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Behavioral Problems in Adolescents

By Sharon Levy, MD, MPH, Assistant Professor of Pediatrics;Director, Adolescent Substance Abuse Program, Harvard Medical School;Boston Children's Hospital

Adolescence is a time for developing independence. Typically, adolescents exercise their independence by questioning, and sometimes breaking, rules. Parents and doctors must distinguish occasional errors of judgment from a degree of misbehavior that requires professional intervention. The severity and frequency of infractions are guides. For example, regular drinking, frequent episodes of fighting, truancy, and theft are much more significant than isolated episodes of the same activities. Other warning signs include deterioration of performance at school and running away from home. Of particular concern are adolescents who cause serious injury or use a weapon in a fight.

Because adolescents are much more independent and mobile than they were as children, they are often out of the direct physical control of adults. In these circumstances, adolescents' behavior is determined by their own moral and behavioral code. Parents guide rather than directly control the adolescents' actions. Adolescents who feel warmth and support from their parents are less likely to engage in risky behaviors. Also, adolescents whose parents convey clear expectations regarding their children’s behavior and show consistent limit setting and monitoring are less likely to engage in risky behaviors. Authoritative parenting is a parenting style in which children participate in establishing family expectations and rules. This parenting style, as opposed to authoritarian-style parenting (in which parents make decisions with minimal input from their children) or permissive parenting (in which parents set few limits) is most likely to promote mature behaviors.

Authoritative parenting typically uses a system of graduated privileges, in which adolescents initially are given small bits of responsibility and freedom (such as caring for a pet, doing household chores, purchasing clothing, decorating their room, or managing an allowance). If adolescents handle this responsibility well over a period of time, more responsibilities and more privileges (such as going out with friends without parents, and driving) are granted. By contrast, poor judgment or lack of responsibility leads to loss of privileges. Each new privilege requires close monitoring by parents to make sure adolescents comply with the agreed-upon rules.

Some parents and their adolescents clash over almost everything. In these situations, the core issue is really control. Adolescents want to feel in control of their life, and parents want adolescents to know the parents still make the rules. In these situations, everyone may benefit from the parents picking their battles and focusing their efforts on the adolescent's actions (such as attending school and complying with household responsibilities) rather than on expressions (such as dress, hairstyle, and preferred entertainment).

Adolescents whose behavior is dangerous or otherwise unacceptable despite their parents' best efforts may need professional intervention. Substance use is a common trigger of behavioral problems, and substance use disorders require specific treatment. Behavioral problems also may be a symptom of learning disabilities, depression, or other mental health disorders. Such disorders typically require counseling and mental health disorders often also require treatment with drugs. If parents are not able to limit an adolescent’s dangerous behavior, they may request help from the court system and be assigned to a probation officer who can help enforce reasonable household rules.

Specific Behavioral Disorders

Disruptive behavioral disorders are common during adolescence.

Attention-deficit/hyperactivity disorder (ADHD) is the most common mental health disorder of childhood and often persists into adolescence and adulthood. However, adolescents who have difficulty paying attention may instead have another disorder, such as depression or a learning disability. Although ADHD is often treated with stimulant drugs (such as amphetamine or methylphenidate), which are often abused, such treatment does not appear to increase the risk of developing a substance use disorder in individuals who are appropriately diagnosed with ADHD. On the other hand, some adolescents complain of symptoms of inattention in an attempt to obtain a prescription for stimulants, either to be used as a study aid or recreationally.

Other common disruptive behaviors of childhood include oppositional defiant disorder and conduct disorder.

Violence and Gang Membership

Children occasionally engage in physical confrontation. During adolescence, the frequency and severity of violent interactions may increase. Although episodes of violence at school are highly publicized, adolescents are much more likely to be involved in violent episodes (or more often the threat of violence) at home and outside of school. Many factors contribute to an increased risk of violence for adolescents, including

  • Gang membership

  • Access to firearms

  • Substance use

  • Poverty

There is little evidence to suggest a relationship between violence and genetic defects or chromosomal abnormalities.

Gang membership has been linked with violent behavior. Youth gangs are self-formed associations made up of 3 or more members, typically ranging in age from 13 to 24. Gangs usually adopt a name and identifying symbols, such as a particular style of clothing, the use of certain hand signs, or graffiti. Some gangs require prospective members to perform random acts of violence before membership is granted.

Increasing youth gang violence has been blamed at least in part on gang involvement in drug distribution and drug use, particularly heroin. Firearms and other weapons are frequent features of gang violence. By 2015, almost 25% of high school males in the United States reported carrying a weapon at least once during the month before they took part in a study about youth risks. A much smaller percentage (4%) reported having carried a gun to school during that same period.

Violence prevention begins in early childhood with violence-free discipline. Limiting exposure to violence through media and video games may also help because exposure to these violent images has been shown to desensitize children to violence and cause children to accept violence as part of their life. School-age children should have access to a safe school environment. Older children and adolescents should not have access to weapons and should be taught to avoid high-risk situations (such as places or settings where others have weapons or are using alcohol or drugs) and to use strategies to defuse tense situations.

All victims of gang violence should be encouraged to talk to parents, teachers, and even their doctor about problems they are experiencing.

Drugs Mentioned In This Article

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  • CONCERTA, RITALIN