AGE: 12 through 18 years

THEORY
Piaget (cognitive development) -- This "Stage of Formal Operations" is characterized by a reduced dependence upon objects or imagery for thinking through problems and situations. The adolescent develops an ability to comprehend purely abstract content such as higher mathematic concepts and philosophy. An ability evolves to learn about and apply general information necessary to adapt, and specific information necessary for an occupation.

Erickson (personal-social development) -- Two different tasks are identified by Erickson for adolescence. The first is "Identity vs. Role Diffusion," which requires the individual to question old values without a sense of dread or loss of identity and to move gradually towards a more mature sense of identity and purpose. The second task, "Intimacy vs. Isolation," is necessary for the individual to pave the way for establishing and maintaining satisfying personal relationships by learning to share intimacy without inhibition or dread.

Freud (psychosexual stages) -- The "Genital Stage" is characterized by new energy which breaks the stability of the repressed sexuality of childhood with a new and dynamic focus upon physical changes and a move from sexual indifference toward more mature and intimate relationships, which may include sexual attractions.

Kohlberg (moral development) -- "Post Conventional Morality" develops as the individual begins to conceptualize abstract moral philosophies including rights and privileges. The more sophisticated moral code allows one to distinguish between morality and legality.

PHYSICAL DEVELOPMENT
Adolescence is characterized by dramatic physical changes moving the individual from childhood into physical maturity. Early, prepubescent changes are noted with the appearance of secondary sexual characteristics.

Girls may begin to develop breast buds as early as 8 years old, with full breast development achieved anywhere from 12 to 18 years. Pubic hair growth (as well as armpit and leg hair) typically begins at about age 9 or 10 and reaches adult distribution patterns at about 13 to 14 years.

Menarche (the beginning of menstrual periods) typically occurs about 2 years after initial pubescent changes are noted. It may occur as early as 10 years, or as late as 15 years, with the average in the United States being about 12.5 years. A concurrent rapid growth in height occurs between the ages of about 9.5 and 14.5 years, peaking somewhere around 12 years.

Boys may begin to note scrotal/testicular enlargement as early as 9 years of age followed closely by lengthening of the penis. Adult size and shape of the genitals is typically reached by age 16 to 17 years. Pubic hair growth (as well as armpit, leg, chest, and facial hair) in males usually begins about age 12 years and reaches adult distribution patterns at about 15 to 16 years.

A concurrent rapid growth in height occurs between the ages of about 10.5 to 11 and 16 to 18, peaking somewhere around 14 years. Puberty is not marked with a sudden incident in males, as it is with the onset of menstruation in females. The appearance of regular nocturnal emissions "wet dreams", which may occur about every 2 weeks with the build-up of seminal fluid, marks the onset of puberty in males.

This typically occurs somewhere between the ages of 13 to 17 years, with the average at about 14.5 years. Voice changes in the male typically occur parallel to penile growth, the occurrence of nocturnal emissions and the peak of the height spurt.

BEHAVIOR
The sudden and rapid physical changes that adolescents experience typically lend this period of development to be one of self-consciousness, sensitivity and concern over one's own body changes, and excruciating comparisons between oneself and peers.

Because physical changes may not occur in synchrony, adolescents may go through stages of awkwardness, both in terms of appearance and physical mobility/coordination. Unnecessary anxieties may arise if adolescent girls are not informed and prepared for the menarche (the onset of menstrual periods) and adolescent males are not provided accurate information and prepared for the onset of nocturnal emissions.

During adolescence, it is appropriate for youngsters to have and demonstrate a need to separate from their parents and establish their own identity. In some, this may occur with minimal reaction on the part of all involved.

However, in some families, significant conflict may arise over the adolescent's acts or gestures of rebellion and the parents' needs to maintain control and have the youth continue in his or her former childhood behaviors of compliance.

As adolescents pull away from parents in a search for their own identity, the peer group takes on a special significance. It may become a "safe" haven, in which the adolescent can test new ideas and compare his or her own physical and psychological growth.

In early adolescence, the peer group usually consists of members of the same gender forming "cliques", gangs, or clubs. Members of the peer group attempt to behave alike, dress alike, have secret codes or rituals, and participate in the same activities. As the youth moves into mid-adolescence (14 to 16 years) and beyond, the peer group expands to include members of the opposite sex.

Mid to late adolescence is characterized by a need to establish sexual identity through becoming comfortable with one's own body and sexual feelings. Through friendships with members of the opposite sex, dating, and experimentation, adolescents learn to express and receive intimate or sexual advances in a comfortable manner that is consistent with internalized values.

Young people who do not have the opportunity for such experiences may demonstrate difficulty in establishing intimate relationships into adulthood.

Adolescents typically demonstrate behaviors consistent with several "myths of adolescence":

• The first is that they are "on stage" with the attention of others constantly centered upon their appearance or actions. This preoccupation stems from the fact that adolescents spend so much time thinking and looking at themselves, it is only natural to assume that everyone else is also thinking and looking at them as well. In reality, this doesn't occur because "everyone else" (usually peers) are too preoccupied with themselves and their own issues to be overly concerned with those of others. This normal self-centeredness may appear (especially to adults) to border on paranoia, narcissism, or even hysteria.
• Another "myth of adolescence" is that of the "indestructible self." This belief feeds into ideation of "it will never happen to me, only the other person." In this sense, "it" may represent becoming pregnant or incurring a sexually transmitted disease after having unprotected intercourse; causing an auto accident while driving under the influence of alcohol or drugs; developing oral cancer as a result of chewing tobacco; or any of the numerous adverse effects of a wide range of risk-taking behaviors.

SAFETY
Adolescent safety issues stem from increased strength and agility that may develop before optimal decision-making skills develop. A strong need for peer approval, coupled with the "myths of adolescence," may initiate youths attempting hazardous feats and participating in a variety of risk-taking behaviors.

Appropriate motor vehicle safety needs to be emphasized, focusing upon the roles of driver, passenger, and pedestrian; the influence of substance abuse; and the importance of using seat belts. Privileges associated with cars and recreational motor vehicles should depend upon the adolescent's ability to demonstrate an adequate knowledge base and safe use of such vehicles.

Adolescents pursuing recreational athletic activities should be taught to use adequate equipment, protective gear or clothing, safe facilities, proper rules of safe play, and rational approaches to activities requiring advanced skill levels.

Young people need to be acutely aware of the potential dangers (including sudden death) which may occur not only with regular substance abuse, but even experimental use of drugs and alcohol.

Adolescents who are allowed to use or have access to firearms need to learn proper use, safety, and legal issues associated with guns.

If adolescents appear to be isolated from peers, disinterested in school or social activities, or demonstrate a sudden decrease in performance related to school, work, or sports; psychological evaluation may be necessary.

Many adolescents are at increased risk for depression and potential suicide due to pressures and conflicts that may arise within families of origin, school or social organizations, and intimate relationships.

PARENTING TIPS
Adolescents usually require privacy in which to contemplate changes taking place within their own bodies. Ideally the youth should be allowed to have his or her own room, but if this is not possible some private space needs to be allotted.

Teasing an adolescent child about physical changes is inappropriate, because it may cause self-consciousness and embarrassment.

Parents need to remember that the adolescent's interest in body changes and sexual topics is natural, normal development and does not necessarily indicate movement into sexual activity.

One must take care not to label emerging instinct/behaviors as "wrong," "sick," or "immoral." Adolescents may experiment with or consider a wide range of sexual orientations/behaviors prior to settling upon their own sexual identity.

A re-emergence of the Oedipal complex (child's attraction for the parent of the opposite sex) is common during adolescent years. Healthy parents deal with this by noting the physical changes and attractiveness of the child and taking pride in the youth's growth into maturity without crossing appropriate parent and child relationship boundaries.

It is normal for the parent to find the adolescent attractive, particularly as the teen often looks very similar to appearance of the other (same sex) parent at an earlier age. This attraction may cause the parent to feel awkward, but care should be taken by the parent not to create distance (and potentially make the adolescent feel something is wrong with him or her self). It is inappropriate for a parent's attraction to their child to be anything more than an attraction as a parent (incest).

The teenager's quest for independence is normal development and need not be looked upon by the parent as rejection or a loss of control. To be of most benefit to the growing adolescent, parents need to remain a constant and consistent figure, available as a sounding board for the youth's ideas without dominating and overtaking the emerging, independent identity of the young person.

Despite adolescents constantly challenging authority figures, they need or want limit setting as it provides a safe boundary in which to grow and function. Limit setting refers to predetermined and negotiated rules and regulations regarding behavior.

In contrast, "power struggles" arise when authority is at stake or being "right" becomes the primary issue. These situations should be avoided as ultimately one of the parties (typically the teen) is overpowered; causing the youth to lose face and activating feelings of embarrassment, inadequacy, resentment, and bitterness.

Parents need to be prepared for and recognize that there are commonly occurring conflicts that may develop in parenting adolescents. The experience may be influenced by unresolved issues from their own childhoods as well as unresolved issues from the adolescent's earlier years.

Parents can anticipate their positions of authority to be repeatedly challenged as children enter and move through their adolescent years. Maintaining open lines of communication and clear, yet negotiable, limits or boundaries may prove useful in minimizing major conflicts.

Most parents report a sense of increased wisdom and self-growth and they rise to the challenges presented through parenting adolescents.