Adolescent development
Aditya Roy
DS502WeekThreeSlidesAdolescentsWhoStruggle.pptxWeek Three: Adolescents Who Struggle
Anxiety Disorders
Mood Disorders
Substance Use
Anxiety and Teens
Primary reason for mental health referrals but only 20% receive treatment
Lifelong struggle for many
Developmental Pathway: migrating symptoms
Anxiety alone is not sufficient for a diagnosis: impairment creates the category
Not due to a medical condition or substance use
Separation Anxiety
Considered to be a condition of childhood but often a precursor to adolescent anxiety
Case Study: Sam
Social Phobia
Different than shyness
Fear of being embarrassed
Symptoms for at least 6 months
Significant correlation with depressed mood
Obsessive-Compulsive Disorder
Recurrent and intrusive thoughts and actions that consume at least one hour per day
In almost 90% of cases the rituals change over time
Earlier onset for boys
Discussion
All kids have rituals. What is the difference between a ritual and an obsessive-compulsive disorder
Specific Phobias
Impairment creates the category
Specific phobias are ubiquitous in the general population
Illogical and involuntary
Bimodal onset: adolescence and mid-twenties
May be due to traumatic event
Generalized Anxiety Disorder
Somatic responses including clammy hands, palpitations, dry mouth
Worry about future events with low probability of occurrence
Panic Disorder
Repeated panic attacks
Fear of dying
Especially common in puberty
Anticipatory anxiety
Challenges of Anxiety Categories
Many more almost meet the diagnostic criteria than actually meet the criteria
Many teens are more focused on the symptoms of anxiety and may not be aware of the underlying anxiety itself
Many diagnoses include the need for “persistent” symptoms, but there is no operational definition of “persistent”
Anxiety is highly correlated with depression, but not suicidal ideation
Prevalence
Anxiety occurs in 12-20% of teens
As high as 50% in clinical samples
Very little cultural variation in prevalence rates
Moderate genetic indications
Childhood anxiety diagnoses predict adolescent panic attacks, depression, and conduct disorders
The Biology of Fear
Amygdala and Hippocampus
Primitive non-logical responses
Heightened alarm threshold
The symptom becomes the problem
Discussion
Given the overlap in many categories, what might be the advantages and disadvantages of an “anxiety spectrum”?
What might be the benefits and drawbacks of prescribing anti-anxiety medications for teens?
Mood Disorders
Use of the Word “Depressed”
Description: state
Syndrome: anhedonia, psychomotor retardation, sleep disturbance, loneliness, worry
Clinical Disorder: Impairment
Internalizing Disorder
Not a squeaky wheel
Likely to be overlooked
The Social Dimension of Depression
Solitude
Not connected to peers
Miserable
Somatic complaints
Absent from school or school difficulty
Major Depressive Disorder
Major Depressive Disorder: More than one episode of depression lasting at least two weeks. Significant impairment: irritability, lack of interest in peers, sleep disturbance, inability to concentrate
Episodic: 7-9 months duration
The good news: often clears up without treatment
The not-so-good news: 80% have reoccurrence within 5-7 years
Theories of causation: Family life, biology, cognitive models, interpersonal models, life stress models
The Depression Cycle
Family and other experiences create an encoded memory of beliefs about self and others
Effect is greater on those with biological vulnerabilities
Cognitive schema develop that become self-fulfilling prophesies
Depression is itself a life stress that disrupts personal relationships
Suicidality
The wish to escape emotional pain
Lack of social support- no way out
Suicidal ideation, intent, plan
Asking about suicidality does not increase probability
Dysthymic Disorder
Two years of depressed mood for more days than not
Ego-syntonic: I’ve always been this way”
Low self-esteem
Considered by many to be a personality factor
Discussion
Does one suicide increase the possibility of suicide on other students?
How would you approach a student you suspect might be suicidal?
Is depression contagious?
How should a suicide be discussed in a school setting?
Does medication increase learned helplessness?
Drug Use and Abuse
Definitions
Dependence = subjective feeling of needing the substance to function properly
Tolerance = Need to use larger amounts of the substance to produce the same effect
Withdrawal = adverse physiological symptoms if use is discontinued abruptly
Substance use disorder vs. substance induced disorder
What is Normal Use?: Health Behavior in School Age Children Survey (Adolescent Results)
Late adolescence is the time of greatest use
By senior year in high school, 80% report drinking alcohol at least once, 50% within the past month, 8% drink weekly, 40% drink monthly, 22% report binge drinking
5% have used an inhalant
30% have used a prescription drug for other than the intended use. Most common?
27% have been offered or said they sold an illegal drug on school property (2011 marijuana illegal)
Theories About Substance Use
Experimentation Model
Immaturity Model
Self-Medication Model
Predisposition Model
Discussion
Caffeine?
Nicotine?
Cannabis?
Levels of Concern
Use = developmental
Abuse = problematic
Dependence = evidence of tolerance or withdrawal
National Household Survey on Drug Abuse: 8% current and 35% lifetime meet the criteria and abuse or dependence
Carey (2015)
Abuse is often less problematic for teens
Fewer hangovers, less motor impairment, no major indicator of problematic behavior such as a car accident, fight, etc.
Experience fewer negative consequences while tolerance and dependency are developing
Reinforcement because of less social impairment
Discussion Issues
Getting high before or during school
Why don’t prevention programs seem to work?
Conflicting messages: “you have a disease”, but the cure is spiritual
Should schools be allowed to conduct random searches?
What is the role of teachers?
