by Syeda N. Sultana, M.D.

The following are excerpts from Dr. Syeda N. Sultana’s March 2008 presentation, to the Bangladesh Medical Association Florida Chapter in Orlando. Dr. Sultana is available to share in greater detail, or for consultations.


Adolescence (12 -20)

•    Proceeded by a Period 10-12( there is renewed interest in anatomical differences and sexual curiosity)

•    Early Adolescence ( 12-14): Endocrinological and Biological process of Puberty ( Body Change, Sexual sensations, primary and secondary sexual characteristics, i. e. growth spurt, voice change, menarche, nocturnal emissions, breast development, pubic, axillary and facial hair)

•    Cognitive Stage-some still focus on logic , some able to combine logic and abstract thinking, some can’t think ahead to consequences of their actions, starts seeing things are relative rather then absolute.

•    Moral development-



Continued Changes during Adolescence

•    Self –Concept-self images may be challenged by body change during puberty and social comparisons, own identity separate from family, gender stereotype, may concern about skin problem, height, weight, overall appearance, intense self focus-worrying about what others thinking about them, increase desire for privacy, frequent mood swings with change with activity



Adolescent’s Relationship with Parents

•    Tumultuous as rapid shift between longings to remain close and dependent and requirement for privacy and striving for Autonomy

•    These struggle played out around old issue having to do with bodily care and hygiene, cleanliness and orderliness of personal property , insensitivity to the feelings and needs of other, intense preoccupations with immediate satisfaction of ones own needs



Adolescence is a Journey from Childhood to Adulthood

•    They struggle with Hormones, loss of control on their body, peer pressure, on emerging Identity.



Parenting is a Journey

•    Parent also struggles with – how much autonomy to give, ‘Attitude’ to take, what kind of discipline is effective, which issue worth fighting about, how to talk with offspring –turned –alien , challenge parental creativity, patience and courage



Temperament Categories

•    Activity level

•    Rhythmicity (regularity)

•    Approach or withdrawal

•    Adaptability

•    Threshold of responsiveness

•    Intensity of reaction

•    Quality of Mood

•    Distractibility

•    Attention span and persistence



Attachment and Bonding

•    Attachment from child to parent

•    Bonding from parents to child



Goodness of Fit

•    Expectations or demands of the child are in consonance with the child’s  temperament characteristic and capabilities

•    With such ‘goodness of Fit’ a child’s optimal development in a progressive direction as possible



‘Poorness of Fit’

•    Discrepancies and dissonances between environmental opportunities and demands on one hand and the child’s capacities and temperament characteristics on the other.

•    Under such circumstances distorted and maladaptive function occur



Easy Temperament

•    Biological regularity, approach tendency to the new, quick adaptability to change and predominantly positive mood of mild to moderate intensity



Difficult Temperament {opposite of easy Temperament}

•    Biological irregularity

•    Withdrawal tendency to new, slow adaptability to change and frequent negative emotional expression of high intensity



Slow to Warm-up Temperament

•    Withdrawal tendencies to the new, slow adaptability to change and frequent negative emotional reactions of low intensity. Such individual label as ;shy’



Parenting Process Maybe Interrupted By

•    Mental illness

•    Substance abuse

•    Incarceration

•    Abuse /neglect and need for Foster care



Parental Style

•    Authoritarian

•    Permissive (freedom without limits)

•    Democratic (freedom within limits)





Authoritarian Style

•    Children are obedient, distrustful, discontent, withdrawn,  unhappy, hostile, not high achiever, often rebel

•    Children from authoritarian home are so strictly control either by punishment /guilt they often prevented from making a conscious choice about particular behavior because they are overly concern about what their parents will do



Permissive

•    Parents allow their children do their own things, little respect for order and routine, Parents make few demands on children, Impatience in children, Parents are resources rather then standard makers, rarely punishes, parents are warm, children walk all over the parents

•    Outcome—aggressive, least self reliant, self controlled, least exploratory, most unhappy  as they receive so little guidance they often become uncertain and anxious - they are doing right or wrong



Democratic or Authoritative (freedom within limits}

•    Parents stress freedom along rights of others and responsibilities

•    Parents set limits and enforces rules

•    Willing to listen receptively to children’s request and question

•    Exert firm control when necessary but explains reasoning behind it

•    Parents are loving, consistent and demanding

•    Parents have reasonable expectation and realistic standard



Outcome of Democratic Parenting Style

•    Children are happy

•    Mostly self reliant

•    Mostly self control

•    Friendly and generous, cooperative

•    High achiever

•    Less likely to be seriously disruptive or delinquent



Ways to Foster Children’s Self Esteem

•    Provide more success then failure

•    Give lots of encouragement

•    Give freedom to fail with acceptance

•    Unconditional love

•    Allow independence

•    Do not set standard unreasonably  high

•    Be available, a good role model, set limits, take their ideas, emotions and feeling seriously, allow exploration and encourage questions





Teenagers and Peer Pressure

•    Cigarettes and Alcohol

•    Drugs

•    Sex

•    Physical looks, dress/cloths, stress with money, future, relationship problem with friends and family

•    Try to fit in / be part of group

•    Internet/ my space/ cell phone



Drugs

•    Cigarette

•    Marijuana-first and commonly available cheap, teenagers do not think it harmful, — gateway to other street drugs

•     Alcohol, Cocaine, heroine, prescription medication (pain medication, Benzodiazepine, muscle relaxant, OTC antihistamine, cough medicine, stimulants, mushrooms, huffing gasoline, painting, free — on, designer drugs, mouth wash



Sex

•    Explain to teenager, not to give into peer pressure, self worth, security, moral value, outcomes, religious values, fear of pregnancy and sexually transmitted diseases and AIDS

•    Convey to your teen –you understand the pressure he or she is facing

•    Threats and punishment puts extra pressure on teen, does not work, teenagers may avoid contact with parents or lie if fear of punishment



How to Improve Relationship with Your Teenager

•    Treat your teenager like individual

•    Ask their opinion first

•    Don’t be judgmental or elaborate on their failure – help resolve problems

•    Take time to listen

•    Stay active in your teen’s life

•    Help them to make decision



Suicide Warning Signs in Teenagers

•    Taking or joking about committing suicide

•    “ I’d better off dead” “I wish I could disappear forever” Speaking positively about death or romanticizing dying, writing suicide notes

•    Giving away prized possessions, saying goodbye to friends and family

•    Writing stories about death, dying or suicide, engaging in reckless behavior/ having lots of accidents resulting in injury

•    Seeking out weapons, pills or other ways to kill themselves



Syeda N. Sultana, M.D. is Board Certified - American Board of Psychiatry and Neurology. She completed her Fellowship, at the University Of Florida Shands Hospital, in Children & Adolescent Psychiatry and Residency in Adult Psychiatry from St. Louis University Hospital.



Bay Hill Psychiatric Associates
Enhancing Mental Wellbeing for Children, Adolescent, and Adults
www.BayHillPsych.com