Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 1 Chapter Thirteen: Psychosocial Problems in Adolescence

Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved.

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Chapter Thirteen:Chapter Thirteen:

Psychosocial Problems in Psychosocial Problems in Adolescence Adolescence


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Problems in AdolescenceProblems in Adolescence• Contrary to media portrayal, adolescents do not Contrary to media portrayal, adolescents do not

generally develop serious psychological or social generally develop serious psychological or social problems, problems,

• Most problems reflect transitory experimentation, not Most problems reflect transitory experimentation, not enduring patterns of bad behaviorenduring patterns of bad behavior

• Not all problems begin in adolescence (some have Not all problems begin in adolescence (some have their roots in childhood)their roots in childhood)

• Most problems do not persist into adulthood (especially Most problems do not persist into adulthood (especially drug and alcohol use as well as delinquency)drug and alcohol use as well as delinquency)

• Problems during adolescence are not biologically Problems during adolescence are not biologically rooted or caused by the normative changes of rooted or caused by the normative changes of adolescence (“raging hormones” do not cause problem adolescence (“raging hormones” do not cause problem behaviors)behaviors)


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Psychosocial Problems: Psychosocial Problems: Their Nature and Co-VariationTheir Nature and Co-Variation

• Substance abuse Substance abuse –– the maladaptive the maladaptive use of drugs (legal and illegal)use of drugs (legal and illegal)

• Internalizing disorders Internalizing disorders –– problems are problems are turned inward (emotional and cognitive turned inward (emotional and cognitive distress)distress)

• Externalizing disorders Externalizing disorders –– problems are problems are turned outward (behavioral problems)turned outward (behavioral problems)

• Substance abuse problems are likely Substance abuse problems are likely comorbidcomorbid

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Problem Behavior SyndromeProblem Behavior Syndrome• Many adolescents with psychosocial problems Many adolescents with psychosocial problems

have more than one type of problem at oncehave more than one type of problem at once• The comorbidity of externalizing and substance The comorbidity of externalizing and substance

abuse problems has led researchers to propose abuse problems has led researchers to propose theoretical explanations for this phenomenon, theoretical explanations for this phenomenon, sometimes called Problem Behavior Syndromesometimes called Problem Behavior Syndrome


Externalizing ProblemsExternalizing Problems

• Problem behavior syndrome: Unconventionality in adolescents’ Problem behavior syndrome: Unconventionality in adolescents’ personality and social environment leads to risk-taking behaviors personality and social environment leads to risk-taking behaviors (Jessor)(Jessor)– Tolerance of devianceTolerance of deviance– Not connected to school/religious institutionsNot connected to school/religious institutions– Highly liberal viewsHighly liberal views

• Problem clusters: Involvement in one problem behavior may lead to Problem clusters: Involvement in one problem behavior may lead to involvement in a second one (Kandel)involvement in a second one (Kandel)– Cascading effectsCascading effects

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Externalizing ProblemsExternalizing Problems• Social control theorySocial control theory

– Individuals who do not have strong Individuals who do not have strong bonds to societal institutions, (family, bonds to societal institutions, (family, work, school) will be likely to deviate and work, school) will be likely to deviate and behave unconventionallybehave unconventionally

– Helps explain why behavior problems Helps explain why behavior problems are far more prevalent among poor, are far more prevalent among poor, inner-city, minority youthsinner-city, minority youths


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The Comorbidity of Internalizing The Comorbidity of Internalizing ProblemsProblems

• Although less research has studied comorbidity Although less research has studied comorbidity among internalizing problems, one underlying among internalizing problems, one underlying factor appears to be negative affectivityfactor appears to be negative affectivity

• Negative affectivity refers to how easily someone Negative affectivity refers to how easily someone becomes distressedbecomes distressed– Adolescents high in negative affectivity are more likely Adolescents high in negative affectivity are more likely

to suffer from depression, anxiety, and other to suffer from depression, anxiety, and other symptoms of distress symptoms of distress


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Substance Use and Abuse Substance Use and Abuse in Adolescencein Adolescence

• Society sends mixed messages to youthSociety sends mixed messages to youth– TV programs “Just say NO”TV programs “Just say NO”– TV football games and situation comediesTV football games and situation comedies

“Having a good time is impossible without “Having a good time is impossible without alcohol”alcohol”

• Alcohol and nicotine are by far the most Alcohol and nicotine are by far the most commonly used and abused substances, commonly used and abused substances, according to Monitoring the Future dataaccording to Monitoring the Future data


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Prevalence of Substance Use and AbusePrevalence of Substance Use and Abuse

• Most adolescents have experimented with alcohol, tobacco, Most adolescents have experimented with alcohol, tobacco, and marijuana but not with other drugsand marijuana but not with other drugs

• Only a very small number of adolescents use any substance Only a very small number of adolescents use any substance dailydaily– 10% smoke cigarettes every day; 3% use alcohol daily; 10% smoke cigarettes every day; 3% use alcohol daily;

5% use marijuana daily5% use marijuana daily


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Earlier Age of InitiationEarlier Age of Initiation• Adolescents are experimenting Adolescents are experimenting

with drugs at earlier ages than with drugs at earlier ages than in the pastin the past

• The chances of becoming The chances of becoming addicted to alcohol or nicotine addicted to alcohol or nicotine are increased when use begins are increased when use begins before age 15before age 15– Drugs can affect dopamine Drugs can affect dopamine

production in the brain, possibly production in the brain, possibly altering it permanentlyaltering it permanently

• The effects of alcohol and The effects of alcohol and nicotine on brain functioning nicotine on brain functioning (especially memory) are worse (especially memory) are worse in adolescence than in in adolescence than in adulthoodadulthood


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Developmental Trajectories of Developmental Trajectories of Substance AbuseSubstance Abuse

• Gateway drugs Gateway drugs – Alcohol and marijuanaAlcohol and marijuana– Are typically used before harder drugsAre typically used before harder drugs

• Studies have identified six patterns of Studies have identified six patterns of substance use:substance use:

– NonusersNonusers– Alcohol ExperimentersAlcohol Experimenters– Low EscalatorsLow Escalators– Early StartersEarly Starters– Late StartersLate Starters– High EscalatorsHigh Escalators


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Risk and Protective Factors For Risk and Protective Factors For Substance AbuseSubstance Abuse

• Adolescents who use alcohol, tobacco, or other drugs Adolescents who use alcohol, tobacco, or other drugs frequently are usually exhibiting symptoms of prior frequently are usually exhibiting symptoms of prior psychological disturbancepsychological disturbance– More maladjusted as children and teenagersMore maladjusted as children and teenagers

• Major risk factors are:Major risk factors are:– Personality Personality –– Anger, impulsivity, and inattentiveness Anger, impulsivity, and inattentiveness– Family Family –– Distant, hostile, or conflicted relationships Distant, hostile, or conflicted relationships– Socially Socially –– Friends who use and tolerate the use of drugs Friends who use and tolerate the use of drugs– Contextual Contextual –– Live in a context that makes drug use easy Live in a context that makes drug use easy

• Major protective factors are:Major protective factors are:– Positive mental health, high academic achievement, engagement in Positive mental health, high academic achievement, engagement in

school, close family relationships, and involvement in religious activitiesschool, close family relationships, and involvement in religious activities


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Prevention and Treatment of Prevention and Treatment of Substance Use and AbuseSubstance Use and Abuse

• Efforts to prevent abuse target:Efforts to prevent abuse target:– The supply of drugs (most government attention The supply of drugs (most government attention

and money focused here)and money focused here)– The environment in which teens are exposed to The environment in which teens are exposed to

drugsdrugs– Characteristics of the potential drug user Characteristics of the potential drug user

• Experts believe it is more realistic to focus Experts believe it is more realistic to focus prevention efforts on adolescents’ motivation prevention efforts on adolescents’ motivation and environment and environment


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Prevention and Treatment of Substance Use Prevention and Treatment of Substance Use and Abuseand Abuse

• The most encouraging interventions The most encouraging interventions are programs that combine:are programs that combine:

– Social competence training for Social competence training for adolescentsadolescents

– Community-wide interventions Community-wide interventions aimed at adolescents, peers, aimed at adolescents, peers, parents, and teachersparents, and teachers

• These kinds of programs have These kinds of programs have reduced the use of alcohol, drugs, reduced the use of alcohol, drugs, and cigarettes, especially if started and cigarettes, especially if started in late childhood and continued in late childhood and continued through high schoolthrough high school


Categories of Externalizing Categories of Externalizing DisordersDisorders

• Conduct DisorderConduct Disorder

• AggressionAggression

• Juvenile OffendingJuvenile Offending

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Externalizing Problems: Conduct DisorderExternalizing Problems: Conduct Disorder• Conduct Disorder (CD)Conduct Disorder (CD)

– Clinical diagnosisClinical diagnosis– A pattern of persistent antisocial A pattern of persistent antisocial

behavior that routinely violates the behavior that routinely violates the rights of others and leads to rights of others and leads to problems in social relationships, problems in social relationships, school, or workschool, or work

– Related diagnosis is oppositional-Related diagnosis is oppositional-defiant disorder (less aggressive)defiant disorder (less aggressive)

• If CD persists beyond age 18, may be If CD persists beyond age 18, may be diagnosed with antisocial personality diagnosed with antisocial personality disorder, characterized by a lack of disorder, characterized by a lack of regard for moral standards regard for moral standards (psychopaths)(psychopaths)

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Externalizing Problems: Externalizing Problems: AggressionAggression

• Aggression Aggression –– behavior that is behavior that is done intentionally to hurt done intentionally to hurt someonesomeone– Physical fightingPhysical fighting– Relational aggressionRelational aggression– IntimidationIntimidation

• Can be instrumental Can be instrumental (planned) or reactive (planned) or reactive (unplanned)(unplanned)

• Usually declines over the Usually declines over the course of childhood and course of childhood and adolescenceadolescence


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Externalizing Problems: Juvenile OffendingExternalizing Problems: Juvenile Offending

• Juvenile offending is defined legallyJuvenile offending is defined legally• Violent (e.g., assault, rape, robbery, and murder) and property Violent (e.g., assault, rape, robbery, and murder) and property

crimes (e.g., burglary, theft arson)crimes (e.g., burglary, theft arson)– Increase in frequency between the preadolescent and Increase in frequency between the preadolescent and

adolescent years adolescent years – Peak during high school then declines in young adulthood Peak during high school then declines in young adulthood

(the age-crime curve)(the age-crime curve)• Delinquency v. criminal behaviorDelinquency v. criminal behavior• Status offenses Status offenses –– behaviors that are not against the law for behaviors that are not against the law for

adults (truancy, running away, drinking)adults (truancy, running away, drinking)


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Externalizing Problems: Juvenile Externalizing Problems: Juvenile OffendingOffending

• Antisocial behavior takes Antisocial behavior takes the form of:the form of:– Authority conflicts (running Authority conflicts (running

away)away)– Covert antisocial behavior Covert antisocial behavior

(stealing)(stealing)– Overt antisocial behavior Overt antisocial behavior

(attacking someone with a (attacking someone with a weapon)weapon)

• Onset of serious Onset of serious delinquency begins between delinquency begins between ages 13 and 16ages 13 and 16


Changes in Juvenile Offending Changes in Juvenile Offending Over timeOver time

• Juvenile crime rate has declined since its Juvenile crime rate has declined since its peak in the early 1990speak in the early 1990s– However, adolescents still account for a However, adolescents still account for a

disproportionately high number of crimesdisproportionately high number of crimes– Substantial decline in the gender gap in Substantial decline in the gender gap in

serious offending over the past several serious offending over the past several decadesdecades• Not clear whether this change is mainly due to Not clear whether this change is mainly due to

changes in actual offending or changes in arrest changes in actual offending or changes in arrest practices among girlspractices among girls

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Two Types of Adolescent OffendersTwo Types of Adolescent Offenders

• Life-course persistent offendersLife-course persistent offenders– Demonstrate antisocial behavior Demonstrate antisocial behavior

before adolescencebefore adolescence– Are involved in delinquency during Are involved in delinquency during

adolescenceadolescence– Are at great risk for continuing Are at great risk for continuing

criminal activity in adulthoodcriminal activity in adulthood• Adolescent-limited offendersAdolescent-limited offenders

– Engage in antisocial behavior only Engage in antisocial behavior only during adolescenceduring adolescence

• These two types have very different These two types have very different causes and consequencescauses and consequences


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Life-Course Life-Course Persistent OffendersPersistent Offenders

• Usually are poor, male, perform poorly in schoolUsually are poor, male, perform poorly in school• From disorganized families with hostile or inept From disorganized families with hostile or inept

parentsparents– Harsh parenting may affect brain chemistry (serotonin)Harsh parenting may affect brain chemistry (serotonin)– Worse behavior elicits more bad parenting, leads to a Worse behavior elicits more bad parenting, leads to a

vicious cyclevicious cycle– Have histories of aggression identifiable as early as age 8Have histories of aggression identifiable as early as age 8

• Have problems with self regulation Have problems with self regulation – More likely than peers to suffer from ADHDMore likely than peers to suffer from ADHD

• Exhibit hostile attributional bias Exhibit hostile attributional bias –– interpret interpret ambiguous interactions with others as deliberately ambiguous interactions with others as deliberately hostile and retaliatehostile and retaliate


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Adolescent-Limited OffendingAdolescent-Limited Offending• Do not usually show signs of psychological Do not usually show signs of psychological

problems or family pathology problems or family pathology • Still show more problems than teens who are Still show more problems than teens who are

not at all delinquentnot at all delinquent– More mental health, substance abuse, and financial More mental health, substance abuse, and financial

problemsproblems

• Risk factors include:Risk factors include:– Poor parenting (especially poor monitoring)Poor parenting (especially poor monitoring)– Affiliation with antisocial peersAffiliation with antisocial peers


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Internalizing Problems and Internalizing Problems and Depression in AdolescenceDepression in Adolescence

• Depression is the most common Depression is the most common psychological disturbance among psychological disturbance among adolescentsadolescents– Emotional symptomsEmotional symptoms –– dejection, dejection,

decreased enjoyment of pleasurable decreased enjoyment of pleasurable activities, low self-esteemactivities, low self-esteem

– Cognitive symptomsCognitive symptoms –– pessimism and pessimism and hopelessnesshopelessness

– Motivational symptomsMotivational symptoms –– apathy, apathy, boredomboredom

– Physical symptomsPhysical symptoms –– loss of appetite, loss of appetite, difficulty sleeping, loss of energydifficulty sleeping, loss of energy

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Imprecise Use of the Word Imprecise Use of the Word “Depression”“Depression”

• Depressed moodDepressed mood– Feeling sadFeeling sad

• Depressive symptomsDepressive symptoms– Having multiple symptoms of depressionHaving multiple symptoms of depression

• Depressive disorderDepressive disorder– Having enough symptoms to be diagnosed Having enough symptoms to be diagnosed

with the illnesswith the illness

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Sex Differences in DepressionSex Differences in Depression• Before adolescence, boys are Before adolescence, boys are

more likely to exhibit depressive more likely to exhibit depressive symptomssymptoms

• After After pubertypuberty, females are more , females are more likely to be depressed, possibly likely to be depressed, possibly because of:because of:– Gender rolesGender roles –– pressure to act pressure to act

passive, dependent, and fragile, passive, dependent, and fragile, heightened self-consciousness over heightened self-consciousness over physical appearance physical appearance

– Greater levels of stress during early Greater levels of stress during early adolescence adolescence

– Ruminating moreRuminating more –– turning feelings turning feelings inwardinward

– Greater sensitivity to others Greater sensitivity to others (oxytocin)(oxytocin)


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Adolescent SuicideAdolescent Suicide• ~20% of girls and 10% of boys think about killing ~20% of girls and 10% of boys think about killing

themselves every year (suicidal ideation)themselves every year (suicidal ideation)– 10% girls & 5% boys make attempts serious enough to 10% girls & 5% boys make attempts serious enough to

require treatmentrequire treatment

• Risk factors include:Risk factors include:– Having a psychiatric problemHaving a psychiatric problem

• Especially depression or substance abuseEspecially depression or substance abuse

– Having a family history of suicide in the familyHaving a family history of suicide in the family– Experiencing extreme family conflictExperiencing extreme family conflict

• Parental rejection, family disruptionParental rejection, family disruption

– Being under intense stressBeing under intense stress

• Suicide rate is highest among American Indian and Suicide rate is highest among American Indian and Alaskan Native adolescentsAlaskan Native adolescents– Lowest among Black and White adolescentsLowest among Black and White adolescents


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The Diathesis-Stress The Diathesis-Stress Model of DepressionModel of Depression

• Depression occurs when people with a predisposition (a Depression occurs when people with a predisposition (a diathesis) toward internalizing problems are exposed to chronic diathesis) toward internalizing problems are exposed to chronic or acute stressors (a stress)or acute stressors (a stress)– Those without the diathesis are able to withstand a great Those without the diathesis are able to withstand a great

deal of stress without developing psychological problemsdeal of stress without developing psychological problems• The Diathesis The Diathesis

– May be biological in origin (neuroendocrine or genetically May be biological in origin (neuroendocrine or genetically linked), or because of cognitive stylelinked), or because of cognitive style

• The StressThe Stress– Primarily from having a high-conflict and low cohesion Primarily from having a high-conflict and low cohesion

family, being unpopular, or reporting more chronic and acute family, being unpopular, or reporting more chronic and acute stressorsstressors


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Treatment and Prevention Treatment and Prevention of Internalizing Problemsof Internalizing Problems

• Treatment approaches:Treatment approaches:– Biological therapiesBiological therapies –– Antidepressant medications (SSRIs) Antidepressant medications (SSRIs)

that address the neuroendocrine problems that may existthat address the neuroendocrine problems that may exist– PsychotherapiesPsychotherapies –– Designed to help adolescents Designed to help adolescents

understand the roots of their depression or change their understand the roots of their depression or change their cognitions cognitions

– Family therapyFamily therapy –– Changing patterns of family relationships Changing patterns of family relationships that contribute to symptomsthat contribute to symptoms

• Evidence-based approaches are superior to approaches that Evidence-based approaches are superior to approaches that do not have a scientific basisdo not have a scientific basis


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Stress and CopingStress and Coping

• Stress responses vary, so some Stress responses vary, so some adolescents experience:adolescents experience:

– Internalized disorders (anxiety, Internalized disorders (anxiety, depression, headaches, indigestion, depression, headaches, indigestion, immune system problems)immune system problems)

– Externalized disorders (behavior Externalized disorders (behavior and conduct problems)and conduct problems)

– Drug and alcohol abuse problemsDrug and alcohol abuse problems• Stress does not always lead to Stress does not always lead to

negative outcomes negative outcomes – Resilience in the face of adversityResilience in the face of adversity

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What Explains Stress Vulnerability?What Explains Stress Vulnerability?• Multiple stressors have a much greater impact than Multiple stressors have a much greater impact than

single stressors (multiplicative)single stressors (multiplicative)• Adolescents who have internal and external Adolescents who have internal and external

resources are less likely to be affected by stress resources are less likely to be affected by stress than their peersthan their peers

– Internal: high self-esteem, healthy identity Internal: high self-esteem, healthy identity development, high intelligencedevelopment, high intelligence

– External: social support from othersExternal: social support from others• Using more effective coping strategies also buffers Using more effective coping strategies also buffers

the effects of stressthe effects of stress– Primary control: taking steps to change the source Primary control: taking steps to change the source

of stress (usually the best strategy)of stress (usually the best strategy)– Secondary control strategies: trying to adapt to Secondary control strategies: trying to adapt to

the problem (better when situation is the problem (better when situation is uncontrollable)uncontrollable)

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Copyright © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 1 Chapter Thirteen: Psychosocial Problems in Adolescence