Psychosocial Development in Normal Adolescents and Young Adults

Sara Sherer

Mari Radzik

This chapter provides a framework of the psychosocial developmental process and discusses ways to enhance interactions between health care providers and adolescents and young adults (AYAs). General considerations are reviewed, including a review of the normal developmental phases and tasks of early adolescence (approximate ages 10 to 13), middle adolescence (approximate ages 14 to 17), late adolescence (approximate ages 17 to 21), and young adulthood (approximate ages 18 to 25). A review of the primary tasks for each of these phases includes a discussion of cognitive development, independence, body image, peer group, and identity development.

As modern Western societies lengthen the course of a lifetime, the end of adolescence and the initiation of adulthood has extended and become more fluid. The phase of life between adolescence and adulthood is now referred to as “emerging adulthood.”¹,² Today’s emerging adults are known for their late entrance into formal adulthood and slow exit out of their parents’ homes.³ They are more educated than previous generations and enjoy connectedness to all forms of digital apparatus, resulting in far-reaching global influences impacting their identities.⁴

In terms of physical development, adolescence can be described as the period of life beginning with the appearance of secondary sexual characteristics and terminating with the cessation of somatic growth. In modern Western culture, the behavioral aspects of this developmental period have become equally important. Adolescence is, in fact, a biopsychosocial process that may start before the onset of puberty and last well beyond the termination of growth. Adolescence involves physical, psychological, emotional, and social growth and development, and each of these domains occurs at different rates. As such, adolescence is a period of increased vulnerability characterized by an ongoing process of transition and adjustment.⁵ The events and challenges that arise during this period are often perplexing to parents, health care providers, and AYAs.

Over the past decade, advances in neuroimaging techniques have led to a greater understanding of the structural and functional development of the AYA brain, and the cognitive processes during this period of life. Studies have demonstrated that changes in brain structure continue beyond adolescence, with the most dramatic growth occurs in the development of executive functioning, organization, decision making and planning, and response inhibition.⁶,⁷,⁸ Understanding biologic changes in brain structure and function during adolescence and young adulthood has important implications for understanding behaviors (see Chapter 2).

Health care professionals who are knowledgeable about normal adolescent psychosocial development are in a good position to identify the range of mental health problems, as well as the various emotional and behavioral issues that can affect the health and well-being of AYAs.⁹

THE PROCESS OF ADOLESCENCE

First, it is important to keep in mind that no outline of psychosocial development can adequately describe every AYA. Globally, 10- to 24-year-olds are now the largest generational group in history.¹⁰ These AYAs are not members of a homogeneous group, but a diverse group that display wide variability in biologic, psychological, social, and emotional growth. Each AYA must meet his or her individual life demands and respond to the opportunities and challenges he or she faces in a unique and personal manner.⁹,¹¹

Second, the transition from childhood to adulthood is not a continuous, uniform, or synchronous process. In fact, biologic, social, emotional, and intellectual growth may be totally asynchronous.⁵ In addition, psychosocial growth may be accented by frequent periods of regression. It must be remembered that all of life, from birth to death, is a constant process of change and that adolescence and young adulthood is not the only challenging period.

Third, whereas adolescence has historically been described as a period of extreme instability, most adolescents do not experience difficulties during this time, and most are unperturbed by the developmental process.¹² This ability to cope with this developmental period reflects a resiliency that is often overlooked, as the behaviors of adolescents are often the primary focus of attention.¹³ Recent studies that focus attention on parenting AYAs find that difficulties are far less prevalent than previously thought.¹³ Only one in five families report difficult parent-child relationships. Overall, there is no evidence that intractable and major conflict between parents and their adolescent children is a “normal” part of adolescence,¹⁴,¹⁵,¹⁶ and in fact most AYAs and their parents enjoy healthy relationships as adults.

Phases and Tasks of Adolescence

Adolescence and young adulthood can be conceptualized by dividing the process into four psychosocial developmental phases:

Early adolescence: approximate ages 10 to 13 years, or middle school years
Middle adolescence: approximate ages 14 to 17 years, or high school years
Late adolescence: approximate ages 17 to 21 years, or college or employment
Young or “emerging” adults: approximate ages 18 to 25 years

Regardless, by the end of adolescence, emerging adults strive to become emancipated from their parents and other adults. Some have attained a psychosexual maturity along with the necessary skills and resources from family, education, and community to begin to support themselves in an emotionally, socially, and financially satisfying way.³ Others may still be supported as they attain the necessary skills and resources necessary to transition to adult independence.

Several tasks characterize the development of AYAs and are discussed in the following sections in conjunction with the various developmental phases. These tasks include the following:

Expanding cognitive development that allows young people to think in new, more complex ways
Achieving independence from parents
Accepting one’s body image
Adopting peer codes and lifestyles
Establishing self, sexual, vocational, and moral identities

EARLY ADOLESCENCE (APPROXIMATE AGES 10 TO 13)

Early adolescent psychosocial development is heralded by rapid physical changes with the onset of puberty. These physical changes engender self-absorption and initiate the adolescent’s struggle for independence. The onset of puberty occurs 1 to 2 years earlier for girls than for boys (see Chapter 2). Concomitantly, the psychosocial and emotional changes also occur 1 to 2 years earlier in girls.¹⁷ Recent studies have provided evidence that the earlier age at onset of pubertal development in girls, the more challenging this developmentally period tends to be.¹⁷

Cognitive Development

Early adolescent development is characterized by cognitive abilities dominated by concrete thinking, egocentrism, and impulsive behavior. Young adolescents may start showing improvements in reasoning, information processing, and expertise.⁵ The adolescent is at an early developmental stage in his or her abilities to long-range plan, see another’s point of view and consider others’ feelings.¹⁸

Movement Toward Independence

Early adolescence is characterized by the beginning of the shift from dependence on parents/caregivers to independent behavior. Common events at this time include the following:

Less interest in parental activities and more reluctance to accept parental advice or criticism; occasional rudeness; more realization that the parent is not perfect
An emotional void created by separation from parents, without the presence of a consistent alternative support group, which can create behavioral problems (e.g., a decrease in school performance)
Emotional lability (wide mood and behavior swings)
Increased ability to express oneself through speech
Search for new people to love in addition to parents

Body Image

Rapid physical changes lead the adolescent to be increasingly preoccupied with body image and the question of, “Am I normal?” Body image is a concept that changes with physical and psychosocial growth and development throughout adolescence and young adulthood. Male and female youth show increased dissatisfaction with their body image from middle school and can persist into young adulthood. Weight dissatisfaction is especially pervasive among teenage girls and can lead to concerning health-compromising behaviors such as caloric restriction, dieting, binging, and purging (including excessive exercise, diuretics, diet pills, and laxatives). Girls who are precociously developed or less developed than their peers are prone to body dissatisfaction and low self-esteem. Dissatisfaction with body image may lead to dieting and eating disorders.¹⁹

The early adolescent’s concern with body image is characterized by the following four factors:

Preoccupation with self
Uncertainty and concerns about appearance and attractiveness
Frequent comparison of own body with those of other adolescents
Increased interest in sexual anatomy and physiology, including anxieties and questions regarding menstruation or nocturnal emissions, masturbation, and breast or penis size.

Peer Group

With the beginning of separation from the family, the adolescent becomes more dependent on friends as a source of comfort.¹⁸,²⁰ The adolescent’s peer group is characterized by the following:

Increasing focus on peers. Solitary friendships with a member of the same sex. These idealized friendships may become intense; boys, for example, may become “comrades-in-arms” with sworn pacts and allegiances, and young teenage girls may develop deep crushes on men as well as women.
Strongly emotional, tender feelings toward peers. The peer group usually consists of nonromantic friendships, which may lead to opposite-, same-, or both-sex attractions, exploration, fears, and/or relationships later on.
Peer contact primarily with the same sex, with some contact of the opposite sex made in groups of friends.

Identity Development

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