Problems in Adolescence -- OverviewProblems in Adolescence -- Overview

““Storm and Stress” legacyStorm and Stress” legacy In reality, most A’s manage and many are In reality, most A’s manage and many are

resilientresilient when coping with problems when coping with problems Still, Still, teens and twentiesteens and twenties are a time when various are a time when various

probs are probs are more likely more likely to occur to occur (e.g., risky automobile (e.g., risky automobile driving; schizophrenia)driving; schizophrenia)

Are problems “A-limited” – transitory – or “life-Are problems “A-limited” – transitory – or “life-course”? (Origin & onset is important.)course”? (Origin & onset is important.)

Factors involved in problemsFactors involved in problems

Bio-Psycho-Bio-Psycho-Social Social

perspectiveperspective

Biological(e.g. prefrontal

cortex;Puberty)

Psychological(e.g., sensation-

seeking, resiliency, abilityto manage stress)

Socio-cultural(e.g., expectations,

gender roles, Peers, neighborhood)

Two Broad Problem TypesTwo Broad Problem Types

1.1. InternalizingInternalizing Problems – primarily affect a person’s Problems – primarily affect a person’s internal world (cause distress)internal world (cause distress)

More common in femalesMore common in females

2.2. ExternalizingExternalizing Problems – create difficulties in a Problems – create difficulties in a person’s external worldperson’s external world

More common among malesMore common among males Often motivated by Often motivated by thrill-seekingthrill-seeking, not necessarily , not necessarily

underlying unhappiness or psychopathologyunderlying unhappiness or psychopathology

Reality: Not so distinct -- problems are often a combo of internal/external (e.g., substance abuse)

Internalizing ProblemsInternalizing Problems

Examples: Schizophrenia (The Secret Life of the

Brain, PBS DVD

Eating disorders Depression and anxiety

Externalizing ProblemsExternalizing Problems

Examples:Risky driving behaviorDelinquency issuesSubstance abuse

Driver Crash Involvement: Driver Crash Involvement: FatalityFatality

Rates per 100,000: 1997

Sex and age diffs

Risky DrivingRisky Driving

16 – 24 year olds have the 16 – 24 year olds have the highest rates of auto accidents, highest rates of auto accidents,

injuries, & fatalitiesinjuries, & fatalities

Possible Reasons?Possible Reasons?

Driver Inexperience?Risks taken while drivingDriving while impairedNot wearing a seatbeltLack of parental monitoringCultural norms that glorify speeding and racingBelief that friends

approve of risky drivingSensation-seeking

personalityAggressivenessOptimistic Bias

Shope’s Model of Young Driver

Crash Risks (2002)

Delinquency issuesDelinquency issues

(Increasing in severity)(Increasing in severity)• Delinquency – destructive, antisocial, and/or Delinquency – destructive, antisocial, and/or

lawbreaking activitieslawbreaking activities• Oppositional Defiant Disorder Oppositional Defiant Disorder (DSM-IV criteria)(DSM-IV criteria)

• Conduct disorder Conduct disorder (DSM-IV criteria)(DSM-IV criteria)

Two Types of DelinquencyTwo Types of Delinquency

Life-course-persistentLife-course-persistent delinquents delinquents

Pattern of problems from childhoodPattern of problems from childhood

May originate in neuropsychological deficits May originate in neuropsychological deficits (difficult temperament, LD) (difficult temperament, LD) (see next slide)(see next slide)

Likely to grow up in high risk environmentLikely to grow up in high risk environment

Adolescence-delimitedAdolescence-delimited delinquents delinquents

No signs of early problemsNo signs of early problems

Period of occasional criminal activity between Period of occasional criminal activity between ages of 12-25 (e.g., vandalism)ages of 12-25 (e.g., vandalism)

(Moffit, 1993)

– A’s with conduct disorderA’s with conduct disorder

Fail to show normal fearFail to show normal fear

Fail to avoid punishmentFail to avoid punishment

May have under-aroused May have under-aroused CNSCNS

(next slide)(next slide)

– A’s with conduct disorderA’s with conduct disorder

Fail to show normal fearFail to show normal fear

Fail to avoid punishmentFail to avoid punishment

May have under-aroused May have under-aroused CNSCNS

(next slide)(next slide)

Neurobiological influences in Neurobiological influences in conduct problemsconduct problems

Arousal level in boys (as a Arousal level in boys (as a predictor of criminality)predictor of criminality)

Adrenalineexcretion(ng/min)

15

10

5

0 Nonstressfulsituation

Stressfulsituation

Those with laterconvictions have lower

levels of arousal

No criminal convictionCriminal conviction

Prevention and TreatmentPrevention and Treatment

Prevention programs for children who Prevention programs for children who show signs of risk for serious delinquency show signs of risk for serious delinquency (life-course pattern)(life-course pattern)

• Individual and family therapyIndividual and family therapy• Group therapyGroup therapy• Scared StraightScared Straight “Boot Camp” “Boot Camp”• Outdoor Behavioral Healthcare (OBH)Outdoor Behavioral Healthcare (OBH)

Wilderness &/or outdoor adventure therapyWilderness &/or outdoor adventure therapy

Preventing Crime & DelinquencyPreventing Crime & Delinquency

Problems with prevention programs:Problems with prevention programs:

1.1. Participation is typically non-voluntaryParticipation is typically non-voluntary

2.2. Prevention comes too late (in adolescence) Prevention comes too late (in adolescence) after behavior patterns have been establishedafter behavior patterns have been established

3.3. Often have too narrow an approachOften have too narrow an approach

• The Multisytemic Approach has been met with some success

• MST includes parent training, job training, vocational counseling, development of neighborhood activities and centers – directing the energy of delinquents in positive directions.

• See the next slide for data on MST.

Preventing Crime & DelinquencyPreventing Crime & DelinquencyMultisytemic therapy (MST) vs. usual Juvenile Justice Multisytemic therapy (MST) vs. usual Juvenile Justice Services for serious adolescent offendersServices for serious adolescent offenders

Substance UseSubstance Use& Abuse& Abuse

ATOD – Alcohol, Cigarettes, ATOD – Alcohol, Cigarettes, other drugs (e.g., MJ, cocaine, other drugs (e.g., MJ, cocaine, LSD, X)LSD, X)

A & T use common in A & T use common in adolescence and emerging adolescence and emerging adulthoodadulthood

When is use problematic (e.g., When is use problematic (e.g., “addiction,” substance “addiction,” substance abuseabuse)? )? Biopsychosocial approach Biopsychosocial approach (“teen (“teen brain DVD”)brain DVD”)

GatewayGateway theorytheory in Substance abusein Substance abuse

1.1. Drinking beer and wineDrinking beer and wine

2.2. Smoking cigarettes and drinking hard Smoking cigarettes and drinking hard liquorliquor

3.3. Smoking marijuanaSmoking marijuana

4.4. Using “hard” drugsUsing “hard” drugs