyy, 2007).

72. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 72 Problems and Disorders What research reveals about adolescent eating disorders (Continued) : Body Image (Continued) Girls who felt negatively about their bodies in early adolescence were more likely to develop eating disorders two years later than their counterparts who did not feel negatively about their bodies (Attie & Brooks- Gunn, 1989). Adolescent girls with an eating disorder rated their physical appearance lower and the importance of physical appearance higher than their adolescent female counterparts who did not have an eating disorder (Kirsch & others, 2007).

73. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 73 Problems and Disorders What research reveals about adolescent eating disorders (Continued) : Parenting Adolescents who reported observing more healthy eating patterns and exercise by their parents had more healthy eating patterns and exercised more themselves (Pakpreo & others, 2005). Negative parent-adolescent relationships were linked with increased dieting by girls over a one-year period (Archibald, Graber, & Brooks-Gunn, 1999).

74. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 74 Problems and Disorders What research reveals about adolescent eating disorders (Continued) : Sexual activity Girls who were both sexually active with their boyfriends and in pubertal transition were the most likely to be dieting or engaging in disordered eating patterns (Cauffman, 1994).

75. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 75 Problems and Disorders What research reveals about adolescent eating disorders (Continued) : Role models and the media Girls who were highly motivated to look like same-sex figures in the media were more likely than their peers to become very concerned with their weight (Field & others, 2001). Watching commercials with idealized thin females images increased adolescent girls’ dissatisfaction with their bodies (Hargreaves & Tiggemann, 2004).

76. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 76 Problems and Disorders Overweight Adolescents –The Centers for Disease Control and Prevention (2009) has a category of obesity for adults but not an obesity category for children and adolescents because of the stigma the label obesity may bring. –Rather, the Centers for Disease Control and Prevention (2009) does have categories for being overweight or at risk for being overweight in childhood and adolescence. –These categories are determined by body mass index (BMI). –Only children and adolescents at or above the 95th percentile of BMI are included in the overweight category. –Children and adolescents at or above the 85th percentile of BMI are included in the at-risk category.

77. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 77 Problems and Disorders Overweight Adolescents –The percentage of overweight adolescents has been increasing. –Being overweight as a child is a strong predictor for being overweight as an adolescent. –An increase in being overweight has also occurred in emerging adulthood (Park & others, 2006).

78. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 78 Problems and Disorders Overweight Adolescents –U.S. children and adolescents are more likely to be overweight or obese than their counterparts in most other countries. –A survey by the National Center for Health Statistics (2002) found that African American girls and Latino boys have especially high risks of being overweight during adolescence.

79. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 79 Problems and Disorders Percentage of Overweight U.S. Adolescent Boys and Girls in Different Ethnic Groups Fig. 13.13

80. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 80 Problems and Disorders Overweight Adolescents –Eating patterns established in childhood and adolescence are highly associated with obesity in adulthood. –80 percent of obese adolescents become obese adults. –Both heredity and environmental factors are involved in obesity (Hahn, Payne, & Lucas, 2009).

81. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 81 Problems and Disorders Overweight Adolescents –The dramatic increase in obesity is likely due to greater availability of food (especially food high in fat), energy-saving devices, and declining physical activity. –Being overweight or obese has negative effects on adolescent health, in terms of both biological development and socio-emotional development (Schiff, 2009).

82. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 82 Problems and Disorders What types of interventions have been successful in reducing overweight in adolescents? –A combination of caloric restriction. –Exercise. –Reduction of sedentary activity. –Behavioral therapy. –School-based approaches have been less effective than the clinically based individual approaches (Lytle & others, 2004).

83. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 83 Problems and Disorders Anorexia Nervosa –Anorexia nervosa is an eating disorder that involves the relentless pursuit of thinness through starvation. –Anorexia nervosa is a serious disorder that can lead to death.

84. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 84 Problems and Disorders Anorexia Nervosa (Continued) –Three main characteristics of anorexia nervosa are: Weighing less than 85 percent of what is considered normal for age and height. Having an intense fear of gaining weight. The fear does not decrease with weight loss. Having a distorted image of body shape (Stice, 2002). Even when they are extremely thin, anorexics see themselves as too fat. They never think they are thin enough, especially in the abdomen, buttocks, and thighs. They usually weigh themselves frequently, often take their body measurements, and gaze critically at themselves in mirrors (Seidenfeld, Sosin, & Rickert, 2004).

85. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 85 Problems and Disorders Anorexia Nervosa (Continued) –Begins in the early to middle teenage years. –10 times more likely to characterize females than males. –Most anorexics are non-Latino white adolescents from well-educated, middle- and upper-income families that are competitive and high-achieving. –“Thin is beautiful” contributes to the incidence of anorexia nervosa.

86. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 86 Problems and Disorders Bulimia Nervosa –An eating disorder in which the individual consistently follows a binge-and-purge eating pattern. –To have a serious bulimic disorder the episodes must occur at least twice a week for three months. –Most bulimics are preoccupied with food, have a strong fear of becoming overweight, and are depressed or anxious (Speranza & others, 2005).

87. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 87 Problems and Disorders Bulimia Nervosa (Continued) –Unlike anorexics, people who binge and purge typically fall within a normal weight range, which makes bulimia more difficult to detect. –Typically begins in late adolescence or early adulthood. –About 90 percent of the cases are women. –About 70 percent of individuals who develop bulimia nervosa eventually recover from the disorder (Agras & others, 2004).

88. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 88 Interrelation of Problems and Prevention/Intervention Adolescents with Multiple Problems –The four problems that affect most adolescents are: (1) Drug abuse (2) Juvenile delinquency (3) Sexual problems (4) School-related problems (Dryfoos, 1990; Dryfoos & Barkin, 2006). –The adolescents most at risk have more than one of the problems listed above.

89. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 89 Interrelation of Problems and Prevention/Intervention Prevention and Intervention –Programs that have been successful in preventing or reducing adolescent problems: Intensive individualized attention Community-wide, multi-agency collaborative approaches Early identification and intervention –High Scope –Fast Track –National Longitudinal Study on Adolescent Health

90. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 90 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS Adolescence by Joy Dryfoos and Carol Barkin. (2006). New York: Oxford University Press. An outstanding book on adolescent problems and the programs and strategies that can successfully prevent and intervene in these problems.

91. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 91 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS Developmental Psychopathology edited by Dante Cicchetti and Donald Cohen. (2006). New York: Wiley. This up-to-date three-volume set provides extensive information about many aspects of developmental psychopathology.

92. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 92 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS The Future of Children, Vol. 18, No. 2 (2008) Up-to-date coverage of many aspects of juvenile delinquency, including effective prevention and intervention programs.

93. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 93 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS National Adolescent Suicide Hotline 800–621–4000 This hotline can be used 24 hours a day by teenagers contemplating suicide, as well as by their parents.

94. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 94 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS National Clearinghouse for Alcohol Information www.health.org This clearinghouse provides information about a wide variety of issues related to drinking problems, including adolescent drinking.

95. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 95 RESOURCES FOR IMPROVING THE LIVES OF ADOLESCENTS Reducing Adolescent Risk edited by Daniel Romer. (2003). Thousand Oaks, CA: Sage. A number of experts analyze ways to reduce adolescent risk in a number of problem areas.

96. Copyright © 2010 The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill 96 E-LEARNING TOOLS To help you master the material in this chapter, visit the Online Learning Center for Adolescence, 13th edition at: http://www.mhhe.com/santrocka13e