Adolescent Psychology
Adolescent Psychology
Adolescent Psychology
Cognitive Development
Adolescence marks the transition from childhood into adulthood. It is characterized by
cognitive, psychosocial, and emotional development. Cognitive development is the pro-
gression of thinking from the way a child does to the way an adult does.
There are 3 main areas of cognitive development that occur during adolescence. First,
adolescents develop more advanced reasoning skills, including the ability to explore a full
range of possibilities inherent in a situation, think hypothetically (contrary-fact situations),
and use a logical thought process.
Second, adolescents develop the ability to think abstractly. Adolescents move from be-
ing concrete thinkers, who think of things that they have direct contact with or knowledge
about, to abstract thinkers, who can imagine things not seen or experienced. This allows
adolescents to have the capacity to love, think about spirituality, and participate in more
advanced mathematics. Youth who remain at the level of a concrete thinker focus largely
on physically present or real objects in problem solving and, as a result, may present with
difficulty or frustration with schoolwork as they transition throughout high school. Clini-
cians can help parents recognize this problem to help adolescents adjust to the educational
pace.
Adolescents may also experience a personal fable as a result of being able to think more
abstractly. The personal fable is built on the fact that if the imaginary audience (peers) is
watching and thinking about the adolescent, then the adolescent must be special or differ-
ent. For decades, this adolescent egocentrism was thought to contribute to the personal
fable of invincibility (eg, other adolescents will get pregnant or get sexually transmitted
infections) and risk-taking behavior.
Several studies have found that adolescents perceive more risk in certain areas than adults
but that being aware of the risks fails to stop adolescents from participating in risk-taking
behavior. Neuroimaging studies demonstrate that adolescents may experience greater emo-
tional satisfaction with risk-taking behavior. This satisfaction can predispose adolescents to
engage in behavior despite being aware of risks. In addition, concrete-thinking adolescents
Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, MD.
may be unable to understand the consequences of actions become less preoccupied with their bodily changes as
(eg, not taking medications), may be unable to link cause they approach the end of puberty. The adolescent’s at-
and effect in regard to health behavior (eg, smoking, tention shifts from being focused on self to adopting
overeating, alcohol, drugs, reckless driving, and early the codes and values of larger peer, parental, or adult
sex), and may not be prepared to avoid risk (eg, having groups. Clinicians who treat adolescents can help by dis-
condoms and avoiding riding with intoxicated drivers). cussing with families that this process of pubertal matu-
Alternatively, youth who feel the personal fable is threat- ration will often require role readjustments among and
ened can present with stress, depression, or multiple psy- between family members, which can sometimes result
chosomatic symptoms. in increased stress and conflict.
Third, the formal operational thinking characteristic During middle adolescence (ages 15-17 years), the
of adolescence enables adolescents to think about think- peer group becomes a mixed-sex peer group and assumes
ing or meta-cognition. This characteristic allows youth to a primary social role for the adolescent. Adolescents be-
develop the capacity to think about what they are feeling gin to have short, intense “love” relationships, while
and how others perceive them. This thought process, looking for the “ideal” partner. It is not uncommon
combined with rapid emotional and physical changes that for adolescents to have crushes on adults during this
occur during puberty, causes most youth to think that ev- stage. Family conflict is likely to be at its peak. As adoles-
eryone is thinking not just about what they are thinking cents’ independent functioning increases, adolescents
about but about the youth themselves (imaginary may examine their personal experiences, relate their expe-
audience). rience to others, and develop a concern for others.
The imaginary audience can be detrimental to youth By late adolescence (ages 18-21 years), adolescents
obtaining clinical care and services. For example, youth have developed a separate identity from parents. Simulta-
with chronic illnesses may hide or deny their illnesses neously, adolescents may move away from their peer
for fear that the imaginary audience (peers) may learn group and strive to achieve adult status. Adolescent con-
about their condition or to prove to the audience that flict with parents may very well decline during this stage.
the condition does not exist. It is important to remember As adolescents begin to enter more permanent relation-
that the audience is very real to the adolescent. By being ships, they establish responsible behavior and their per-
aware and sympathetic to the adolescent’s concerns, as sonal value system matures.
a clinician, you might be able to find solutions to address Pediatric health care professionals should be aware
the health needs and social needs of the patient. that most adolescents seek independence in a gradual
fashion, and a sudden shift from parents can be a warning
sign that the adolescent needs help in transitioning. In
Adolescent Psychosocial Development fact, some studies have demonstrated that 11-year-old
The psychosocial development that occurs during this pe- girls spend 68% of their time with family and 22% with
riod can be characterized as developmental tasks that em- friends compared with 46% and 44%, respectively, in
phasize development of autonomy, the establishment of 18-year-old girls. Anticipatory guidance for parents
identity, and future orientation. about the emerging needs of independence will help
The first area of adolescent development—establishment to inform parents about this important developmental
of autonomy—occurs when the adolescent strives to stage, provide guidance in promoting independence
become emotionally and economically independent in a safe setting, and alleviate some of the problems ex-
from parents. This struggle begins during early adoles- perienced in the family. Development of clinic policies
cence (ages 12-14 years), which is characterized by form- that promote an adolescent’s need for privacy, confi-
ing same-sex peer groups, with decreasing interest in dentiality, and involvement in decision-making can
family activities and parental advice. During this time, aid in this transition.
adolescents are concerned with how they appear to The second task of adolescence is for youth to develop
others. The peer group, which is typically same-sex, is of- a sense of identity. Identity relates to one’s sense of self. It
ten idealized and has a strong influence on the adoles- can be divided into 2 areas: self-concept and self-esteem.
cent’s development. As a result, adolescents may use Self-concept refers to an adolescent’s perception of self—
clothing, hairstyles, language, and other accessories to one’s talents, goals, and life experiences. It can also relate
fit in with their peers. Similarly, adolescents who do to identity as part of ethnic, religious, and sexual identity
not identify with any peers may have significant psycho- groups. Self-esteem relates to how one evaluates self-
logical difficulties during this period. Adolescents worth.
In 1950, Erikson described the psychosocial crisis that Emotional and Social Development
was occurring during this stage as “identity vs. role con- Adolescence is also characterized by the development of
fusion” (13-19 years). As adolescents transition into emotional and social competence. Emotional compe-
adults, they start to think about their roles in adulthood. tence relates to the ability to manage emotions, whereas
Initially, it is common for adolescents to experience role social competence focuses on one’s ability to relate effec-
confusion about their identity and describe mixed ideas tively with others. During this process, adolescents be-
and feelings about the specific ways in which they feel come more aware of being able to identify and label
they fit into society. As a result, they may experiment with their own feelings and the feelings of others.
a range of behaviors and activities to sort out this identity. The rate of emotional and cognitive development does
Adolescents may experiment with different peer groups not parallel the rate of physical maturation. Dr Deborah
or different styles of dress or behavior as a way of search- Yurgelun-Todd, director of Neuropsychology and Cog-
ing for their identity. Some degree of rebellion away from nitive Neuroimaging at McLean Hospital in Belmont,
the family’s image is part of the adolescent’s search for Massachusetts, compared magnetic resonance images
identity. of adults and teenagers to demonstrate how cognitive de-
Erikson described that an adolescent’s inability to set- velopment does not occur simultaneously with emotional
tle on an identity or career path can result in identity cri- development in adolescents. Unlike in the adult brain,
sis. Although this stage likely lasts for a short period, where both the limbic area of the brain (emotion center)
because of the current extension of adolescence and
and the prefrontal cortex (judgment and reasoning cen-
young adulthood, with more youth obtaining advanced
ter) are enhanced when viewing images that expressed
degrees or vocational training, it may take more time
fear, in the adolescent brain, after seeing the same images,
for youth to establish their identity. Adolescents with
the limbic area is enhanced, with almost no activity in the
a chronic illness may have a harder time developing a pos-
prefrontal cortex. Such emotional-cognitive asynchrony
itive identity or self-image because of the impact of the
can result in adolescents misinterpreting other’s feelings
illness on body image and the limited ability to achieve
and emotions, whereas emotional-physical asynchrony
independence. Pediatric health care professionals can
can result in adolescents being treated as older than their
support adolescent identity development by encouraging
emotional stage of development.
parents to allow adolescents to have the space and time to
Early rapid pubertal development in girls and boys may
independently make health care decisions and to partic-
significantly affect body image and social performance.
ipate in and explore a range of activities that can promote
Early maturing boys are often perceived as older and more
this development.
Inadequate development of self-identity can result responsible. In general, they perform better on team sports
in poor self-esteem in the adolescent. Poor self-image than boys who mature late and, as a result, may be more
and esteem have been associated with poor adjust- popular and seen as class leaders. However, timing and du-
ment (depression or suicide), school underachieve- ration of puberty appear to matter. In a study by Ge et al,
ment, substance use, and other risk-taking behaviors. boys who were physically more developed in seventh
Educating parents about the importance of praise grade, compared with their less physically developed peers,
and acceptance during this stage may be helpful to en- manifested more externalized hostile feelings and internal-
sure that adolescents emerge from it with a secure ized distress symptoms in grades 8 through 10. Early mat-
identity. uration may predispose girls to social disadvantage. Early
The ability for future orientation is the third area maturation has been identified as a risk factor for conduct
of adolescent psychosocial development. This stage problems, depression, early substance use, poor body im-
usually occurs during late adolescence (ages 18-21 age, pregnancy, and early sexual initiation.
years). Youth have gained the cognitive maturity that Management or self-regulation of emotions is an im-
is necessary to develop realistic goals pertaining to portant process in any adolescent. Research has found that
future vocation or career, have developed a sense of an increased level of testosterone during puberty can result
self-identity, and are most likely refining their moral, in swelling of the amygdala, the area of the brain critical in
religious, and sexual values. It is during this time that emotional regulation. Health care professionals can help
youth also expect to be treated as an adult. As auton- adolescents recognize triggers and symptoms of out-of-
omy increases, youth are given more responsibility. control emotions and use reasoning skills to step back, ex-
They are also provided with more access to alcohol amine emotions, and consider long-term consequences of
and drugs. behavior.
Suggested Reading Ge X, Conger R, Elder GH. The relation between puberty and psy-
American Academy of Pediatrics. Bright Futures Guidelines for chological distress in adolescent boys. J Res Adolesc. 2001;11:49–70
Health Supervision of Infants. Elk Grove Village, IL: Children, Litt IF. Pubertal and psychosocial development implications for
Adolescents; 2008 pediatricians. Pediatrics. 1995;16(7):243–247
Deardorff J, Gonzales NA, Christopher FS, Roosa MW, Millsap McNeely C, Blanchard J, Center for Adolescent Health. Teen Years
RE. Early puberty and adolescent pregnancy: the influence of Explained: A Guide to Healthy Adolescent Development. Balti-
alcohol use. Pediatrics. 2005;116(6):1451–1456 more, MD: Bloomberg School of Public Health; 2010
Diamond LM, Savin-Williams RC, Dube EM. Sex, dating, Piaget J. Intellectual evolution from adolescence to adulthood.
passionate friendships, and romance: Intimate peer relations Hum Dev. 1972;15:1–12
among lesbian, gay, bisexual adolescents. In: Furman W, Russell STSN. Adolescent sexuality and positive youth develop-
Brown BB, Feiring C, eds. The Development of Romanic ment. In: Perkins D, Borden L, Keith J, Villarruel FA, eds.
Relationships. Cambridge, UK: Cambridge University Press; Positive Youth Development: Beacons, Challenges, and Opportu-
1999:175–210 nities. Thousand Oaks, CA: Sage; 2003:146–161
Douvan E, Adelson J. The Adolescent Experience. New York, NY: Steinberg L. A social neuroscience perspective on adolescent risk-
John Wiley and Sons; 1966 taking. Dev Rev. 2008;28(1):78–106
Elkind D. Teenage thinking: implications for health care. Pediatr Slap GB. Normal physiological and psychosocial growth in the
Nurs. 1984;10(6):383–385 adolescent. J Adolesc Health Care. 1986;7(6 suppl):13S–23S
Erikson E.Childhood and Society. New York, NY: WW Norton; Yurgelun-Todd D. Emotional and cognitive changes during
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PIR Quiz
This quiz is available online at http://www.pedsinreview.aappublications.org. NOTE: Learners can take Pediatrics in Review quizzes and claim credit
online only. No paper answer form will be printed in the journal.
1. You see a girl for regular management of her asthma. She does well academically and participates in
extracurricular activities in the community. You and her parents have encouraged her to take more
responsibility for her asthma medication and treatments, but she has not been interested and has had several
asthma exacerbations in the past year. She has several close girlfriends, none of whom have asthma, and she
would rather not talk about her asthma management, saying that her friends don’t have to talk about these
things. She is not sexually active and is embarrassed when you meet with her privately and discuss sex. This girl
is MOST likely
A. In early adolescence.
B. In late adolescence.
C. Manifesting evidence of abstract thinking.
D. Ready to graduate from high school.
E. Spending very little time with her family.
2. You have seen a boy since infancy and know his family well. At a recent sports participation well-child
examination, he discusses his interest in spirituality and his plans to become more active in a religious group at
his school. His parents are not active in a religious community, and he is thinking about how to discuss this
with them without offending or upsetting them. He would like your advice on how to discuss this issue with his
parents. This boy is MOST likely
A. Beginning to show signs of puberty.
B. In late adolescence.
C. In junior high school.
D. In early adolescence.
E. Manifesting evidence of concrete thinking.
3. A 16-year-old girl has acute lymphocytic leukemia, and she is now in remission. She has been a gymnast since
age 9 years but has not been able to participate in gymnastic activities for the past year since her diagnosis. She
has been attending school this semester but has been greatly affected by her hair loss and lack of participation
in sports. You see her for a physical examination before she enrolls in a camp for teenagers who have cancer. On
physical examination, she is well-nourished but has scalp alopecia. Her examination findings are otherwise
normal. Her mother is reluctant to give the girl permission to attend the camp because of possible medical
complications while she is away from home. You are MOST likely to respond that the girl’s participation in the
camp
A. Is likely to slow her move toward vocational independence.
B. May cause her to become depressed because everyone at the camp has a history of cancer.
C. May help her develop a better self-image as a teenage cancer survivor.
D. Should be approved only if the camp is designed for girls with a history of acute lymphocytic leukemia.
E. Should be postponed until she is in remission for another year.
4. A 17-year-old boy is spending much of his time out of the home with friends. His parents are concerned that
he may be experimenting with drugs. They are also concerned that he is acting depressed. They ask for your
guidance on the best ways to help their son. You are MOST likely to state that
A. Authoritative parenting style has better outcome for family relationships and teen behavior.
B. Providing clear guidance on their expectations for his behavior will cause stress for the boy.
C. They should avoid discussing the issue of drugs with their son.
D. They should send the boy to a community seminar with information on depression.
E. You recommend drug testing during the visit.
5. A 15-year-old girl was concerned that her teachers did not like her, but her mother met a few of her teachers in
the community and each of them told her that they appreciate and like her daughter. The girl is doing well
academically. She has been spending more time with friends and less time with her family, but her mother likes
the girl’s friends and has no concerns about the girl’s behavior. On physical examination, she has a sexual
maturity rating of V, and her mother states that she matured physically before her peers. The mother notes that
her daughter seems to misinterpret emotions at times with family members, and she wonders if this is what is
happening at school. The mother would like your opinion on why this might be occurring. You are MOST likely
to respond that this emotional-cognitive pattern is seen typically
A. In adolescents.
B. In children with depression.
C. In mild forms of autism.
D. In children with learning disabilities.
E. When children mature physically before their peers.