. Personality development is the development of the organized pattern of behaviors and attitudes that makes a person distinctive.

Personality development occurs by the ongoing interaction of temperament , character, and environment.

In 1956, psychiatrist Erik Erikson provided an insightful description as to how personality develops based on his e tensive e perience in psychotherapy with children and adolescents from low, upper, and middle!class backgrounds. "ccording to Erikson, the sociali#ation process of an individual consists of eight phases, each one accompanied by a $psychosocial crisis$ that must be solved if the person is to manage the ne t and subse%uent phases satisfactorily. &he stages significantly influence personality development, with five of them occurring during infancy, childhood, and adolescence . 'efinition of adolescent Sometimes referred to as teenage years, youth, or puberty , adolescence is the transitional period between childhood and maturity, occurring roughly between the ages of 10 and 20.

&he word adolescence is (atin in origin, derived from the verb adolescere, which means $to grow into adulthood.$ "dolescence is a time of moving from the immaturity of childhood into the maturity of adulthood. &here is no single event or boundary line that denotes the end of childhood or the beginning of adolescence. )ather, e perts think of the passage from childhood into and through adolescence as composed of a set of transitions that unfold gradually and that touch upon many aspects of the individual*s behavior, development, and relationships. &hese transitions are biological, cognitive, social, and emotional. +uberty

he biological transition of adolescence, or puberty, is perhaps the most observable sign that adolescence has begun. echnically, puberty refers to the period during which an individual becomes capable of se!ual reproduction. "ore broadly speaking, however, puberty is used as a collective term to refer to all the physical changes that occur in the growing girl or boy as the individual passes from childhood into adulthood. he timing of physical maturation varies widely. #n the $nited States, menarche %onset of menstruation & typically occurs around age 12, although some youngsters start puberty when they are only eight or nine, others when they are well into their teens. he duration of puberty also varies greatly' 1( months to si! years in girls and two to five years in boys. he physical changes of puberty are triggered by hormones, chemical substances in the body that act on specific organs and tissues. #n boys a ma)or change incurred during puberty is the increased production of testosterone, a male se! hormone, while girls e!perience increased production of the female hormone estrogen. #n both se!es, a rise in growth hormone produces the adolescent growth spurt, the pronounced increase in height and weight that marks the first half of puberty. Perhaps the most dramatic changes of puberty involve se!uality. #nternally, through the development of primary se!ual characteristics, adolescents become capable of se!ual reproduction. *!ternally, as secondary se!ual characteristics appear, girls and boys begin to look like mature women and men. #n boys primary and secondary se!ual characteristics usually emerge in a predictable order, with rapid growth of the testes and scrotum, accompanied by the appearance of pubic hair. +bout a year later, when the growth spurt begins, the penis also grows larger, and pubic hair becomes coarser, thicker, and darker. ,ater still comes the growth of facial and body hair, and a gradual lowering of the voice. +round mid-adolescence internal changes begin making a boy capable of producing and e)aculating sperm. #n girls, se!ual characteristics develop in a less regular se.uence. $sually, the first sign of puberty is a slight elevation of the breasts, but sometimes this is preceded by the appearance of pubic hair. Pubic hair changes from sparse and downy to denser and coarser. /oncurrent with these changes is further breast development . #n teenage girls, internal se!ual changes include maturation of the uterus, vagina, and other parts of the reproductive system. "enarche, the first

menstrual period, happens relatively late in puberty. 0egular ovulation and the ability to carry a baby to full term usually follow menarche by several years. ,ognitive transition + second element of the passage through adolescence is a cognitive transition. /ompared to children, adolescents think in ways that are more advanced, more efficient, and generally more comple!. his is evident in five distinct areas of cognition. 1irst, during adolescence individuals become better able than children to think about what is possible, instead of limiting their thought to what is real. 2hereas children3s thinking is oriented to the here and now %i.e., to things and events that they can observe directly&, adolescents are able to consider what they observe against a backdrop of what is possible4they can think hypothetically. Second, during the passage into adolescence, individuals become better able to think about abstract ideas. 1or e!ample, adolescents find it easier than children to comprehend the sorts of higher-order, abstract logic inherent in puns, proverbs, metaphors, and analogies. he adolescent3s greater facility with abstract thinking also permits the application of advanced reasoning and logical processes to social and ideological matters. his is clearly seen in the adolescent3s increased facility and interest in thinking about interpersonal relationships, politics, philosophy, religion, and morality4topics that involve such abstract concepts as friendship, faith, democracy, fairness, and honesty. hird, during adolescence individuals begin thinking more often about the process of thinking itself, or metacognition. +s a result, adolescents may display increased introspection and selfconsciousness. +lthough improvements in metacognitive abilities provide important intellectual advantages, one potentially negative byproduct of these advances is the tendency for adolescents to develop a sort of egocentrism, or intense preoccupation with the self. +cute adolescent egocentrism sometimes leads teenagers to believe that others are constantly watching and evaluating them. Psychologists refer to this as the imaginary audience. + fourth change in cognition is that thinking tends to become multidimensional, rather than limited to a single issue. 2hereas children tend to think about things one aspect at a time,

adolescents describe themselves and others in more differentiated and complicated terms and find it easier to look at problems from multiple perspectives. 5eing able to understand that people3s personalities are not one-sided, or that social situations can have different interpretations, depending on one3s point of view, permits the adolescent to have far more sophisticated and complicated relationships with other people. 1inally, adolescents are more likely than children to see things as relative, rather than absolute. hey are more likely to .uestion others3 assertions and less likely to accept 6facts6 as absolute truths. his increase in relativism can be particularly e!asperating to parents, who may feel that their adolescent children .uestion everything )ust for the sake of argument. Emotional transition +dolescence is also a period of emotional transition, marked by changes in the way individuals view themselves and in their capacity to function independently. +s adolescents mature intellectually and undergo cognitive changes, they come to perceive themselves in more sophisticated and differentiated ways. /ompared with children, who tend to describe themselves in relatively simple, concrete terms, adolescents are more likely to employ comple!, abstract, and psychological self-characterizations. +s individuals3 self-conceptions become more abstract and as they become more able to see themselves in psychological terms, they become more interested in understanding their own personalities and why they behave the way they do. 1or most adolescents, establishing a sense of autonomy, or independence, is as important a part of the emotional transition out of childhood as is establishing a sense of identity. 7uring adolescence, there is a movement away from the dependency typical of childhood toward the autonomy typical of adulthood. 1or e!ample, older adolescents do not generally rush to their parents whenever they are upset, worried, or in need of assistance. hey do not see their parents as all-knowing or all-powerful, and often have a great deal of emotional energy wrapped up in relationships outside the family . #n addition, older adolescents are able to see and interact with their parents as people, not )ust as their parents. "any parents find, for e!ample, that they can confide in their adolescent children, something that was not possible when their children were younger, or that their adolescent children can easily sympathize with them when they have had a hard day at work.

5eing independent, however, means more than merely feeling independent. #t also means being able to make decisions and to select a sensible course of action. his is an especially important capability in contemporary society, where many adolescents are forced to become independent decision makers at an early age. #n general, researchers find that decision-making abilities improve over the course of the adolescent years, with gains continuing well into the later years of high school. "any parents wonder about the susceptibility of adolescents to peer pressure . #n general, studies that contrast parent and peer influences indicate that in some situations, peers3 opinions are more influential, while in others, parents3 are more influential. Specifically, adolescents are more likely to conform to their peers3 opinions when it comes to short-term, day-to-day, and social matters4styles of dress, tastes in music, and choices among leisure activities. his is particularly true during )unior high school and the early years of high school. 2hen it comes to long-term .uestions concerning educational or occupational plans, however, or values, religious beliefs, and ethical issues, teenagers are influenced in a ma)or way by their parents. Susceptibility to the influence of parents and peers changes during adolescence. #n general, during childhood, boys and girls are highly oriented toward their parents and less so toward their peers8 peer pressure during the early elementary school years is not especially strong. +s they approach adolescence, however, children become somewhat less oriented toward their parents and more oriented toward their peers, and peer pressure begins to escalate. 7uring early adolescence, conformity to parents continues to decline and conformity to peers and peer pressure continues to rise. #t is not until middle adolescence that genuine behavioral independence emerges, when conformity to parents as well as peers declines. -ocial transition +ccompanying the biological, cognitive, and emotional transitions of adolescence are important changes in the adolescent3s social relationships. 7evelopmentalists have spent considerable time charting the changes that take place with friends and with family members as the individual moves through the adolescent years. 9ne of the most noteworthy aspects of the social transition into adolescence is the increase in the amount of time individuals spend with their peers. +lthough relations with age-mates e!ist well

before adolescence, during the teenage years they change in significance and structure. 1or e!ample, there is a sharp increase during adolescence in the sheer amount of time individuals spend with their peers and in the relative time they spend in the company of peers versus adults. #n the $nited States, well over half of the typical adolescent3s waking hours are spent with peers, as opposed to only 1: percent with adults, including parents. Second, during adolescence, peer groups function much more often without adult supervision than they do during childhood, and more often involve friends of the opposite se!. 1inally, whereas children3s peer relationships are limited mainly to pairs of friends and relatively small groups4three or four children at a time, for e!ample4adolescence marks the emergence of larger groups of peers, or crowds. /rowds are large collectives of similarly stereotyped individuals who may or may not spend much time together. #n contemporary +merican high schools, typical crowds are 6)ocks,6 6brains,6 6nerds,6 6populars,6 6druggies,6 and so on. #n contrast to cli.ues, crowds are not settings for adolescents3 intimate interactions or friendships, but instead serve to locate the adolescent %to himself and to others& within the social structure of the school. +s well, the crowds themselves tend to form a sort of social hierarchy or map of the school, and different crowds are seen as having different degrees of status or importance. he importance of peers during early adolescence coincides with changes in individuals3 needs for intimacy. +s children begin to share secrets with their friends, loyalty and commitment develop. 7uring adolescence, the search for intimacy intensifies, and self-disclosure between best friends becomes an important pastime. eenagers, especially girls, spend a good deal of time discussing their innermost thoughts and feelings, trying to understand one another. he discovery that they tend to think and feel the same as someone else becomes another important basis of friendship. 9ne of the most important social transitions that takes place in adolescence concerns the emergence of se!ual and romantic relationships. #n contemporary society, most young people begin dating sometime during early adolescence. 7ating during adolescence can mean a variety of different things, from group activities that bring males and females together %without much actual contact between the se!es&8 to group dates, in which a group of boys and girls go out )ointly %and spend part of the time as couples and part of the time in large groups&8 to casual dating as couples8 and to serious involvement with a steady boyfriend or girlfriend. "ore

adolescents have e!perience in mi!ed-se! group activities like parties or dances than dating, and more have e!perience in dating than in having a serious boyfriend or girlfriend. "ost adolescents3 first e!perience with se! falls into the category of 6autoerotic behavior,6 se!ual behavior that is e!perienced alone. he most common autoerotic activities reported by adolescents are erotic fantasies and masturbation . 5y the time most adolescents are in high school, they have had some e!perience with se!ual behaviors in the conte!t of a relationship. he ;outh 0isk 5ehavior Surveillance System %;05SS&, a self-reported survey of a national representative sample of high school students in grades nine to 12, indicated that in 200<, =>.? percent of the students reported having had se!. 5y grade level, the rates were <2.( percent for ninth grade, ==.1 percent for tenth grade, :<.2 percent for eleventh grade, and >1.> percent for twelfth grade.

7#+@A9S#S +A7 P0*-9P*0+ #B* "+A+@*"*A ' C/urrently, ""/ is usually diagnosed pr enatally by ultrasound during the second trimester. Positive screening for maternal serum alpha-fetoprotein may also prompt a fetal ultrasound. + select group of patient s are being evaluated for inclusion in a randomized trial between conventional post- natal ""/ repair and fetal surgery. 7ocument if the mother is a participant in th e clinical trial and, if she is, whether the fetus had prenatal repair and whether the procedure was associated with any complications. /ontact the Aurses at the 1etal reatment /enter %=?>-0==:& of the e!pected delivery8 they will inform you whether the mother is in the clinical trial. CAotify Aeurosurgery of the e!pected delivery. CPediatric team should be present for deliver y, which will almost always be by cesarean section. C$se sterile non-late! gloves . C+fter birth, position infant on side or on abdomen. 0esuscitate as needed. +lthough all ""/ patients have a /hiari ## malforma tion %hindbrain herniation& visualized on "0 imaging, only a minority will be sympto matic at birth. stridor and upper ai rway obstruction. his may consist of

C#f infant did not undergo prenatal repair of ""/' -/arefully e!amine ""/ to estimate the an atomic level of lesion and whether sac is intact. + small amount of /S1 usually DweepsE from the translucent edges of the neural placode. #f the sac ruptures, it usually decompresses and drops to the level of the back. -$sing sterile techni.ue, c over lesion with sterile elfaF dressing soaked in bacitracin %:0,000 unitsG 1,000 m, of 0.HI Aa/l& and apply transparent dressing %7o not use SilvadeneF, 5etadineF, or other anti-infective agents&. -9nce the dressing is in place and if repair is planned within 2=-=(h, do not change dressing unless it is soiled. #f closure is delayed greater than =(h, change the dressing bid and keep it mois t with bacitracin solution. -+void contamination of site and dressing from stool and urine. C#f infant did have pr enatal repair of ""/ ' -*!amine operative site for evidence of breakdown, leakage of /S1, or inflammation. "eningomyelocele

1>? -#f operative site is well heale d, no special wound care is needed. -#f there is leakage of / S1, breakdown of site, or evidence of inflammation, cover lesion with sterile elfaF dressing soaked in bacitracin %:0,000 unitsG 1,000 m, of 0.HI Aa/l& and apply transparent dressing. -/onsult with Aeurosurgery and Pediatric Surgery regarding possible need for further surgery andGor special treatment. CPerform a careful neurological e!amination to determine the levels of the sensory and motor defects. Aote the presence of any orthopedic deformities such as clubfeet. C"easure the head circumference and l ook carefully for clinical findings of hydrocephalus. 9btain a baseline head ultrasound. he decision to place a ventricuo-peritoneal shunt is individualized for each patient. #n general, symptomatic hydrocephalus, progressive increase in head si ze, or leakage of /S1 from the repaired

defect site are indications for shunt placement. $sually a shunt is placed several days after the initial repair, although infre.uently this may need to be done at the same time as the repair. CJeep infant flat and either prone or on side. C"onitor infant closely for signs of meningitis. C/heck with Aeurosurgery rega rding further investigation %e.g., cranial and abdominal ultrasound, radiograph of spine&, timing of surgical repair and whether feedings can be started. P9S -9P*0+ #B* "+A+@*"*A ' C+fter surgical repair, a dry elfaF dressing should be applied to the incision daily or P0A if soiled. @ently clean the incision with sterile normal saline and apply a layer of bacitracin ointment. Place 7uodermF around the incision and use paper tape to prevent skin breakdown. 79 A9 use ega dermF or 9psiteF post-operatively. 9bserve carefully for signs of wound infection or /S1 leak. C7iscuss orders with Aeurosurgery regarding positioning of infant, antibiotics, feeding, and timing of post-operative cranial ultrasounds. C9btain abdominal and hip ultrasound and re .uest $rology and 9rt hopedic consults for evaluation of urinary function and as sociated orthopedic abnormalities. Prior to discharge, arrange with Aeurosurgical Aurse Specialist for patient to be enrolled in Spina 5ifida /linic