Psychosocial Development in Adolescents

In school, as adolescents encounter lessons and homework that is increasingly complex, they begin to identify areas of interest as well as relative strengths and weaknesses. Adolescence is a period during which young people may begin to consider career options, although most do not have a clearly defined goal. Parents and clinicians must be aware of the adolescent’s capabilities, help the adolescent formulate realistic expectations, and be prepared to identify impediments to learning that need remediation, such as learning disabilities, attention problems, behavior problems, or inappropriate learning environments.

Particular school issues may include:

• Fear of going to school

• School avoidance

• Academic underachievement (particularly a change in grades or a drop in performance)

• Truancy

• Dropping out

If school-related issues arise, school personnel and parents should collaborate to identify the reason and develop an approach to help the adolescent address these challenges.

Cognitive development also impacts how adolescents view and navigate their lives. In early adolescence, children begin 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 often also has a preoccupation with physical appearance and attractiveness and a heightened sensitivity to differences from peers. These feelings are also impacted by social expectations and pressures, and by social media (1).

Adolescents apply their new reflective capabilities to moral issues. Preadolescents typically understand right and wrong as fixed and absolute (2). Adolescents often question standards of behavior and may reject traditional customs or values—sometimes to the consternation of parents. Ideally, this reflection culminates in the development and internalization of the adolescent’s own moral code.

During adolescence, many regions of the brain develop and mature, including the limbic system, which is responsible for emotional regulation (1). This phase is characterized by impulsivity and seemingly spontaneous outbursts that can be challenging for parents and teachers. Adolescents gradually learn to suppress inappropriate thoughts and actions and replace them with goal-oriented behaviors. The emotional aspect of growth during adolescence is often challenging in that it taxes the patience of parents, teachers, and clinicians. Emotional lability is a direct result of neurologic development during this period as the parts of the brain that control emotions mature.

Psychosocial adjustment is a hallmark of this phase of development because even healthy adolescents with normal development struggle with issues of identity, autonomy, sexuality, and relationships (2).

Communication, even within stable families, can be difficult and is worsened when there are significant stressors in the family or parents have emotional issues of their own. Clinicians can be of great help by offering adolescents and parents sensible, practical, concrete, supportive help while facilitating communication within the family.

Mental health disorders, such as depression, anxiety, and eating disorders, are important issues to identify during adolescence (3). Clinicians should screen adolescents for mental health issues.

During adolescence, developing independence is a major focus. “Who am I, where am I going, and how do I relate to all of these people in my life?” are frequent preoccupations for most adolescents. This period of development provides opportunities for adolescents to learn about how to take care of their own health and adopt healthy behaviors and also often involves risk-taking behavior or vulnerability to health risks.

The adolescent’s desire for more freedom may clash with the parents’ strong instincts to protect their children from harm, resulting in conflict. Caregivers may need help in renegotiating their role and slowly allowing their adolescents more privileges as well as expecting them to accept greater responsibility for themselves and within the family.

Adolescents are becoming increasingly independent and therefore are often not in the direct physical control of adults. In these circumstances, adolescents determine their own behavior, which is influenced by maturity and executive functioning. Parents guide, rather than directly control, their children's actions.

Typically, one way that adolescents exercise independence is by questioning or challenging parents' or guardians' rules, which, at times, leads to breaking rules. Many adolescents begin to engage in risky behaviors (1, 2), such as fast driving. Many adolescents begin to experiment sexually, and some may engage in risky sexual practices. Some adolescents may engage in drug and alcohol use. Experts speculate that these behaviors occur in part because adolescents are testing boundaries and are primed for seeking novel experiences, which is an important component of this developmental stage (3). Studies of the nervous system also have shown that the parts of the brain that suppress impulses are not fully mature until early adulthood (4, 5).

Parents and health care professionals must distinguish occasional errors of judgment, which are expected and help adolescents learn about healthy risk taking, from a degree of misbehavior that requires professional intervention. The severity and frequency of infractions inform the need for intervention. For example, recurrent binge drinking and engaging in frequent school truancy are much more significant than isolated episodes of the same activities (6, 7, 8). If a disruptive behavioral disorder is impairing functioning, warning signs include deterioration of performance at school, disengagement from activities previously enjoyed, and running away from home. Of particular concern are adolescents who cause serious injury to themselves or others or who use a weapon in a fight.

Taking risks, engaging in extreme behaviors, and testing abilities and limits are all normal actions and are developmentally typical during adolescence. Adolescents who feel warmth and support from their parents are less likely to develop serious problems (9, 10), as are those whose parents convey clear expectations regarding their children's behavior and show consistent limit setting and monitoring (11, 12).

The family is the center of social life for young children. During adolescence, the peer group begins to replace the family as the child’s primary social focus. Peer groups are often established based on distinctions in dress, appearance, attitudes, hobbies, interests, and other characteristics that may seem profound or trivial to outsiders. 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 mental health issues and, rarely, for antisocial behavior.

Conversely, the peer group can assume too much importance, also resulting in challenging behavior due to peer pressure or fear of being ostracized. Bullying among peers is common and has well-described negative outcomes for adolescents (1).