The
Fundamental
Changes of
Adolescence
Chapter 1 Biological Transitions
Biological
Transitions Puberty: An Overview
The Endocrine System
What Triggers Puberty?
Somatic Development
Changes in Stature and the Dimensions of the Body
Sexual Maturation
Eating Disorders
Physical Health and Health Care in Adolescence
22 Part I The Fundamental Changes of Adolescence
3. The development of secondary sex characteristics, Hormonal levels are set at a certain point, just as you
which involves changes in the genitals and breasts; might set a thermostat at a certain temperature. By setting
the growth of pubic, facial, and body hair; and the your room’s thermostat at 60°F, you are instructing your
further development of the sex organs. heating system to go into action when the temperature
4. Changes in body composition—specifically, in the falls below this level. Similarly, when a particular hor-
quantity and distribution of fat and muscle monal level in your body dips below the endocrine sys-
5. Changes in the circulatory and respiratory systems, tem’s set point for that hormone, secretion of the hor-
which lead to increased strength and tolerance for mone increases; when the level reaches the set point,
exercise secretion temporarily stops. And, as is the case with a
thermostat, the setting level, or set point, for a particular
Each of these sets of changes is the result of develop- hormone can be adjusted up or down, depending on en-
ments in the endocrine and central nervous systems, vironmental or internal bodily conditions.
many of which begin years before the external signs of Such a feedback loop becomes increasingly important
puberty are evident—some occur even before birth. at the onset of puberty. Long before early adolescence—
in fact, during infancy—a feedback loop develops involv-
ing the pituitary gland (which controls hormone levels in
RECAP general), the hypothalamus (the part of the brain that
The term puberty refers to the physical changes that oc- controls the pituitary gland), and the gonads (in males,
cur in the growing girl or boy as the individual passes the testes; in females, the ovaries), a feedback loop known
from childhood into adulthood. The chief physical man- as the HPG axis (for hypothalamus, pituitary, gonads).
ifestations are the growth spurt, the further development The gonads release the sex hormones—androgens and
of the gonads, the development of secondary sex charac- estrogens (see figure 1.1). Although one typically
teristics, changes in body composition, and changes in thinks of androgens as “male” hormones and estrogens
circulation and respiration. as “female” hormones, both types of hormones are pro-
duced by each sex, and both are present in males and fe-
males at birth. During adolescence, however, the aver-
age male produces more androgens than estrogens,
The Endocrine System and the average female produces more estrogens than
The endocrine system produces, circulates, and regulates androgens (Petersen & Taylor, 1980).
levels of hormones in the body. Hormones are highly The hypothalamus responds to the levels of sex hor-
specialized substances secreted by one or more endocrine mones circulating in the body. Your HPG axis is set to
glands. Glands are organs that stimulate particular parts maintain certain levels of androgens and estrogens.
of the body to respond in specific ways. Just as specialized When these levels fall below the set points, the hypo-
hormones carry messages to particular cells in the body, thalamus no longer inhibits the pituitary, thus permit-
so are the body’s cells designed to receive hormonal mes- ting it to stimulate the release of sex hormones by the
sages selectively. For example, one of the many effects of gonads and other, puberty-related hormones by the ad-
the hormone adrenaline, secreted by the adrenal gland, is renal gland. When sex-hormone levels reach the set
to stimulate the heart to increase its activity. The heart re- point, the hypothalamus responds by inhibiting its
sponds to adrenaline but not to all other hormones. stimulation of the pituitary gland.
Puberty may appear to be rather sudden, judging Hormones play two very different roles in adolescent
from its external signs, but, in fact, it is part of a gradual development; they perform both an organizational role
process that begins at conception (Petersen & Taylor, and an activational role (Coe, Hayashi, & Levine, 1988;
1980). You may be surprised to learn that no new hor- Collaer & Hines, 1995). Long before adolescence—in
mones are produced and no new bodily systems develop fact, prenatally—hormones shape, or organize, the
at puberty. Rather, some hormones that have been pres- brain in ways that may not be manifested in behavior
ent since before birth increase, and others decrease. until childhood or even adolescence. Generally speak-
The endocrine system receives its instructions to in- ing, until about eight weeks after conception, the human
crease or decrease circulating levels of particular hor- brain is “feminine” unless and until it is exposed to cer-
mones from the central nervous system—chiefly, the tain “masculinizing” hormones, such as testosterone.
brain. The system works somewhat like a thermostat. Because levels of testosterone are higher among males
24 Part I The Fundamental Changes of Adolescence
than females while the brain is developing, males, in Other changes in behavior at adolescence occur,
general, end up with a more “masculinized” brain than however, because of changes in hormone levels at pu-
females. This sex difference in brain organization prede- berty; these hormonal changes are said to activate the
termines certain patterns of behavior, many of which changes in behavior. For instance, the increase in cer-
may not actually appear until much later (Collaer & tain hormones at puberty is thought to stimulate the
Hines, 1995). Studies of sex differences in aggression, for development of secondary sex characteristics, such as
example, show that, even though some of these differ- the growth of pubic hair. Other hormonal changes at
ences may not appear until adolescence, they likely re- adolescence, controlled by the adrenal gland, may stim-
sult from the impact of prenatal hormones, rather than ulate an increase in individuals’ sex drive (McClintock
from hormonal changes at puberty. & Herdt, 1996).
In other words, the presence or absence of certain Still other changes during puberty are likely to be re-
hormones early in life may program the brain and sults of an interaction between the organizational and
nervous system to develop in certain ways later on. Be- activational effects of hormones (Collaer & Hines,
cause we may not see the resulting changes in behavior 1995). Hormones that are present during the develop-
until adolescence, it is easy to conclude mistakenly that ment of the fetus may organize a certain set of behav-
the behaviors result from hormonal changes specific to iors (for example, the brain may be set up to have us
puberty. In reality, however, exposure to certain hor- later engage in sexual behavior), but certain changes in
mones before birth may set a sort of alarm clock, which those hormones at puberty may be needed to activate
does not go off until adolescence. Just because the the pattern; that is, individuals may not become moti-
alarm clock rings at the same time that puberty begins vated to engage in sex until puberty.
does not mean that puberty caused the alarm to go off.
What Triggers Puberty?
Although the HPG axis is active long before
Hypothalamus adolescence—before birth, in fact—it is relatively quiet
during much of childhood. Something happens during
middle childhood, though, that reawakens the HPG
LH-RF (luteinizing
hormone-releasing axis and signals it that the body is ready for puberty.
Hypothalamus factor) and FSH-RF
monitors levels (follicle-stimulating
of androgens hormone-releasing
and estrogens. factor) stimulate
pituitary gland.
Pituitary
gland
LH (luteinizing
hormone) and FSH
(follicle-stimulating
hormone) stimulate
gonads.
(Testes in
Gonads males, ovaries
in females)
Androgens
Estrogens
Figure 1.1 Levels of sex hormones are regulated by a feedback ▲ The timing of puberty is affacted by experience as well as
system composed of the hypothalamus, pituitary gland, and heredity. Exercise can affect the onset of puberty. (Li-Hua Lan/
gonads. (Grumbach, Roth, Kaplan, & Kelch, 1974) The Image Works)
Chapter 1 Biological Transitions 25
24
23
22
190 21
180 Boy 20
19
170
Girl 18
160 17
16
130
12
120 11
110 10
Boy
9
100 8 Girl
90 7
6
80 5
70 4
60 3
2
50 1
1 3 5 7 9 11 13 15 17 19 1 3 5 7 9 11 13 15 17 19
Age (years) Age (years)
Figure 1.2 Left: height (in centimeters) at different ages for the average male and female youngster. Right: gain in height per year
(in centimeters) for the average male and female youngster. Note the adolescent growth spurt. (Adapted from Marshall, 1978)
height after the age of 18. But look at the right-hand ethnic difference in adolescence may account for the
graph, which shows the average increase in height per fact that, during adulthood, African American women
year (i.e., the rate of change) over the same age span. are less likely than white women to develop osteoporo-
Here you can see the acceleration in height at the time sis, and they have fewer bone fractures (Gilsanz, Roe,
of peak height velocity. Mora, Costin, & Goodman, 1991).
Figure 1.2 also indicates quite clearly that the Much of the height gain during puberty results from
growth spurt occurs, on the average, about two years an increase in torso length rather than in leg length. The
earlier among girls than among boys. In general, as sequence in which various parts of the body grow is
you can see by comparing the two graphs, boys tend to fairly regular. Extremities—the head, hands, and
be somewhat taller than girls before age 11; then girls feet—are the first to accelerate in growth. Then acceler-
tend to be taller than boys between ages 11 and 13; fi- ated growth occurs in the arms and legs, followed by
nally, boys tend to be taller than girls from about age torso and shoulder growth. In concrete terms, “a boy
14 on. You may remember what this was like during stops growing out of his trousers (at least in length) a
fifth and sixth grades. Sex differences in height can be year before he stops growing out of his jackets” (J.
a concern for many young adolescents when they be- Tanner, 1972, p. 5).
gin socializing with members of the opposite sex, es- Young adolescents often appear to be out of propor-
pecially if they are tall, early-maturing girls or short, tion physically—as though their noses or legs were
late-maturing boys. growing faster than the rest of them. It’s not an optical
During puberty, the composition of the skeletal illusion. The parts of the body do not all grow at the
structure also changes; bones become harder, more same rate or at the same time during puberty. This
dense, and more brittle. One marker of the conclusion asynchronicity in growth can lead to an appearance of
of puberty is the closing of the ends of the long bones in awkwardness or gawkiness in the young adolescent,
the body, which terminates growth in height. Interest- who may be embarrassed by the unmatched accelerated
ingly, there are ethnic differences in some of these skele- growth of various parts of the body. It is probably little
tal changes, with bone density increasing significantly consolation for the young adolescent to be told that an
more during puberty among African American than aesthetic balance probably will be restored within a few
among white youngsters. Some experts believe that this years; nevertheless, this is what usually happens.
Chapter 1 Biological Transitions 27
16
14
25
12
20 10
Muscle mass (kg)
6
10
4
5 Male
Female 2 Male
Female
4 6 8 10 12 14 16 18 4 6 8 10 12 14 16 18
Age (years) Age (years)
Figure 1.3 During preadolescence, important sex differences emerge in body composition that continue through adolescence. These
graphs reflect muscle and body fat for individuals of average height at each age. Note the changes in muscle mass (left) and body fat
(right). (Adapted from Gumbach et al., 1974)
The spurt in height during adolescence is accompa- Although most girls diet unnecessarily during this time
nied by an increase in weight, which results from an in- in response to the increase in body fat, the young
crease in both muscle and fat. However, there are impor- women who are most susceptible to feelings of dissatis-
tant sex differences along these latter two dimensions. In faction with their bodies during this phase of develop-
both sexes, muscular development is rapid and closely ment are those who mature early, begin dating early,
parallels skeletal growth, but muscle tissue grows faster and come from relatively more affluent families (Dorn-
in boys than in girls (see figure 1.3). Body fat increases busch et al., 1981; Smolak, Levine, & Gralen, 1993).
for both sexes during puberty, but more so for females African American females seem less vulnerable to these
than for males and at a somewhat faster rate for girls, es- feelings of body dissatisfaction than other girls, and
pecially during the years just before puberty. For boys, consequently they are less likely to diet, presumably be-
there is actually a slight decline in body fat just before pu- cause of ethnic differences in conceptions of the ideal
berty. The result of these sex differences in growth is that body type. Even among African American youngsters,
boys finish adolescence with a muscle-to-fat ratio of however, dieting is common in early adolescence
about 3:1, but the comparable ratio for girls is approxi- (Halpern & Udry, 1994). Many studies point to adoles-
mately 5:4. This has important implications for under- cence as the period of greatest risk for the development
standing why sex differences in strength and athletic abil- of eating disorders, such as anorexia and bulimia.
ity often appear for the first time during adolescence. Accompanying the gains in strength that occur dur-
According to one estimate, about half of the sex differ- ing early adolescence are increases in the size and ca-
ence in physical performance during early adolescence pacity of the heart and lungs and, consequently, in exer-
results simply from the difference in body fat (Smoll & cise tolerance. In all these areas, the rate and magnitude
Schutz, 1990). Before puberty, there are relatively few sex of the gains favor males over females. By the end of pu-
differences in muscle development and only slight sex berty, boys are stronger, have “larger hearts and lungs
differences in body fat. relative to their size, a higher systolic blood pressure, a
The rapid increase in body fat that occurs among fe- lower resting heart rate, a greater capacity for carrying
males in early adolescence frequently prompts young oxygen to the blood, . . . a greater power for neutraliz-
girls to become overly concerned about their weight— ing the chemical products of muscular exercise, such as
even when their weight is within the normal range for lactic acid,” higher blood hemoglobin, and more red
their height and age (Smolak, Levine, & Gralen, 1993). blood cells (Petersen & Taylor, 1980, p. 129).
28 Part I The Fundamental Changes of Adolescence
Boys Girls
Age of First Appearance Age of First Appearance
Characteristic (Years) Characteristic (Years)
Testes
1. 2. 3. 4. 5.
Stage 1: The infantile state that persists from birth until puberty begins. During this time
the genitalia increase slightly in overall size but there is little change in general
appearance.
Stage 2: The scrotum has begun to enlarge, and there is some reddening and change in
texture of the scrotal skin.
Stage 3: The penis has increased in length and there is a smaller increase in breadth.
There has been further growth of the scrotum.
Stage 4: The length and breadth of the penis have increased further and the glans has
developed. The scrotum is further enlarged and the scrotal skin has become darker.
Stage 5: The genitalia are adult in size and shape. The appearance of the genitalia may
satisfy the criteria for one of these stages for a considerable time before the penis and
scrotum are sufficiently developed to be classified as belonging to the next stage.
Pubic Hair
1. 2. 3. 4. 5.
Stage 1: There is no true pubic hair, although there may be a fine velus over the pubes similar
to that over other parts of the abdomen.
Stage 2: Sparse growth of lightly pigmented hair, which is usually straight or only slightly
curled. This usually begins at either side of the base of the penis.
Stage 3: The hair spreads over the pubic symphysis and is considerably darker and coarser and
usually more curled.
Stage 4: The hair is now adult in character but covers an area considerably smaller than in
most adults. There is no spread to the medial surface of the thighs.
Stage 5: The hair is distributed in an inverse triangle as in the female. It has spread to the
medial surface of the thighs but not up the linea alba or elsewhere above the base of the
triangle.
Figure 1.4 The five pubertal stages of penile and pubic hair growth. (Morris & Udry, 1980)
stages, after the British pediatrician who devised the spurt in height begins, accompanied by growth of the
categorization system. penis and further development of pubic hair—now of
a coarser texture and darker color. The five Tanner
•velopments
Sexual Maturation in Boys The sequence of de-
in secondary sex characteristics among
stages of penis and pubic hair growth in boys are
shown in figure 1.4.
boys is fairly orderly (see table 1.1). Generally, the first The emergence of facial hair—first at the corners of
stages of puberty involve growth of the testes and the upper lip, next across the upper lip, then at the up-
scrotum, accompanied by the first appearance of pu- per parts of the cheeks and in the midline below the
bic hair. Approximately one year later, the growth lower lip, and finally along the sides of the face and the
30 Part I The Fundamental Changes of Adolescence
lower border of the chin—and body hair are relatively come distinct from the breast and project beyond the
late developments in the pubertal process. The same is breast contour. In the final stages, the areola is recessed
true for the deepening of the voice, which is gradual to the contour of the breast, and only the nipple is ele-
and generally does not occur until very late adoles- vated. The female breast undergoes these changes at
cence. During puberty, there are changes in the skin as puberty regardless of changes in breast size. Changes in
well; the skin becomes rougher, especially around the the shape and definition of the areola and nipple are far
upper arms and thighs, and there is increased develop- better indicators of sexual maturation among adoles-
ment of the sweat glands, which often gives rise to acne, cent girls than is breast growth alone. The five Tanner
skin eruptions, and increased oiliness of the skin. stages of breast and pubic hair growth in girls are
During puberty, there are slight changes in the shown in figure 1.5.
male breast—to the consternation and embarrass- As is the case among boys, puberty brings important
ment of many boys. Breast development is largely in- internal changes for adolescent girl that are associated
fluenced by the estrogen hormones. Both estrogens with the development of reproductive capacity. In girls,
and androgens are present in both sexes and increase these changes involve the development and growth of the
in both sexes at puberty, although in differing uterus, vagina, and other aspects of the reproductive sys-
amounts. In the male adolescent, the areola (the area tem. In addition, the labia and clitoris enlarge.
around the nipple) increases in size, and the nipple As is apparent in table 1.1, the growth spurt is likely
becomes more prominent. Some boys show a slight to occur during the early and middle stages of breast
enlargement of the breast, although in most cases this and pubic hair development. Menarche, the beginning
development is temporary. of menstruation, is a relatively late development,
Other, internal changes occur that are important el- which reflects the culmination of a long series of hor-
ements of sexual maturation. At the time that the penis monal changes (Dorn et al., 1999). Hence, it is incor-
develops, the seminal vesicles, the prostate, and the rect to use menarche as a marker for the onset of pu-
bilbo-urethral glands also enlarge and develop. The berty among girls. A great deal of pubertal
first ejaculation of seminal fluid generally occurs about development has taken place long before the adoles-
one year after the beginning of accelerated penis cent girl begins to menstruate. Generally, full repro-
growth, although this is often determined culturally, ductive function does not occur until several years af-
rather than biologically, since for many boys first ejacu- ter menarche, and regular ovulation follows menarche
lation occurs as a result of masturbation (J. Tanner, by about two years (Hafetz, 1976). Unlike boys, there-
1972). One interesting observation about the timing fore, girls generally appear physically mature before
and sequence of pubertal changes in boys is that boys they are capable of becoming pregnant.
are generally fertile (i.e., capable of fathering a child)
before they have developed an adultlike appearance.
The opposite is true for girls.
RECAP
• Sexual Maturation in Girls The sequence of devel-
opment of secondary sex characteristics among girls
One of the most important physical changes of puberty
is the development of secondary sex characteristics—
(shown in Table 1.1) is somewhat less regular than it is the changes in outward appearance that signal the onset
among boys. Generally, the first sign of sexual matura- of reproductive maturity. These changes include the
tion is the elevation of the breast—the emergence of growth of pubic hair, changes in the appearance of the
sex organs, and breast development.
the so-called breast bud. In about one-third of all ado-
lescent girls, however, the appearance of pubic hair pre-
cedes breast development. The development of pubic Food for Thought
hair follows a sequence similar to that in males—gen-
erally from sparse, downy, light-colored hair to more Think about the changes in secondary
dense, curled, coarse, darker hair. Breast development sex characteristics that take place dur-
often occurs concurrently and generally proceeds ing puberty. Why might humans have
through several stages. In the bud stage, the areola evolved so that puberty occurs on the “outside” of
widens, and the breast and nipple are elevated as a small the body as well as internally?
mound. In the middle stages, the areola and nipple be-
Chapter 1 Biological Transitions 31
1.
Breasts
Pubic Hair
1. 2. 3.
Stage 1. No pubic hair.
Figure 1.5 The five pubertal stages for breast and pubic hair growth. (Marshall & Tanner, 1969. Reprinted by permission of
BMJ publishing Group)
32 Part I The Fundamental Changes of Adolescence
THE TIMING AND TEMPO effect on the ultimate adult stature or bodily dimen-
sions of the individual, with late maturers, on average,
OF PUBERTY being taller than early maturers as adults, and early ma-
You may have noted that, thus far, no mention has been turers, on average, being somewhat heavier—at least
made about the “normal” ages at which various puber- among females (St. George, Williams, & Silva, 1994).
tal changes are likely to take place. The truth is that the Adult height and weight are far more strongly corre-
variations in the timing of puberty (the age at which lated with height and weight before childhood than
puberty begins) and in the tempo of puberty (the rate with the timing of puberty, however.
at which maturation occurs) are so great that it is mis- Many people believe that there are ethnic differences
leading to talk even about average ages. in the timing and rate of pubertal maturation, although
The onset of puberty can occur as early as age 7 years the results of studies in this area have been inconclu-
in girls and 91/2 in boys, or as late as 13 in girls and 131/2 sive. One large-scale study of U.S. youngsters does
in boys. In girls, the interval between the first sign of indicate, however, that African American females may
puberty and complete physical maturation can be as mature significantly earlier than their white counter-
short as a year and a half or as long as six years. In boys, parts (the study did not include enough youngsters
the comparable interval ranges from about two years to from other ethnic groups to make statistical compar-
five years (J. Tanner, 1972). Within a totally normal isons). For example, whereas the average age of menar-
population of young adolescents, some individuals will che among white U.S. girls is closer to 13, among
have completed the entire sequence of pubertal changes African American girls, it is closer to 12. And, as figure
before others have even begun. In more concrete terms, 1.6 shows, more than 27 percent of African American
it is possible for an early-maturing, fast-maturing girls, but less than 7 percent of white girls, have entered
youngster to complete pubertal maturation by the age puberty by age 7 (Herman-Giddens et al., 1997). Al-
of 10 or 11—two years before a late-maturing young- though the reasons for this ethnic difference are not
ster has even begun puberty and seven years before a known, one possibility is that African-American girls
late-maturing, slow-maturing youngster has matured are more frequently exposed to chemicals in the envi-
completely. ronment, such as synthetic hormones, which may stim-
There is no relation between the age at which pu- ulate earlier puberty.
berty begins and the rate at which pubertal develop- What factors underlie the tremendous variations
ment proceeds. The timing of puberty may have a small in the timing and tempo of puberty? Why do some
100
% 98.4 96.6100.0
94.6
White
90 88.0
African American
80 77.4
70 67.9
60
50 48.3
40 38.2
30 27.2
20
14.3 14.7
10 7.6 5.7 6.7
3.7
1.0 3.1 0.9 1.9
0
3 4 5 6 7 8 9 10 11 12
Age (years)
Figure 1.6 Prevalence of African American and white girls at different ages who show signs of either breast development or pubic
hair. (Herman-Giddens et al., 1997)
Chapter 1 Biological Transitions 33
individuals mature relatively early and others rela- For example, girls in ballet companies or in other rig-
tively late? orous training programs often mature later than their
Researchers who study variability in the onset and peers (Frisch, 1983). Generally speaking, then, after
timing of puberty approach the issue in two ways. One genetic factors, an important determinant of the on-
strategy involves the study of differences among indi- set of puberty is the overall physical well-being of the
viduals (that is, studying why one individual matures individual from conception through preadolescence
earlier or faster than another). The other involves the (Marshall, 1978).
study of differences among groups of adolescents (that Interestingly, a number of studies suggest that so-
is, studying why puberty occurs earlier or more rapidly cial as well as physical factors in the environment in-
in certain populations than in others). Both sets of fluence the onset of maturation, especially in girls.
studies point to both genetic and environmental influ- Several studies, for example, have found that puberty
ences on the timing and tempo of puberty. may occur somewhat earlier among girls who have
grown up in less cohesive, or more conflict-ridden,
family environments or in households in which a
Individual Differences stepfather is present (e.g., Ellis & Garber, 2000; Ellis,
in Pubertal Maturation McFadyen-Ketchum, Dodge, Pettit, & Bates, 1999;
Differences in the timing and rate of puberty among Graber, Brooks-Gunn, & Warren, 1995; Moffitt, Caspi,
individuals growing up in the same general environ- Belsky, & Silva, 1992; Steinberg, 1988; Surbey, 1990).
ment result chiefly, but not exclusively, from genetic One explanation for the finding that distant family re-
factors. Comparisons between pairs individuals who lations may accelerate pubertal maturation is that dis-
are genetically identical (identical twins) and pairs who tance in the family may induce a very small amount of
are not reveal patterns of similarity in pubertal matura- stress, which, in turn, may affect hormonal secretions
tion indicating that the timing and tempo of an indi-
vidual’s pubertal maturation are largely inherited ▼ The age at which adolescents mature physically varies around
(Marshall, 1978). the world. On average, teenagers in highly industrialized coun-
Despite this powerful influence of genetic factors, tries, such as Japan, mature earlier than their counterparts in de-
the environment plays an important role. In all likeli- veloping nations, where health and nutritional problems slow
physical growth. (R. M. Collins, III/Image Works)
hood, every individual inherits a predisposition to de-
velop at a certain rate and to begin pubertal maturation
at a certain time. But this predisposition is best thought
of as upper and lower age limits, not a fixed absolute.
Whether the genetic predisposition that each person
has to mature around a given age is actually realized,
and the time within the predisposed age boundaries at
which he or she actually goes through puberty, are sub-
ject to the influence of the environment. In this respect,
the timing and rate of pubertal maturation are the
product of an interaction between nature and nurture,
between one’s genetic makeup and the environmental
conditions under which one has developed.
By far the two most important environmental in-
fluences on pubertal maturation are nutrition and
health. Puberty occurs earlier among individuals who
are better nourished throughout their prenatal, in-
fant, and childhood years. Not surprisingly, then, girls
who are taller or heavier than their peers mature ear-
lier (St. George et al., 1994). In contrast, delayed pu-
berty is more likely to occur among individuals with
a history of protein and/or caloric deficiency. Chronic
illness during childhood and adolescence is also asso-
ciated with delayed puberty, as is excessive exercise.
34 Part I The Fundamental Changes of Adolescence
13.8
13.2
13.2
12.9 13.0
13.0 13.2
13.4 13.2 14.2
13.1 13.0 13.2 14.3
12.6 12.3 - 13.2
12.8 12.8
12.5 13.2 14.4 - 15.2
12.9
12.8 13.6 - 14.0 13.3
15.1 12.9 13.4 - 14.0 13.2
12.8-
14.6 15.2 1.44 13.2
12.5 12.5
14.1
13.3 14.1 13.4 13.3
16.5 12.8 -13.0
17.0
14.9
15.4 13.0
15.0
14.9
12.7
12.3 13.2
13.0
13.0
in the adolescent (Graber et al., 1995). Puberty may be Group Differences in Pubertal Maturation
sped up by small amounts of stress; a great deal of
stress, however, is likely to slow maturation (Ellis & Researchers typically study group differences in pu-
Garber, 2000). In addition, the presence of a stepfather berty by comparing average ages of menarche in differ-
may expose the adolescent girl to pheromones (chem- ent regions. Most of these studies have indicated that
icals secreted by animals that stimulate certain behav- genetic factors play an extremely small role in deter-
iors in other members of the species) that stimulate mining group differences in pubertal maturation
pubertal maturation. In general, among humans and (Eveleth & Tanner, 1990). Differences among countries
other mammals, living in proximity to one’s close bio- in the average rate and timing of puberty are more
logical relatives appears to slow the process of puber- likely to reflect differences in their environments than
tal maturation, whereas exposure to unrelated mem- differences in their populations’ gene pools (Morabia,
bers of the opposite sex may accelerate it (Izard, 1990; Costanza, & World Health Organization, 1998).
Surbey, 1990). The influence of the broader environment on the tim-
Although it may seem surprising that something as ing and tempo of puberty can be seen in more concrete
biological as puberty can be influenced by factors in terms by looking at three sorts of group comparisons: (1)
our social environment, scientists have long known comparisons of the average age of menarche across coun-
that our social relationships can indeed affect our bio- tries, (2) comparisons among socioeconomic groups
logical functioning. One of the best-known examples within a country, and (3) comparisons within a popula-
of this is that women who live together—such as dor- tion during different eras. (Although menarche does not
mitory roommates—find that their menstrual peri- signal the onset of puberty, researchers often use the aver-
ods begin to synchronize over time (Graham, 1991; age age of menarche when comparing the timing of pu-
McClintock, 1980). berty across different groups or regions.)
Chapter 1 Biological Transitions 35
Germany
17.0 Norway
Sweden
Denmark
United States
16.0 Finland
15.0
14.0
14.0
13.5
13.0
13.0
First, consider variations in the age of menarche across of these regions range from about 6 months to about
different regions of the world. Figure 1.7 presents median 18 months.
menarcheal ages throughout the world, across regions Finally, we can examine environmental influences
that vary considerably in typical dietary intake and health on the timing of puberty by looking at changes in the
conditions. As you can see, the average age at menarche average age of menarche over the past two centuries.
generally is lower in those countries where individuals are Because nutritional conditions have improved during
less likely to be malnourished or to suffer from chronic the past 150 years, we would expect to find a decline in
disease. For example, in Western Europe and in the the average age at menarche over time. This is indeed
United States, the median menarcheal age ranges from the case, as can be seen in figure 1.8. Generally, “chil-
about 12.5 years to 13.5 years. In Africa, however, the me- dren have been getting larger and growing to maturity
dian menarcheal age ranges from about 14 years to about more rapidly” (Eveleth & Tanner, 1990, p. 205). This
17 years. The range is much wider across the African con- pattern, referred to as the secular trend, is attributable
tinent because of the much greater variation in environ- not only to improved nutrition but also to better sani-
mental conditions there. tation and better control of infectious diseases. In most
When we look within a specific region, we find European countries, maturation has become earlier by
that, almost without exception, girls from affluent about three to four months per decade. For example, in
homes reach menarche before economically disad- Norway 150 years ago, the average age of menarche may
vantaged girls. In comparisons of affluent and poor have been about 17 years. Today, it is between 12 and
youngsters from the United States, Hong Kong, Tunis, 13 years. Similar declines have been observed over the
Baghdad, and South Africa, for example, differences same time period in other industrialized nations and,
in the average menarcheal ages of economically ad- more recently, in developing countries. The secular
vantaged and disadvantaged youngsters within each trend is less well documented among boys, in part be-
36 Part I The Fundamental Changes of Adolescence
Changes in
Hormonal
adolescent's
changes
behavior
Young people’s reactions to the changes brought on puberty. One approach is to look at individuals who are
by puberty, and others’ reactions to them, are influenced at various stages of puberty, either in a cross-sectional
by the broader social environment, where messages study (in which groups of individuals are compared at
about physical attractiveness, sexuality, and sexual matu- different stages of puberty) or in a longitudinal study
ration change, often markedly, from era to era. Although (in which the same individuals are tracked over time as
it is difficult to imagine an era in which adolescents, es- they move through the stages of puberty). Studies of
pecially girls, did not obsess about their shape, size, and this sort examine the immediate impact of puberty on
sexual allure, adolescent females’ preoccupation with young people’s psychological development and social
their body is a relatively recent phenomenon, created relations. Researchers might ask, for example, whether
largely by marketers of clothing, undergarments, cos- youngsters’ self-esteem is higher or lower during pu-
metics, weight-loss programs, and “feminine” products berty than before or after.
(Brumberg, 1997). Contemporary society’s views of pu- A second approach compares the psychological de-
berty and physical maturation are expressed through tel- velopment of early and late maturers. The focus of
evision commercials, newspaper and magazine adver- these studies is not so much on the absolute impact of
tisements, and depictions of young adolescents in films puberty but on the effects of differential timing of the
and other media. People cannot help but be influenced changes. Here, a typical question might be whether
by these images, and the expectations they associate with early maturers are more popular in the peer group than
puberty as well as the meaning they give it determine the late maturers are.
reactions puberty brings out in them. Consider, for ex-
ample, the treatment of menstruation in each of the ad-
vertisements on page 000. What sorts of reactions might
The Immediate Impact of Puberty
each of the ads foster? Studies of the psychological and social impact of pu-
Researchers have generally taken two approaches to berty indicate that physical maturation, regardless of
studying the psychological and social consequences of whether it occurs early or late, affects the adolescent’s
38 Part I The Fundamental Changes of Adolescence
self-image, mood, and relationships with parents. As hormonal changes of puberty cause adolescents to be
you will read, however, the short-term consequences of moody or, for that matter, that these hormonal changes
puberty may be more taxing on the adolescent’s family affect the adolescent’s psychological functioning or be-
than on the adolescent. havior at all?
According to several comprehensive reviews of re-
• Puberty and Self-Esteem Research suggests that
puberty is a potential stressor with temporary adverse
search on hormones and adolescent mood and be-
havior, the direct connection between hormones and
psychological consequences for girls (but not boys), mood, although apparent, is not very strong
but only when it is coupled with other changes that (Buchanan, Eccles, & Becker, 1992; Flannery,
necessitate adjustment (Simmons & Blyth, 1987). In- Torquati, & Lindemeier, 1994). When studies do find
deed, studies suggest that the impact of puberty on a connection between hormonal changes at puberty
adolescents’ psychological functioning is, to a great and adolescent mood or behavior, the effects are
extent, shaped by the social context in which puberty strongest early in puberty, when the system is being
takes place (Brooks-Gunn & Reiter, 1990; Susman, “turned on” and when hormonal levels are highly
1997). Accordingly, the impact of puberty on mental variable. For example, studies indicate that rapid in-
health varies by gender and across ethnic groups, creases in many of the hormones associated with pu-
with girls more adversely affected than boys and with berty—such as testosterone, estrogen, and various
white girls, in particular, at greatest risk for develop- adrenal androgens—especially when the increases
ing a poor body image (Rosenblum & Lewis, 1999; take place very early in adolescence, may be associ-
Siegel, Yancey, Aneshensel, & Schuler, 1999). Given ated with increased irritability, impulsivity, aggres-
the premium placed in contemporary society on sion (in boys), and depression (in girls). One inter-
thinness, the increase in body dissatisfaction among pretation of these findings is that it is not so much the
white girls that takes place at puberty is, not surpris- absolute increases in these hormones during puberty
ingly, linked to specific concerns girls have about but their rapid fluctuation early in puberty that may
their hips, thighs, waist, and weight (Rosenblum & affect adolescents’ moods. Once the hormone levels
Lewis, 1999). Interestingly, the way adolescents feel stabilize at higher levels, later in puberty, their nega-
about their physical appearance when they begin tive effects appear to wane (Buchanan et al., 1992).
adolescence remains remarkably stable over time, re- There is also evidence, which is discussed in chapter
gardless of whether their actual attractiveness 2, that important changes take place in early adoles-
changes (Rosenblum & Lewis, 1999). cence in the regions of the brain that play major roles
in the processing of emotion (Spear, 2000).
•self-image
Adolescent Moodiness Although an adolescent’s
could be expected to be changed during a
Even still, most researchers agree that the impact
of hormonal change on mood and behavior in ado-
time of dramatic physical development, it could also lescence is greatly influenced by environmental fac-
be the case that self-esteem or self-image is a reason- tors (Susman, 1997). An excellent illustration of the
ably stable characteristic, with long and sturdy roots way in which hormones and environment interact at
reaching back to childhood. For this reason, some re- puberty comes from the work of psychologist Jeanne
searchers have turned their attention to the impact of Brooks-Gunn and her colleagues (Brooks-Gunn,
puberty on more transient states, such as mood. One 1987, 1989; Brooks-Gunn, Graber, & Paikoff, 1994;
reason for this focus is that adolescents are thought to Brooks-Gunn & Warren, 1989), who have been study-
be moodier, on average, than either children or ing the development of psychological problems, such
adults. One study, in which adolescents’ moods were as depression and aggression, in young girls around
monitored repeatedly by electronic pagers, for exam- the time of puberty. Although rapid increases in hor-
ple, showed that adolescents’ moods fluctuate during mones early in puberty are associated with depressed
the course of the day more than the moods of adults mood in girls, it turns out that stressful life events,
do (Csikszentmihalyi & Larson, 1984) (see figure such as problems in the family, in school, or with
1.10). friends, play a far greater role in the development of
Many adults assume that adolescent moodiness is depression than do hormonal changes. Moreover, as
directly related to the hormonal changes of puberty she and others point out, it is possible that changes in
(Petersen, 1985). Is there any scientific evidence that the the environment—in levels of stress, for instance—
Chapter 1 Biological Transitions 39
Pattern Size of Mood Change Rate of Mood Change Typical Mood Intensity of Mood
affect hormonal activity, which in turn may affect moodiness. In one study of adolescents, for example,
adolescents’ mood. five distinct patterns of mood change were identified
Interestingly, not only is there little evidence that (Bence, 1992) (see table 1.2). One group showed con-
adolescents’ moodiness results from the storm and siderable fluctuation in mood over the course of a
stress of raging hormones, but there is also research week, but members typically were in a positive mood
that questions the very idea that adolescents are inher- (these youngsters bounced back up to positive moods
ently moodier than children. Psychologists Mihaly quickly after being in a bad mood). A second group
Csikszentmihalyi and Reed Larson (1984; Larson & was, on average, equally positive as the first but
Lampman-Petraitis, 1989) had teenagers carry elec- showed much less mood fluctuation. The third group
tronic pagers similar to the ones physicians carry, and was similar to the second, in that members showed
the researchers paged them periodically throughout the little fluctuation in mood; however, in contrast to the
day. When the adolescents were paged, they filled out second group, the third group was generally in a
forms noting how they were feeling, what they were do- slightly bad mood. The fourth group, like the first,
ing, where they were, and whom they were with. By showed considerable fluctuation in mood but was
looking at changes in mood across activities and set- generally in a bad mood (that is, members dropped
tings, the researchers were able to determine the corre- back down to negative moods quickly after being in a
lates of adolescent moodiness. positive mood). Finally, the fifth group was composed
Their findings suggest that adolescent mood of youngsters whose mood did not fluctuate greatly
swings parallel their changes in activities. Over the but who were in an extremely negative mood most of
course of a day, a teenager may shift from elation to the time.
boredom, back again to happiness, and then to anger.
But this shifting appears to have more to do with shifts
in activities—elated when seeing a girlfriend, bored
•ingChanges in Sleep Patterns One fascinating find-
on hormones and behavior in adolescence con-
in social studies class, happy when having lunch with cerns adolescents’ sleep preferences. Many parents
friends, and angry when assigned extra work at the complain that their teenage children go to bed too
fast-food restaurant—than with internal, biological late in the evening and sleep too late in the morning.
changes. More important, comparisons of youngsters It now appears that the emergence of this pattern—
between the ages of 9 and 15 did not show increases in called a delayed phase preference—is directly re-
moodiness during the transition into adolescence. Al- lated to the biological changes of puberty
though adolescents may be moodier than adults, it is (Carskadon, Acebo, Richardson, Tate, & Seifer, 1997).
probably because they change activities and contexts Thus, physically mature teenagers who are forced to
more often than adults do. maintain a sleep schedule similar to that of prepuber-
How can we reconcile these scientific studies, tal individuals have biological reasons to feel ener-
which provide little support for the notion that ado- getic when it is time to go to bed and lethargic in the
lescents are especially prone to mood swings, with the morning. When allowed to regulate their own sleep
popular portrayals of teenagers as exceedingly schedules (as on weekends), most teenagers will stay
moody? One suggestion is that there is a great deal of up until around 1 A.M. and sleep until about 10 A.M.
variability within the adolescent population in It is therefore ironic that many school districts ask
40 Part I The Fundamental Changes of Adolescence
Tuesday 8:42 A.M. Reading history assignment in music room; thinking "whether
or not to drop the atomic bomb."
10:58 In gym, talking with friend, and listening to teacher
5:24 P.M. Practicing violin in her room/Alone
7:04 Doing history assignment; "thinking about other
things"/Alone
Wednesday 7:32 A.M. Getting ready for school, worrying how late she will be/Alone
10:25 In Music class, taking notes and listening to the teacher
12:16 P.M. In English, reading paper that was just returned; "panicking"
1:35 In Orchestra, playing the violin
3:00 Walking home,"bothering Lonnie and Suzanne"
6:02 Watching the news; eating dinner with sister
8:58 Playing violin solo for Carmen; "the show is terrific!"
Friday 9:06 A.M. In History, talking about the beeper with a friend;
worrying about a quiz
11:32 In the hall; talking with friends about the maltreatment of
the music department by the student newspaper
3:15 P.M. Walking home, talking to Suzanne
4:58 Getting ready for Carmen; talking on the phone
7:00 Leaving for the show; talking with family; worrying
about being late
Sunday 9:45 A.M. In church, having discussion with youth class; "daydreaming"
10:15 In church; planning activities; talking with friends
and relaxing
7:25 P.M. Sleeping; trying to get homework done/Alone
Monday 7:20 A.M. Getting ready for school; worrying about being on time
10:32 In Music Literature, listening to a Charles Ives recording;
"daydreaming about what I had done the day before"
12:40 P.M. Eating lunch in the cafeteria; daydreaming and talking;
"What a gorgeous day! 80 finally! Everyone is spaced."
Figure 1.10 Fluctuations in two adolescents’ moods over the course of week. (Csikszentmihalyi & Larson, 1984)
Chapter 1 Biological Transitions 41
Wednesday 7:30 A.M. In kitchen, pulling toast from the toaster, talking to sister
10:30 In Chemistry, taking notes on the reactions of hydrogen
and oxygen
12:15 P.M. "Rapping to friends" on the school mall; admiring graffiti
1:30 In typing class; typing a letter; being bored
3:00 Walking to work alone; staring at a squirrel
4:25 At work; pricing and stocking Q-tips
6:00 At work; making room for new products; listening
to the radio
8:55 Doing homework in room; listening to new wave music
Friday 9:05 A.M. Walking to Gym class; "Will this be another Drugland
weekend?"
11:30 In Chemistry; "Spacing off"
12:15 P.M. At home watching "Bozo's Circus," heating a sandwich for lunch
1:20 In Sociology, handing in a test
3:15 Taking out the garbage at work; "Checking out a girl"
4:55 At work, bringing stock out from the back room
6:45 Mopping the bathroom at work; thinking about "a lecture on
the E.R.A. I attended a few weeks ago"
8:15 At girlfriend's, watching a game of backgammon; drinking beer
10:20 At girlfriend's, taking a hit off a joint; talking and
reminiscing; "We're wasted!"
Monday 7:20 A.M. Talking to mother in kitchen; "Should I eat pizza with my
mother tonight?"
10:30 In Chemistry; daydreaming about the girl and the bike ride
42 Part I The Fundamental Changes of Adolescence
▲ Studies indicate that parent-adolescent conflict may increase during puberty. (Stewart Cohen/Tony Stone Images)
adolescents to report to school even earlier than grades also reported staying up considerably later on
younger children, since this demand clearly conflicts weekends than they did on school nights. Despite many
with the natural sleep preferences of adolescents. In- adolescents’ belief that catching up on their sleep on
deed, one study found that adolescents were least weekends makes up for sleep deprivation during the
alert between the hours of 8 and 9 A.M. (when most week, research indicates that having markedly different
schools start) and were most alert after 3 P.M., when bedtimes on weekend versus weekday evenings con-
the school day is over (Allen & Mirabell, 1990). tributes to further sleep-related problems (Wolfson &
Although individuals’ preferred bedtime gets later as Carskadon, 1998).
they move from childhood into adolescence, the
amount of sleep they need each night remains constant,
at around nine hours. Yet in one study of more than
3,000 Rhode Island high school students, it was found
•thePuberty and Family Relationships Research into
impact of puberty on family relationships has
that only one-fifth of the students got at least eight pointed to a fairly consistent pattern—namely, that
hours of sleep on an average school night and that puberty appears to increase conflict and distance be-
nearly half got seven hours or less (Wolfson & tween parents and children. The distancing effect of
Carskadon, 1998). There is now a clear consensus puberty on adolescent-parent relationships is not as
among scientists that most American teenagers are not strong in single-parent homes (Anderson, Hethering-
getting enough sleep, and that inadequate sleep is asso- ton, & Clingempeel, 1989) and not as consistently ob-
ciated in adolescence with poorer mental health (more served in ethnic minority families, however (Molina
depression and anxiety) and lowered school perfor- & Chassin, 1996; Sagrestano, McCormick, Paikoff, &
mance. In the Rhode Island study, for example, the stu- Holmbeck, 1999). Among white families, though,
dents who were earning grades of C or lower were going several studies show that, as youngsters mature from
to bed 40 minutes later and sleeping about 25 minutes childhood toward the middle of puberty, distance be-
less each night than their classmates whose grade-point tween them and their parents increases, and conflict
averages were B or better. The students with poorer intensifies, especially between the adolescent and his
Chapter 1 Biological Transitions 43
or her mother (Laursen, Coy, & Collins, 1998; Paikoff sons and daughters enter early adolescence. It may
& Brooks-Gunn, 1991). The change that takes place is take some time for the individual and the family to
reflected in an increase in “negatives” (e.g., conflict, achieve a new equilibrium that takes into account the
complaints, anger) and, to a lesser extent, a decrease changes brought on by puberty.
in “positives” (e.g., support, smiles, laughter) (e.g., Puberty may have an effect on relationships in the
Flannery et al., 1994; Holmbeck & Hill, 1991). Al- peer group, too. One study of adolescents’ social net-
though negative interchanges may diminish after the works—the people they are most likely to see and
adolescent growth spurt, adolescents and their par- spend time with—found that adolescents who were
ents do not immediately become as close as they were physically mature were less likely than their less devel-
before the adolescents entered puberty. Interestingly, oped peers to name adults as people who were impor-
puberty increases distance between children and their tant to them, and they were more likely to name other
parents in most species of monkeys and apes, and adolescents (Garbarino, Burston, Raber, Russell, &
some writers have suggested that the pattern seen in Crouter, 1978). This finding suggests that pubertal mat-
human adolescents has some evolutionary basis uration may influence adolescents’ interests and ener-
(Steinberg, 1987a). gies toward the peer group. Boys and girls who are
Because this connection between pubertal matu- physically mature are more likely than less mature age-
ration and parent-child distance is not affected by the mates to be involved in cross-sex activities, such as hav-
age at which the adolescent goes through puberty— ing a boyfriend or girlfriend and going out on dates
in other words, the pattern is seen among early as well (Crockett & Dorn, 1987), although this depends on the
as late maturers—it suggests that something about social norm of the adolescent’s peer group and the pre-
puberty in particular transforms the parent-child vailing expectations about the age at which teenagers
bond. To date, it is unknown whether this effect re- should begin dating (Dornbush et al., 1981; Gargiulo,
sults from the hormonal changes of puberty, from Attie, Brooks-Gunn, & Warren, 1987).
changes in the adolescent’s physical appearance, or
from changes in adolescent psychological function-
The Impact of Specific Pubertal Events
ing, which in turn affect family relationships. More-
over, because few studies of family relationships at Several studies have focused specifically on adolescents’
puberty have examined multiple aspects of adoles- attitudes toward and reactions to particular events at
cent development simultaneously, it is difficult to say puberty, such as girls’ reactions to menarche or breast
whether the patterns of change in family relation- development, and boys’ reactions to their first ejacula-
ships that many studies have found do, in fact, result tion. In general, most adolescents react positively to the
from puberty and not from another change taking biological changes associated with puberty, especially
place at the same time in the adolescent or in the par- those associated with the development of secondary sex
ent (Paikoff & Brooks-Gunn, 1991). characteristics. One study of adolescent girls’ attitudes
Whatever underlying mechanism that is involved, towards breast development, for example, found that
one interpretation of these studies is that develop- most of the girls greeted this change positively (Brooks-
ments occurring around the time of puberty can up- Gunn, Newman, Holderness, & Warren, 1994).
set the interpersonal balances established during Girls’ reactions to menarche are more varied, how-
childhood, causing temporary periods of disruption ever, in part because the onset of menstruation is “not
in the family system. During a son’s or daughter’s just one of a series of physiological events during pu-
childhood, families develop patterns of relationships berty, but is also a sociocultural event . . . imbued with
that are comfortable and workable, but they may find special meaning” (Brooks-Gunn & Ruble, 1979, p. 1).
that puberty disrupts the patterns to which they have Cultural beliefs concerning menarche and the specific
grown accustomed. They have developed a certain information that a young woman receives from parents,
way of discussing things and a certain way of includ- teachers, friends, and health practitioners all influence
ing the children in discussions. However, as the chil- how she greets and experiences menarche (Brooks-
dren go through puberty, they may want to be treated Gunn & Ruble, 1982).
more like adults and may want to have greater say in Adolescent girls’ attitudes toward menarche are less
family decisions. Consequently, families may experi- negative today than they appear to have been in the past
ence a temporary period of conflict or tension when (Grief & Ulman, 1982; Ruble & Brooks-Gunn, 1982), a
44 Part I The Fundamental Changes of Adolescence
it does come as an abrupt interruption to the more re- ventive means of problem solving and greater cognitive
laxed preadolescent era. A later puberty, and hence a and social flexibility. In other words, the greater diffi-
longer preadolescence, might allow for coping skills to culty that late maturers face as early adolescents may
develop more fully before adolescence. This may ac- lead to their developing coping skills that prove useful
count in part for the apparently better coping skills when they reach adulthood. Unfortunately, however, at
demonstrated by late maturers—not only during pu- least one study of late-maturing boys indicates that
berty but as adults. heavy drinking may be one of the “coping” behaviors
Do the psychological and interpersonal differences that persists into young adulthood (Andersson &
that are observed between early and late maturers during Magnusson, 1990).
adolescence persist into adulthood? In order to answer
such questions, a series of follow-up studies conducted 25
years later looked at the adult personalities of males who
•search
Early Versus Late Maturation in Girls Early re-
on this issue, again conducted by researchers
had been studied during adolescence (Livson & Peskin, working on the Oakland Growth Study, suggested that,
1980). At age 38, the early maturers were more responsi- in contrast to boys, early-maturing girls are at a disad-
ble, more cooperative, more self-controlled, and more so- vantage—although the findings were far less consistent
ciable. At the same time, though, early maturers had also than they were in the studies of boys (Jones, 1949; Jones
grown up to be more conforming, conventional, and hu- & Mussen, 1958). Early-maturing girls were found to be
morless. Their peers who had been late maturers re- “less popular, less poised, less expressive, and more sub-
mained somewhat more impulsive and more assertive missive, withdrawn, and unassured then [their] age-
but turned out to be more insightful, more inventive, and mates” (Livson & Peskin, 1980, p. 71). Like the late-
more creatively playful. What had happened? maturing boy, the early-maturing girl is out of step with
One interpretation is that, because of their more her peers. And, since girls mature about two years ear-
adultlike appearance, the early-maturing boys had been lier than boys, the early-maturing girl is not only more
pushed into adult roles earlier than their peers. They physically advanced than her female peers but far more
were more likely to be asked to assume responsibility, to advanced than nearly all her male classmates as well. In
take on leadership positions, and to behave in a more these studies, the late-maturing girls were more likely to
grown-up manner. But this early press toward adult- be seen as attractive, sociable, and expressive.
hood may have come too soon and may have stifled a As is the case with research on early- and late-
certain amount of creativity and risk taking. maturing boys, more recent research on girls has
Have you gone to any gatherings of former high tended to corroborate the findings of the earlier studies,
school classmates? Did you discover that some of the but we have learned a good deal more about the
people you had remembered as extremely mature and development of early-maturing girls, in particular, in
socially successful during high school have turned out the ensuing years. A number of studies find that early-
to be not all that interesting a few years after gradua- maturing girls have more emotional difficulties than do
tion? Perhaps too much leadership, responsibility, so- girls who mature on time or late, including lowered
cial success, and maturity during the high school years self-image and higher rates of depression, anxiety, eat-
interferes with the sort of psychological development ing disorders, and panic attacks (Aro & Taipale, 1987;
that makes for interesting and creative adults. Many Ge, Conger, & Elder, 1996; Graber et al., 1997; Hayward
psychologists believe that adolescents may benefit in et al., 1997). These difficulties seem to have a great deal
the long run from having an extended period of to do with girls’ feelings about their weight, because
time during which they are not being pushed into early maturers are, almost by definition, heavier than
adulthood. their late-maturing peers (Petersen, 1988). In societies
In short, success and social status may come too eas- that define as physically attractive the thin, “leggy”
ily and too early for early-maturing boys, leaving them woman, a late-maturing girl will look more like this
with less need to develop creative or flexible solutions image than an early-maturing girl will.
to life’s problems and less time to experiment with new Whether earlier maturation has a negative effect on
roles and identities. In contrast, late-maturing young- the young girl’s feelings about herself appears to de-
sters, experiencing more difficulty in achieving social pend on the broader context in which maturation takes
standing and recognition because of their immature place, however. For example, studies of American girls
physical appearance, may be forced to develop more in- generally find that early-maturing girls have lower self-
Chapter 1 Biological Transitions 47
esteem and a poorer self-image because of our cultural maturing girls are more likely to spend time with older
preference for thinness and our national ambivalence adolescents, especially older adolescent boys, who initi-
about adolescent sexuality (Brooks-Gunn & Reiter, ate them into activities that might otherwise be delayed
1990). In Germany, however, where sex education is (Magnusson et al., 1986). Girls with a history of prob-
more open and attitudes toward adolescent sexuality lem behavior prior to puberty appear most susceptible
are less conflicted, early-maturing girls are found to to the adverse effects of early maturation (Caspi & Mof-
have higher self-esteem (Silbereisen et al., 1989). fitt, 1991) (see “The Scientific Study of Adolescence:
Interestingly, even within the United States, the im- Early Maturation and Girls’ Problem Behavior—
pact of physical maturation appears to depend on the Activation or Accentuation?”).
social context in which teenagers live (Dyer & Tigge- Again, however, it is important to consider the role
mann, 1996). One study of suburban Chicago young- of context in interaction with pubertal change. Al-
sters, for example, found that the girls’ body image was though it is generally true that early-maturing girls are
significantly higher in one community than in more likely to engage in delinquent behavior than are
another—despite comparable levels of physical matu- their late-maturing peers, a study of New Zealand
ration between the two groups. One factor that differ- youngsters indicates that this may hold true only for
entiated the two communities was “cliquishness”: In girls who attend coeducational high schools (Caspi,
the more cliquish high school, girls were less satisfied Lynam, Moffitt, & Silva, 1993). Early-maturing girls in
with the way they looked, perhaps because cliquish girls all-female schools are no more likely than late maturers
place more emphasis on physical appearance in to be involved in delinquent activities, presumably
determining popularity (Richards, Boxer, Petersen, & because there are far fewer opportunities for delin-
Albrecht, 1990). quency in same-sex schools. Thus, although early pu-
Although some early-maturing girls may have self- berty may predispose girls toward more frequent and
image difficulties, their popularity with peers is not earlier deviance, this predisposition may be realized
jeopardized. Indeed, some studies indicate that early only in an environment that permits the behavior—
maturers are more popular than other girls, especially, such as a school that places early-maturing girls in close
as you would expect, when the index of popularity contact with older boys.
includes popularity with boys (Simmons, Blyth, & One study of the adult personalities of women who
McKinney, 1983). Ironically, it may be in part because had been either early or late maturers suggests some in-
the early maturer is more popular with boys that she re- teresting parallels between the personality development
ports more emotional upset: At a very early age, pres- of early-maturing girls and late-maturing boys (Peskin,
sure to date and, perhaps, to be involved in a sexual re- 1973). Both sets of youngsters may have self-esteem prob-
lationship may take its toll on the adolescent girl’s lems during adolescence, but both appear to be somewhat
mental health. Consistent with this, research indicates more psychologically advanced than their peers during
that early-maturing girls are more vulnerable to emo- adulthood. Like late-maturing boys, early-maturing girls
tional distress when they have relatively more opposite- may be forced to develop coping skills during adolescence
sex friendships (Ge et al., 1996) and when they are in that have some long-term positive effects.
schools with older peers (for example, sixth-graders At the same time, however, more recent research in-
who are in a school that also has seventh- and eighth- dicates that the earlier involvement of early-maturing
graders) (Blyth, Simmons, & Zakin, 1985). Again, we girls in problem behavior may adversely affect their
see the importance of context. long-term educational achievement. In one study of
Like their male counterparts, early-maturing girls Swedish girls, for example, the researchers found that
are also more likely to become involved in deviant ac- the school problems of the early-maturing adolescent
tivities, including delinquency and drug and alcohol girls persisted over time, leading to the development of
use; are more likely to have school problems; and are negative attitudes toward school and lower educational
more likely to experience early sexual intercourse (Aro aspirations. In young adulthood, there were marked
& Taipale, 1987; Caspi & Moffitt, 1991; Flannery, Rowe, differences between the early- and late-maturing girls’
& Gulley, 1993; Ge et al., 1996; Graber et al., 1997; levels of education; for example, the late-maturing girls
Magnusson, Stattin, & Allen, 1986). This is true in were twice as likely as the early-maturing girls to con-
Europe as well as in the United States (Silbereisen et al., tinue beyond the compulsory minimum number of
1989). These problems appear to arise because early- years of high school (Magnusson et al., 1986).
48 Part I The Fundamental Changes ofXAdolescence
The Scientific Early Maturation and Girls’ Problem
48 Part Part Title
Behavior_Activation or Accentuation?
Study of As you know, researchers have ob- (menarche before age 13), on-time
Adolescence served for some time now that early
physical maturation in both boys and
(menarche between 13 and 14), and late
(menarche after age 14) maturation.
girls is associated with higher rates of They looked to see whether problem
problem behavior, including delin- behavior increased between 13 and 15
quency, drug and alcohol use, and pre- to a greater degree among early matur-
cocious sexual activity. But does early ers than among the other girls.
maturation by itself actually cause As hypothesized, and consistent
problem behavior to emerge at adoles- with other studies, Caspi and Moffitt
cence? Or are the two variables associ- noted a larger increase in problem be-
ated in some other fashion? havior between ages 13 and 15 among
In order to examine this question, the early-maturing girls. However,
psychologists Avshalom Caspi and when they further broke down the
Terrie Moffitt drew on data from an early-maturing sample into two
extensive study of 15-year-old New smaller groups—girls who had shown
Zealand girls who had been studied high rates of problem behavior before
since birth (Caspi & Moffitt, 1991). One puberty and those who had not—they
of the interesting features of the data set saw an interesting pattern: Early matu-
used by the researchers was that meas- ration was associated with an increase
ures of problem behavior had been in problem behavior only among those
gathered on the adolescents both dur- girls who had a history of difficulties.
ing childhood, well before the onset of As you can see in the accompanying
puberty (at age 9), and during adoles- figure, the discrepancy in problem be-
cence, after puberty had begun (at ages havior between early maturers and
13 and 15). The researchers used age at other girls is far more evident in the
menarche as their indicator of early group of girls who had been rated high
Problem behavior
ences between individuals. Although 4
we tend to think of stress as something
that changes people in dramatic ways,
Caspi and Moffitt say that just the op-
posite is true: During times of stress, 2
not only do we not change markedly
but we also become even more like we
were before the stress occurred.
0
Interestingly, in another paper,
these and other researchers used the
same data set to examine the possibil-
ity that problem behavior leads to –2
early puberty, rather than the reverse Problem behavior high, Problem behavior low,
(Moffitt, Caspi, Belsky, & Silva, 1992). age 9 age 9
image is very much tied to his or her body image. Devia- studies showing higher levels of psychological distress
tion from the ideal physique can lead to loss of self-esteem (e.g., depression, low self-esteem) among obese indi-
and other problems in the adolescent’s self-image. In light viduals, especially during adolescence, but many stud-
of the tremendous emphasis that contemporary society ies show no such effect (Friedman & Brownell, 1995).
places on being thin, particularly for females, it comes as Nevertheless, because nearly 80 percent of obese ado-
no surprise to learn that the normal weight gain and lescents will be obese adults, obesity during adolescence
change in body composition that accompanies puberty places the individual at much higher risk for other
leads many adolescents, especially girls, to become ex- health problems, including hypertension (high blood
tremely concerned about their weight. pressure), high cholesterol levels, and diabetes (Must,
Many adolescents, of course, have legitimate con- Jacques, Dallal, Bajema, & Dietz, 1992). The high preva-
cerns about being overweight. According to national lence of obesity among African American females,
surveys, for example, nearly 20 percent of adolescents in particular, poses a serious risk to the cardiovascu-
in the United States are overweight, and about 5 percent lar health of this group (Flynn & Fitzgibbon, 1996;
are obese—that is, they are more than 20 percent over Morrison, Payne, Barton, Khoury, & Crawford, 1994).
the maximum recommended weight for their height— Often, a program of intense physical exercise combined
and an additional 15 percent are seriously overweight with proper nutrition can help youngsters lose weight
(Gans, 1990). Current research indicates that obesity is (Kimm, 1995).
a result of an interplay of genetic and environmental Health-care professionals have been concerned not
factors (Friedman & Brownell, 1995). only about adolescents who are obese but also about
Research on the psychological consequences of obe- adolescents who have unhealthy attitudes toward eating
sity has not led to consistent conclusions, with some and toward their body image (French, Story, Downes,
49
The Sexes The Effects of Early Maturation
Chapter X Chapter Title 50
Researchers are still trying to make sense they are clearly in a racial minority—
of the complicated pattern of findings support the view that standing out too
that emerges from comparisons of early much can be an unfortunate disadvan-
and late maturers, but one fact is clear: tage (Blyth et al., 1980; Simmons et al.,
Early maturation brings many more 1983). Because girls mature earlier
disadvantages for girls than it does for than boys, on average, early-maturing
boys. Psychologists have offered sev- girls mature much earlier than their
eral explanations for this sex differ- male and female agemates. This makes
ence. The explanations all are compat- them stand out at a time when they
ible, but they derive from very would rather fit in and, as a result, may
different premises. make them more vulnerable. This ex-
One explanation might be termed planation would also account for the
the “deviance” hypothesis (Simmons lower self-esteem of late-maturing
& Blyth, 1987). Simply put, youngsters boys, who are deviant toward the other
who stand far apart from their extreme.
peers—in physical appearance, for A second explanation focuses on
instance—may experience more psy- “developmental readiness.” Here the
chological distress than adolescents notion is that psychological distress
who blend in more easily. Studies of results when youngsters have experi-
adolescents who stand out physically ences before they are psychologically
in other ways—obese students and ready for them (Simmons & Blyth,
students who attend schools in which 1987). If puberty is a challenge that
Resnick, & Blum, 1995). Egged on by advertisers, who zines aimed particularly at women and adolescent girls
promote the idea that thin is beautiful—middle-class reveal clear and consistent messages implying that
white girls define bodily perfection as being five feet women cannot be beautiful without being slim and
seven inches tall and 110 pounds—many adolescents suggesting a range of products designed to promote
respond to normal bodily changes at puberty by diet- weight loss. Between 1970 and 1990, moreover, the im-
ing, often unnecessarily (Brumberg, 1997). Studies, for ages used in these magazines’ advertisements changed,
example, indicate that more than half of all adolescent with the ideal body shape becoming slimmer and less
girls consider themselves overweight and have at- curvaceous (Guillen & Barr, 1994, p. 471). Ironically, re-
tempted to diet (Fisher et al., 1995). Psychologists use search indicates that adolescents’ attempts to control
the term disordered eating to refer to patterns of be- their weight through intensive dieting, the use of
haviors and attitudes about eating that are unhealthy. laxatives and appetite suppressants, and deliberate
Disordered eating can range from unnecessary preoc- vomiting leads to weight gain, not loss (Stice, Cameron,
cupation with weight and body image to full-blown Killen, Hayward, & Taylor, 1999). Girls whose mothers
clinical eating disorders, such as anorexia and bulimia. have their own body image problems are especially
Studies show that disordered eating is associated with a likely to engage in extreme weight-loss behaviors
range of psychological problems associated with stress, (Benedikt, Wertheim, & Love, 1998), as are those who
including poor body image, depression, alcohol and to- report more negative relationships with their parents
bacco use, and poor interpersonal relationships (Archibald, Graber, & Brooks-Gunn, 1999). Interest-
(French et al., 1995; Graber, Brooks-Gunn, Paikoff, & ingly, among Hispanic American girls, those who are
Warren, 1994; Neumark-Sztainer, Story, Dixon, & more acculturated (i.e., “Americanized”) are signfi-
Murray, 1998), although it is not clear whether these cantly more likely to develop disordered eating than are
problems precede, or follow from, disordered eating those who are less acculturated (Gowen, Hayward,
(Leon, Fulkerson, Perry, Keel, & Klump, 1999). Killen, Robinson, & Taylor, 1999).
In contemporary America, as the expression goes, Not everyone is genetically or metabolically meant
one can never be too rich or too thin. Studies of maga- to be as thin as fashion magazines tell people they
50
requires psychological adaptation by types (Petersen, 1988). Early matura- peers and therefore are more likely to
the adolescent, perhaps younger ado- tion for girls means leaving behind the react well to puberty. The fact that the
lescents are less able than older ones to culturally admired state of thinness. effects of early maturation on girls’
cope with the challenge. Because pu- Among girls, the ratio of fat to muscle self-esteem vary across cultures sug-
berty occurs quite early among early- increases dramatically at puberty, and gests that contextual factors need to be
maturing girls (some may begin ma- many girls feel distressed when they taken into account in explaining this
turing at age 8 or 9 and may mature because they gain weight. Early pattern of sex differences.
experience menarche at age 10), it may maturers experience this weight gain at Whatever the explanation, the fact
tax their psychological resources. Early a time when most of their peers are that early-maturing girls are at height-
maturation among boys, because it oc- still girlishly thin. One interesting ened risk for temporary psychological
curs at a much later age, would pose study showed that, in ballet compa- problems, at least in the United States, is
less of a problem. The developmental nies—where thinness is even more an important fact for parents and
readiness hypothesis has been used to important than in the culture at school counselors to bear in mind. Un-
account for the finding that older large—late maturers, who can retain fortunately, as long as our culture over-
youngsters (eighth-graders) fare better the “ideal” shape much longer than values thinness and encourages the view
during the transition from elementary earlier maturers, have fewer psycho- that females should be judged on the
to secondary school than do younger logical problems than even on-time basis of their physical appearance rather
students (sixth-graders). This perspec- girls do (Brooks-Gunn & Warren, than their abilities, values, or personal-
tive also helps account for the fact that, 1985). In contrast, at puberty boys ity, the risks of early puberty will proba-
in puberty, late-maturing boys seem move from a culturally undesirable bly persist. Adults can help by being
better able than early maturers to con- state for males (being short and supportive, by helping the early-matur-
trol their temper and their impulses scrawny) to a culturally admired one ing girl to recognize her strengths and
(Peskin, 1967). (being tall and muscular). Early ma- positive features—physical and non-
A final explanation concerns the turers enjoy the special advantage of physical alike—and by preparing her
cultural desirability of different body being tall and muscular before their for puberty before it takes place.
should be. Some young women become so concerned incidence of genuine anorexia and genuine bulimia is
about gaining weight that they take drastic—and dan- rather small (Fisher et al., 1995). Fewer than one-half of
gerous—measures to remain thin. Some go on eating 1 percent of adolescents are anorexic, and only about 3
binges and then force themselves to vomit to avoid percent are bulimic (American Psychiatric Association,
gaining weight, a pattern associated with an eating dis- 1994). Anorexia and bulimia are far more common
order called bulimia. In the more severe cases, young among females than males, however, and are rarely seen
women who suffer from an eating disorder called before puberty.
anorexia nervosa actually starve themselves in an effort Although the incidence of anorexia and bulimia is
to keep their weight down. Adolescents with these sorts small, the proportion of adolescents who are unhappy
of eating disorders have an extremely disturbed body with their body shape or weight is not. This is especially
image. They see themselves as overweight when they the case among female adolescents from relatively more
are actually underweight. Some anorectic youngsters affluent backgrounds, which no doubt accounts for the
may lose between 25 and 50 percent of their body greater incidence of anorexia and bulimia in this popula-
weight. As you would expect, bulimia and anorexia, if tion (Gardner, Friedman, & Jackson, 1999). In one study,
untreated, lead to a variety of serious physical prob- for example, more than one-third of the girls whose
lems; in fact, nearly 20 percent of anorectic teenagers weight was considered normal by medical and health
inadvertently starve themselves to death. standards believed that they were overweight—including
Anorexia and bulimia both began to receive a great 5 percent who actually were underweight by medical cri-
deal of popular attention during the 1980s, because of teria. (Less than 7 percent of normal-weight boys, and no
their dramatic nature and their frequent association in underweight boys, described themselves as being over-
the mass media with celebrities. Perhaps because of this weight.) In this study, more than 70 percent of the girls re-
attention, initial reports characterized these eating dis- ported that they would like to be thinner than they are (as
orders as being of epidemic proportion. Although un- opposed to one-third of the boys), and more than 80 per-
healthy eating and unnecessary dieting may be preva- cent said that being thinner would make them happier,
lent among teenagers, careful studies indicate that the more successful, and more popular (Paxton et al., 1991).
51
52 Part I The Fundamental Changes of Adolescence
0.70
Whites African Americans, African Americans,
mother college graduate mother noncollege
0.60
0.60
0.50
Probability of no dates
0.44
0.40
0.34
0.29 0.30
0.30
0.26 0.26
0.20
0.15
0.10 0.08
0.00
1 SD M 1 SD 1 SD M 1 SD 1 SD M 1 SD
Body fat factor score
Figure 1.11 White girls and middle-class African American girls are significantly less likely to date when they are not as slim as
their peers. The same is not true for less affluent black girls, however. (Halpern et al., 1999)
A third school of thought views eating disorders as broader social forces are a main factor in the development
part of a more general syndrome of psychological dis- of these eating disorders (Brumberg, 1988). Research in-
tress. Many studies have pointed to links between eat- dicates, for example, that girls who are early maturers and
ing disorders and other serious mental health prob- early daters are likely to report greater dissatisfaction with
lems, such as depression, obsessive-compulsive their bodies and to be at greater risk for disordered eating
disorder, and substance abuse; many anorectic and bu- (Cauffman & Steinberg, 1996; Smolak et al., 1993; Swarr
limic women display such psychological problems & Richards, 1996) and that girls who turn to popular
along with their eating disorder (Casper & Jabine, 1996; magazines, such as Seventeen, Sassy, and Glamour, for in-
Leon, Fulkerson, Perry, & Dube, 1994; Munoz & formation about dieting and appearance are more likely
Amado, 1986; Rastam, Gillberg, & Gillberg, 1996; to have a high drive for thinness and disturbed patterns of
Strober, Freeman, Bower, & Rigali, 1996). These studies eating (Levine, Smolack, & Hayden, 1994). One interest-
suggest that anorexia and bulimia may be best under- ing study showed, for example, how bulimia became so-
stood not as independent or unique disorders but as cially “contagious” in a college sorority (Crandall, 1988).
particular manifestations of a more general underlying This researcher found that, over the course of the aca-
psychological problem—called internalized distress— demic year, the women’s eating behavior became more
which can be displayed in a variety of ways. (As you will and more like that of their sorority friends—even in a
read in chapter 13, many different psychological disor- sorority in which binge eating was the norm. Other re-
ders in adolescence occur together, or “covary.”) In sup- search indicates that girls’ attitudes toward eating and di-
port of this view, there is some evidence that the med- eting are influenced by the attitudes of their parents and
ications that are successful in treating depression and friends (Mukai, 1996).
obsessive-compulsive disorder are useful in treating Just because cultural conditions contribute to the
anorexia (Condit, 1990). development of anorexia nervosa doesn’t mean that in-
Finally, because anorexia and bulimia are 10 times dividual characteristics do not play a role as well. It may
more common in females than males, it is likely that be that cultural conditions predispose females more
54 Part I The Fundamental Changes of Adolescence
than males toward these eating disorders and that, PHYSICAL HEALTH AND
within the population of adolescent women, those who
have certain psychological traits (proneness to depres-
HEALTH CARE IN
sion, for example), physical characteristics (e.g., early ADOLESCENCE
pubertal maturation), familial characteristics (e.g., Although puberty is undoubtedly the most important
strained relations with parents), or social concerns biological development of the adolescent decade, con-
(e.g., high interest in dating) may be more likely to de- cerns about the physical health and well-being of young
velop problems (e.g., Cauffman & Steinberg, 1996; people are far broader than those involving reproduc-
Frank & Jackson, 1996; Swarr & Richards, 1996). The tive maturation. In the past two decades, the field of
onset of eating disorders, like so many aspects of ado- adolescent health care has grown rapidly, as health ed-
lescent development, cannot be understood apart from ucators and health-care practitioners have come to bet-
the context in which young people live. ter understand that the health-care needs of young peo-
A variety of therapeutic approaches have been used ple differ from those of children and adults in
successfully in the treatment of anorexia and bulimia, important respects (Slap & Jablow, 1994).
including individual psychotherapy and cognitive- Adolescence is a paradox as far as physical health is
behavior modification, group therapy, family therapy, concerned. On the one hand, adolescence is one of the
and, more recently, the use of antidepressant medica- healthiest periods in the life span, characterized by a
tion (Agras, Schneider, Arnow, Raeburn, & Telch, 1989; relatively low incidence of disabling or chronic illnesses
Condit, 1990; Killian, 1994; Vigersky, 1977). The treat- (e.g., asthma, cancer), fewer short-term hospital stays,
ment of anorexia often requires hospitalization initially and fewer days in which individuals stay home sick in
in order to ensure that starvation does not progress to bed. Nonetheless, in the United States, nearly 1 in 15
fatal or near-fatal levels (Mitchell, 1985). adolescents has at least one disabling or chronic illness,
with the main causes of disability being mental disor-
ders, such as depression; respiratory illnesses, such as
RECAP asthma; and muscular and skeletal disorders, such as
arthritis (Ozer, Macdonald, & Irwin, in press). Fortu-
Many writers link the emergence of eating problems in
nately, in the past 50 years, the rates of death and dis-
adolescence to the biological changes of puberty, which
typically include increases in weight and changes in body ability resulting from illness and disease during adoles-
composition. Disordered eating can range from mild dis- cence have decreased substantially, and new medical
turbances in attitudes and diet to serious and potentially technologies and better health-care delivery have im-
life-threatening clinical disorders, such as anorexia. Al- proved the physical well-being of children, especially
though many adolescents, especially girls, are unhappy those with chronic illness and disabling medical condi-
with their body and concerned about being overweight— tions (Gans, 1990). Adolescents are far less likely than
even when their weight is perfectly normal—clinical eat- individuals of any other age to seek and receive medical
ing disorders such as anorexia and bulimia are actually care through traditional office visits to practitioners,
quite rare. Nevertheless, studies indicate that individuals however. Moreover, there are large socioeconomic and
with eating disorders are at risk for a wide range of other
ethnic disparities in adolescents’ access to care, with
mental health problems, including depression, substance
poor and ethnic minority youth far less likely to have
abuse, and other forms of internalized distress. Current
thinking suggests that eating disorders are caused by a adequate health insurance and health-care access than
complex interplay of biological and environmental factors. affluent or white youth (Ozer et al., in press).
The most virulent threat to adolescent health comes
from unhealthy behaviors (such as drug use), violence
Food for Thought (both self-inflicted and inflicted by others), and risky
activity (such as unprotected sexual intercourse or
Boys may not show the symptoms of drunk driving). In some senses, then, many of the im-
anorexia or bulimia to the extent that provements made in preventing and treating the tradi-
girls do, but many boys are overly con- tional medical problems of the period—those having
cerned about their body and weight nevertheless. to do with chronic illnesses—have been offset by what
What might be some signs in an adolescent male some scientists call the “new morbidity and mortality”
that could indicate problems in this area? of adolescence (Hein, 1988b). Contributors to this new
morbidity and mortality include accidents (especially
Chapter 1 Biological Transitions 55
automobile accidents), suicide, homicide, substance iors, such as violence, drug use, unsafe driving, and un-
abuse (including tobacco and alcohol use), and sexually protected sexual intercourse, and increase health-
transmitted diseases (including AIDS). enhancing behaviors, such as eating properly, exercising
The contrast between the old and new mortalities of adequately, and wearing seat belts? Current efforts in-
adolescence is readily apparent. Fifty years ago, illness and clude providing teenagers education about alcohol and
disease accounted for more than twice as many deaths other drug use, accident prevention, safe sex, and proper
among teenagers as violence or injury, but the reverse is nutrition, as well as encouraging health-care profession-
true today, although deaths due to accidents, mainly au- als to do more direct screening for risky health practices
tomobile accidents, have fallen dramatically in the past among their adolescent patients—as one group of ex-
two decades (Ozer et al., in press). According to recent es- perts put it, “Don’t Ask, They Won’t Tell” (Blum,
timates, approximately 45 percent of all teenage deaths re- Beuhring, Wunderlich, & Resnick, 1996, p. 1767).
sult from car accidents and other unintentional injuries, Adolescent medicine expert Charles Irwin, Jr.
and another 30 percent are a result of homicide or suicide (1993), has suggested that parents, practitioners, and
(Ozer et al., in press). Adolescents are involved in more educators who are interested in helping adolescents live
driving accidents than are adults primarily because they healthier lives keep in mind the “five As” of successful
are less experienced behind the wheel (at any age, new health promotion:
drivers are more likely to have accidents than seasoned
drivers) but also because adolescents are more likely to Anticipatory guidance. Establish a trusting relation-
take chances while driving—perhaps because they are ship with the young person prior to adolescence.
likely to be driving with other teenagers who encourage Ask. Query adolescents directly about their health-
risk-taking (Simpson, 1996). Adolescents are also more enhancing and health-compromising behaviors.
likely than other age groups to be injured as pedestrians Advise. Give advice about health promotion, even if
and bicyclists in traffic accidents (Hingson & Howland, the young person doesn’t ask for it.
1993). One piece of good news is that, although alcohol Assist. Encourage the adolescent to participate in
contributes greatly to automobile accidents among young programs that promote health.
drivers, the rate of alcohol-related traffic fatality among Arrange. Arrange follow-up visits or consultations
young people has dropped dramatically in recent years to monitor the adolescent’s progress.
(Sells & Blum, 1996).
The consensus among health-care experts, then, is A variety of new, wide-reaching strategies for pro-
that the most significant threats to the health of today’s moting adolescent health have been attempted in recent
youth arise from psychosocial rather than from natural decades. Among the most popular of the latest wave in-
causes (Ozer et al., in press). Unlike many other periods volve school-based health centers. These are located in
of the life span (such as infancy or old age), when we are or adjacent to schools, and they provide such services as
more vulnerable to disease and illness, most of the physical examinations, the treatment of minor injuries,
health problems of teenagers are preventable. More- health education programs, dental care, and counseling
over, patterns of diet, smoking, and exercise established related to substance abuse, sexuality, and mental health.
during adolescence persist into adulthood (Kelder, They often are set up to serve poor youth, who gener-
Perry, Klepp, & Lytle, 1994). As a result of this recogni- ally are less likely to receive medical and dental care
tion, the focus in the field of adolescent health has than are their more affluent counterparts.
shifted away from traditional medical models (in which School-based health centers became increasingly
the emphasis is on the assessment, diagnosis, and treat- popular because they are positioned to address the
ment of disease) toward more community-oriented, most pressing problems in adolescent health care: the
educational approaches (in which the emphasis is on fact that most adolescent health problems are preventa-
the prevention of illness and injury and the promotion ble, the fact that adolescents underutilize conventional
of good health) (Millstein, Petersen, & Nightingale, medical services, and the fact that adolescents often
1993; Susman, Koch, Maney, & Finkelstein, 1993). want their health-care needs to remain confidential. Al-
In other words, instead of asking how we can best treat though the development of these centers has generated
sick adolescents, experts in adolescent health care are now controversy in a number of communities because some
asking how we can encourage adolescents to take the steps school-based health centers distribute contraceptives (a
necessary to prevent illness and disability. How can we practice that upsets many adults), studies show that the
help adolescents reduce health-compromising behav- vast majority of visits to these centers are for injuries,
56 Part I The Fundamental Changes of Adolescence