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Title page
Title - &=
nbsp; &nbs=
p; “Adolescent
Behaviour and Health”
Author - &=
nbsp; Diana
M.L. Birch
Position - &=
nbsp; Di=
rector
Youth Support
Address for correspond=
ence
- Youth
Support House
=
&nb=
sp; =
&nb=
sp; 13,
Crescent Road
=
&nb=
sp; =
&nb=
sp; London
BR3 2NF
Tel no - 0181 650 6296=
/ 0181 659 9926
Fax no - 0181 659 3309=
Adolescent Behaviour a=
nd
Health
Adolescent health and well-being is inextricably linked with adoles=
cent
behaviour and these behaviour patterns are determined by the stage of emoti=
onal
and physical development of the individual influenced by the pressures which
society may exert at a vulnerable stage.
Adolescence is regarded traditionally as a time of
‘delinquency’ and rebellion. It is also a time of energy and
change. Both can be channelled in the healing process and that is what makes
working with young people so exciting.
Rebellion and Identity=
-
Adolescence is a time of radical psychological change and readjustm= ent. The first question to be answered is ‘ Who am I?’ A young person must find his or her place in the world and establish a personal identity.<= o:p>
Throughout early childhood the tendency is for a ‘false
self’ to be built up - a persona who stands between the individual and
the world - showing adults the child they would like to see. The child may
decide that there are parts of himself which others do not want and do not =
like
and so learns to hide them from others and from himself. He lives in a world of denial wher=
e he
can try to be all things to other people while real feelings and needs fade
‘out of pain’. This building up of a false self occurs to an ex=
tent
in all of us, since we do not have perfect childhoods or perfect mothers. I=
t is
a healthy search for the ‘true self’ which prompts the rebellio=
us
adolescent to alter his appearance, break the family dress code with dirty =
torn
jeans, studded leather jacket, tattoos, rings in the nose, long hair or sha=
ved
head - whatever goes against the norm - making an outward statement of inner
change “Look, I’m not what you wanted me to be any more!”=
.
Winnicott once wrote a paper titled ‘Delinquency as a sign of
hope’. Rebelling, pushing out against the injustices that you have
suffered in childhood - that is indeed a sign of hope - a sign that the spi=
rit
is not broken, that there is an individual in there shouting out “Hey!
What about ME!” The beginnings of change, of a sense of one’s o=
wn
needs, of self worth. 1
Independence - Moving =
out of
the nest -
Human development is a series of progressions from total dependence=
on
the parent or family through a stage of total independence or breaking free=
and
culminating, hopefully in the mutual interdependence of satisfying
relationships. The qual=
ity of
and nature of the patterns of attachment established in early childhood
fundamentally affect the way that a teenager is able to ‘break
free’ and whether he or she is likely to be harmed by that process.
A teenager with a ‘secure attachment’ fostered by a sta=
ble
loving home, will feel able to explore his expanding world from a ‘secure base’ <=
sup>2
; he will thus be able to safely ‘test the water’ , gain new
experiences and ‘grow up’ - secure in the knowledge that by
distancing himself a little from parents and indulging in mildly risky
behaviour he will not be rejected and can always - like the prodigal - retu=
rn
to loving arms.
In contrast an unloved, rejected adolescent with insecure attachmen=
t to
his family will have no secure base from which to explore his world, will h=
ave
no boundaries or limits to his risk taking, and will be likely to become
involved in harmful experiences which serve to confirm his belief that the
world is a cruel and dangerous place. Such rejected and rejecting youngsters will often become invol=
ved in
crime, violence and drug abuse. Their health will suffer as a direct result=
of
drug, alcohol or solvent abuse and indirectly by virtue of their lifestyles
which may involve poor diet, sleeping rough and general deprivation.
The tragic reality is that young people who have been abused and sp=
ent
their early childhood in care are
often those who leave the care system for a life of deprivation on the stre=
ets.
They constitute a high percentage of homeless youth who may be further expo=
sed
to the abuse of ‘survival sex’ and sexually transmitted
disease 3 . Leaving
‘home’ with the prospect of&nb=
sp;
family ties and support bears no comparison to leaving
‘care’ when you
are ‘out on your own=
217;.
Peer group influences -
Replacement families? -
Personal identity involves separation from others, working out what=
you
believe in as opposed to what your family believes in, deciding on an
‘image’ - which often means choosing which peer group or
‘cult’ figure you will follow.=
Teenagers reject their family norms in search of their own while needing =
the
approval of the peer group. The chosen group and hence it’s influence=
can
vary from week to week - resulting in dietary fads and varying dress codes
mainly harmless in the long term although there are casualties - malnourish=
ed
‘vegans’; infected ‘piercing’ sites; scarring tatto=
os;
hepatitis; sexually transmitted disease; unwanted pregnancy ....
Problems arise when group influence is pernicious in gang culture;<=
span
style=3D'mso-spacerun:yes'> in dance schools where desired sli=
mness
may encourage anorexia; in American female college ‘barf parties̵=
7;
(eat and vomit) sanctioning bulimia or extreme as in cult membership exploi=
ting
the mentally vulnerable; or historically when the followers of Thomas
Chatterton made ‘copycat’ suicide bids.
Self Worth
Self esteem relates to an individuals personal values and not
necessarily to those of his peers, his doctors or his teachers. Skills and
attributes such as being good at maths should not be presumed to be somethi=
ng
valued by the teenager ..... “positive correlations between self este=
em
and educational performance are likely to be found only in populations in w=
hich
self esteem is bound up with aspirations for achievement. There are no a pr=
iori
reasons why academic achievements or anything else, should be of value to a=
ll
pupils" 4 .
If indeed self esteem is dependant on a personal value system, chan=
ge
may be achieved by altering these values, rather than by changing one's
position within the existing hierarchy. If you lower your expectations, you=
can
fulfil them more easily without having to improve your achievements. This
mechanism appears to be operational in schools where teenagers who have been
conditioned to 'failing' academically form a 'counter culture' of academic
incompetence within whose inverted value system they can succeed and consti=
tute
a model for younger pupils.
Self esteem can be boosted by changing how you view yourself within=
a
given value system - or by changing the value system altogether. If you are=
not
measuring up in one club - then join another or form your own. Teenage 'gan=
g'
culture, delinquency and 'drop outs' can all be manifestations of this proc=
ess.
 =
; &n=
bsp;  =
; * &=
nbsp; * &=
nbsp; * &=
nbsp; * &=
nbsp; *
Danny never knew his f=
ather.
His mother placed him in a children's home at the age of eleven. He had nev=
er
been particularly clever at school but was not doing too badly. His behavio=
ur
had not attracted much comment - that was the problem - not attracting much
comment. Danny was nothing special, he did not excel or stand out in any wa=
y.
Children's homes are n=
ot
easy places to live in, there is always a 'pecking order', bullies, bullied=
and
care workers 'pets'. Danny did not have a 'niche'. Not until he found somet=
hing
to excel in, some way to be noticed. He began to be involved in petty crime=
at
the age of fourteen, at first just a little shoplifting, which he exaggerat=
ed
and bragged about. Then as his exploits were not always believed, he made s=
ure
he got caught a few times - not enough to get into serious trouble with the
law, but it improved his image.
As his image became to=
ugher,
he had to keep up with it, so he found himself getting into heavier crime.
Younger boys and then a girlfriend went with him on exploits - so he had to
prove that he really could burgle homes and 'mug' people in the street. Dan=
ny
had to be the 'badest of the bad' and for a while his girlfriend acted like=
his
'moll'. She joined his 'counter culture' - a girl who was bright and doing =
well
at school pretended not to be so clever around him, 'so as not to show him =
up'
and convinced herself that her worth too lay in being tough, intimidating
others and getting her name on police files.
The next step was pret=
ending
to get high on drugs - first using solvents and beer and 'acting' stoned. D=
anny
was afraid to use hard drugs to begin with although he would never admit it.
Finally his bluff was called, doubly - he started using hard drugs, and as =
his
'alternative value system' of juvenile crime and hard guy image began to sl=
ip,
became incapable of maintaining his self image, he turned increasingly to d=
rug
use to boost his flagging ego.
Danny, the violent drug
addict, lost all his followers and his girlfriend. He was now compelled to
continue in crime to fuel his habit, he had lost control and the means by w=
hich
he had sought a boost to his self worth had become the means to drag him do=
wn.
 =
; &n=
bsp;  =
; * &=
nbsp; * &=
nbsp; * &=
nbsp; * &=
nbsp; *
The answer to “=
who am
I?” can very easily become negative for a deprived teenager with litt=
le
chance of achieving adult goals such as doing well at school, getting a job=
and
setting up their own home. It is easy for the answer to the question to bec=
ome
“I’m a failure”. Hence the loopholes “I can be a success if I can=
be
.... a gang leader .. a fathe=
r ... a mother”. Schoolgirls who become pregnant
frequently experience academic failure and in becoming young mothers they c=
ould
be seen to be 'finding and accepting alternative dimensions of value' establishing or joining a 'counter
culture' of schoolgirl mothers. Many appear to use their pregnancies as a
source of self worth, seem fulfilled and happy during and soon after the
pregnancy and do better in th=
eir
individual tuition than they had done at school. 5
A self esteem measure=
of
pregnant schoolgirls and a comparable group of schoolgirl mothers indicated
that while painful life experiences and deprivation resulted in an expected fall in se=
lf
esteem scores, the girls who were pregnant at the time of the testing felt =
much
more positive about themselves than the schoolgirl mothers. Pregnancy seeme=
d to
have protective value in conserving self-worth. Girls were finding an alter=
native
value system by which to judge their lives. 6
“Seen from a young girl’s viewpoint, pregnancy may not =
be
so undesirable; motherhood is a fulfilment; she takes on a valued role and =
out
of her loveless world creates a baby who will love her. Pregnancy is thus u=
sed
as a source of self-worth and a false solution to problems. That being so, an alternative solu=
tion
must be offered. These young people need an alternative source of self-wort=
h in
order to ensure that when they become parents this is because they desire
parenthood, with all its responsibilities, hardships and joys, not merely as
the only perceived escape from a catalogue of problems.” 7
Risk Taking Behaviour<= o:p>
Risk taking behaviour is an integral part of adolescence. All teena=
gers
take risks - the variability lies in the degree of risk taking and the leng=
th
of this phase. As with other aspects of teenage emotional development - some
‘grow up faster then others’ and come through with fewer
scars.
Risk taking is associated with several factors - Firstly the inabil=
ity
to accurately perceive risk. For instance it has been suggested that
adolescents may fail to protect themselves from some risks because they can=
not
appreciate them as such. This is a time for exploring the world , not for
hiding behind closed doors, hence teens do not expect to be harmed while
pushing out the boundaries. Some girls may expose themselves to risk of sex=
ual
assault because they are unable to estimate the risk posed by ‘predat=
ory
men’.
Denial of risk. Many girls deny that they can become pregnant. They
believe they are too young. Belief in the impossibility of pregnancy tends =
to
become almost a magical protection like a lucky charm “It won’t happen to
me”. These teenagers are
still at the stage of concrete
reasoning and cannot identify with
the experiences of others. 8 This explains why health education
methods based on shock tactics do not work with this age group.
Adolescents believe in their own invincibility and hence are unable to appreciate=
the
consequences of behaviours which pose a health risk. Development of a future
time perspective is another aspect of adolescent development. 9 Couple a belief of invincibi=
lity
with a delay in the cause and effect sequence and the possibility of harm
becomes even more remote. Hence teenagers cannot link smoking with cancer
(which may not strike for 20 years); sex with the birth of a child (9 months
later) or unprotected sex with HIV infection and with death from AIDS.
The adolescent psyche is geared not to hear traditional health
education messages and the approach to HIV prevention is a good example of =
how
the ‘message’ can be misinterpreted. In this respect profession=
als
must take care to distinguish good education from good advertising. A campa=
ign
based on cult rock ‘heroes’ who have died of AIDS - and are thus
‘martyrs’ to ‘the cause’ - can engender a heightened
feeling of ‘separateness’; an alternative culture; living life =
in
the fast lane and “who wants to be thirty anyway?” rather than =
an
educated group of young people wishing to practice safe sex. This is simila=
r to
the drug culture promoted by rock musicians in the sixties and seventies. Y=
oung
people were more likely to smoke cannabis like John Lennon or try drugs to =
be
like Eric Clapton than to be put off by the deaths of Janis Joplin and Jimi
Hendrix.
Sexual behaviour -
Each year in England and Wales approximately 10,000 schoolgirls bec=
ome
pregnant. Conception rates for
girls aged 14 and under rose by 27% in the decade 1978-88 indicating
that the very young, most
vulnerable, girls and boys needing most support are being failed by prevent=
ive
and educational programmes.
By understanding the =
belief
systems of the adolescent and his or her peer group we can more effectively
interact with that young person in a way which has relevance and meaning. Parental, cultural and relig=
ious
beliefs or myths form a basis upon which more contemporary, up-market, peer
group beliefs are built.
These basic belief systems, can to some extent be modified with sex education. For instance, =
peer
group beliefs such as “You can’t get pregnant standing up”
can be confronted with factual knowledge such as sperm can swim uphill!
At a deeper level the adolescent has ‘magical beliefs’.
Intrinsic ideals with a high emotional content, a feeling of instinct and
intuition which may have no perceivable basis in current reality. Magical
beliefs centre on fundamental concepts such as feelings about self, body and
control and on the nature of life itself.&=
nbsp;
Beliefs which conjure the ‘autonomous womb’ and give ris=
e to
statements such as “Well I kn=
ew
someone was pregnant, but I didn’t know it was me”. 10
We have discussed how the adolescent during psychological developme=
nt
is much preoccupied with the question “Who am I?” Confusion inevitably arises when
“Who am I?” becomes “Who are we?” Establishing a
personal identity may thus be=
an
impossible task for a pregnant adolescent who suddenly finds that her
identity is changing beyond h=
er control.
She is no longer a little girl, she is a fertile woman. The role of a mother is thrust upo=
n her
before she establishes her own identity, hence the belief that she cannot g=
et
pregnant and her frequent denial of pregnancy. “I knew about sex and how girls =
could
get pregnant, but I never thought it could happen to me”.
Many factors interact in limiting contraceptive use. For young
teenagers under the age of 16, it is
not so much a matter of availability of contraceptive services which
affects sexual practices and conception rates. Much more important is the
social situation and life experiences which affect their emotional maturity=
, motivation
and their value systems.
Locus of Control
Teenage behaviour, particularly with regard to sexuality is profoun=
dly
affected by beliefs about control. Lack of control is at the basis of young
teenager’s notoriously poor use of contraception. Only 7% of London
pregnant schoolgirls ever used contraception. 5 Young girls deny to themselv=
es
that they are having sex, and convince themselves that if they do end up in=
bed
with a boy it is a one-off event. This denial is a protective mechanism. Unplanned sex is an accident. Nob=
ody
can be blamed for the occasional slip however, premeditated planned sex is inexcu=
sable.
Emotional development involves internalising the
“locus of control”, assuming responsibility for one̵=
7;s
actions and one’s body. Those
maintaining an external locus of control are not in control of when they ha=
ve
sex or whether they get pregnant, are not responsible for their actions or
their bodies - pregnancy is something that happens
to them. It is a matter of fate.
The same applies to many other aspects of adolescent behaviour.
Assuming responsibility for one’s own actions and thus being able to
decide whether to ‘say no’ to drugs implies awareness of the
consequences of those actions,
ability to appreciate ‘cause and effect’ and ability to accept feasibility of
control. The adolescent who cannot relate to these concepts remains buffete=
d by
fate and places responsibility on external control.
Our responsibility is to ensure that children can be raised with en=
ough
self confidence and self worth so that as teenagers they are able to seek h=
elp
and guidance in facing the challenges, thrills and risks of adolescence wit=
hout
suffering irrevocable harm.
References:
1. Winnic=
ott
D.W. "Delinquency as a s=
ign of
hope" in - Davis D.,
Wallbridge D. <=
/span>'Boundary=
and
space' Karnac Books 1981
2. Bowlby J. 'A secure
Base' Routledge 1988.
3. MacKenzie R, Pennbridge J., David T., Yeates G. “Runaway a=
nd
Homeless Youth in Los Angeles county California” Journal of Adolescent Health Care =
1990;
11 : 159-165.
4. Robinson J. "=
Self
Esteem, Identity and achievement in secondary school pupils" Bristol
University Press 1989.
5. Birch, D.M.L. “Unwillingly to School - Education of Pregna=
nt
schoolgirls” in “Are you my Sister, Mummy?”, Youth Support
Publications 1987 : 18 : 199-205.
6. Birch, D.M.L. “Challenges to self worth” in “I=
nner
worlds & Outer Challenges”
Youth Support Publications1992 : 80-99.
7. Birch, D.M.L. “Schoolgirl Pregnancies” in
‘Progress in Obstetrics & Gynaecology Vol.7’ 1989; Chapter =
5 :
75-90.
8. Coleman J. “Identity in adolescence; Present and Future
Self-concept”. Human Development. 1972 15: 1.
9. Blum R.W., Resnick M.D. “Adolescent Sexual Decision-making;
contraception, pregnancy, abortion, motherhood.” Pediatric Annals 1982
11:10 797-805
10. Birch, D.M.L. “That Old Black Magic. Teenage Sexual Belief Systems” International Journal of Adolescent Medicine and Health 1991; 5 :1 37-47