Millenium Development Goals Specific Objectives: By the end of
this lecture, the student will be able to: Identify the importance
of growth and development. Define growth and development. Mention
the principles of growth and development. List factors affecting
growth and development. Mention types of growth and development.
Identify the stages of development. 10 to 19 Year Old Adolescent
age Physical growth Physiological growth Secondary sex
characteristics Cognitive development Emotional development Social
development Definition of adolescent: Adolescence is a transition
period from childhood to adulthood. Its is based on childhood
experiences and accomplishments. It begins with the appearance of
secondary sex characteristics and ends when somatic growth is
completed and the individual is psychological mature. Physical
growth: Weight: Growth spurt begins earlier in girls (10 14 years,
while it is 12 16 in boys). Males gains 7 to 30kg, while female
gains 7 to 25kg. Height: By the age of 13, the adolescent triples
his birth length. Males gains 10 to 30cm in height. Females gains
less height than males as they gain 5 to 20cm. Growth in height
ceases at 16 or 17 years in females and 18 to 20in males
Physiological growth: Pulse: Reaches adult value 60 80 beats/min.
Respiration: 16 20C/minute. NB:The sebaceous glands of face, neck
and chest become more active. When their secretion accumulates
under the skin in face, acne will appear. Appearance of secondary
sex characteristics 1- Secondary sex characteristics in girls:
Increase in transverse diameter of the pelvis. Development of the
breasts. Change in the vaginal secretions. Growth of pubic and
axillary hair. Menstruation (first menstruation is called menarche,
which occurs between 12 to 13 years). Body image 2- Secondary sex
characteristics in boys: Increase in size of genitalia. Swelling of
the breast. Growth of pubic, axillary, facial and chest hair.
Change in voice. Rapid growth of shoulder breadth. Production of
spermatozoa (which is sign of puberty). Adolescent As teenagers
gain independence they begin to challenge values Critical of adult
authority Relies on peer relationship Mood swings especially in
early adolescents Cognitive development: Through formal operational
thinking, adolescent can deal with a problem. Emotional
development: This period is accompanied usually by changes in
emotional control. Adolescent exhibits alternating and recurrent
episodes of disturbed behavior with periods of quite one. He may
become hostile or ready to fight, complain or resist every thing.
Social development: He needs to know "who he is" in relation to
family and society, i.e., he develops a sense of identity. If the
adolescent is unable to formulate a satisfactory identity from the
multi-identifications, sense of self-confusion will be developed
according to Erikson:- Adolescent shows interest in other sex. He
looks for close friendships. Adolescent behavioral problems
Anorexia Attention deficit Anger issues Suicide Adolescent Teaching
Relationships Sexuality STD s / AIDS Substance use and abuse Gang
activity Driving Access to weapons Adolescence iis derived from the
Latin word adolescere, which brings the meaning of to grow in
maturity or to grow into adulthood pperiod of self-examination and
emerging identity that spans the second decade, during which
individual changes from being childlike to adultlike TThe
physiologic period between the beginning of puberty & cessation
of bodily growth tthe life stage that bridges childhood and
adulthood 19 Phase of rapid physical, psychological, emotional
development A time of new opportunities, new capacities, new
experiences and new challenges Changing roles, responsibilities,
influences and expectations: moving towards family formation,
economic security, citizenship What makes adolescence different
from childhood and being an adult? 20 Classification Adolescence :
10 19 years Early Adolescence : 10 13 years Middle adolescence : 14
16 years Late adolescence : 17 19 years Youth : 15 24 years Young
people : years Characteristics of Early Adolescence Preoccupation
with body changes in search for identity Minor parental conflicts
and rebellion common Peers are usually same sex and age, peer
acceptance paramount Concrete cognition Beginning to seek
independence Limited dating Characteristics of Early Adolescence
Limited ability to imagine the consequences of risky behavior
Limited ability to link cause and effect in regard to health
behavior (eg, smoking, reckless driving, overeating) Attachment to
non-parental adults is common Early Adolescence Very moody Very
sensitive to their changing body and often measure their physical
appearance and skills against idealized images. Curiosity about
sexual matters begins. Young teens would much rather be with their
friends than their family, especially their parents. Realizes
parents are not perfect and often points out their faults. Early
Adolescence Searches for new adults to confide in instead of
parents. They often need a hero or an adult to look up today. Young
adolescents may be quick to disagree with parents and take the
opposite view on an issue to test parental values. Quick to
demonstrate feel through behavior (acting- out). They become
frustrated and anxious because of lack of experience and inability
to cope with certain events and problems Characteristics of Middle
Adolescence years of age Peer group remains very important for
social and behavioral norms Dating a major activity Conflicts with
parents, emancipation issues become dominant themes Beginning of
abstract cognition Feelings of omnipotence and invincibility
Characteristics of Middle Adolescence Pubescence almost complete
Risk-taking behaviors, rebellion, and impulsiveness are necessary
as part of achieving independence Rejection of authority and
risk-taking tendencies may include rejection of medical advice and
treatment previously accepted Middle Adolescence The majority of
changes associated with puberty have taken place Tenderness is
shown toward the opposite sex with frequently changing
relationships. they often write down their inner thoughts and
feelings in a diary. Complains that parents interfere with their
independence. Teens during this stage experience the most conflict
with their parents. Middle Adolescence Most teens this age still
feel invincible and that nothing bad could possibly happen to them.
This will cause them to engage in high risk behaviors.
Experimentation with alcohol, cigarettes, marijuana, and sexual
intercourse increases sharply during this stage. Char acteristics
of Late Adolescence years of age (or older) Emancipation complete,
parent-child relationship is adult to adult Peer group superseded
by strong individual relationships Intimacy with commitment rather
than exploration Planning for the future Self-identity established
Char acteristics of Late Adolescence Understands consequences of
actions and risk- taking behavior Age does not equate to stage Late
Adolescence Physiological development is generally complete.
Greater emotional stability. Develops clear sexual identity. Is
very concerned about serious relationships and develops the
capacity for tender and sensual love. Young adult will start to
listen to parents advice again. They may even seek out their
parents opinion as parents accept adolescent as a young adult. Late
Adolescence Teens this age begin to realize their mortality and
begin to worry about the future. Has greater ability to express
ideas rather than acting out. Their value system is also changing.
Often idealistic. Causes are embraced with conviction. Peer-group
relationships are replaced by individual friendships. Adolescent
Growth and Development Physiology of Pubescence (Puberty) The term
puberty refers to the physical changes that occur in a growing girl
or boy during the transition from childhood to adulthood Puberty is
the period in which an individual first becomes capable of
reproduction - Pubescence is a dynamic process that can take 2.5 to
5 years to complete - GnRH stimulates production of LH and FSH,
which stimulates the ovaries and testes to make estrogen and
testosterone - Bone age (skeletal maturity) may be disparate by as
much as two years from chronological age and still be normal -
Individuals who begin growth spurt early are initially taller than
peers,but they will ultimately be relatively shorter than those who
begin their growth spurt later Five chief physical manifestations
of Puberty 1. Rapid acceleration in growth - w/c results in
dramatic increase in height and weight 2. Development of Primary
sexual characteristics - includes further development of gonads or
sex glands - gonads: testes- in males ovaries in females 3.
Development in secondary sex characteristics - involves changes in
the genitals & breasts, the growth of pubic, facial & body
hair & further development of the sex organs 4. Changes in body
composition -refers specifically to the quantity & distribution
of fat & muscles 5. Changes in circulatory & respiratory
systems -w/c leads to an increase in strength & tolerance to
exercise - The first sign of pubescence in males in usually
testicular enlargement (normal age of onset is 11.5 years with a
range of 9-14 years) - The first sign of pubescence in females is
usually breast bud formation (normal age of onset has a range of
8-14 years) -Most girls are 1 to 2 inches taller than boys coming
into adolescence and generally stop growing three years post
menarche -Boys grow about 4 to 12 inches on height and gain 15 to
65 lbs during adolescence -Girls grow 2 to 8 inches in height and
gain 15 to 55 lbs. I. Physical Growth & Development -Growth
stops with closure of the epiphyseal lines of long bones- this
occurs at about 16 or 17 years in females and about 18 to 20 years
of age in males -Increase in body size does not occur in all organ
at the same rate -Because the heart and lungs increase in size more
slowly than the rest if the body, blood flow and oxygen
availability are reduced. Thus adolescents may have insufficient
energy and become more fatigued trying to do various activities
that interest them -Androgen stimulates sebaceous glands to extreme
activity, sometimes resulting in acne, a common adolescent skin
problem -Apocrine sweat glands form shortly after puberty which
produces a strong odor in response to emotional stimulation.
Therefore, adolescents begin to notice they must shower or bathe
more frequently than they once did in order to be free from body
odor. Secondary Sexual Characteristics Males - testicular growth,
pubarche, penile growth, peak height velocity Females - breast
budding, pubarche, peak height velocity, menarche Menarche usually
occurs around 2 years after thelarche The height of girls will
rarely increase more than two inches after menarche Stage I
(Preadolescent) Only the papilla is elevated abovethe level of the
chest wall. Stage II - (Breast Budding) Elevation of the breasts
and papillae may occur as small mounds along with some increased
diameter of the areolae. Stage III - The breasts and areolae
continue to enlarge, although they show no separation of contour.
Stage I Preadolescent Stage II Breast Budding Stage III Continued
Enlargement Tanner Staging of Breasts Stage IV The areolae and
papillae elevate above the level of the breasts and form secondary
mounds with furtherdevelopment of the overall breast tissue. Stage
V Mature female breasts have developed. The papillae may extend
slightly above the contour of the breasts as the result of the
recession of the aerolae. Stage IV Areola and papilla form
secondary mound Stage v. Mature female breasts Gynecomastia Breast
enlargement in males Gynecomastia occurs very commonly in pubertal
males. Pubertal gynecomastia can be asymmetric and not indicate
pathology. Gynecomastia can cause a change in dressing habits and
physical activity. Usually resolves in 1 to 2 years, and it rarely
needs plastic surgery for correction. Stages of Pubic Hair
Development Stage I (Preadolescent) - Vellos hair develops over the
pubis in a manner not greater than that over the anterior wall.
There is no sexual hair. Stage II - Sparse, long, pigmented, downy
hair, which is straight or only slightly curled, appears. These
hairs are seen mainly along the labia. I Preadolescent no sexual
hair II Sparse, pigmented, long, straight, mainly along labia Pubic
hair growth in females is staged as follows: Stage III
-Considerably darker, coarser, and curlier sexual hair appears. The
hair has now spread sparsely over the junction of the pubis. Stage
IV - The hair distribution is adult in type but decreased in total
quantity. There is no spread to the medial surface of the thighs.
Stage V - Hair is adult in quantity and type and appears to have an
inverse triangle of the classically feminine type. There is spread
to the medial surface of the thighs but not above the base of the
inverse triangle. III Darker, coarser, curlier IV Adult, but
decreased distribution V Adult in quantity and type with spread to
medial thighs Stage I (Preadolescent) - Vellos hair appears over
the pubes with a degree of development similar to that over the
abdominal wall. There is no androgen-sensitive pubic hair. Stage II
- There is sparse development of long pigmented downy hair, which
is only slightly curled or straight. The hair is seen chiefly at
the base of penis. This stage may be difficult to evaluate on a
photograph, especially if the subject has fair hair. Stage III -
The pubic hair is considerably darker, coarser, and curlier. The
distribution is now spread over the junction of the pubes, and at
this point that hair may be recognized easily on black and white
photographs. I Preadolescent no sexual hair II Sparse, pigmented,
long, straight, mainly along base of penis III Darker, coarser,
curlier The stages in male pubic hair development are as follows :
Stage IV - The hair distribution is now adult in type but still is
considerably less that seen in adults. There is no spread to the
medial surface of the thighs. Stage V - Hair distribution is adult
in quantity and type and is described in the inverse triangle.
There can be spread to the medial surface of the thighs. IV Adult,
but decreased distribution V Adult in quantity and type with spread
to medial thighs Stages of Testicular Development Stage I
(Preadolescent - The testes, scrotal sac, and penis have a size and
proportion similar to those seen in early childhood, < 4 mL
volume Stage II There is enlargement of the scrotum and testes and
a change in the texture of the scrotal skin. The scrotal skin may
also be reddened, a finding not too obvious when viewed on a black
and white photograph. 4 to 6 mL Volume I Preadolescent II
Enlargement, change in texture Stage III 8 to 10 mL volume -Further
growth of the penis has occurred, initially in length, although
with some increase in circumference. There also is increased growth
of the testes and scrotum. 8 to 10 mL volume Stage IV - The penis
is significantly enlarged in length and circumference, with further
development of the glans penis. The testes and scrotum 10 to 15 mL
volume continue to enlarge, and there is distinct darkening of the
scrotal skin. This is difficult to evaluate on a black-and-white
photograph. 10 to 15 mL volume Stage V 15 to 25 mL volume - The
genitalia are adult with regard to size and shape. 15 to 25 mL
volume III Growth in length and circumference IV Further
development of glans penis, darkening of scrotal skin V Adult
genitalia -The onset of sexual maturation (puberty) typically is
accompanied by an interest in sexual anatomy, which may be a source
of anxiety. -As adolescents mature emotionally and sexually, they
may begin to engage in sexual behaviors. -Masturbation is common
among girls and nearly universal among boys. Sexual experimentation
- often begins as touching or petting and may progress to oral,
vaginal, or anal sex. - By late adolescence, sexuality shifts from
experimentation to being an expression of intimacy and sharing. II.
DEVELOPMENT OF SEXUAL MATURITY Management: 1.Healthcare provider
should provide appropriate advice on safe-sex practices as part of
routine health care and should screen all sexually active
adolescents for sexually transmitted diseases. 2.Helping
adolescents put sexuality into a healthy context, including issues
of morality and the formation of a family, is extremely important
3.Parents should share their values and expectations openly with
their adolescent children. Issue of Sexual Identity Many of those
who explore homosexual relationships ultimately do not continue to
be interested in same-sex relationships, whereas others never
develop interest in opposite-sex relationships. Homosexuality is a
normal variation of human sexuality and not a disorder Adolescents
may feel unwanted or unaccepted by family or peers if they express
homosexual desires. Such pressure (especially during a time when
social acceptance is critically important) can cause severe stress
Eriksons Psychosocial Theory: a) achieving a sense of identity b)
achieving a sense of intimacy world views become important and the
individual enters what is called a "psychological moratorium
Psychological moratorium - refers to a period of exploring
different roles, values, and skills. Fidelity: Identity vs. Role
Confusion (Adolescence, 12 to 19 years) Psychosocial Crisis:
Identity vs. Role Confusion Main Question: "Who am I and where am I
going?" Ego quality: Fidelity (Devotion to ones work. Implies the
unfailing fulfillment of one's duties and obligations and strict
adherence to vows or promises.) Fidelity: Identity vs. Role
Confusion (Adolescence, 12 to 19 years) The adolescent is newly
concerned with how they appear to others. As they make the
transition from childhood to adulthood, adolescents ponder the
roles they will play in the adult world. Initially, they are apt to
experience some role confusion- mixed ideas and feelings about the
specific ways in which they will fit into society- and may
experiment with a variety of behaviors and activities (e.g.
tinkering with cars, baby-sitting for neighbors, affiliating with
certain political or religious groups). Fidelity: Identity vs. Role
Confusion (Adolescence, 12 to 19 years) This turning point in human
development seems to be the reconciliation between 'the person one
has come to be' and 'the person society expects one to become'.
Fidelity: Identity vs. Role Confusion (Adolescence, 12 to 19 years)
Once people have established their identities, they are ready to
make long- term commitments to others. They become capable of
forming intimate, reciprocal relationships (e.g. through close
friendships or marriage) and willingly make the sacrifices and
compromises that such relationships require.marriage The four main
areas where adolescents must make gains to successfully achieve a
sense of identity are: 1.Accepting their changed body image 2.
Establishing a value system of what kind of person they want to be
3. Making a career decision 4. Becoming emancipated from their
parents - Management: 1. Healthcare providers can help open lines
of communication by offering adolescents and parents sensible,
practical, supportive advice. IV. Cognitive Development Jean
Piaget: Formal Operational Thought Jean Piaget, a famous Swiss
psychologist and theorist, placed adolescents in a cognitive stage
he called formal operational thought. In between ages 11 and 15
Piaget believed that thought becomes more abstract than a childs,
more idealistic, and more logical. -This step involves the ability
to think in abstract terms and use the scientific method to arrive
at conclusions -Problem solving in any situation depends on the
ability to think abstractly and logically -With the ability to use
scientific thought, adolescents can plan their future. They can
create a hypothesis. V. Psychosocial Development Peer group begins
to replace the family as the child's primary social focus.
Initially, peer groups are usually same-sex but typically become
mixed later in adolescence These groups assume an importance to
adolescents because they provide validation for the adolescent's
tentative choices and support in stressful situations. Gang
membership is more common when the home and social environments are
unable to counterbalance the dysfunctional demands of a peer group
Social Cognition Adolescents begin to develop a type of egocentrism
characterized by two parts : 1. imaginary audience - is the youth's
belief that others are as preoccupied with them as they are. 2.
personal fable - is characterized by the thought, "That would never
happen to me." - Adolescents have a sense of personal uniqueness
that leads them to believe no one can really understand them
Personality- Temperament - Early teen-agers feel more full of
self-doubt than self-confidence - They want to look grown-up, but
they still look like children - Most girls bodies have not yet
fully developed; they make look at themselves in the mirror and
compare their profiles with those of the girls in popular magazines
and feel inadequate - Many 13-year old adolescents fall in love
Communication - The voices of most boys have not yet dependably
deepened, thus they cannot trust their voices to carry the serious
tones they wish to convey - Fourteen-year olds are often quieter
and more introspective than they were the year before PLAY GGirls:
social functions, romantic TV shows, reading romance books cooking,
sewing, art and poetry, outings, movies, daydreaming, lengthy
telephone conversations BBoys: group activities predominate (e.g.
drinking sessions), sports, mechanical and electrical devices,
part-time employment, outings, movies, parties VI. Moral
Development Kohlbergs Theory of Moral Development: Adolescents:
Conventional moral reasoning - refers to adolescents and adults who
look to society norm for moral guidance. - One behaves properly in
order to receive the approval of others as well as to maintain in
the respecting social order. Diagnosis Health-seeking behaviors
related to normal growth and development Low self-esteem related to
facial acne Anxiety related to concerns about normal growth and
development Risk for injury related to peer pressure to use alcohol
and drugs Readiness for enhanced parenting related to increased
knowledge of teenage years
