Adolescent developmental trajectories

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Adolescent developmental trajectories

• Dr Julie Alderson
• Paediatric Clinical Psychologist BCH

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Aims

• Revision what adolescent development is
• Recent advances adolescent thinking
• Position the adolescent patient within family
  and healthcare systems
• Prompt thinking how cancer treatment can
  impact on adolescent development

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Adolescent to adult
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Theorists

• Freud - psychosexual development, adolescence as
  a recapitulation of the development of sexual
  awareness in infancy.
• Piaget - cognitive development, seeing the
  development of abstract thinking abilities as
  making possible the transition to independent
  adult functioning.
• Erikson - development of personal identity

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Biopsychosocial

• Adolescence involves biological (puberty, sexual
  development brain) , psychological and social
  changes.

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To Do

• Challenge authority
• Seek spiritual paths
• Take risks
• Experiment with drugs, alcohol and sex
• Change educational environment
• Challenge moral and social structure of society

• Develop relationships
• Demand rights
• Understand sexuality
• Renegotiate rules at home
• Take responsibility for self and others
• Get job

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Nutshell

• Grow up
• Find self
• Get a sexuality that fits

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The problem/beauty of adolescence

• the Piagetian concept of "formal operations" in
  thinking style not established.
• egocentric and feel invulnerable to harm.
• depend more on intuition than rational thinking.

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You said my risk of developing skin cancer is
greater than other peoples

• Concrete
• Well, Ive had holidays in Spain for the 5 years
  before coming to this clinic and Ive come to no
  harm. My skin copes well with sun.

• Abstract
• Ive seen no problems yet but I may have already
  done some damage and increased my risk further.
  Id better be extra careful in future just in
  case.

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Neurological development

• Adolescents are not adults.
• They are on their way to becoming adults.

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Early to mid 20s

• The prefrontal cortex (PFC) is one of the last
  areas of the brain to mature
• Executive functions are
• not reliably in full effect

• Make complex judgments
• Weigh closely competing alternatives
• Control impulses
• Take the long view.

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• Interpretation of body states (Baird Bennett,
  2006)
• Visuospacial working memory (Kilgore et al, 2002)
• Greater activation of PFC in adults than
  adolescents on stop task (Rubia et al, 2000)

• Intention (Blakemore et al, 2007)
• Interpretation of emotional stimuli (Baird et
  al,1999 Kilgore et al, 2007 Thomas et al, 2007)
  

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Interpretation of emotional stimuli
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Response to fear face

• Adults

• correctly identified the expression as fear
• relied on the frontal cortex, which governs
  reason and planning

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Response to fear face

• Adults

• Adolescents

• correctly identified the expression as fear
• relied on the frontal cortex, which governs
  reason and planning

• shocked, surprised, angry
• mostly used the amygdala, a region that guides
  "gut" reactions

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Implications of

• Interpretation of body states (Baird Bennett,
  2006)
• Visuospacial working memory (Kilgore et al, 2002)
• Greater activation of PFC in adults than
  adolescents on stop task (Rubia et al, 2000)

• Intention (Blakemore et al, 2007)
• Interpretation of emotional stimuli (Baird et
  al,1999 Kilgore et al, 2007 Thomas et al, 2007)
  

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Implications

• PFC matures more slowly than other brain
  structures
• Leads to impulsivity, gut reactions risk-taking
  
• Impacts on decision making understanding
  others communication
• Knock on effects on emotional expression

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Knock on effects on emotional expression

• Dad says

• Its got so that Im afraid to remind him to do
  his physio. Whenever I say to him its time to do
  it he looks at me with sheer vitriol like he
  could kill me!

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Knock on effects on emotional expression

• Dad says

• Son says

• Its got so that Im afraid to remind him to do
  his physio. Whenever I say to him its time to do
  it he looks at me with sheer vitriol like he
  could kill me!

• Hes always wound-up and he takes it out on me.
  Hes always on at me about what I should do next.
  I just look at him and think looser.

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Add cancer

• a ball in uniform circular motion subjected to a
  centrifugal force and accelerates away from the
  centre.

• a ball in uniform circular motion held to its
  path by a string tied to a post stuck in the
  ground. the ball is subjected to a centripetal
  force by the string.

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Add cancer

• a ball in uniform circular motion subjected to a
  centrifugal force and accelerates away from the
  centre.

• a ball in uniform circular motion held to its
  path by a string tied to a post stuck in the
  ground. the ball is subjected to a centripetal
  force by the string.

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Not problem thinking

• Not deficient, but fully developed for
  adolescence
• ie, to deal with the tremendous transitions
  that humans face at this stage of life.
• (National Institute of Health 2006)

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