Adolescent Behaviour and Health

Title page

Title - &= nbsp; &nbs= p; “Adolescent Behaviour and Health”

Author - &= nbsp; Diana M.L. Birch

Position - &= nbsp; Di= rector Youth Support

Address for correspond= ence - Youth Support House

= &nb= sp; = &nb= sp; 13, Crescent Road

= &nb= sp; = &nb= sp; London BR3 2NF

Tel no - 0181 650 6296= / 0181 659 9926

Fax no - 0181 659 3309=

Adolescent Behaviour a= nd Health

Adolescent health and well-being is inextricably linked with adoles= cent behaviour and these behaviour patterns are determined by the stage of emoti= onal and physical development of the individual influenced by the pressures which society may exert at a vulnerable stage.

Adolescence is regarded traditionally as a time of ‘delinquency’ and rebellion. It is also a time of energy and change. Both can be channelled in the healing process and that is what makes working with young people so exciting.

Rebellion and Identity= -

Adolescence is a time of radical psychological change and readjustm= ent. The first question to be answered is ‘ Who am I?’ A young person must find his or her place in the world and establish a personal identity.<= o:p>

Throughout early childhood the tendency is for a ‘false self’ to be built up - a persona who stands between the individual and the world - showing adults the child they would like to see. The child may decide that there are parts of himself which others do not want and do not = like and so learns to hide them from others and from himself. He lives in a world of denial wher= e he can try to be all things to other people while real feelings and needs fade ‘out of pain’. This building up of a false self occurs to an ex= tent in all of us, since we do not have perfect childhoods or perfect mothers. I= t is a healthy search for the ‘true self’ which prompts the rebellio= us adolescent to alter his appearance, break the family dress code with dirty = torn jeans, studded leather jacket, tattoos, rings in the nose, long hair or sha= ved head - whatever goes against the norm - making an outward statement of inner change “Look, I’m not what you wanted me to be any more!”= .

Winnicott once wrote a paper titled ‘Delinquency as a sign of hope’. Rebelling, pushing out against the injustices that you have suffered in childhood - that is indeed a sign of hope - a sign that the spi= rit is not broken, that there is an individual in there shouting out “Hey! What about ME!” The beginnings of change, of a sense of one’s o= wn needs, of self worth. ¹

Independence - Moving = out of the nest -

Human development is a series of progressions from total dependence= on the parent or family through a stage of total independence or breaking free= and culminating, hopefully in the mutual interdependence of satisfying relationships. The qual= ity of and nature of the patterns of attachment established in early childhood fundamentally affect the way that a teenager is able to ‘break free’ and whether he or she is likely to be harmed by that process.

A teenager with a ‘secure attachment’ fostered by a sta= ble loving home, will feel able to explore his expanding world from a ‘secure base’ <= sup>2 ; he will thus be able to safely ‘test the water’ , gain new experiences and ‘grow up’ - secure in the knowledge that by distancing himself a little from parents and indulging in mildly risky behaviour he will not be rejected and can always - like the prodigal - retu= rn to loving arms.

In contrast an unloved, rejected adolescent with insecure attachmen= t to his family will have no secure base from which to explore his world, will h= ave no boundaries or limits to his risk taking, and will be likely to become involved in harmful experiences which serve to confirm his belief that the world is a cruel and dangerous place. Such rejected and rejecting youngsters will often become invol= ved in crime, violence and drug abuse. Their health will suffer as a direct result= of drug, alcohol or solvent abuse and indirectly by virtue of their lifestyles which may involve poor diet, sleeping rough and general deprivation. <= /o:p>

The tragic reality is that young people who have been abused and sp= ent their early childhood in care are often those who leave the care system for a life of deprivation on the stre= ets. They constitute a high percentage of homeless youth who may be further expo= sed to the abuse of ‘survival sex’ and sexually transmitted disease ³ . Leaving ‘home’ with the prospect of&nb= sp; family ties and support bears no comparison to leaving ‘care’ when you are ‘out on your own= 217;.

Peer group influences - Replacement families? -

Personal identity involves separation from others, working out what= you believe in as opposed to what your family believes in, deciding on an ‘image’ - which often means choosing which peer group or ‘cult’ figure you will follow.= Teenagers reject their family norms in search of their own while needing = the approval of the peer group. The chosen group and hence it’s influence= can vary from week to week - resulting in dietary fads and varying dress codes mainly harmless in the long term although there are casualties - malnourish= ed ‘vegans’; infected ‘piercing’ sites; scarring tatto= os; hepatitis; sexually transmitted disease; unwanted pregnancy ....

Problems arise when group influence is pernicious in gang culture;<= span style=3D'mso-spacerun:yes'> in dance schools where desired sli= mness may encourage anorexia; in American female college ‘barf parties̵= 7; (eat and vomit) sanctioning bulimia or extreme as in cult membership exploi= ting the mentally vulnerable; or historically when the followers of Thomas Chatterton made ‘copycat’ suicide bids.

Self Worth<= /span>

Self esteem relates to an individuals personal values and not necessarily to those of his peers, his doctors or his teachers. Skills and attributes such as being good at maths should not be presumed to be somethi= ng valued by the teenager ..... “positive correlations between self este= em and educational performance are likely to be found only in populations in w= hich self esteem is bound up with aspirations for achievement. There are no a pr= iori reasons why academic achievements or anything else, should be of value to a= ll pupils" ⁴ .

If indeed self esteem is dependant on a personal value system, chan= ge may be achieved by altering these values, rather than by changing one's position within the existing hierarchy. If you lower your expectations, you= can fulfil them more easily without having to improve your achievements. This mechanism appears to be operational in schools where teenagers who have been conditioned to 'failing' academically form a 'counter culture' of academic incompetence within whose inverted value system they can succeed and consti= tute a model for younger pupils.

Self esteem can be boosted by changing how you view yourself within= a given value system - or by changing the value system altogether. If you are= not measuring up in one club - then join another or form your own. Teenage 'gan= g' culture, delinquency and 'drop outs' can all be manifestations of this proc= ess.

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Danny never knew his f= ather. His mother placed him in a children's home at the age of eleven. He had nev= er been particularly clever at school but was not doing too badly. His behavio= ur had not attracted much comment - that was the problem - not attracting much comment. Danny was nothing special, he did not excel or stand out in any wa= y.

Children's homes are n= ot easy places to live in, there is always a 'pecking order', bullies, bullied= and care workers 'pets'. Danny did not have a 'niche'. Not until he found somet= hing to excel in, some way to be noticed. He began to be involved in petty crime= at the age of fourteen, at first just a little shoplifting, which he exaggerat= ed and bragged about. Then as his exploits were not always believed, he made s= ure he got caught a few times - not enough to get into serious trouble with the law, but it improved his image.

As his image became to= ugher, he had to keep up with it, so he found himself getting into heavier crime. Younger boys and then a girlfriend went with him on exploits - so he had to prove that he really could burgle homes and 'mug' people in the street. Dan= ny had to be the 'badest of the bad' and for a while his girlfriend acted like= his 'moll'. She joined his 'counter culture' - a girl who was bright and doing = well at school pretended not to be so clever around him, 'so as not to show him = up' and convinced herself that her worth too lay in being tough, intimidating others and getting her name on police files.

The next step was pret= ending to get high on drugs - first using solvents and beer and 'acting' stoned. D= anny was afraid to use hard drugs to begin with although he would never admit it. Finally his bluff was called, doubly - he started using hard drugs, and as = his 'alternative value system' of juvenile crime and hard guy image began to sl= ip, became incapable of maintaining his self image, he turned increasingly to d= rug use to boost his flagging ego.

Danny, the violent drug addict, lost all his followers and his girlfriend. He was now compelled to continue in crime to fuel his habit, he had lost control and the means by w= hich he had sought a boost to his self worth had become the means to drag him do= wn.

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The answer to “= who am I?” can very easily become negative for a deprived teenager with litt= le chance of achieving adult goals such as doing well at school, getting a job= and setting up their own home. It is easy for the answer to the question to bec= ome “I’m a failure”. Hence the loopholes “I can be a success if I can= be .... a gang leader .. a fathe= r ... a mother”. Schoolgirls who become pregnant frequently experience academic failure and in becoming young mothers they c= ould be seen to be 'finding and accepting alternative dimensions of value' establishing or joining a 'counter culture' of schoolgirl mothers. Many appear to use their pregnancies as a source of self worth, seem fulfilled and happy during and soon after the pregnancy and do better in th= eir individual tuition than they had done at school. ⁵

A self esteem measure= of pregnant schoolgirls and a comparable group of schoolgirl mothers indicated that while painful life experiences and deprivation resulted in an expected fall in se= lf esteem scores, the girls who were pregnant at the time of the testing felt = much more positive about themselves than the schoolgirl mothers. Pregnancy seeme= d to have protective value in conserving self-worth. Girls were finding an alter= native value system by which to judge their lives. ⁶

“Seen from a young girl’s viewpoint, pregnancy may not = be so undesirable; motherhood is a fulfilment; she takes on a valued role and = out of her loveless world creates a baby who will love her. Pregnancy is thus u= sed as a source of self-worth and a false solution to problems. That being so, an alternative solu= tion must be offered. These young people need an alternative source of self-wort= h in order to ensure that when they become parents this is because they desire parenthood, with all its responsibilities, hardships and joys, not merely as the only perceived escape from a catalogue of problems.” ⁷

Risk Taking Behaviour<= o:p>

Risk taking behaviour is an integral part of adolescence. All teena= gers take risks - the variability lies in the degree of risk taking and the leng= th of this phase. As with other aspects of teenage emotional development - some ‘grow up faster then others’ and come through with fewer scars.

Risk taking is associated with several factors - Firstly the inabil= ity to accurately perceive risk. For instance it has been suggested that adolescents may fail to protect themselves from some risks because they can= not appreciate them as such. This is a time for exploring the world , not for hiding behind closed doors, hence teens do not expect to be harmed while pushing out the boundaries. Some girls may expose themselves to risk of sex= ual assault because they are unable to estimate the risk posed by ‘predat= ory men’.

Denial of risk. Many girls deny that they can become pregnant. They believe they are too young. Belief in the impossibility of pregnancy tends = to become almost a magical protection like a lucky charm “It won’t happen to me”. These teenagers are still at the stage of concrete reasoning and cannot identify with the experiences of others. ⁸ This explains why health education methods based on shock tactics do not work with this age group. =

Adolescents believe in their own invincibility and hence are unable to appreciate= the consequences of behaviours which pose a health risk. Development of a future time perspective is another aspect of adolescent development. ⁹ Couple a belief of invincibi= lity with a delay in the cause and effect sequence and the possibility of harm becomes even more remote. Hence teenagers cannot link smoking with cancer (which may not strike for 20 years); sex with the birth of a child (9 months later) or unprotected sex with HIV infection and with death from AIDS.

The adolescent psyche is geared not to hear traditional health education messages and the approach to HIV prevention is a good example of = how the ‘message’ can be misinterpreted. In this respect profession= als must take care to distinguish good education from good advertising. A campa= ign based on cult rock ‘heroes’ who have died of AIDS - and are thus ‘martyrs’ to ‘the cause’ - can engender a heightened feeling of ‘separateness’; an alternative culture; living life = in the fast lane and “who wants to be thirty anyway?” rather than = an educated group of young people wishing to practice safe sex. This is simila= r to the drug culture promoted by rock musicians in the sixties and seventies. Y= oung people were more likely to smoke cannabis like John Lennon or try drugs to = be like Eric Clapton than to be put off by the deaths of Janis Joplin and Jimi Hendrix.

Sexual behaviour -

Each year in England and Wales approximately 10,000 schoolgirls bec= ome pregnant. Conception rates for girls aged 14 and under rose by 27% in the decade 1978-88 indicating that the very young, most vulnerable, girls and boys needing most support are being failed by prevent= ive and educational programmes.

By understanding the = belief systems of the adolescent and his or her peer group we can more effectively interact with that young person in a way which has relevance and meaning. Parental, cultural and relig= ious beliefs or myths form a basis upon which more contemporary, up-market, peer group beliefs are built. These basic belief systems, can to some extent be modified with sex education. For instance, = peer group beliefs such as “You can’t get pregnant standing up” can be confronted with factual knowledge such as sperm can swim uphill!

At a deeper level the adolescent has ‘magical beliefs’. Intrinsic ideals with a high emotional content, a feeling of instinct and intuition which may have no perceivable basis in current reality. Magical beliefs centre on fundamental concepts such as feelings about self, body and control and on the nature of life itself.&= nbsp; Beliefs which conjure the ‘autonomous womb’ and give ris= e to statements such as “Well I kn= ew someone was pregnant, but I didn’t know it was me”. ¹⁰

We have discussed how the adolescent during psychological developme= nt is much preoccupied with the question “Who am I?” Confusion inevitably arises when “Who am I?” becomes “Who are we?” Establishing a personal identity may thus be= an impossible task for a pregnant adolescent who suddenly finds that her identity is changing beyond h= er control. She is no longer a little girl, she is a fertile woman. The role of a mother is thrust upo= n her before she establishes her own identity, hence the belief that she cannot g= et pregnant and her frequent denial of pregnancy. “I knew about sex and how girls = could get pregnant, but I never thought it could happen to me”.<= /i>

Many factors interact in limiting contraceptive use. For young teenagers under the age of 16, it is not so much a matter of availability of contraceptive services which affects sexual practices and conception rates. Much more important is the social situation and life experiences which affect their emotional maturity= , motivation and their value systems.

Locus of Control =

Teenage behaviour, particularly with regard to sexuality is profoun= dly affected by beliefs about control. Lack of control is at the basis of young teenager’s notoriously poor use of contraception. Only 7% of London pregnant schoolgirls ever used contraception. ⁵ Young girls deny to themselv= es that they are having sex, and convince themselves that if they do end up in= bed with a boy it is a one-off event. This denial is a protective mechanism. Unplanned sex is an accident. Nob= ody can be blamed for the occasional slip however, premeditated planned sex is inexcu= sable.

Emotional development involves internalising the “locus of control”, assuming responsibility for one̵= 7;s actions and one’s body. Those maintaining an external locus of control are not in control of when they ha= ve sex or whether they get pregnant, are not responsible for their actions or their bodies - pregnancy is something that happens to them. It is a matter of fate.

The same applies to many other aspects of adolescent behaviour. Assuming responsibility for one’s own actions and thus being able to decide whether to ‘say no’ to drugs implies awareness of the consequences of those actions, ability to appreciate ‘cause and effect’ and ability to accept feasibility of control. The adolescent who cannot relate to these concepts remains buffete= d by fate and places responsibility on external control.

Our responsibility is to ensure that children can be raised with en= ough self confidence and self worth so that as teenagers they are able to seek h= elp and guidance in facing the challenges, thrills and risks of adolescence wit= hout suffering irrevocable harm.

References:=

1. Winnic= ott D.W. "Delinquency as a s= ign of hope" in - Davis D., Wallbridge D. <= /span>'Boundary= and space' Karnac Books 1981

2. Bowlby J. 'A secure Base' Routledge 1988.

3. MacKenzie R, Pennbridge J., David T., Yeates G. “Runaway a= nd Homeless Youth in Los Angeles county California” Journal of Adolescent Health Care = 1990; 11 : 159-165.

4. Robinson J. "= Self Esteem, Identity and achievement in secondary school pupils" Bristol University Press 1989.

5. Birch, D.M.L. “Unwillingly to School - Education of Pregna= nt schoolgirls” in “Are you my Sister, Mummy?”, Youth Support Publications 1987 : 18 : 199-205.

6. Birch, D.M.L. “Challenges to self worth” in “I= nner worlds & Outer Challenges” Youth Support Publications1992 : 80-99.

7. Birch, D.M.L. “Schoolgirl Pregnancies” in ‘Progress in Obstetrics & Gynaecology Vol.7’ 1989; Chapter = 5 : 75-90.

8. Coleman J. “Identity in adolescence; Present and Future Self-concept”. Human Development. 1972 15: 1.

9. Blum R.W., Resnick M.D. “Adolescent Sexual Decision-making; contraception, pregnancy, abortion, motherhood.” Pediatric Annals 1982 11:10 797-805

10. Birch, D.M.L. “That Old Black Magic. Teenage Sexual Belief Systems” International Journal of Adolescent Medicine and Health 1991; 5 :1 37-47