PowerPoint slides prepared by Leonard R.

Mendola, PhD
Touro College 1
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 Chapter 13: Problems in Adolescence and
Emerging Adulthood Outline
• Exploring Adolescent and Emerging Adult Problems
– The Biopsychosocial Approach
– The Developmental Psychopathology Approach
– Characteristics of Adolescent and Emerging Adult
Problems
– Stress and Coping
– Resilience
• Problems and Disorders
– Drug Use
– Juvenile Delinquency
– Depression and Suicide
– Eating Disorders

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 Chapter 13: Problems in Adolescence and
Emerging Adulthood Outline
• Interrelation of Problems and Prevention/Intervention
– Adolescents with Multiple Problems
– Prevention and Intervention

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 Preview

• At various points in this book, we have considered

adolescent and emerging adult problems
• In this chapter we exclusively focus on adolescent and
emerging adult problems, covering different approaches
to understanding these problems, some main problems
we have not yet discussed, and ways to prevent and
intervene in problems

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 Exploring Adolescent and Emerging
Adult Problems
• The Biopsychosocial Approach
– Biological Factors
– Psychological Factors
– Social Factors
• The Developmental Psychopathology Approach
• Characteristics of Adolescent and Emerging Adult
Problems
• Stress and Coping
– Stress
– Coping
• Resilience 5
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 The Biopsychosocial Approach

• Emphasizes that biological, psychological, and social

factors interact to produce the problems that adolescents,
emerging adults, and people of other ages develop
• Biological factors
– In the biological approach, problems are believed to be
caused by a malfunctioning of the body
– Focus on such factors as genes, hormones, and the brain as
causes of problems
• Psychological factors
– Among the factors that have been proposed as important
influences on problems are identity, personality traits,
decision making, and self-control 6
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 Figure 13.1

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 The Biopsychosocial Approach

• Social factors
– Factors that have especially been highlighted as
contributors to problems are the social contexts of family,
peers, schools, socioeconomic status, poverty, and
neighborhoods

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 The Developmental Psychopathology
Approach
• Focuses on describing and exploring the developmental
pathways of problems
– Many researchers seek to establish links between early
precursors (such as risk factors and early experiences) and
outcomes (Loeber & Burke, 2011; Masten & others, 2010;
Molilanen, Shaw, & Maxwell, 2010)
– A developmental pathway describes continuities and
transformations in factors that influence outcomes

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 The Developmental Psychopathology
Approach
• This approach often involves the use of longitudinal
studies to track the unfolding of problems over time
(Burt & Roisman, 2010; Veronneau & Dishion, 2010)
• Seeks to identify
– Risk factors that might predispose children and adolescents
to development problems (Garber & Cole, 2010)
– Protective factors that might help to shield children from
developing problems (Bukowski, Laursen, & Hoza, 2010)

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 The Developmental Psychopathology
Approach
• Recently considerable interest has focused on
developmental cascades, which involve connections
across domains over time to influence developmental
pathways and outcomes (Masten & Cicchetti, 2010)
• Developmental cascades can encompass connections
between a wide range of biological, cognitive, and social
processes, including many social contexts

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 The Developmental Psychopathology
Approach
– High levels of coercive parenting and low levels of
positive parenting led to the development of antisocial
behavior in children, which in turn connect children and
adolescents to negative experiences in peer and school
contexts, which further intensifies the adolescent’s
antisocial behavior (Patterson, Forgatch, & DeGarmo,
2010)

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 The Developmental Psychopathology
Approach
• The identification of risk factors might suggest avenues
for both prevention and treatment (Burt & Roisman,
2010)
– Parents who suffer from depression, an anxiety disorder, or
substance abuse are more likely to have children who
experience depression (Morris, Ciesla, & Garber, 2010;
Shaw & others, 2009)
• Problems can be categorized as
– Internalizing: Occur when individuals turn their problems
inward
– Externalizing: Occur when individuals turn their
problems outward
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 The Developmental Psychopathology
Approach
• Links have been established between patterns of
problems in childhood and outcomes in emerging
adulthood (Loeber & Burke, 2011)
• Overall, there is continuity between the presence of
mental health problems in adolescence and the presence
of these in emerging adulthood

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 Characteristics of Adolescent and
Emerging Adult Problems
• The spectrum of problems is wide
• The problems vary in their severity, and in how common
they are for females and males and for different
socioeconomic groups
• Some problems are short-lived; others can persist over
many years
• Some problems are more likely to appear at one
developmental level than at another

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 Characteristics of Adolescent and
Emerging Adult Problems
• A large scale investigation (Achenbach & Edelbrock,
1981) found that:
– Adolescents from a lower-SES background were more
likely to have problems from those from a middle-SES
background
– Most of the problems reported for adolescents from a
lower-SES background were undercontrolled,
externalizing behaviors
– Undercontrolled, externalizing behaviors were most
characteristic of boys

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 Characteristics of Adolescent and
Emerging Adult Problems
– Overcontrolled and internalizing behaviors were more
likely for middle-SES adolescents and girls
– The behavioral problems most likely to cause adolescents
to be referred to a clinic for mental health treatment were
feelings of unhappiness, sadness, or depression, and poor
school performance

17
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 Figure 13.2

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 Characteristics of Adolescent and
Emerging Adult Problems
• Another investigation (Achenbach & others, 1991) found
that lower-SES children and adolescents had more
problems and fewer competencies than did their higher-
SES counterparts
• Many studies have shown that factors such as poverty,
ineffective parenting, and mental disorders in parents
predict adolescent problems (Patterson, Forgatch, &
DeGarmo, 2010)
– Predictors of problems are risk factors, factors which
indicate an elevated probability of a problem outcome in
groups of people who have that factor (Lynne-Landsman,
Bradshaw, & Ialongo, 2010)
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 Characteristics of Adolescent and
Emerging Adult Problems
• Some researchers argue that conceptualizing problems in
terms of risk factors creates a perception that is too
negative (Lerner & others, 2011)
– Instead, they highlight the developmental assets of youth
(Kia-Keating & others, 2011)
– In research by the Search Institute, adolescents with more
developmental assets engaged in fewer risk-taking
behaviors, such as alcohol and tobacco use, sexual
intercourse, and violence

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 Stress and Coping

• Although G. Stanley Hall (1904) and others

overdramatized the extent of storm and stress in
adolescence, many adolescents and emerging adults
today experience stressful circumstances that can affect
their development
• Stress: The response of individuals to stressors,
circumstances and events that threaten them and tax their
coping abilities
– Some stressors are acute: Sudden events or stimuli
– Some stressors are chronic: Long-lasting stressors
– Stressors can be physical, emotional, or psychosocial
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 Stress and Coping

• A recent study of 12- to 19-year-olds revealed that

perceptions of having stress decreased in late
adolescence, and that active and internal coping
strategies increased as adolescents got older (Seiffgre-
Krenke, Aunola, & Nurmi, 2009)
• Stress may come from different sources for adolescents
and emerging adults (Compas & Reeslund, 2009; Morris,
Ciesla, & Garber, 2010; Seiffge-Krenke, 2011)
– Sources include life events, daily hassles, and sociocultural
factors

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 Stress and Coping

• Life events and daily hassles

– Individuals who have had major life changes (loss of a
close relative, the divorce of parents) have a higher
incidence of cardiovascular disease and early death than
those who do not (Taylor, 2011a)
– Some psychologists conclude that information about daily
hassles and daily uplifts provide better clues about the
effects of stressors than life events (McIntosh, Gillanders,
& Rodgers, 2010)
– Stress in relationships is especially common adolescents
• Adolescent girls are more sensitive to relationship stress; they
report higher levels of relationship stress and are more likely to use
coping strategies that maintain relationships (Rose & Rudolph,
2006; Seiffge-Krenke, 2011) 23
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 Stress and Coping

– The biggest hassles for college students include wasting

time, being lonely, and worrying about meeting high
achievement standards (Kanner & others, 1981)
– Critics of the daily-hassles approach argue that it suffers
from some of the same weaknesses as life-events scales
(Dohrenwend & Shrout, 1985)
• Sociocultural factors
– Sociocultural factors help to determine which stressors
individuals are likely to encounter, whether they are likely
to perceive events as stressful or not, and how they believe
stressors should be confronted (Sun & others, 2010)

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 Stress and Coping

– Shelley Taylor (2006, 2011a, 2011b, 2011c) proposed that

females are less likely to respond to stressful and
threatening situations with a fight-or-flight response than
males are
– A recent study revealed no differences in the stress that
adolescent girls and boys reported that they experienced
related to school, self-related problems, leisure, and their
future (Seiffge-Krenke, Aunola, & Nurmi, 2009)

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 Stress and Coping

– Acculturative stress: The negative consequences that

result from contact between two distinctive cultural groups
• Many individuals who have immigrated to the U.S. have
experienced acculturative stress (Grigorenko & Takanishi, 2010)
– Poverty can cause considerable stress for individuals and
families (Taylor, 2010)

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 Stress and Coping

• Coping
– Not every adolescent and emerging adult responds the
same way to stress
– Coping: Managing taxing circumstances, expending effort
to solve life’s problems, and seeking to master or reduce
stress
– Success in coping has been linked to a sense of personal
control, positive emotions, and personal resources
(Folkman & Moskowitz, 2004)
– Success in coping also depends on the strategies used and
on the context (Hernandez, Vigna, & Kelley, 2010)

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 Stress and Coping

– Lazarus (2000) has proposed to types of coping strategies:

• Problem-focused coping: The strategy of squarely facing one’s
troubles and trying to solve them
• Emotion-focused coping: Responding to stress in an emotional
manner, especially by using defense mechanisms
– Sometimes emotion-focused is adaptive
– Many individuals successfully use both problem-focused
and emotion-focused coping to deal with a stressful
circumstance (Romas & Sharma, 2010)
– Over the long term, though, problem-focused coping
usually works better than emotion-focused coping
(Heppner & Lee, 2001)
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 Stress and Coping

– Thinking positively and avoiding negative thoughts are

good strategies when we are trying to handle stress in just
about any circumstance (Greenberg, 2011; McCarty,
Violette, & McCauley, 2010)
– Support from others is an important aspect of being able to
cope with stress (Taylor, 2011a, 2011b, 2011c)
• Close, positive attachments to others consistently show up as
buffers to stress in adolescents’ and emerging adults’ lives (Shaver
& Mikulincer, 2012)

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 Stress and Coping

– Strategies for coping need to be evaluated in the specific

context in which they occur (Mash & Wolfe, 2009)
• A certain strategy may be effective in one situation, but not
another, depending on the extent to which the situation is
controllable
• Coping flexibility: The ability to modify coping strategies to match
the demands of the situation

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 Resilience

• Even when adolescents and emerging adults are faced

with adverse conditions, certain characteristics make
them more resilient (Compas & Reeslund, 2009)
• Resilient adolescents are characterized by a number of
factors (Masten, 2001, 2006, 2007; Masten & others,
2009, 2010):
– Individual factors (good intellectual functioning)
– Family factors (close relationship to a caring parent figure)

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 Resilience

– Extrafamilial factors (bonds to prosocial adults outside the

family)
• Being resilient in adolescence is linked to continuing to
be resilient in emerging adulthood, but resilience can
develop in emerging adulthood (Masten & others, 2006)

32
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 Figure 13.3

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 Problems and Disorders
• Drug Use
– Trends in Overall Drug Use
– Alcohol
– Hallucinogens
– Stimulants
– Depressants
– Anabolic Steroids
– Inhalants
– Factors in Adolescent and
Emerging Adult Drug Use
McGraw-Hill
• Juvenile Delinquency
– What is Juvenile Delinquency?
– Antecedents of Juvenile
Delinquency
– Effective Prevention and
Intervention Programs
• Depression and Suicide
– Depression
– Suicide
• Eating Disorders
– Overweight and Obese Adolescents
– Anorexia Nervosa and Bulimia
Nervosa
34
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 Trends in Overall Drug Use

• The 1960s and 1970s were a time of marked increases in

the use of illicit drugs
• Increases in adolescent and emerging adult alcohol
consumption during this period were also noted
(Robinson & Greene, 1988)

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 Trends in Overall Drug Use

• The 2010 Monitoring the Future Study surveyed more

than 46,000 secondary school students in more than 400
public and private schools (Johnston & others, 2011):
– In the late 1990s and early part of the 21st century, the
proportion of secondary school students reporting the
use of any illicit drug has been declining
– Marijuana is the illicit drug most widely used in the
U.S. and Europe (Hibell & others, 2004; Johnston &
others, 2011)

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 Trends in Overall Drug Use

– When marijuana is included, an increase in illicit drug

use by U.S. adolescents occurred in 2009 and 2010
– The recent downturn in drug use has been attributed to
an increase in the perceived dangers of drug use on
youth

37
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 Figure 13.4

38
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 Alcohol

• Sizable declines in adolescent alcohol use have occurred in

recent years (Johnston & others, 2011)
• A consistent sex difference occurs in binge drinking, with
males engaging in this more than females (Randolph & others,
2009)
• The transition from high school to college may be a critical
transition in alcohol abuse (Johnston & others, 2011)
• In a national survey of drinking patterns on 140 campuses,
almost half of the binge drinkers reported problems that
included missing classes, physical injuries, trouble with
police, and having unprotected sex (Wechsler & others, 1994)

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 Alcohol

• Drinking alcohol before going out (pregaming) and

drinking games (Cameron & others, 2010) have become
common among college students
• Higher levels of alcohol use have been consistently
linked to higher rates of sexual risk taking, such as
engaging in casual sex, sex without contraceptives, and
sexual assaults (Lawyer & others, 2010; White & others,
2009)
• A special concern is the increase in binge drinking by
females during emerging adulthood (Davis & others,
2010; Smith & Berger, 2010)
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 Alcohol

• Among the risk factors in adolescents’ and emerging

adults’ abuse of alcohol are (Pinger & others, 2009):
– Heredity
– Family influences
– Peer relations
– Certain personality and motivational characteristics

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 Hallucinogens

• Hallucinogens: Also called psychedelic (mind-altering)

drugs; drugs that modify an individual’s perceptual
experiences and produce hallucinations
• LSD
– LSD’s popularity in the 1960s and 1970s was followed by
a reduction in use by the mid-1970s as it unpredictable
effects became publicized
– Adolescents’ use of LSD increased in the 1990s, but has
declined since (Johnston & others, 2011)

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 Hallucinogens

• Marijuana
– Because marijuana can impair attention and memory, it is
not conducive to optimal school performance
– Marijuana use by adolescents decreased in the 1980s, but
increased from 2008 to 2010 (Johnston & others, 2011)
– One reason that marijuana use has recently increased is
that fewer adolescents perceive much danger associated
with its use

43
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 Figure 13.5

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 Stimulants

• Stimulants: Drugs that increase the activity of the central

nervous system
– The most widely used stimulants are caffeine, nicotine,
amphetamines, and cocaine
• Cigarette smoking
– One of the most serious yet preventable health problems
– Since the national surveys by Johnston and others begin in
1975, cigarettes have been the substance most frequently
used on a daily basis by high school seniors (Johnston &
others, 2011)
– The peer group especially plays an important role in
smoking (Picotte & others, 2006)
45
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 Figure 13.6

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 Stimulants

– Cigarette smoking is decreasing among adolescents

• Since the mid-1990s an increasing percentage of adolescents have
reported that they perceive cigarette smoking as dangerous, that
they disapprove of it, that they are less accepting of being around
smokers, and that they prefer to date nonsmokers (Johnston &
others, 2011)
– Smoking in the adolescent years causes permanent genetic
changes in the lungs and forever increases the risk of lung
cancer, even if the smoker quits (Wiencke & others, 1999)
• Early age of onset of smoking was more important in predicting
genetic damage than how heavily the individuals smoked
– A number of researchers have developed strategies for
interrupting behavioral patterns that lead to smoking
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 Stimulants

• Cocaine
– Use of cocaine in the last 30 days by high school seniors
has dropped from a peak in 1985
– A growing percentage of high school students are reaching
the conclusion that cocaine use entails considerable
unpredictable risk
• Amphetamines
– Amphetamines are widely prescribed stimulants,
sometimes appearing in the form of diet pills
– Use among high school seniors has decreased significantly
– 40% of today’s females have tried using diet pills by the
time they graduate from high school 48
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 Stimulants

• Ecstasy
– The synthetic drug MDMA which has stimulant and
hallucinogenic effects
– Use by U.S. adolescents began in the 1980s and then
peaked in 2000 to 2001(Johnston & others, 2011)
– In 2010, an upturn in use occurred, possibly because
today’s youth have heard less about the dangers of ecstasy
than their predecessors

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 Depressants

• Depressants: Drugs that slow down the central nervous

system, bodily functions, and behavior
– Among the most widely depressants are alcohol,
barbiturates, and tranquilizers
– Though used less frequently than other depressants, the
opiates are especially dangerous
• Barbiturates are depressant drugs that induce sleep or
reduce anxiety
– Since the initial surveys in 1975, use of depressants by
high school seniors has decreased

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 Depressants

• Opiates, which consist of opium and its derivatives,

depress the activity of the central nervous system
– Opiates are commonly known as narcotics
– Many drugs have been produced from the opium poppy,
among them morphine and heroin
– The opiates are among the most physically addictive drugs
– The rates of heroin use among adolescents are quite low,
but they rose significantly in the 1990s (Johnston & others,
2009)

51
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 Depressants

• An alarming trend has recently emerged in adolescents’

use of prescription painkillers
– Many adolescents cite the medicine cabinets of their
parents or friends’ parents as their main source
– A 2004 survey revealed that 18% of U.S. adolescents had
used Vicodin at some point in their lifetime, whereas 10%
had used OxyContin (Partnership for a Drug-Free
America, 2005)
– A significant drop in Vicodin use occurred in 2010
(Johnston & others, 2011)
– OxyContin use peaked in 2005 but has turned slightly
downward in 2010 (Johnston & others, 2011)
52
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 Figure 13.7

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 Anabolic Steroids

• Anabolic steroids: Drugs derived from the male sex

hormone, testosterone, which promote muscle growth
and increase lean body mass
• Nonmedical uses of these drugs carry a number of
physical and psychological health risks (National
Clearinghouse for Alcohol and Drug Information, 1999)

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 Anabolic Steroids

• Both males and females who take large doses usually

experience
– Changes in sexual characteristics
– Psychological effects including irritability, uncontrollable
bursts of anger, severe mood swings, impaired judgment,
and paranoid jealousy
• The rate of use by 12th-graders declined from 2004 to
2010 (Johnston & others, 2011)

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 Inhalants

• Inhalants: Ordinary household products that are inhaled

or sniffed to get high
– Inhalants include model airplane glue, nail polish remover,
and cleaning fluids
– Short-term use can cause intoxicating effects; long-term
use can lead to heart failure and even death
– Use is higher among younger than older adolescents
– Use has decreased in the 21st century (Johnston & others,
2011)

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 Factors in Adolescent and Emerging Adult
Drug Use
• Early substance use
– A special concern involves adolescents who begin to use
drugs early in adolescence or even in childhood
(Buchmann & others, 2009)
• One study revealed that individuals who began drinking alcohol
before 14 years of age were more likely to become alcohol
dependent than their counterparts who began drinking at age 21 or
older (Hingson, Heeren, & Winter, 2006)

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 Factors in Adolescent and Emerging Adult
Drug Use
• Parents, peers, & schools
– Positive relationships with parents and others can reduce
adolescents’ drug use (Harakeh & others, 2010; Marti,
Stice, & Springer, 2010)
– Parental monitoring is linked with a lower incidence of
drug use (Tobler & Komro, 2010)

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 Factors in Adolescent and Emerging Adult
Drug Use
– A sequence of factors that was related to whether an
adolescent would take drugs by 12 years of age was
(Dodge & others, 2006):
• Being born into a high-risk family
• Experiencing an increase in harsh parenting in childhood
• Having conduct problems in school and getting rejected by peers
in childhood
• Experiencing increased conflict with parents in early adolescence
• Having low parental monitoring
• Hanging out with deviant peers in early adolescence and engaging
in increased substance use
– Educational success is also a strong buffer for the
emergence of drug problems in adolescence (Henry &
others, 2009)
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 Factors in Adolescent and Emerging Adult
Drug Use
• Fortunately, by the time individuals reach their mid-20s,
many have reduced their use of alcohol and drugs
• A longitudinal analysis of more than 38,000 individuals,
from the senior year of high school through their 20s,
found that drug use was related to (Bachman & others,
2002):
– Level of education
– Living arrangements and marital status
– Importance of religion

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 Figure 13.8

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 What is Juvenile Delinquency?

• Juvenile delinquency: Refers to a broad range of

behaviors, from socially unacceptable behavior (such as
acting out in school) to status offenses (such as running
away) to criminal acts (such as burglary)
• For legal purposes, a distinction is made between index
offenses and status offenses:
– Index offenses are criminal acts, whether they are
committed by juveniles or adults, including such acts as
robbery, aggravated assault, rape, and homicide
– Status offenses, such as running away, truancy, underage
drinking, sexual promiscuity, and uncontrollability, are
less serious acts; they are performed by youth under a
specified age, which classifies them as juvenile offenses 62
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 What is Juvenile Delinquency?

• States often differ in the age used to classify an

individual as a juvenile or an adult
– Approximately ¾ of states have established age 18 as a
maximum for defining juveniles
• One issue in juvenile justice is whether an adolescent
who commits a crime should be tried as an adult
– Some psychologists have proposed that individuals 12 and
under should not be evaluated under adult criminal laws
and that those 17 and older should be (Steinberg &
Cauffman, 2001; Steinberg, 2009)

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 What is Juvenile Delinquency?

• Many of the behaviors considered delinquent are

included in widely used classifications of abnormal
behavior
– Conduct disorder is the psychiatric diagnostic category
used when multiple behaviors occur over a 6-month
period, including truancy, running away, fire setting,
cruelty to animals, breaking and entering, and excessive
fighting (Burke, 2011)

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 What is Juvenile Delinquency?

• The number of juvenile court delinquency caseloads in the

U.S. increased dramatically from 1960 to 1996 but has
decreased slightly since 1996 (Puzzanchera & Sickmund,
2008)
– Males are more likely to engage in delinquency than are
females (Colman & others, 2009)
– Percentage of delinquency caseloads involving females
increased from 19% in 1985 to 27% in 2005 (Puzzanchera
& Sickmund, 2008)

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 What is Juvenile Delinquency?

• Rates of delinquency and crime change as adolescents

become emerging adults
• Early-onset antisocial behavior (before age 11) is
associated with more negative developmental outcomes
than late-onset (after age 11) antisocial behavior
(Schulenberg & Zarrett, 2006)

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 Figure 13.9

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 Figure 13.10

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 Antecedents of Juvenile Delinquency

• Delinquency is an attempt to establish an identity

(Erikson, 1968)
• Family support systems play key roles
– Parental monitoring of adolescents is especially important
in determining whether an adolescent becomes a
delinquent (Laird & others, 2008)
• An increasing number of studies have found that siblings
can have a strong influence on delinquency (Bank,
Burraston, & Snyder, 2004)
• Having delinquent peers (Loeber & others, 2009)

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 Antecedents of Juvenile Delinquency

• Low SES and poor neighborhood quality

• Cognitive factors such as low self-control, low
intelligence, and lack of sustained attention
• In a longitudinal study, one of the strongest predictors of
reduced likelihood of engaging in serious theft and
violence was high academic achievement (Loeber &
others, 2008)

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 Effective Prevention and Intervention
Programs
• The most successful programs are those that prevent
juvenile delinquency from occurring the first place
(Greenwood, 2008)
• The most successful programs once adolescents have
engaged in delinquency focus on improving family
interactions and providing skills to adults who supervise
and train the adolescent
• The least effective programs are those that emphasize
punishment and attempt to scare youth

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 Depression and Suicide

• In major depressive disorder, an individual experiences a

major depressive episode and depressed characteristics for
at least two weeks or longer and daily functioning
becomes impaired (American Psychiatric Association,
1994)
• Rates of ever experiencing major depressive disorder
range from 1.5-2.5% in school-age children and 15-20%
for adolescents (Graber & Sontag, 2009)
• By about age 15, adolescent females have a rate of
depression that is twice that of adolescent males
– In many cultures the gender difference holds, in others it
does not 72
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 Depression and Suicide

• Mental health professionals note that depression often

goes undiagnosed in adolescence (Nolen-Hoeksema,
2011)
– Parents, teachers, and other observers may see these
behaviors as simply transitory and reflecting not a mental
disorder but rather normal adolescent behaviors and
thoughts
• Family factors are involved in adolescent depression
(Gladstone, Beardslee, & O’Connor, 2011; Hamza &
Willoughby, 2011)
– Inept parenting, parent-adolescent conflict, low parental
support, mother-daughter co-rumination, exposure to
maternal depression 73
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 Depression and Suicide

• Not having a close relationship with a best friend, having

less contact with friends, and being rejected by peers
increase depressive tendencies in adolescents (Vernberg,
1990)
• In one study, depressed adolescents recovered faster when
they took an antidepressant and received cognitive
behavior therapy that involved improving their coping
skills than when they only took an antidepressant or only
received cognitive behavior therapy (TADS, 2007)
– A safety concern has emerged with regard to taking
antidepressants such as Prozac (fluoxetine)
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 Depression and Suicide

• Depression is linked to an increase in suicidal ideation and

suicide attempts in adolescence (Thompson & Light,
2011; Verona & Javdani, 2011)
– Suicidal behavior in rare in childhood but escalates in
adolescence and then increases further in emerging
adulthood (Park & others, 2006)
– Suicide is the 3rd leading cause of death in 10- to 19-year-
olds today in the U.S. (National Center for Health Statistics,
2007)
– Suicide rates have declined in recent years
• Far more adolescents contemplate or attempt suicide than
actually commit it
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 Depression and Suicide

• According to a national study, females were more likely to

attempt suicide than males, but males were more likely to
succeed in committing suicide (Eaton & others, 2006)
– In emerging adulthood, males are 6 times more likely to
commit suicide as females (National Center for Injury
Prevention and Control, 2006)
– Males use more lethal means

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 Depression and Suicide

• Adolescent suicide attempts vary across ethnic groups in

the U.S.
– Suicide accounts for almost 20% of Native
American/Alaska Native deaths in 15- to 19-year-olds
(Goldston & others, 2008)
• A major risk factor is their elevated rate of alcohol abuse
– African American and non-Latino White males reported the
lowest incidence of suicide attempts

77
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 Figure 13.11

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 Figure 13.12

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 Depression and Suicide

• Both early and later experiences may be involved in

suicide attempts
– These experiences may include a history of family
instability and unhappiness, and physical or sexual abuse
(Evans, Hawton, & Rodham, 2005)
• Peer relations also are linked to suicide attempts
• Depression is the most frequently cited factor associated
with adolescent suicide (Bethell & Rhoades, 2008;
Thompson & Light, 2011)

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 Figure 13.13

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 Eating Disorders

• Eating disorders have become increasingly common

among adolescents (Schiff, 2011; Wardlaw & Smith,
2011)
• Research findings have linked adolescent eating disorders
to:
– Body image
– Parenting
– Sexual activity
– Role models and the media

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 Overweight and Obese Adolescents

• The Centers for Disease Control and Prevention (2011)

does not have an obesity category for children and
adolescents because of the stigma the label obesity may
bring
– They have categories for being overweight or at risk for
being overweight, determined by body mass index (BMI)
• Overweight: Adolescents at or above the 95th percentile of BMI
• At risk for overweight: Adolescents at or above the 85th percentile of
BMI

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 Overweight and Obese Adolescents

• The percentage of overweight adolescents and emerging

adults increased dramatically in the 1980s, 1990s, and
early into the 21st century (Spruijt-Metz, 2011)
– In 2004, 17% of U.S. 12- to 19-year-olds were overweight
(Eaton & others, 2006)
– Despite a recent leveling off, overweight and obesity in
adolescents remains at epidemic levels

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 Overweight and Obese Adolescents

• Being overweight as a child is a strong predictor for being

overweight as an adolescent
• An increase in being overweight also has occurred in
emerging adulthood (Park & others, 2006)
– Approximately 17% of emerging adults are estimated to be
obese (Brown, Moore, & Bzostek, 2005)

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 Overweight and Obese Adolescents

• African American girls and Latino boys have especially

high risks of being overweight during adolescence
(National Center for Health Statistics, 2002)
• U.S. children and adolescents are more likely to be
overweight or obese than their counterparts in most other
countries (Spruijt-Metz, 2011)

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 Figure 13.14

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 Overweight and Obese Adolescents

• Eating patterns established in childhood and adolescence

are strongly linked to obesity in adulthood
• Both heredity and environmental factors are involved in
obesity (Hahn, Payne, & Lucas, 2011)
– Strong evidence of the environment’s role is the doubling of
the rate of obesity in the U.S. since 1900, as well as the
significant increase in adolescent obesity since the 1960s
• This increase is likely due to greater availability of food, energy-
saving devices, and declining physical activity

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 Overweight and Obese Adolescents

• Being overweight or obese has negative effects on

adolescent health in terms of both biological and
socioemotional development (Schiff, 2011; Spruijt-Metz,
2011)

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 Overweight and Obese Adolescents

• Research indicates that regular exercise is a key

component of weight reduction in adolescence (Ingul &
others, 2010; Spruijt-Metz, 2011)
• Interventions targeted at changing family lifestyle were
the most effective in helping children and adolescents lose
weight (Oude Luttikhuis & others, 2009)
• In general, school-based approaches have been less
effective than clinically based individual approaches
(Dobbins & others, 2009; Lytle, 2009)

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 Anorexia Nervosa

• Anorexia nervosa: An eating disorder that involves the

relentless pursuit of thinness through starvation
– It is a serious disorder than can lead to death (Hebebrand &
Bulik, 2011; Knoll, Bulik, & Hebebrand, 2011)
– Three main characteristics are:
• Weighing less than 85% of what is considered normal for age and
height
• Having an intense fear of gaining weight
• Having a distorted image of body shape

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 Anorexia Nervosa

• Anorexia typically begins in the early to middle teenage

years, often following an episode of dieting and some type
of life stress
– It is about 10 times more likely in females than males
– Less than 1% of U.S. adolescent girls ever develop anorexia
(Walters & Kendler, 1994)

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 Anorexia Nervosa

• Most individuals with anorexia are non-Latino White

adolescents or young adults from well-educated, middle-
and upper-income families that are competitive and high-
achieving
– Problems in family functioning are increasingly being found
to be linked to the appearance of anorexia in adolescent
girls (Benninghoven & others, 2007)
– Recent research reviews indicate that family therapy is often
the most effective treatment (Agras & Robinson, 2008;
Fisher, Hetrick, & Rushford, 2010; Halmi, 2009)
• The fashion image in U.S. culture contributes to the
incidence of anorexia nervosa
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 Bulimia Nervosa

• Bulimia nervosa: An eating disorder in which the

individual consistently follows a binge-and-purge eating
pattern
– As in anorexia nervosa, most individuals with bulimia are
preoccupied with food, have a strong fear of becoming
overweight, and are depressed or anxious (Speranza &
others, 2005)
– Unlike anorexia nervosa, people who binge and purge
typically fall within a normal weight range

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 Bulimia Nervosa

• Bulimia typically begins in late adolescence or early

adulthood
– About 90% of cases are women
– About 1-2% of women are estimated to develop bulimia
– As with anorexia nervosa, about 70% of individuals who
develop bulimia eventually recover from the disorder
(Agras & others, 2004)

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 Binge Eating Disorder (BED)

• Binge eating disorder: Involves frequent binge eating but

without compensatory behavior like purging
– Individuals with BED are frequently overweight (New,
2008)
– Approximately 1/3 of those with BED are male (New,
2008)
• A recent research review indicated that the two best
predictors that differentiated BED from other eating
disorders were eating in secret and feeling disgust after the
episode (White & Grilo, 2011)
• Adults in treatment for BED often say that their binging
problems began in childhood or adolescence (New, 2008) 96
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 Interrelation of Problems and
Prevention/Intervention
• Adolescents with Multiple Problems
• Prevention and Intervention

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 Adolescents with Multiple Problems

• The four problems that affect the largest number of

adolescents are (Dryfoos, 1990):
– Drug abuse
– Juvenile delinquency
– Sexual problems
– School-related problems

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 Adolescents with Multiple Problems

• Researchers are increasingly finding that problem

behaviors in adolescence are interrelated (Elkington,
Bauermeister, & Zimmerman, 2011)
– As much as 10% of the adolescent population in the U.S.
have serious multiple-problem behaviors
– It was estimated that in 2005 the figure for high-risk youth
had increased to 20% of all U.S. adolescents (Dryfoos &
Barkin, 2006)

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 Prevention and Intervention

• In a review of programs that have been successful in

preventing or reducing adolescent problems, Dryfoos
(1990, 1997; Dryfoos & Barkin, 2006) described the
common components of these programs:
– Intensive individualized attention
• In successful programs, high-risk youth are attached to a
responsible adult who gives the youth attention and deals with the
child’s specific needs (Glidden-Tracey, 2005; Nation & others,
2003)

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 Prevention and Intervention

– Community-wide, multiagency collaborative approaches

• Programs that include policy changes and media campaigns are
more effective when they are coordinated with family, peer, and
school components (Wandersman & Florin, 2003)
– Early identification and intervention
• Reaching children and their families before children develop
problems, or at the beginning of their problems, is a successful
strategy (Aber & others, 2006)

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 E-LEARNING TOOLS

To help you master the material in this chapter,

visit the Online Learning Center for
Adolescence, 14th edition at:

http://www.mhhe.com/santrocka14e

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