Health Issues in Childhood and Adolescence
Exam Final Study Review
Eli J. Goldberg
Adolescence: The transition between childhood and adulthood.
o Accepting full grown body
o Acquire adult ways of thinking
o Attain greater independence
o Develop more mature ways of relating to peers of the opposite sex.
o Begin to construct an identity.
Puberty: This is the stage that marks the beginning of adolescence.
A flood of biological events leading to an adult-sized body and sexual
Conceptions of Adolescence
In the early 20 Century, major theorists viewed adolescence as a “storm and
o This view was shown to be exaggerated.
Adolescence was described as: “a period so turbulent that it resembled the
era in which humans evolved from savages into civilized beings.”
Anna Freud viewed adolescence as “a biologically based, universal
o The overall rate of psychological disturbance rises only slightly from
childhood to adolescence.
Adolescence is perhaps the pleasantest time the Samoan girl or boy will ever
Alternative View: The social environment is entirely responsible for the
range of teenage experiences, from erratic and agitated to calm and stress
o Samoan adolescence was not as untroubled as Mean had assumed.
Biological, psychological and social forces combine to influence adolescent
Biological changes are universal – they are found in all primates and all cultures. The demands and pressures of adolescence differ substantially among
Industrialized Nations Successful participation in economic life requires
many years of education.
o Young people face extra years of dependence on parents and
postponement of sexual gratification as they prepare for a productive
Adolescence is greatly extended.
o The more the social environment supports young people in achieving
adult responsibilities, the better they fare.
Girls reach puberty, on average, 2 years earlier than boys.
Complex hormonal changes are under way by age 8 or 9.
GH and thyroxine are secreted and lead to tremendous gains in body size and
to attainment of skeletal maturity.
Androgens and Estrogens
Both are present in different amounts in both sexes.
The boys testes release large quantities of the androgen testosterone, which
leads to muscle growth, body and facial hair, and other male sex
o Also contribute to gains in body size.
Estrogens secrete GH, adding to the growth spurt and, in combination with
androgens, stimulating gains in bone density, which continue into early
Estrogens released by girls’ ovaries cause the breasts, uterus, and vagina to
mature, the body to take on feminine proportions and fat to accumulate.
o Also contribute to the regulation of the menstrual cycle.
Adrenal Androgens These are released from the adrenal glands on top of each
kidney, and influence girls’ height spurt and stimulate growth of underarm and
Have very little impact on males.
Pubertal changes are of two broad types:
1. Overall body growth
2. Maturation of sexual characteristics
Puberty is the time of greatest sexual differentiation since prenatal life Androgen Estrogen
•Found in both sexes •Found in both sexes
•Testosterone •Releasedby ovaries
•Body and facialhair growth maturation
•Gains in body size •Fat accumulation
•Regulation of menstrualcycle
•Influencegirls' growth spurt
•Stimulatepubic and underarm
•Little impacton males
The first outward sign of puberty is the rapid gain in height and weight
known as the growth spurt.
o North American Girls: ~ age 10
o North American Boys: ~ age 12½
Growth is usually complete:
o Girls: ~ age 16
o Boys: ~ age 15½
Adolescents add 10-11 inches in height and 50-75 pounds. Body Proportions
o Cephalocaudal growth reverses in puberty.
o The hands and feet usually accelerate first, followed by the torso, which
accounts for the majority of adolescent height gain.
Boys Shoulders broaden relative to the hips.
o Arm and leg fat decreases in adolescent boys.
o The number of red blood cells increases in boys but not in girls.
o Boys gain far more muscle strength than girls, a difference that contributes to
superior athletic performance
Girls Hips broaden relative to the shoulders and the waist.
o Arm and leg fat increases in adolescent girls.
Reason why boys end up taller than girls They have two extra years of
preadolescent growth, when the legs are growing the fastest.
Motor Development and Physical Activity
o Girls’ gains are slow and gradual, leveling off at around age 14.
o Boys show a dramatic spurt in strength, speed, and endurance that continues
throughout the teenage years.
o 3% of NA high-school seniors have reported taking anabolic steroids.
o They are a powerful prescription medication that boosts muscle mass
Side Effects of Anabolic Steroids:
o Excess body hair
o High blood pressure
o Mood swings
o Aggressive behaviour
o Damage to the liver, circulatory system, and reproductive organs.
o 55% of US students and 65% of Canadian students are enrolled in physical
Primary Sex Characteristics: The reproductive organs.
o Uterus o Vagina
Secondary Sexual Characteristics: Visible on the outside of the body and serve as
signs of sexual maturity.
o Breast development
o Hair growth
o Puberty usually begins with the budding of the breasts and the growth spurt.
o Menarche First menstruation
o Typically happens around age 12½ for NA girls; 13 for Western
o Following menarche, breast and pubic hair growth are completed, and
underarm hair appears.
o Nature delays sexual maturity until the girl’s body is large enough for
o Menarche takes place after the peak of the height spurt.
o The first sign of puberty in boys is the enlargement of the testes,
accompanied by changes in the texture and colour of the scrotum.
o Soon after, pubic hair emerges and the penis begins to enlarge.
o The males also experience a deepening of the voice as the larynx enlarges
and the vocal cords lengthen.
o Spermarche The time of the first ejaculation.
o Typically happens around age 13½
o Fat cells release a protein called leptin, which is believed to signal the brain
that girls’ energy stores are sufficient for puberty.
o Girls who begin serious athletic training at young ages or who eat very little
usually experience puberty later.
o In poverty-stricken regions, menarche is greatly delayed (occurring from as
late as 14-16)
o Within developing countries, girls from higher income families reach
menarche 6-18 months earlier than those living in economically
Secular Trend: Or generational change, in pubertal timing lends added support to
the role of physical well-being in pubertal development.
o Worry Girls who reach sexual maturity early on will experience pressure
for unfavourable peer involvements, including sexual activity. Brain Development
o Brain imaging research reveals continued pruning of unused synapses in the
cerebral cortex, especially in the frontal lobes – the governor of thought and
Adolescents go to bed much later than they did as children, yet they need almost as
much sleep as they did in middle childhood – about 9 hours.
o Sleep deprived adolescents perform especially poorly on cognitive tasks
during morning hours.
o In the 1950s, up to 50% of girls received no prior warning (of menarche),
and of those who did, many were given “grin and bear it” messages.
o Almost all girls get some information from their mothers.
o Girls whose fathers know about their pubertal changes adjust especially well.
o Many boys say that no one spoke to them before or during puberty about
o Usually get their information from their own reading.
o Boys who feel better prepared for spermarche tend to react more positively.
o Overall, boys get less social support than girls for the physical changes of
Tribal and village societies celebrate the onset of puberty with an initiation
ceremony a ritualized announcement to the community that marks an important
change in privilege and responsibility.
o Ex. Bar mitzvah, quincearnera.
o Westerns societies grant little formal recognition to movement from
childhood to adolescence or from adolescence to adulthood.
Pubertal Change, Emotion and Social Behaviour
o Biological, psychological, and social forces combine to make adolescence a
time of deeper valleys and higher peaks in emotional experience.
o Adolescents reported less favourable moods than school-age children and
o Linked to certain events:
o Difficulties with parents o Disciplinary actions at school
o Breaking up with a boyfriend/girlfriend.
o Compared with adults’ moods, those of younger adolescents were less stable
and strongly related to situational changes.
o Teenagers who go out report a dramatic increase in mood.
o Teenagers who spend weekend nights at home often feel profoundly
o The frequency of arguing is similar across NA subcultures, occurring as often
in families of European descent as immigrant Asian and Hispanic families.
Psychological Distancing As children become physically mature, they demand to
be treated in adult-like ways.
o This is a trend that emerges as adolescents still rely on financial support
from their parents and cannot yet be fully independent, but are at a stage of
development that warrants maturity.
Parent-Adolescent disagreements Focus largely on mundane, day-to-day matters.
o Beneath these disputes lie serious concerns – parental efforts to protect
teenagers from harm.
Parent-daughter conflicts tend to be more intense than parent-son conflicts.
o This is perhaps because parents place more restrictions on girls. Pubertal Timing
Early Maturing Late Maturing Early Maturing Late Maturing
Boys Boys Girls Girls
Lacking self- Lively
attractive Held few
Athletic stars results in
EARLY-MATURING BOYS, THROUGH VIEWED AS WELL ADJUSTED, REPORTED
SLIGHTLY MORE PSYCHOLOGICAL STRESS THAN THEIR LATE-MATURING
The roles of early- and late-maturation between genders is reversed.
o Early-maturing males and late-maturing females are regarded as the
sociable, popular, leaders.
Role of Physical Attractiveness
Body Image: Conception of and attitude towards physical appearance.
o Early-maturing girls usually report a less positive body image.
Importance of Fitting In
o Early-maturing girls and late-maturing boys have difficulty because they fall
at the extremes of physical development and feel “out of place” when with
their age-mates. o Early-maturing adolescents of both sexes seek out older companions,
sometimes with unfavourable consequences.
o Older peers often encourage them into activities that they are not yet
ready to handle emotionally.
o Ex. Drug use, sexual activity, delinquent acts.
o Early-maturing girls, especially, are prone to lasting difficulties.
o They report poorer-quality relationships with family and friends,
smaller social networks, lower life satisfaction than their on-time
During the growth spurt:
o Boys require about 2,700 calories a day and much more protein than they did
o Girls require about 2,200 calories a day but somewhat less protein than boys
because of their smaller size and muscle mass.
Of all age groups, adolescents are MOST likely to skip breakfast, consume empty
calories, and eat on the run.
o Frequency of family meals is strongly associated with healthy eating in
o Families with adolescents eat fewer meals together.
Anorexia Nervosa A tragic eating disturbance in which young people starve
themselves because of a compulsive fear of getting fat.
o 1% of NA and Western European girls are affected.
o Equally common in ALL SES groups.
o Asian-American, Caucasian-American and Hispanic girls are at a greater risk
than African-American girls tend to be more satisfied with their bodies.
o Boys account for 10% of cases of anorexia
o HALF of these accounts are gay or bisexual young people who are
uncomfortable with a strong, muscular appearance.
o Anorexic’s lose between 25- 50% of their body weight.
o Menarche requires about 15% body fat, so either menstruation does not
occur or it stops all together.
o Malnutrition causes:
o Pale skin o Brittle finger nails
o Fine dark hairs all over the body
o Extreme sensitivity to cold temperatures.
o 6% of anorexics die from the disorder.
o Usually responsible, well-behaved and excellent students.
o Early-maturing girls are at the greatest risk for anorexia because of the
societal image of “thin is beautiful”
o Often the mothers of these girls have high expectations for physical
appearance, achievement, and social acceptance and are overprotective and
o Hospitalization is often required to prevent life-threatening malnutrition.
o Less than 50% of patients recover fully.
Bulimia Nervosa An eating disorder in which young people engage in strict
dieting and excessive exercise accompanied by binge eating, often followed by
deliberate vomiting and purging with laxatives.
o More common than anorexia nervosa
o About 2-3 percent of teenage girls are affected.
o Only 5% have previously been anorexic.
o Influenced by heredity.
o They experience their parents as disengaged and emotionally unavailable
rather than controlling.
o Bulimic usually feel depressed (unlike anorexics) and guilty about their
abnormal eating habits.
o Usually easier to treat than anorexia.
o Through support groups, nutritional education, training in changing
eating habits, and anti-anxiety, antidepressant, and appetite-control
Lose 25-50% of Menstrual cycle
body weight does not occur
Boys account for or fully stops
•are gayboys.e cases 6% die
in all SES groups Cparentsing
1% affected Anorexia Less than 50%
Nervosa recover Parents are Parents are
2-3% and guilty
affected about eating
Binge and Bulimia Easier to
purge treat than
Impact of Culture
o Sexual attitudes in NA are relatively restrictive
o Parents give children little or no information about sex, discourage sex play,
and rarely talk about sex in their presence.
o ½ of young people report talking with their parents about intercourse,
pregnancy prevention, and STD/STI.
o 2/3rds of television programs contain sexual content.
o Most depict partners as spontaneous and passionate, having little
commitment to each other, taking no steps to avoid pregnancy or STI,
and experiencing no negative consequences.
Characteristics of Sexually Active Adolescents
o Youth in the USA begin sexual activity at a younger age than their Canadian
and Western European counterparts.
o Boys’ sexual activity rates were found to be 3-6% higher than that of girls on
o Males tend to have their first intercourse earlier than females.
o 12% of adolescent boys in the US; 8% of adolescent boys in Canada,
have had sexual relations with 3 or more partners in the last year.
o Living in a hazardous neighbourhood, one high in physical deterioration,
crime, and violence, also increases the likelihood that teenagers will become
sexually active. o Social ties are weak, adults exert little oversight and control over
adolescents’ activities, and negative peer influences are widespread.
The rate of premarital intercourse among African-American teenagers is 67%
The rate of premarital intercourse among all U.S. people is 51%.
o This large difference is accounted for by poverty in the black population.
o Early and prolonger father absence predicts higher rates of intercourse and
pregnancy among adolescent girls.
o The fathers’ investment in parenting encourages daughters to delay sexual
activity in favor of seeking a similarly committed male partner to ensure
their offspring’s well-being.
o 27% of sexually active teenagers in the U.S.; 13% of teenagers in Canada are
at risk for unintended pregnancy because they do not use contraception
consistently – rates are considerably higher than in other Western nations.
o About 12% of NA girls; 6% of NA boys say they were pressured into having
intercourse when they did not want to do so.
o About 20% of adolescents using health services say that if their parents were
notified, they would still have sex, but without contraception.
o 2-3% of young people identify as lesbian, gay or bisexual.
o Male homosexuality tends to be more common on the maternal than on the
paternal side of families.
o Suggests it may be X-linked.
Feeling Different The first sense of a biologically determined gay or lesbian sexual
orientation appears between ages 6-12, in play interests more like those of the
o Boys less interested in sports, more drawn to quieter activities.
o Girls Less emotionally sensitive, drawn to sports and athletics.
o Age 10 – Sexual Questioning: Wondering why the typical heterosexual
orientation does not apply to them.
o Sexual questioning children report greater anxiety about peer
relationships and greater dissatisfaction with their biological gender
Confusion Awareness a same-sex physical attraction occurs, on average, between
ages 11-12 for boys; ages 14-15 for girls. Self Acceptance The majority of gay, lesbian, and bisexual teenagers accept their
o When homosexual youths do come out, they often face intense hostility,
including verbal abuse, and physical attacks.
o Parental understanding is the strongest predictor of favourable adjustment.
o When people react positively, coming out strengthens the young persons’
view of homosexuality as a meaningful and fulfilling identity.
o Coming out can foster many aspects of adolescent development, including
self-esteem, psychological well-being, and relationships with family and
Most homosexual adolescents are not “gender deviant” in dress or behaviour.
Attraction to members of the same sex is not limited to gay and lesbian teenagers.
o 50-60% of adolescents who report having engaged in homosexual acts
identify as heterosexual.
o Adolescents have the highest rates of STDs of all age groups.
o 1 in 18 Canadian adolescents contracts an STD each year.
o In the USA, 1 in 6 adolescents contracts an STD each year.
AIDS The most serious STD.
o Typically take 8-10 years to emerge in an HIV-infected person.
o It is at least twice as easy for a male to infect a female with any STD, including
AIDS, as for a female to infect a male.
o 60% of middle-school students and about 90% of high-school students are
aware of basic facts about AIDS.
Adolescent Pregnancy and Parenthood
o 50 % of teenage pregnancies end in abortion.
o In 1960, only 15% of teenage births were to unmarried females, whereas
today, 85% are.
o 1 out of 5 births to adolescents are repeat births.
Correlates and Consequences of Adolescent Parenthood
o Girls at risk for early pregnancy do poorly in school, engage in alcohol and
drug use, have a childhood history of aggressive and antisocial behaviour,
associate with deviant peers, and experience high rates of depression.
o After a baby is born, adolescents’ lives usually worsen in at least 3 aspects: Educational Attainment:
o Giving birth as an adolescent reduces the likelihood of finishing high-school.
o 70% of U.S. adolescent mothers graduate.
o 95% of U.S. girls who wait to become parents graduate.
o Teenage motherhood reduces the chances of marriage.
o When mothers do marry, they are more likely to divorce than their peers
who delay childbearing.
o Consequently, teenage mothers spend more of their parenting years as single
o Many teenage mothers are on welfare.
o If they are employed, their limited education restricts them to unsatisfying,
o Unemployed fathers are generally unemployed or work at unskilled, low
o 50% (estimated) of adolescent fathers have committed illegal offenses
resulting in imprisonment.
o Do not receive early prenatal care.
o Babies have high rates of prenatal and birth complications
Especially low birth-weight.
o Know less about child development.
o Interact less effectively with their babies. o These children tend to score low on intelligence tests, achieve poorly
in school, engage in disruptive social behaviour.
Sexual Education Courses Improve awareness of sexual facts – knowledge
necessary for responsible sexual behaviour.
o Knowledge is NOT ENOUGH.
o Sexual education must also bridge between what teenagers know and what
Effective programs combine the following elements:
o Teaching Skills
o For handing sexual situations through creative discussion and role-
o Promotion of Abstinence
o To teenagers who are not yet sexually active
o Providing Information and Access to Contraceptives
o Making sure that the correct information about contraceptives is
provided and also that there is a barrier-free access to contraceptives.
Intervening with Adolescent Parents
o The most difficult and costly way to deal with adolescent parenthood is to
wait until it has happened.
o Adolescent mothers benefit from relationships with family members and
other adults who are sensitive to their developmental needs.
o Although nearly half of young fathers visit their children during the first few
years after birth, contact usually diminishes.
Substance Use and Abuse
o By 10 grade:
o 40% of U.S. young people have tried cigarette smoking.
o 63% have tried drinking
o 38% have tried at least one illegal drug.
o At the end of high-school:
o 14% smoke cigarettes regularly
o 28% have engaged in heavy drinking during the past 2 weeks.
o 50%+ have experimented with illegal drugs.
o 27% have tried at least one highly addicted and toxic substance.
o The majority of adolescents who dabble in alcohol, tobacco, and weed are
NOT headed for a life of decadence and a