Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Adolescent Development

By

Evan G. Graber

, DO, Sydney Kimmel Medical College of Thomas Jefferson University

Last full review/revision Apr 2021| Content last modified Apr 2021
Click here for the Professional Version

Intellectual and Behavioral 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.

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 drug use. Experts speculate that these behaviors occur in part because adolescents tend to overestimate their own abilities in preparation for leaving home. Recent studies of the nervous system also have shown that the parts of the brain that suppress impulses are not fully mature until early adulthood.

Emotional Development

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.

Social and Psychologic Development

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 and may be difficult to detect because adolescents go to great lengths to hide the behaviors and weight changes.

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 drugs. Parents also should teach children that prescription drugs should be used only as directed by a doctor. All adolescents should be confidentially screened for substance use Substance Use and Abuse 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 practitioners have been shown to decrease substance use by adolescents.

Development of Sexuality

The start of sexual maturation Sexual Maturation (Puberty) During adolescence (usually considered age 10 to the late teens or early 20s), boys and girls reach adult height and weight and undergo sexual maturation (puberty). The timing and speed with... 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 safe-sex practices as part of routine health care and should screen all sexually active adolescents for sexually transmitted diseases.

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

Some adolescents struggle with sexual identity. 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 and are not disorders. Although it is not understood exactly why homosexual or bisexual feelings develop, experts do not think sexual or gender identities are something adolescents learn from their peers or the media or something they choose the same way they select an after-school activity or a career path. Adolescents who have a strong sense of their homosexual or bisexual identity may “come out” to their close friends or family members.

Adolescents may face many challenges as their sexual and gender identities develop. They may feel unwanted or unaccepted by family or peers if they express a certain sexual desire or a transgender identity. 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.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Test your knowledge

Overview of Bacterial Infections in Childhood
Each of the following is a very common bacterial infection that can develop in children EXCEPT:
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP