LESSON 2

Adolescence/Adolescents' Health

NARRATIVE

“The Physiological and Psychological Development of the Adolescent” is a

curriculum unit designed to explain the life of the adolescent from two
perspectives. Once viewed, the adult will be able to understand the reasoning
behind the child’s sudden changes in behavior. In turn, they will be more readily
available to offer help to youth during this phase of life when adolescents are
attempting to identify and formulate their self-image, values, and ideals along with
gaining independence from their parents or guardians. This curriculum unit is
geared towards the middle school grades of 6-8, where most children enter
adolescence. For students to take full advantage of the information included in the
unit, three to four weeks should be set aside to teach the unit in its entirety. The
lesson plans at the end of the physiological portion of paper will focus on the
biological occurrences in the adolescent’s life. Even though the vocabulary may
appear to be difficult, children will tend to learn the words rapidly because of the
direct involvement and interest in the unit of study. After using the lesson plans
supplied at the end of the unit the students should attain the following objectives:

1. Identify, using a diagram, the body parts directly related to reproduction.

2. Differentiate between primary and secondary sexual characteristics.

3. Identify, using proper terminology, the body parts directly related to

reproduction.

4. Place the steps involved in adolescent sexual maturation in sequential order.

5. Describe the function of reproductive organs in both males and females.

The lesson plans at the end of the psychological section of the paper will provide
the students with activities that will help them to focus on establishing their
identity and evaluate their personalities. Through the information provided in the
text and worksheets provided in the lesson plan section, the student will:

1. Explore occupations, and discuss the role of academics in relationship to

their aspiring vocations.

2. Perform activities to define their identity and personalities.

3. Perform activities to establish their values and strengthen decision-making

skills.

4. Discuss KohIberg’s theory of Moral Reasoning.

5. Discuss Piaget’s theory of Cognitive Development.

THE PHYSIOLOGICAL DEVELOPMENT OF THE ADOLESCENT

Introduction

In trying to discuss adolescence, most adults tend to confuse the terms adolescence
and puberty, and use them synonymously. However, puberty refers to the
physiological changes involved in the sexual maturation of a child, as well as other
body changes that may occur during this period of time. Adolescence refers to the
stage from puberty to adulthood, and includes the psychological experiences of the
child during this period. Adolescence is described as being the teenage years from
thirteen to eighteen years of age; however, puberty decides the onset of
adolescence. Therefore, adolescence occurs in some children as early as nine years
of age. During this period of time the child has a great deal of concern over his/her
body image and any discrepancies in the child’s eye such as obesity, early or late
maturation, etc., may be manifested through a variety of disorders. During
adolescence there is a large degree of psychological growth as children make
adjustments in their personality due to the rapid physical and sexual development
which are characteristic of this period of life. Adolescents face ongoing conflict
and difficulty adapting to the sudden upsurge of sexual and aggressive drives.
These changes cause unrest and confusion in the adolescents’ inner selves and in
the way they perceive the world.

What is Puberty?

Puberty refers to the physiological changes that the adolescent undergoes in order
to reach sexual maturity. It is best characterized as the gradual onset of mature
reproductive hormonal activity, triggered by the central nervous system, mainly the
hypothalamus and pituitary gland. Most people look at puberty in three distinct
stages railed the pre-pubescent, pubescent, and postpubescent. The prepubescent
stage includes the first evidence of sexual maturation—primary sexual
characteristics—and terminates at the first appearance of pubic hair. During this
stage, reproduction is virtually impossible. During the pubescent stage the growth
spurt begins to accelerate, males experience their first emission of semen usually in
the form of “wet dreams,” and menarche occurs in the females. The postpubescent
stage is characterized by the deceleration of growth spurt, completion of both
primary and sexual characteristics, and fertility is possible.

The Anatomical Development of the Adolescent

Adolescent growth first centers on the extremities—the legs and arms during the
early stages of adolescence. Changes also occur in the facial configurations of both
sexes.The lower portion of the head begins to grow because the chin lengthens and
the nose grows in width and/or length. Additional changes in proportion of the face
is accredited to changes in tissue distribution. Even though both sexes undergo this
change, within females a layer of subcutaneous fat develops which causes the
rounding and softening of contours of the face and body. Whereas, the male
subcutaneous fat development is much less pronounced, but the development of
muscles and bones in the face is clearly Changes also occur on the surface of the
body in both sexes. The most observable change is the growth on body hair, both
pubic and axillary (armpit). The development of pubic hair is the first sign of a
child ending the prepubescent stage and entering the pubescent stage. This process
begins about the same time as the growth spurt begins, and is in the form of
slightly coarse, straight hairs that grow at the base of the penis and an the labia
majora. The growth of pubic hair continues throughout adolescence, it spreads
horizontally and then vertically until it surrounds the genital areas.
Characteristically, pubic hair becomes longer, thicker, darker and kinkier as it
spreads over the genital areas. In males, the growth of facial and chest hair may be
pronounced, and tends to represent virility in the eyes of the adolescent. Noticeable
chest hair, with a thickness in texture does not usually appear until the
postpubescent stage and continues to grow during manhood. Facial hair usually
appears in the form of a dark shadow above the lip.

Then it appears on the chin, along the jaw line, and then develops along the neck.
Females may also find small amounts of facial and chest hair. This gives the males
a leaner and more angular face than the females. Both male and female skin
undergoes other changes, such as becoming coarser with the sebaceous glands
becoming more active, producing oily secretions which usually help cause acne or
blackheads. Sweat usually causes an odor in adolescents because the chemistry and
composition of sweat is altered by the oils that the sebaceous glands emit.
Adolescents also show an increase in their blood pressure, and a decrease in both
basal metabolic rate—the rate at which the body in a resting state (basal) consumes
oxygen—and in pulse rate.

The Onset of Puberty in Adolescents

Amazing as it may seem, sexual maturation is programmable for the primary

sexual characteristics to begin their development, the pituitary gland must first
release stimulating agents called gonadotropins into the bloodstream. Once they
reach the testes in the male and the ovaries in the female, a number of chThere are
two gonadotropins: follicle stimulating hormone (FSH) and luteinizing hormone
(LH). these gonadotropins are present in the adolescent during childhood, but at
levels too low for sexual maturation to begin. At the beginning of puberty, the
pituitary releases increased amounts of gonadotropins while the child is asleep and
stops immediately after the child awakens. However, once the child enters the
postpubescent stage, gonadotropins are released both during sleep and during the
day. In the ovaries, follicle stimulating hormone is responsible for the development
of the follicle which contains a developing ovum (egg). Follicle stimulating
hormone also helps produce the female hormone estrogen within the follicle when
it is stimulated by luteinizing hormone. In males, FSH incites the growth of
seminiferous tubules, which produce sperm in the testes. Luteinizing hormone is
responsible for producing androgen male hormone in the Leydig cells. The
androgen that the Leydig cells produce, aids in the growth on the seminiferous
tubules. As the adolescent grows older, the pituitary releases increased amounts of
gonadotropins, ovaries and the testes grow more rapidly, and produce larger
amounts of estrogen and/or androgen. anges will occur.

Sexual Maturation In the Male Adolescent

Even though the male adolescent’s growth rate varies from child to child, a
sequential pattern has been identified. The typical sequence of events occurs as
follows:

1. The testes and scrotum begin to increase in size.

2. Pubic hair begins to appear.

3. The penis begins to enlarge, and the adolescent growth spurt begins.

4. The larynx starts to grow and the voice deepens.

5. Hair growth begins on the upper lip.

6. Nocturnal emissions (ejaculation of semen during sleep) may occur as sperm

production increases.

7. Pubic hair becomes pigmented, and growth spurt reaches its peak.
8. The prostrate gland enlarges.

9. Hair growth begins in the axillas (armpits).

10. Sperm production becomes sufficient for fertility, and the growth rate
decreases.

11. Physical strength is at its peak.

Sexual Maturation of the Female Adolescent

Even though the female adolescent’s growth rate varies from child to child, a
sequential pattern has been identified. The typical sequence of events occur as
follows:

1. The adolescent growth spurt begins.

2. Non-pigmented pubic hair (downy) appears.

3. The budding stage of development (breast elevation) and the rounding of the hip
begins, accompanied by the beginning of downy axillary hair.

4. The uterus, vagina, labia and clitoris increase in size.

5. Pubic hair growth becomes rapid and is slightly pigmented.

6. Breast development advances, nipple pigmentation begins, and the areola

increases in size. Axillary hair becomes slightly pigmented.

7. Growth spurt reaches its peak, and then declines.

8. Menarche occurs.

9. Public hair development is completed, followed by mature breast development

and completion of axillary hair development.

10. “Adolescent sterility” ends, and the girl becomes capable of conception.

Menstruation
The menstrual cycle is controlled by the hypothalamus, which acts as a menstrual
clock. The clock operates through the pituitary gland located at the base of the
brain. The pituitary gland cyclically secretes two hormones which directly
stimulate the ovary these hormones are follicle stimulating and luteinizing
hormones. As follicle stimulating and luteinizing hormones act on the follicle, its
cells multiply causing a large fluid—filled cavity to form. The growth and activity
of the follicular cells result in the secretion of estrogen by the cells, and this
hormone is found in the fluid of the follicle. Luteinizing hormones cause the cells
of the follicle to rupture and expel the ovum. Then the fluids and cells form a new
structure called the corpus luteum. The corpus luteum is stimulated by the
gonadotropins and initiate the production of the hormone, progesterone.
Progesterone causes the lining of the uterus to change, thus getting it ready for the
reception, embedding, and gestation of a fertilized ovum. The coordinated action
of progesterone and estrogen makes the lining of the uterus an environment where
an embryo can survive during pregnancy.

Menstruation occurs approximately every three to four weeks. If the ovum is not
fertilized, most of the lining of the uterus mixed with blood is expelled through the
cervix into the vagina. This bloody discharge is referred to as menstruation
(menses) or a menstrual period. The entire cycle repeats itself with regularity
throughout the reproductive life of the female. However, at its onset after puberty,
menstruation may be irregular for up to a year or two.

Adolescent maturation is a personal phase of development where children have to

establish their own beliefs, values, and what they want to accomplish out of life.
Because adolescents constantly and realistically appraise themselves, they are
often characterized as being extremely self-conscious. However, the self-
evaluation process leads to the beginning of long-range goal setting, emotional and
social independence, and the making of a mature adult.

Three distinct stages can be identified in the psychological development of the

adolescent, even though there is a great deal of overlap in the stages, and they may
not occur during the age span indicated. During early adolescence (ages 11-13),
development usually centers around developing a new self-image due to their
physiological changes. Adolescents need to make use of their newly acquired skills
of logical thinking and ability to make judgments rationally. When they reach the
ages of fourteen and fifteen (the period known as mid-adolescence), adolescents
strive to loosen their ties to their parents and their emotions and intellectual
capacities increase. The adolescent becomes adventuresome, and experiments with
different ideas. This plays an important role in finding one’s relations to oneself,
groups, and opposite sex. During this time, the adolescent battles over his own set
of values versus the set established by parents and other adult figures. The
adolescent also begins to take on more control of educational and vocational
pursuits and advantages. It is during this time that adolescents’ self-dependence
and a sense of responsibility become apparent, along with their quest to contribute
to society and find their place in it. During late adolescence (ages range from
sixteen on), adolescents have a more stable sense of their identity and place in
society. At this stage in life they should feel psychologically integrated and should
have a fairly consistent view of the outside world. Adolescent should, by this time,
have established a balance between their aspirations, fantasies, and reality. In order
for them to achieve this balance they should be displaying concern for others
through giving and caring, instead of the earlier childhood pattern of self-
gratification.

At the conclusion of late adolescence they should have had designed or discovered
their role in society, have set a realistic goal in life, and have begun in ernest to
achieve it.

Using Developmental Psychology To Understand the Adolescent

Explaining the psychological development of adolescent is difficult due to the lack
of empirical research and the great variety of adolescent behavioral modes.
However, developmental psychologists have formulated theories describing human
psychological development which are useful in understanding adolescents. They
demonstrate sequential patterns of development and make some rough estimates
about the ages at which they should demonstrate particular developmental
characteristics. Because of the great benefits that developmental psychology offers
both teachers and parents in suggesting ways to help children in our society, and its
usefulness in identifying children who lack skills, I will conclude this section by
exploring three significant theories to show how they characterize adolescent’s
development in the areas of cognition, moral reasoning, and establishing identity.
In developing lesson plans that utilize these theories, the teacher must find the
overall level at which the class is functioning. For example, once Piaget’s theory is
reviewed, the teacher should develop lessons which will help the students move
from the concrete level of thinking, to the formal operational stage. I have included
two activities in which Piaget’s theory is performed with a group of students. As
you read the lesson plans based on Piaget’s theory, it is the behavioral tasks that
are important not the outcome. The more advanced the adolescents performing the
experiment, the more systematically they will perform the task. Upon completion
of this exercise, teachers will discover the connection between Piaget’s theory and
Erickson’s psychosocial theory. In order for the adolescent to develop a sense of
industry (See Erickson’s theory below for explanation), students must feel that
they are academically successful in school. Therefore, when students complete
“hands-on” academic tasks like those given by Piaget, they will feel good about
themselves. Review of Erickson’s theory below will stress to the teacher the
critical importance of identity development within the adolescent. In the lesson
plans provided in this curriculum unit you will find exercises that will help
children critically think about their personalities and future vocation.
Another vital aspect of adolescent psychological development includes the
evolution of values through moral reasoning. Lawrence KohIberg’s theory on
moral development provides valuable insight into the evolution of moral reasoning
within human beings. This theory provides educators a basis for understanding
how this aspect of adolescent psychological development occurs and helps to
categorize the level at which the adolescent reasons. According to KohIberg’s
theory, adolescence should be provided with hypothetical dilemmas where students
can explore their feelings and openly discuss their viewpoints in choosing between
conflictual situations. Through their discussions, adolescents become more aware
of their power to make choices and decisions about their lives. Lesson plans
reflecting this theory have been included which involve two hypothetical situations
which help to guide adolescent moral reasoning through group discussion. The
teacher’s role in the lessons will be to act as a facilitator in encouraging the
students to voice and accept opinions of others.

Piaget’s Theory of Cognitive Development

Jean Piaget dedicated most of his life’s work to understanding how children
develop intellectually. His work on cognitive development is the most complete
theory available today and is widely used. (Pulaski, 1970) According to Piagetian
theory, children progress through four stages in their cognitive development—
seriomotor (birth to two years of age), pre-operational (2 to 7 years of age),
concrete operational (7 to 11 years of age) and formal operational (11 to 15 years
of age). Each of these stages represent a qualitative leap forward in the child’s
ability to solve problems and reason logically. As children enter adolescence, their
cognitive abilities lie somewhere between Piaget’s third stage of cognitive
development—the period of concrete operational—and the fourth, or last stage—
formal operational. During the concrete operational stage, children begin to
understand the concept of conservation. From the Piagetian perspective,
conservation means that children realize that quantities remain the same, even if
they are placed in containers of. different shapes and sizes. The adolescent also
becomes less egocentric, that is, he now understands that everyone does not see
things in the same way that he does. The adolescent also becomes capable of
reasoning deductively, perform simple operations with physical objects, and apply
logic to arrive at conclusions. Even though adolescents at the latter part of this
stage display some cognitive maturity, they still are incapable of thinking
abstractly .

During this stage, things are understood concretely and literally. For example, you
cannot say: “That was the straw that broke the camels back,” and expect the child
to understand what you are talking about. Unrealistic math problems such as: if a
dog has six legs, then how many legs will four dogs have, will result in a child
arguing that a dog does not have six legs. However, once the adolescent enters the
last stage—formal operational he/she develops the ability to test hypotheses in a
mature, scientific manner. They can communicate their position on complex
ethical issues, and become capable of thinking abstractly. They can discuss abstract
terms such as freedom or liberty without difficulty. Although Piaget was not
interested in formal teaching strategies, educators have applied Piagetian concepts
to educate children. Examples of Piagetian theory being used in school includes:
(1) using Piagetian tasks to determine the intellectual ability of students; (2)
teaching students with cognitive levels in mind; (3) being careful to sequence
instruction; (4) testing children to find the results of teaching; (5) encouraging
social interaction to facilitate learning, and (6) remembering that children’s thought
processes are not the same as adults.

Erik Erikson’s Psychosocial Theories

Psychosocial theorists based the development of identity on the outcome of crises

that occur during the life of a person. Psychosocial theorists define crises as times
at which a person actively focuses on, and questions, aspects of his/her identity.
Erickson’s psychosocial theory states that human beings develop according to a
preset plan, the epigenetic principle, that consist of two main elements. First,
personality develops according to a predetermined pattern that is maturationally
set. Second, each society is structured to encourage challenges that arise during
these times.

According to Erikson’s theory, individuals proceed through eight stages of

development which begin at birth and conclude at death. If the particular crisis is
handled appropriately, the outcome will be positive. If not, then a negative
outcome will be the result. The two stages which involve conflicts that
significantly affect early and late adolescent development are stage 4, the latency
state (ages 6-11), and stage 5, puberty and adolescence (ages 12-18).

Stage four of Erikson’s theory occurs during the middle school years when
children must master skills in math, reading, and writing. At that time the child is
faced with the conflict of industry versus inferiority. If the child masters the skills,
the child develops a sense of industry and has a positive view of the achievement.
However, if a child doesn’t meet the expectations of mastering these skills and is
constantly criticized, then he/she may develop a feeling of inferiority. The fifth
psychosocial stage occurs during the ages of 11-18. Adolescents begin to consider
their futures and decide on careers. During this stage they face the conflict of
identity versus role confusion. If the adolescent formulates a satisfying plan of
action about his/her future, then the outcome is positive and establishment of
identity is achieved. Adolescents who do not develop this sense of identity may
develop “role confusion” and aimlessly move through life without any plan of
action or sense of security about their future. Erikson’s theory demonstrates the
importance of the educator’s role in helping children establish their identity upon
reaching adolescence. The child must master academic skills in order to feel
positive about him/herself. In addition to monitoring skill mastery, the educator
must cover the topic of career exploration, and expose the adolescence to as many
career choices as possible. Should the adolescent show interest in a certain
occupation, then exposure to the right vocational program or academic track is in
order to help him/her successfully pursue a goal.

KohIberg’s Theory of Moral Reasoning

Lawrence Kohlberg viewed development in terms of different levels of reasoning
applied to choices people make in their lives. This type of moral reasoning occurs
throughout a person’s life and depends on an individual’s social interaction. A
person evolves from one level of reasoning to another as he/she is able to
understand the higher level of reasoning and is able to experience in social
interactions a conflict that imples then to accept the newer, higher-level values.
KohIberg viewed moral reasoning in three levels which included six sequential
stages. KohIberg perceived these stages as universal, that is, no stage is ever
skipped, and applicable to all cultures. Kohlberg stressed that the actual decisions
people make are not important, but that the reasoning behind the decisions was
important. This reasoning determines which stage of development a child is in.

Unlike the other theories discussed above, Kohlberg’s developmental levels and
stages are not related to age. Developmental levels are determined by the dilemmas
people face and the reasoning they apply in making decisions to resolve these
dilemmas. The levels of development range from reasoning based upon self-
gratification (preconventional morality), to reasoning based upon conformity
(conventional morality) to reasoning based upon individual values that have been
internalized (post conventional morality). As each level and its respective stages
are discussed below, it is important to remember that adolescents will function at a
level or stage more so than others. Determination of the stage at which an
adolescent is functioning must be determined by observation and evaluation of the
reasoning applied by the child to the dilemmas he/she faces.
Level One: Pre-conventional Morality

At this level, the child makes decisions based on cultural roles of what is considered to be right
or wrong. The reasoning applied is based upon reward and punishment and the satisfaction of
their own needs. This level is divided into two stages.

Stage One Punishment and Obedience Orientation.

The child acting in this level avoids breaking rules because he/she may be punished. The child
demonstrates complete deference to rules. Often the interest of others are not considered.

Stage Two Instrumental Relativist Orientation.

The reasoning applied during this stage is the one that satisfies the needs of the individual and
sometimes the needs of others. However, the only reason that the individual helps another is
because a deal has been made where the person the individual helps owes him/her something.

Level Two: Conventional Morality

Conformity is the most important aspect at this level. The individual conforms to the expectation
of others, including the general social order. KohIberg has identified two stages within this level.

Stage Three Interpersonal concordance or “Good Boy/Nice Girl Orientation.”

Living up to the expectations of others and good behavior are the important considerations for
the individual in this stage. There is an emphasis on gaining approval by being nice.

Stage Four “Law and Order” Orientation.

The person acting in this stage is oriented towards authority and maintaining the social order.
The emphasis is on doing one’s duty and showing respect for authority.

Level Three: Post conventional Morality

People who are in this level make decisions on the basis of individual values that have been
internalized. These values are not dependent on one’s friends, family, or group, but totally on the
individual making the decision. The stages of reasoning also comprise this level.

Stage Five Social Contract, Legalistic Orientation.

In this stage, correct behavior is defined in terms of individual rights and the consensus of
society. Right is a matter of personal opinion and values, but there is an emphasis on the legal
point of view present here.

Stage Six Universal Ethical Principle Orientation.

In this highest stage, the correct behavior is defined as a decision of conscience in accordance
with self-chosen ethical principles that are logical, universal and consistent. These are very
abstract guidelines. (Kohlberg and Kramer, 1969)