The Complexity of Adolescence

I would like to write about a topic that I presented with a colleague several years ago entitled The Complexity of Adolescence. Adolescence is a transitional stage of physical, cognitive, emotional, and developmental stages generally occurring between puberty and legal adulthood, but largely characterized as beginning and ending with the teenage years. For the purpose of this essay, it will be broken down into 3 stages: 10-15 early adolescence, 14-18 middle adolescence, and 17-22 late adolescence. 

Adolescents face a number of issues that will be explored in this posting including: 

  • Depression and anxiety
  • Substance abuse
  • Suicide
  • Peer pressure
  • Self esteem
  • Teen sexual development
  • Teen violence
  • Grief and loss

*A cautionary note regarding adolescent problems: Adolescence is a time of physical, cognitive, behavioral, and social growth which may be confusing to the adolescent and others around them. Many issues they face may develop simultaneously which can further complicate adolescent thinking and behavior. It can be difficult at times to sort through co-occurring issues, especially concerning the adolescents mental health. It would be prudent to seek professional help in diagnosing and treating these complex issues.

Depression and Anxiety

  • Can be a temporary response to the normal process of maturing
  • Can occur as the adolescent struggles with parents concerning their independence
  • May develop due to the influence of sex hormones
  • May be related to disturbing events such as the loss of a friend or relative
  • Can be produced by the loss of a boyfriend / girlfriend
  • Problems at school should be explored

Some events or situations which an adolescent has little control over are:

  • Chronic illness
  • Learning disabilities
  • Abuse at home
  • Parental divorce
  • Bullying or harassment in school or elsewhere

Some serious symptoms of depression and anxiety include:

  • Restlessness, irritability, agitation
  • Loss of interest in pleasurable activities
  • Isolative behavior / avoiding behavior
  • Increase or decrease in appetite or sleep
  • Difficulty concentrating
  • Feelings of worthlessness or hopelessness
  • Signs of substance use
  • Thoughts of death or suicide

Adolescent suicide

*If left untreated, a major depressive disorder with accompanying symptoms can lead to suicidal ideation or the taking of ones own life. One must never discount a verbal threat of suicide as just "attention-seeking" behavior. The threat must be taken seriously and the person must be taken to the hospital for an assessment ASAP. 

Since mental illness and substance-related disorders so frequently accompany suicidal behavior, many other "high risk" signs to look for are:

  • Extreme personality changes
  • Loss of interest in pleasurable activities
  • Feelings of worthlessness, guilt, or shame
  • Withdrawal from family and friends
  • Poor hygiene
  • Poor school performance
  • Aggressive, destructive, or defiant behavior
  • Extreme anxiety or panic
  • Lethargy and apathy
  • Giving away favorite belongings
  • Putting affairs in order
  • Prior suicide attempts

Possible triggers of suicide may include:

  • Major disappoints or rejection
  • Break up with a boyfriend or girlfriend
  • Family turmoil
  • Problems in school
  • Guilt over disappointing parents or letting others down
  • Having a close friend or family member commit suicide

How to help:

  • Don't leave the person contemplating suicide alone
  • Do not blame the person for their "dark" thoughts
  • Take the individual to the nearest hospital Emergency Department
  • If they refuse to go, you may need to call the police for help
  • Support the individual and encourage compliance with their treatment

Substance Abuse 

Note: Although the following signs may infer that the adolescent is using drugs, there could be other reasons for changes in an individual that are not drug related. However, (3) areas to look for are:

  • Signs in the home
  • Signs concerning school and school work
  • Physical and emotional signs

Signs in the Home:

  • Loss of interest in family activities
  • Disrespectful toward family members
  • Disappearance of money and other valuables
  • Lies about friends or activities
  • Not coming home on time or at all
  • Drug paraphernalia such as rolling papers, pipes, small plastic bags small rubber bands, burned aluminum foil, etc.
  • Spending a lot of time alone in their room

Signs concerning school / school work:

  • Sudden drop in grades
  • Loss of interest in learning
  • Skipping classes / sleeping in class
  • Poor attitude toward school authority
  • Not doing homework
  • Not informing parents of teachers meetings, open house, etc.

Physical and emotional signs:

  • Wide mood swings / "hair-trigger" anger
  • Drastic weight loss
  • Hanging out with new friends
  • Poor hygiene / always looks unkempt
  • Always needs money and may lie about what it will be used for
  • Overly tired or hyperactive
  • Smell of alcohol or marijuana on breath
  • Cigarette burn holes on front of shirt

What to do:

  • Have a talk with your adolescent and discuss the changes you have noticed
  • Support your adolescent, but do not play the role of a friend - you are the parent!
  • Set the rules in the home and use leverage if necessary
  • Do not feel guilty about enforcing the rules
  • Offer to help adolescent with detox, rehab, relapse prevention, AA / NA meetings
  • Use "tough love" if necessary

Peer pressure

Peer pressure refers to the influence exerted by a peer group in encouraging a person to change his or her attitudes, values, or behaviors in order to conform to group norms.

There are (2) levels of peer pressure:

  1. large group such as a school which may dictate clothing, music, and other trends
  2. small group of close relationships with just one or several friends which is more personal than a larger group

Why is peer pressure so influential to adolescents?

  • Adolescents want to be liked, fit in, and want to be perceived as "cool" and accepted
  • Some adolescents want others to take the lead in helping them to experience something new
  • Many adolescents see their peers as a new "family" and begin to rely and trust in them
  • Many adolescents want to test their ideas with like-minded peers and feel accepted for doing so

Negative peer pressure can lead to high-risk behavior such as:

  • Doing drugs and drinking alcohol
  • Smoking cigarettes
  • Having sex
  • Shoplifting
  • Gang membership
  • Criminal activity
  • Vandalizing property

Ways to reduce high-risk behavior and to increase better judgment are: 

  • Communicate honestly with your adolescent
  • Help adolescent understand the consequences of their actions
  • Help demonstrate appropriate decision-making
  • Let your adolescent know that you will be there for them
  • Help teach your adolescent that is okay to say "no"

Self Esteem

Adolescent self esteem is often described as self-value, satisfaction, pride, respect, and confidence in oneself. Developing self esteem requires support from family or caregivers in (3) main areas:

  • Provide acceptance and affirmation
  • Foster independence and autonomy
  • Help adolescents feel competent

Acceptance and affirmation:

  • Affirm adolescents worth while correcting their behavior
  • Be physically present for your adolescent - be available for them
  • Be emotionally present - share feelings
  • Listen to what your adolescent is saying
  • Validate adolescents feelings then discuss options for problem-solving

Fostering independence and autonomy:

  • Encourage and allow teens to make their own decisions about lives
  • Set guidelines and principles to help structure adolescents problem-solving
  • Include teens and ask their opinions when making rules around the house
  • Encourage adolescents to think for themselves and to problem-solve with your guidance
  • Respect your teens physical and emotional space 

Helping teens to feel competent:

  • Never push your teen to do something they do not want to do
  • Coach your adolescent in order to help them develop their strengths
  • Use words of affirmation when speaking to your teen, not harsh or demeaning words
  • Acknowledge your teens worth in spite of their negative behavior
  • Admit your own mistakes and teach the value of learning from them

Teen Sexual Development

The beginning of teen sexual development is most often associated with Puberty in early adolescence (boys generally 11-12; girls 10-11). Over the next 4-5 years (girls are, on average, 2-3 years ahead of boys), a number of processes occur including what is referred to as the development of Primary Sexual Characteristics and Secondary Sexual Characteristics.

Primary Sexual Characteristics are defined as the maturation of the reproduction organs so that a sperm cell can fertilize an egg to begin reproduction

Secondary Sexual Characteristics are related to other areas of maturity including deepening of the voice, bone and muscle growth, body hair, breast development and menarche, and the widening of the hips in females (mostly features that can be visibly seen).


  • Approximately 50% of all 17 year old teens have experienced sexual intercourse
  • A sexually active teen who does not use contraceptives has a 90% chance of becoming pregnant within a year
  • Teenagers are less likely than older women to practice birth control consistently
  • Every year about 1 in 4 sexually active teens acquire a sexually transmitted disease (STD)
  • In a single act of unprotected sex, a teenage woman has a 1% chance of acquiring HIV, a 30% chance of getting Herpes, and a 50% chance of contracting Gonorrhea
  • Each year, almost 1 million teenage woman (10% of all women aged 15-19) and 19% of those who have had sex become pregnant
  • 78% of all teen pregnancies are unplanned
  • · 83% of teens who give birth are more likely to come from poor or low-income families
  • 40% of teens terminate their pregnancy believing that having a baby at their age would negatively affect their lives

What to do:

  • As a parent, open a dialogue with your teen early on about the risks and responsibilities of having sex especially unprotected sex ·
  • Educate your teen on how to avoid situations where she may be put in a vulnerable position (i.e. date rape) ·
  • Let your teen know that they can speak to you about any concerns they may have without fear of judgment or harsh criticism ·
  • If your teen tells you that she thinks she may be pregnant or have a STD, Don’t Panic – take her to the doctor ASAP to have a complete physical

Date Rape (acquaintance rape):

  • It has been reported that date rape among adolescents ranges from 20% - 68%
  • Drug and alcohol use is a contributing factor to date rape
  • There is a myth that date rape is more permissible that “stranger” rape
  • Teens who have a history of victimization tend to be at greater risk for abuse
  • Contextual factors may also increase the risk

Teen Violence

Teens are exposed to and in some cases participate in a wide range of violence including:

  • Drugs and associated criminal activity
  • Gangs (including assaults and homicide)
  • Bullying
  • Internet predators
  • Date rape
  • Violence on TV (including news of school shootings)
  • Violent video games
  • Violence and abuse in the home


  • Teens could wind up the victims of a crime by someone whose judgment is impaired
  • Teens could be harmed by the use of drugs they have taken
  • Teens could be the aggressors after consuming alcohol or other drugs
  • Teen could become involved in a much bigger crime network with far reaching implications then they imagine
  • Teens could end up in prison which could delay or completely derail having a successful future


  • Street gangs are all about violence toward innocent people and other gang members as well
  • Gangs invite vulnerable teens into their “family” and expect individuals to carry out violent acts for them
  • Many gang members end up in prison and forfeit their futures for the gang
  • Gang members are generally not allowed to leave and may be hurt or killed if they try
  • Gang members who were successful in breaking free from a gang have reported that everything they were promised by gang members when they joined did not come true


  •  Bullying is an on-going pattern of harassment and abuse
  • One in 5 kids admit to being bullied or bullying someone else
  • Although teachers report that they always intervene in bullying, only 25% of students believe they do so
  • There is evidence that in some cases students may perpetuate their own bullying
  • Bullying usually peaks in middle school
  • Teens may be embarrassed to tell others they are being bullied

Internet Predators:

  • One in 5 teens are approached by an internet predator (e.g. Facebook, Craig’s List, etc.)
  • Most victims are between 12-15 years old
  • Most victims tend to be loners with few offline friends
  • Most victims are secretive about their internet activities
  • Most teens do not set up security settings and leave themselves vulnerable to on-line predators

Violence on TV / Violent Video Games:

  • By age 12, the average child has witnessed at least 8,000 murders on TV
  • TV violence has been linked to aggression in our culture
  • TV and video game violence desensitizes teens to the horror of violence
  • A U.S. Army expert on the psychology of combat, believes that violent video games can act as “murder simulators” which some may want to copy in real life
  • It has been shown that violent music lyrics can also increase aggression in teens

Violence and Abuse in the Home:

  • One of the main reasons that children become violent is because they are exposed to violence in their own homes
  • Violence at home can be physical, verbal, or sexual or demonstrated through neglect or abandonment
  • Most abusive parents were abused themselves
  • Abusive homes and neighborhoods are strong predictors of adult violent behavior
  • Abuse in the home may be covered up and not reported

 Grief and Loss

When a parent, sibling, friend, or relative dies, teens feel the overwhelming loss of someone who has played an important role in shaping their fragile self-identities. The feelings generated from the loss can become part of the teens life forever. It is important to be available to your adolescent at this time to help support, talk, and listen to what they have to say and try to answer questions as sensitively and honestly as possible. The adolescent years are confusing enough and when a loss occurs, it can be for many, a traumatizing event. In some cases, a healthcare professional may need to be contacted.

What not to say to your adolescent:

  • “You have to be ‘strong’ now that your dad is gone”
  • “It’s your job to take care of the family now”
  • “At least she died quickly and didn’t suffer”
  • “Grandma’s in a better place now”
  • “Try not to think about the loss”
  • “Don’t let others see how sad you are”

Signs a teen may need extra help:

  • Symptoms of chronic depression, isolation, sleeping problems, or restlessness
  • Academic failure or apathy toward school-related activities
  • Deterioration of relationships with family or friends
  • Risk-taking behaviors such as drug or alcohol abuse, fighting, or unusual behaviors for the teen
  • Acting overly strong or mature; denying feelings

As we have just read, the teen years are fraught with a multitude of complex problems, physical, emotional, cognitive, and sexual growth, and changes that may be confusing to the adolescent. It is an exciting time for the maturing teen to have new experiences and to try out new approaches to interacting with others and getting to know themselves. With the proper guidance, adolescents can navigate the teen age years in a healthy and productive way.  

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