SOME GENERAL PRINCIPLES ABOUT PROBLEMS IN ADOLESCENCE
Although the vast majority of young people move through the adolescent years without experiencing major difficulty, some encounter serious psychological and behavioral problems that disrupt not only their own lives, but also the lives of those around them. Problems such as substance abuse, depression and suicide, and disorders of conduct (including crime and delinquency), while certainly not the norm during adolescence, affect a worrisome number of teenagers.
In thinking about problem behavior during adolescence, it is important to distinguish between experimentation and enduring patterns of behavior, between problems that have their origins during adolescence and those that do not, and between problems that are transitory and those that persist into adulthood.
PSYCHOSOCIAL PROBLEMS: THEIR NATURE AND CO-VARIATION
Clinical practitioners distinguish between three broad categories of problems: substance abuse, internalizing, and externalizing disorders. There is a great deal of comorbidity or co-occurrence among these problems.
Problem Behavior Syndrome: Adolescents who engage in unconventional behavior, for example, are more likely than their peers to be truant, to use and abuse drugs, engage in precocious sexual behavior, and commit acts of aggression or risk-taking behavior--a perspective called problem behavior syndrome. An alternative theory, posited by Denise Kandel, argues that problem behavior simply breeds other problem behavior. A third view, social control theory, suggests that individuals who do not have strong bonds to society's institutions (e.g., school, family) will be likely to deviate and behave in unconventional ways.
Comorbidity of Internalizing Problems: Adolescents who suffer from depression are more likely than their peers to feel anxious and exhibit other symptoms of negative affectivity.
SUBSTANCE USE AND ABUSE IN ADOLESCENCE
Prevalence of Substance Use and Abuse in Adolescence: Studies of drug and alcohol use indicate that most adolescents have experimented with alcohol and marijuana (considered gateway drugs), that many have used one or both of these drugs regularly, that alcohol is clearly the drug of choice among teenagers, and that most teenagers have not experimented with other drugs. Survey data indicate that alcohol use has been steady during the past few years, while the use of cigarettes, marijuana, LSD, stimulants, and inhalants have all increased significantly during the last half of the 1990s. The reason for these increases is unclear.
Causes and Consequences of Adolescent Substance Use and Abuse: Research indicates a clear need to distinguish between experimentation with alcohol and marijuana (which has not been shown to be harmful) and substance abuse (which has). Adolescents who abuse alcohol and other drugs are more likely to come from hostile family environments, to have friends who use drugs, and to have other problems in school as well as in their interpersonal relationships. Four sets of risk factors for substance abuse have been identified: psychological, familial, social, and contextual. Researchers have also identified important protective factors (e.g., positive mental health, high academic achievement, close family relations, and involvement in religious activities) that decrease the likelihood of adolescents' engaging in substance use.
Prevention and Treatment of Substance Use and Abuse: One of the problems with all prevention programs is that they often do not distinguish between drug use and drug abuse. The most promising interventions for substance abuse programs in adolescence are those that target the adolescent's social environment as well as the individual.
ANTISOCIAL BEHAVIOR, VIOLENCE, AND OTHER EXTERNALIZING PROBLEMS
The Prevalence of Antisocial Behavior During Adolescence: Adolescents account for a disproportionately high number of crimes, including violent crimes and property crimes. Research on juvenile crime and delinquency suggests that although most adolescents violate the law at one time or another, a relatively small number of adolescents account for a relatively high proportion of serious criminal activity. Part of this pattern stems from the fact that certain violations, called status offenses (e.g., truancy, running away from home), are by definition limited to minors. In general, the earlier an adolescent's "criminal career" begins, the more likely he or she is to become a chronic offender, commit serious and violent crimes, and continue committing crimes as an adult.
Minority youth are far more likely to be arrested and far more likely to be treated harshly by the juvenile justice system than are non-minority youth.
Causes of Antisocial Behavior in Adolescents: Studies show that children who become delinquents are more likely than their peers to suffer from attention deficit/hyperactivity disorder(ADHD). In addition, individuals with a hostile attributional bias are more likely than their peers to interpret ambiguous interactions with other children as deliberately hostile and react aggressively in retaliation.
Children who develop antisocial tendencies have histories of aggressive and violent behavior that are identifiable as early as age 8. These delinquents typically come from disorganized families with hostile, neglectful parents who have mistreated their children and failed to instill in them proper standards of behavior or the psychological foundations of self-control. Some delinquent adolescents continue their delinquent behavior into adulthood, a pattern called life-course persistent antisocial behavior. Other delinquent adolescents desist their antisocial tendencies, which has been referred to as adolescent-limited antisocial behavior.
Little empirical work has focused on runaways. Surveys indicate that half of all runaways stay within their community and return home with a few days.
Prevention and Treatment of Externalizing Problems in Adolescence: Because few approaches to the treatment of chronic offenders have proven successful, many efforts today are being directed at prevention, through early intervention and parent training.
DEPRESSION, SUICIDE, AND OTHER INTERNALIZING PROBLEMS IN ADOLESCENCE
The Nature and Prevalence of Adolescent Depression: Depression is probably the most common psychological disturbance among adolescents. Approximately 3 percent of the adolescent population meets the diagnostic criteria for clinical depression, but about 25 percent of adolescents have suffered from depressive feelings.
Adolescent Suicide: Although completed suicide is more common among adults, surveys indicate that 5% to 10% of adolescents have attempted suicide, and 30-70% have considered suicide. The adolescent suicide rate has increased alarmingly during the past forty years and is especially high among Native American and Alaskan Native adolescents.
Causes of Adolescent Depression and Internalizing Disorders: Although males are more likely to suffer from depression during childhood, depression is much more common among females after puberty--a sex difference that persists into adulthood. Current consensus is that depression is more likely to be the result of an interacting set of environmental conditions and individual predispositions (suggested by a diathesis-stress model) than the result of either set of factors alone.
Treatment and Prevention of Internalizing Problems in Adolescence: The treatment of depression during adolescence is very similar to the treatment of the disorder at other points in the life span, and clinicians use a wide range of approaches, including biological therapies, psychotherapies, and family therapies. Primary preventions teach social competencies and life skills to all adolescents in order to help them cope, while secondary preventions are aimed at adolescents who are believed to be at high risk for developing depression.
STRESS AND COPING IN ADOLESCENCE
For some adolescents, exposure to chronic or severe stress can result in psychological or physical difficulties, but for others, the very same sources and levels of stress do not seem to be associated with upset at all. In general, the effect of stress is exacerbated if it is accompanied by other stressors, if the adolescent lacks sufficient internal or external resources, or if the adolescent has poorly developed coping skills.
Specialists who study coping strategies distinguish between two types of coping. Primary control strategies (or "problem-focused coping") involve taking steps to change the source of the stress. Secondary control strategies (or "emotion-focused coping") involve efforts to change one's emotional response to the stress. In general, adolescents who rely on the primary control strategies are better adjusted than adolescents who rely on the secondary control strategy.
