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The Adolescent Transition

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The Adolescent Transition

OTs can help teens

find healthy outlets

By Jill Diffendal

The life journey from the carefree days of childhood to the responsibility-laden concerns of adulthood passes, for each of us, through a tumultuous and confusing period known as adolescence. From the first day of high school to the first kiss to the first job, youths must constantly deal with issues of identity, physical and emotional frontiers, peer pressure and independence. In order to provide holistic occupational therapy to this group, a provider must understand and be prepared to address these issues.

OTcoverbw1 "It's important to look at (a child's) difficulties superimposed upon where they are in terms of their normal development," said Sherry Goldman, MD, a child and adolescent psychiatrist with a private practice in Rockville, MD. Dr. Goldman, also a pediatrician, is board certified in both general psychiatry and child and adolescent psychiatry. She is a member of the Committee for Adolescence of the American Academy of Child and Adolescent Psychiatry

"Adolescence begins with physical changes, initially," Dr. Goldman explained. "Girls go through puberty about two years ahead of boys, but it can vary. Chronological age is not a good marker of development. Children at this stage also experience cognitive changes, developing formal reasoning and abstract thought."

As adolescents begin these physical, emotional and hormonal changes, they begin to form a sense of self that is initially very egocentric. They experience intense, confusing emotions and feel alone, as if no one else has ever felt this way before. As development continues, adolescents begin to realize that their peers are dealing with the same issues, which leads to stronger peer bonds.

"An important stage of adolescence is affiliating with a group,'" said Franklin Stein, PhD, OTR/L, FAOTA, professor of occupational therapy at the University of South Dakota. "One of the major problems which comes up is being rejected--not being accepted by the group."

Some teens may do extremely well even without a social group, often setting high goals for themselves and spending most of their time working toward those goals. On the other hand, "if a person wants to be part of a social group and is rejected, that could cause depression, eating disorders or drug dependence," Dr. Stein observed.

This can be even more of a problem with children with disabilities. "I see a lot of kids who have learning disabilities or ADHD," Dr. Goldman said. "Their social skills and social awareness are affected, and they often are ostracized from the 'in-group.' They struggle with wanting to be accepted, wanting to like themselves and at the same time having to deal with the rejection."

Identification with peer groups brings with it a struggle for separation and autonomy, Dr. Goldman added. Adolescents push away from adult authority figures by devaluing them or acting out in ways that those authority figures will react to. As teens develop a sense of self, they try on different personality styles within their peer groups, including ways of dressing, different interests, and ways of approaching their education. Moving into young adulthood, the individual finds the qualities that are right for him and begins to incorporate them into a more fixed sense of self.

Some children handle separating from parents easily, but many have problems with this transition. Because they are so dependent upon their parents during childhood, they tend to idealize them as infallible protectors. During adolescence, as teens develop a more realistic worldview, they begin to realize that their parents are not perfect. To deal with this psychological loss, the adolescent will devalue his parents.

"This psychological separation from mom and dad is necessary for adolescents to later be able to develop a competent and healthy individual identity," Dr. Goldman said. Because of the sense of loss, however, the pull away may be taken to an extreme. Depression, running away, substance abuse or sexual activity are often consequences. "Later, after adolescence is finished and young adulthood is securely in place, they often come back to identify more strongly with mom and dad than they had during their rebellious stages."

This acting out affects the ways in which children interact with authority figures, and it often presents challenges when health care workers encounter adolescents. Dr. Goldman offers the example of a teen with juvenile diabetes. During his childhood, the disease may be easily controlled, but as the child ages, he wants to be less dependent. To show that he is, he may break his diabetes control regimen.

Healthy use of time is part of the key to successful transition. Teens need occupational options that they can participate in together, or peer pressure may lead them to do things they might not do otherwise. "If your friends are experimenting with drugs and alcohol, you will," Dr. Stein said. "If you want to be a part of that group, you do what the group does. So much of adolescence is abiding by group norms."

"In this day and age it is uncommon for kids not to experiment," Dr. Goldman agrees. "There are multiple factors, one of which is that extended family is a rarity, so that you don't have the support of multiple generations. Society itself is changing in terms of its roles. Mothers often have a career path as well as a family path. In general there is a tremendous amount of information that kids are exposed to that in some ways can be traumatizing."

Healthy use of time is part of the key to successful transition. Teens need occupational options that they can participate in together, or peer pressure may lead them to do things they might not do otherwise. "If your friends are experimenting with drugs and alcohol, you will," Dr. Stein said. "If you want to be a part of that group, you do what the group does. So much of adolescence is abiding by group norms."

"In this day and age it is uncommon for kids not to experiment," Dr. Goldman agrees. "There are multiple factors, one of which is that extended family is a rarity, so that you don't have the support of multiple generations. Society itself is changing in terms of its roles. Mothers often have a career path as well as a family path. In general there is a tremendous amount of information that kids are exposed to that in some ways can be traumatizing."

Experimenting, when taken to extremes or coupled with other destructive behaviors, can seriously affect an adolescent's normal development and ability to function. Rebellious attitudes can reduce success in school and lead to poor social adjustment and neglected responsibilities. Overcoming these behaviors and developing less egocentric attitudes are key to moving successfully beyond the adolescent stage.

"Those adolescents who are able to develop a niche for themselves--find a small job, start to make their own choices as to what to get involved in--when they make these steps, that's where independence begins," Dr. Stein concluded.

Navigating the obstacles of this difficult stage and developing the skills that will be necessary later in life are challenges that every adolescent must face. It takes a functional adolescent to become a functional adult. *

For more information on adolescent psychiatry, contact the American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Ave. NW, Washington, DC 20016-3007; (202) 966-7300; (202) 966-2891 (fax); www.aacap.org.

Jill Diffendal is ADVANCE editorial assistant.




     

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