Transcript Adolescent Maladaptive Behaviors

Adolescent Maladaptive
Behaviors
Madeline Gervase RN,MSN,CCRN,FNP
Advanced Practice Nurse
Maladaptive Behavior
• What is it?
Behavior that is deviant, maladaptive
and personally distressful.
Results in: Discouraging well-being,
growth and fulfillment.
Presents itself by: Addiction to drugs,
eating disorders, non-compliance, etc…
Causes of Abnormal Behavior
• 1. Biological
Factors
• 3. Sociocultural
Factors
• 2. Psychological
Factors
• 4. Biopsychological
Factors
(Interactionist
approach)
Biological Factors:
• Malfunctioning of the person’s body,
specifically brain processes and genetic
factors
Psychological Factors
• Distorted thoughts, emotional turmoil,
inappropriate learning, and troubled
relationships
Sociocultural Factors
• Frequency and intensity varies from
culture to culture, and is based on
social, economic, technological and
religious aspects
Biopsychosocial: The
Interactionist
Approach
• Biological, psychological and
sociocultural factors may interact
Characteristics of Adolescent
Disorders
• Vary in severity based on developmental
level, sex, and socioecomomic status
• Duration: short-term to long-term – which
could be for many years
• Younger adolescents: fighting, arguing and
being loud
• Older adolescents: depression, drug abuse
and skipping school
Gender Comparison on Behavior
• Boys:
Under-controlled,
externalized
behaviors.
- fighting,
destroying
property
Gender Comparison on Behavior
• Girls:
Over-controlled
and internalized
behavior
- Anxiety
- Depression
Abnormal Behavior Associated
With:
• Increase of problems with fewer related
adults in home
• Biological parents unmarried
• Separated or divorced parents
• Families that receive public assistance
• Family members who receive mental
health services
Drugs and Alcohol…….
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Why?
Reduce tension & frustration
Relieve boredom, curiosity
Escape realities of the world
Social reasons: make you feel
comfortable and relaxed
• Drugs provide: relaxation,
skewed perceptions and a
“pleasurable high”
Definitions:
• Tolerance: More of the drug is needed to
produce the original effect
• Physical Dependence: Physical need for a
drug, symptoms of withdrawel when drug is
stopped
• Psychological Dependence: Strong craving to
keep using the drug for emotional needs such
as to reduce stress
Alcohol:
• Most widely used drug by U.S.
adolescents
Effects: depressant, slows brain activity
- reduces inhibition and impairs
judgement
- excess, can damage or kill
biological tissues – like muscle and
brain cells
- extreme intoxication can result
in coma
Alcohol Effects:
• Vary according to
weight, amount
drunk, person’s
alcohol tolerance
• More males binge
drink than females
• Alcoholism is the 3rd
leading killer in the
U.S.
• 13 million people are
alcoholics
Statistics……..
• In 1999, more than 50% of HS seniors drank every
month.
• Marijuana ( Cannabis sativa) is the most common
illicit drug used by children and adolescents in the US
Risk Factors…
• Heredity: more evidence of alcoholism
related to genetic factors with an
influence on environmental
• Family influences
• Peer Relations
• Personality Characteristics
• A strong family support system reduces
alcohol abuse in adolescents
Cloninger’s Personality Characteristics
• Four inherited “temperments”
- novelty seeking
- ha avoidance
- reward
dependence
- persistence
• Three learned “characters”
- self-directedness
- cooperativeness
- self-transcendence
DRUGS…….DRUGS…….DRUGS……
• Hallucinogens:
• LSD and Marijuana
-”mind altering” drugs that
produce hallucinations.
Increased use by
adolescents
Experimental and peer
influence
LSD
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Is powerful in low doses
Objects glow and change shape
Kaleidoscope images
Pleasant and frightening images
Dizziness, nausea, tremors
Rapid mood swings, impaired attention
span and memory
Marijuana
• More mild than LSD – active ingredient THC
• Increases heart rate and blood pressure
• Combined excitation, depression and
hallucinatory characteristics
• Distorted perceptions of time and place
• Changes in verbal behavior
• Can effect reproduction system and cause
birth defects
STIMULANTS
• Increase CNS activity
• Caffeine, nicotine, amphetamines and
cocaine
• Increase heart rate, respirations and
temperature
• Increases energy, decrease fatigue
• Lifts mood and self-confidence
• After effects wear off, become tired,
irritable, depressed
• Can be physically and psychologically
addictive
CIGARETTES
• Onset: 7-9 grades
• In 1999, nearly 20% of 8th
graders had smoked
• Male % = Female %
• Smoking in adolescents
causes permanent genetic
changes in lungs
• Increases risk of lung cancer.
Cocaine
• Coca plant
• Exhilerated feelings followed by
depressive feelings and lethargy
• Insomnia & irritability
• Can result in : Heart attack, stroke and
seizures
• Crack Cocaine: Inexpensive, purified,
smokable form .
Amphetamine
• Widely prescribed stimulant –
sometimes in the form of “diet pills”
• OTC – over-the-counter – “stay awake”
pills. Sharp increase in use
• Overall, amphetamine use has
decreased
• OTC diet pills has decreased, however,
fairly common among women
Depressants
• Slow down central nervous system
bodily functions and behavior
• Medically: reduce anxiety, induce sleep
• Most widely used: alcohol, barbituates
and tranquilizers
• Barbituates:
• Induce sleep, reduce
anxiety
• Decreased use since 1975
Depressants
• Opiates:
• Opium and its’ derivative
• Effects last for several hoursdepress CNS activity
• Euphoria
• Pain relief, increased appetite
for food & sex
• Physically addictive drug
• Tranquilizers:
• Reduce anxiety and
induce relaxation
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Heroin:
Opiate
Body craves
Withdrawel is very
painful physically &
mentally
• Heroine rates low – but,
recent use increased
Anabolic Steroids
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Female Changes:
Acne
Weaening tendons
Decrease HDL ( The
“good” cholesterol
• High blood pressure
• Male changes
• Shrinking testicles
• Reduced sperm
count
• Impotence
• Premature baldness
• Enlarged prostate
• Breast enlargement
Psychological Effects of Anabolic
Steroids
• Irritability and uncontrollable bursts of anger
• Severe mood swings
• May result in depression during withdrawel
and when stopped
• Impaired judgement
• Feelings of invincibility
• Paranoid jealousy
• Increase use: 1999, 1.7% of 8th & 9th graders
used steroids
Roles of Development:
Parents, Peers & Schools in
Adolescent Drug Abuse
• Most adolescents use drugs at some point in
their development
• When using drugs to cope with stress, it can
interfere with competent coping skills and
responsible decision making
• Parents, peers & social support play
important roles in preventing drug abuse
Steps to Reduce Drug Use:
• Early intervention
• Peer led programs
• Community-wide
prevention efforts
• Teacher support and
training
• Alternative physical
activities to keep the body
as well as mind occupied
and challenged
Major Adolescent Problems
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Depression
Suicide
Eating Disorders
Juvenile Delinquency
Substance Abuse
Adolescents are at most risk to have more
than one problem.
• Problem behaviors in adolescents are
interrelated.
Depression
Signs & Symptoms
• Depressed mood most of the day.
• Reduced interest or pleasure in all/most
activities.
• Significant weight loss or weight gain ,
significant increase or decrease in
appetite.
• Trouble sleeping or sleeping too much.
• Psychomotor agitation or retardation.
Depression
Signs & Symptoms
• Persistent sad or irritable mood.
• Fatigue or loss of energy.
• Feeling worthless or guilty in an
excessive or inappropriate manner.
• Problems n thinking, concentration, or
making decisions.
• Recurrent thoughts of death or suicide.
Depression
• 5 or more of these symptoms must be
persist for 2 or more weeks before the
diagnosis is made.
• The way symptoms are expressed
varies with the developmental stage of
the child.
• Children have difficulty in identifying &
describing their internal emotional or
mood states.
Associated Signs & Symptoms of
Depression
• Frequent vague, non-specific physical complaints
such as headache, muscle aches, stomach aches
or tiredness.
• Frequent absences form school or poor
performance.
• Talk of efforts to run away from home
• Outburst of shouting, complaining, unexplained
irritability, or crying.
• Being bored.
• Lack of interest in playing with friends.
Associated Signs & Symptoms of
Depression
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Social isolation, poor communication.
Alcohol or substance abuse.
Fear of death.
Extreme sensitivity to rejection of
failure.
• Increased irritability, anger or hostility.
• Reckless behavior.
• Difficulty with relationships.
Risk Factors for Depression
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Family history of the disorder.
Stress
Cigarette smoking.
A loss of a parent or loved one.
Break-up of a romantic relationship.
Attentional, conduct or learning disorders.
Chronic illness, such as diabetes.
Abuse or neglect.
Risk Factors for Depression
• Previous depressive episode
• Family conflict.
• Parents who are emotionally unavailable.
Immersed in marital conflict, and
economic problems.
• Parental divorce.
• Period of puberty.
• Uncertainty regarding sexual orientation.
• Poor peer relationships (friends).
Is Depression a serious
problem?
• 1/3 of adolescents who for to a mental
health clinic suffer from depression.
• Depression increases in the adolescent
years, and being twice as common as in
the elementary years.
• In childhood, boys & girls appear ot be
at equal risk for depressive disorders.
• Adolescent girls are twice as boys .
likely to develop depression
Suicide
• Rate has tripled in the past 30 years in
the US. 11.3 per 100,000 or 30,575
Americans completed suicide in 1998.
• The third leading cause of death in 1024 year olds.
• Males are 5x as likely to commit suicide
as females are.
Males
vs.
• Commit suicide
more frequently
• Active methods for
attempting suicide
• Shooting
Females
• Attempt suicide
more frequently
• Passive methods
• Sleeping pills
Why Suicide?
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Loss of boyfriend/girlfriend.
Poor grades at school.
Unmated pregnancy.
Drugs.
Family history of instability/unhappiness.
Lack of affection, emotional support,
friendship.
• Pressure for achievement by parents.
Why Suicide?
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Mental illness.
Family discord.
Absence of biological parents.
Physical abuse.
Unemployment.
Interpersonal Stress.
Residential transience.
Chronic behavioral problems.
Eating Disorders
• Increasing problem in adolescent girls who feel
negative about their bodies I early adolescence
were more likely to develop eating disorders
later in adolescent.
• Adolescent girls with a positive relationship
with their parents tended to have healthier
eating habits.
• Girls who are both sexually active and in
pubertal transition are morel likely to be dieting
or engaging in an eating disorder.
• 5 million Americans are affectd by an eating
disorder each year.
Three most common
Eating Disorders
• Obesity
• Anorexia Nervosa
• Bulimia
Obesity
• Children born in the USA today have a 50%
chance of becoming overweight at some point
in their lifetime.
• 25% of today's adolescent are obese.
• 80% of obese adolescents become obese
adults.
• 10% of children who DO NOT have obese
parents become obese themselves.
• 40% of children who become obese have 1
obese parent.
• 70% of children who become obese have 2
obese parents.
Obesity
• Identical twins have similar weights even
when reared apart.
• The dramatic increase in obesity is likely
due to greater availability of food,
energy saving devices, and declining
physical activity,
• American adolescents are more obese
than European adolescents from other
parts of the world.
Anorexia Nervosa
• An eating disorder that involves the relentless
pursuit of thinness through starvation. Self is
viewed as “Fat”. Intense fear of gaining
weight
• Primarily affects females during adolescence
and early adulthood.
• 5% anorexics are male.
• Most adolescents with this disorder are white
& from well educated middle & upper class
homes.
Anorexics
• Avoid eating but have an intense interest in
food.
• Distorted body image perceiving they will only
be attractive when they are skeletal
appearance.
• Repeatedly check body wieght.
• As starvation continues the fat content of
their bodies drops to a bare minimum;
menstruation stops; behavior is hyperactive.
Common findings in Patients
with Anorexia Nervosa
• Bradycardia
• Orthostatic changes
in pulse or blood
pressure
• Hypothermia
• Cardiac murmur
• Dull, thinning hair
• Sunken cheeks,
sallow skin
• Atrophic breasts
(post pubertal)
• Atrophic vaginitis
(post pubertal)
• Pitting edema of
extremities
• Emaciation
• Flat affeft
• Cold extremities,
acrocyanosis
Causes of anorexia nervosa
• Societal – current fashion image of thinness.
• Psychological
-Motivation for attention
-Desire for individuality
-Denial of sexuality
-Way to cope with over controlling parents
• Physiological- Hypothalamus functions
abnormally when an adolescent becomes
anorexic.
Bulimia
• An eating disorder in which the individual
consistently follows a binge-and-purge eating
pattern.
• Eating an excessive amount of food within a
discrete period of time with a sense of lack of
control during the episode.
• Inappropriate behavior to prevent weight
gain, self induced vomiting, misuse of
laxatives, diuretics, enemas, fasting, &
excessive exercise.
Bulimics
• Binge and then purge by self-induced
vomiting or by using a laxative.
• May alternate binges with fasting or normal
eating
• Female
• Depression is common
• Bulimia can cause gastric and chemical
imbalance.
• Many of the causes offered for anorexia are
also offered for bulimia.
Common findings in patients
with Bulimia
• Sinus bradycardia
• Cardiac arrhythmias
• Orthostatic changes
in pulse or blood
pressure
• Cardiac murmur
• Hair without shine
• Parotitis
• Russell’s sign (callus on knuckles
from self induced
emesis)
• Mouth sores
• Palatal scathes
• Dental enamel
erosions
• Possible normal
appearance
Juvenile Delinquency
• Refers to a broad range of behaviors
from socially unacceptable behavior,
i.e. acting out in school, to status
offenses, i.e. running away, and
criminal acts, i.e. burglary.
Index Offenses
• Criminal acts, whether committed by
juveniles or adults.
• Robbery, aggravated assault, rape , &
homicide.
Status Offenses
• Performed by youths under specific age,
these are not as serious as index
offenses.
• Acts of drinking under age, truancy, and
sexual promiscuity.
Conduct Disorder
• The psychiatric diagnostic category for
the occurrence of multiple delinquent
activities over a 6 month period.
• Truancy, running away , fire setting ,
cruelty to animals, breaking & entering,
& excessive fighting.
Antecedents of Delinquency
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Negative identity
Low degree of self control
Early initiation
Males
Low expectations & low grades
Low parental monitoring, supporting, &
disciplining
Factors often present
• Early involvement with drugs & alcohol.
• Easy access to weapons, especially
handguns.
• Association with antisocial, deviant peer
group.
• Pervasive exposure to violence in the
media.