Adolescent Development

In early adolescence, a child begins to develop the capacity for abstract, logical thought. This increased sophistication leads to an enhanced awareness of self and the ability to reflect on one’s own being. Because of the many noticeable physical changes of adolescence, this self-awareness often turns into self-consciousness, with an accompanying feeling of awkwardness. The adolescent also has a preoccupation with physical appearance and attractiveness and a heightened sensitivity to differences from peers.

In mid adolescence, the weight of making decisions about a future career gets increasingly heavy, and most adolescents do not have a clearly defined goal, although they gradually realize their areas of interest and talent. Parents must be aware of the adolescent’s capabilities and help the adolescent set realistic goals. Parents also must be prepared to identify roadblocks to learning, such as learning disabilities Definition of Developmental Disorders Developmental disorders are better called neurodevelopmental disorders. Neurodevelopmental disorders are neurologically based conditions that can interfere with the acquisition, retention, or... read more , attention problems Attention-Deficit/Hyperactivity Disorder (ADHD) Attention-deficit/hyperactivity disorder (ADHD) is poor or short attention span and/or excessive activity and impulsiveness inappropriate for the child’s age that interferes with functioning... read more , behavior problems Behavioral Problems in Adolescents Adolescence is a time for developing independence. Typically, adolescents exercise their independence by questioning or challenging, and sometimes breaking, rules. Parents and doctors must distinguish... read more , or inappropriate learning environments, which need to be corrected.

Adolescents also apply their new reflective capabilities to moral issues. Preadolescents understand right and wrong as fixed and absolute. Older adolescents often question standards of behavior and may reject traditions—to the consternation of parents. Ideally, this reflection culminates in the development and internalization of the adolescent’s own moral code.

Many adolescents begin to engage in risky behaviors, such as fast driving. Many adolescents begin to experiment sexually, and some may engage in risky sexual practices. Some adolescents may engage in illegal activities, such as theft and alcohol and illicit drug use. Experts speculate that these behaviors occur in part because adolescents tend to overestimate their own abilities in preparation for leaving home. Studies of the nervous system also have shown that the parts of the brain that suppress impulses are not fully mature until early adulthood.

During adolescence, the regions of the brain that control emotions develop and mature. This phase is characterized by seemingly spontaneous outbursts that can be challenging for parents and teachers who often receive the brunt. Adolescents gradually learn to suppress inappropriate thoughts and actions and replace them with goal-oriented behaviors.

A typical area of conflict is the adolescent’s normal desire to seek more freedom, which clashes with the parents’ instincts to protect their children from harm. Frustration caused by trying to grow in many directions is common. Communication can be challenging as parents and adolescents renegotiate their relationship. All of these challenges are accentuated when families face other stresses or parents have emotional difficulties of their own because adolescents continue to need parenting. Doctors can help open lines of communication by offering adolescents and parents sensible, practical, supportive advice.

The family is the center of social life for children. During adolescence, the peer group begins to replace the family as the child’s primary social focus. Peer groups are often established because of distinctions in dress, appearance, attitudes, hobbies, interests, and other characteristics that may seem profound or trivial to outsiders. Initially, peer groups are usually same-sex but typically become mixed later in adolescence. These groups assume an importance to adolescents because they provide validation for the adolescent’s tentative choices and support in stressful situations.

Adolescents who find themselves without a peer group may develop intense feelings of being different and alienated. Although these feelings usually do not have permanent effects, they may worsen the potential for dysfunctional or antisocial behavior. At the other extreme, the peer group can assume too much importance, also resulting in antisocial behavior. Gang membership Violence and Gang Membership Adolescence is a time for developing independence. Typically, adolescents exercise their independence by questioning or challenging, and sometimes breaking, rules. Parents and doctors must distinguish... read more is more common when the home and social environments are unable to counterbalance the dysfunctional demands of a peer group.

Doctors should screen all adolescents for mental health disorders Overview of Mental Health Disorders in Children The treatment section for bipolar disorder has been extensively revised with separate treatment sections for mania and for depression. In addition, information has been added throughout to address... read more , such as depression Depression and Mood Dysregulation Disorder in Children and Adolescents Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more , bipolar disorder Bipolar Disorder in Children and Adolescents In bipolar disorder, periods of intense elation and excitation (mania) alternate with periods of depression and despair. Mood may be normal in between these periods. Children may rapidly go... read more , and anxiety Overview of Anxiety Disorders in Children and Adolescents Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances. There are many types of anxiety disorders... read more . Mental health disorders increase in incidence during this stage of life and may result in suicidal thinking or behavior Suicidal Behavior in Children and Adolescents Suicidal behavior is an action intended to harm oneself and includes suicidal gestures, suicide attempts, and completed suicide. Suicidal ideation is thoughts and plans about suicide. Suicide... read more . Psychotic disorders, such as schizophrenia Schizophrenia in Children and Adolescents Schizophrenia is a chronic disorder involving abnormal thoughts, perceptions, and social behavior and causing considerable problems with relationships and functioning. It lasts 6 months or more... read more , although rare, most often come to attention during late adolescence. Eating disorders, such as anorexia nervosa Anorexia Nervosa Anorexia nervosa is an eating disorder characterized by a relentless pursuit of thinness, a distorted body image, an extreme fear of obesity, and restriction of food consumption, leading to... read more and bulimia nervosa Bulimia Nervosa Bulimia nervosa is an eating disorder characterized by the repeated rapid consumption of large amounts of food (binge eating), followed by attempts to compensate for the excess food consumed... read more , are relatively common among girls but may also occur in boys. Eating disorders may be difficult to detect because adolescents go to great lengths to hide the behaviors and weight changes.

Illicit drug use Substance Use in Adolescents Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more typically begins during adolescence.

Alcohol use Alcohol Use in Adolescents Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more is common and is the substance most often used by adolescents. The Monitoring the Future Survey on Drug Use is a long-term study of substance use conducted by the U.S. National Institute on Drug Abuse. This survey reported that in 2021 in the United States, 54% of 12th graders had tried alcohol, and 26% had consumed alcohol in the past month and were considered current drinkers. Binge drinking Alcohol Use in Adolescents Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more is common and leads to both acute and chronic health risks. Research has shown that adolescents who start drinking alcohol at a young age are more likely to develop an alcohol use disorder Alcohol Use Alcohol (ethanol) is a depressant (it slows down brain and nervous system functioning). Consuming large amounts rapidly or regularly can cause health problems, including organ damage, coma,... read more as an adult. For example, adolescents who start drinking at age 13 are 5 times more likely to develop an alcohol use disorder than those who start drinking at age 21.

The survey reported that in 2021, about 4.1% of 12th graders reported current cigarette use Tobacco Use in Adolescents Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more (smoked in the previous 30 days), which was down from 28.3% in 1991 and from 5.7% in 2019. Only about 2% of 12th graders reported smoking every day.

Current nicotine e-cigarette use Electronic Cigarettes (Vaping Products) Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more (vaping) among 12th graders increased markedly from 11% in 2017 to 25.5% in 2019. According to the survey, in 2021 e-cigarette use decreased to 19.6%, and about 40.5% of 12th graders tried e-cigarettes (nicotine and other substances), which is a decrease from 45.6% in 2019.

The survey reported that in 2021 19.5% of 12th graders were current cannabis (marijuana) users Other Substances Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more , which is a decrease from 22.3% in 2019. About 38.6% of 12th graders reported having used cannabis one or more times in their life.

Use of other illicit drugs Other Substances Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more is much less common, although misuse of prescription medications Other Substances Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more , including drugs for pain and stimulants, is also a significant issue.

Parents can have a strong positive influence on their children by setting a good example (such as using alcohol in moderation and avoiding use of illicit drugs), sharing their values, and setting high expectations regarding staying away from illicit drugs. Parents also should teach children that prescription medications should be used only as directed by a health care professional. All adolescents should be confidentially screened for illicit drug use Substance Use in Adolescents Substance use among adolescents ranges from experimentation to severe substance use disorders. All substance use, even experimental use, puts adolescents at risk of short-term problems, such... read more . Appropriate advice should be given as part of routine health care because even very brief interventions by doctors and health care professionals have been shown to decrease substance use by adolescents.

The start of sexual maturation Sexual Maturation (Puberty) During adolescence (usually considered age 10 to the late teens), boys and girls reach adult height and weight and undergo sexual maturation ( puberty). The timing and speed with which these... read more (puberty) typically is accompanied by an interest in sexual anatomy, which may be a source of anxiety. As adolescents mature emotionally and sexually, they may begin to engage in sexual behaviors. Masturbation is common among girls and nearly universal among boys. Sexual experimentation with a partner often begins as touching or petting and may progress to oral, vaginal, or anal sex. By late adolescence, sexuality shifts from experimentation to being an expression of intimacy and sharing.

Doctors should provide appropriate advice on safer sex practices as part of routine health care and should screen all sexually active adolescents for sexually transmitted infections.

As adolescents navigate their sexuality, they may also begin to question their sexual identity and gender identity.

Gender identity starts to develop early on, but may evolve over time. In some children and adolescents, the sex they were assigned at birth does not match their gender identity. This mismatch can cause considerable mental distress known as gender dysphoria Gender Dysphoria Gender dysphoria is having feelings of significant distress or difficulty functioning related to a persistent feeling that a person's sex at birth does not match their inner sense of self as... read more . Gender dysphoria can be treated Treatment Gender dysphoria is having feelings of significant distress or difficulty functioning related to a persistent feeling that a person's sex at birth does not match their inner sense of self as... read more with psychotherapy and sometimes hormones and surgery.

Some adolescents are uncertain about sexual orientation. They may be unsure of what they are feeling, but it is common for adolescents to be attracted to or have sexual thoughts about people of the same sex and people of the opposite sex. However, many adolescents who explore homosexual or bisexual relationships ultimately do not continue to be interested in same-sex relationships, whereas others never develop interest in opposite-sex relationships.

Homosexuality Overview of Sexuality Sexuality is the way in which people experience and express the instincts and feelings that make up physical attraction for others. It is a normal part of human experience and is determined... read more , bisexuality, and asexuality are normal variations of human sexuality. Adolescents who have a strong sense of their homosexual or bisexual identity may “come out” to their close friends or family members.

Some adolescents may face challenges as their sexual and gender identities develop. They may fear their sexual identity or gender identity will not be accepted by family or peers. Such pressure (especially during a time when social acceptance is critically important) can cause severe stress. Fear of abandonment by parents, sometimes real, may lead to dishonest or at least incomplete communication between adolescents and their parents. These adolescents can also be taunted and bullied Bullying Bullying is a form of youth violence in which repeated verbal, emotional, physical, or psychologic attacks are done to dominate or humiliate. (See also Overview of Social Issues Affecting Children... read more by their peers. Threats of physical violence should be taken seriously and reported to school officials or other authorities. The emotional development of these adolescents is best helped by supportive friends and family members.

Few elements of the human experience combine physical, intellectual, and emotional aspects as thoroughly as sexuality and all the feelings that go along with it. Helping adolescents put sexuality and gender identity into a healthy context is extremely important. Parents should share their values and expectations openly with their adolescents but be receptive and supportive as their child’s sexual and gender identities develop.