Child development is an integral process that occurs in human beings as they experience biological, psychological, social, and emotional changes. The processes begin from early on during pregnancy to the end of adolescence. The individual progresses through the various stages starting off with high levels of dependency to increased autonomy. It is evident that child development is a continuous process that despite being able to predict its sequence, it has a unique experience for every child. The stages that an individual progresses through are strongly influenced by genetics and events taking place during pregnancy hence the inclusion of the prenatal development as part of the study. It is important to understand the different stages as they are affected by the preceding experiences and will influence the future behavior. The following research paper will address the middle adolescence stage which usually occurs between the age of 14 and 16 years along with the presenting issues.
Description of Developmental Stage and Relevant Issues
The middle adolescence stage as previously mentioned occurs when an individual is between the age of 14 and 16 years. The developmental stage is a critical period as the child slowly approaches adulthood and seeks to establish a clear personality. According to Erik Erikson, middle adolescence is at the heart of identity crisis. At this stage, the youths are seeking to understand themselves as human beings and their purpose in life. The children at this age clearly show a significant increase in hypothetical reasoning and conduct futuristic planning. It is defined as a critical period as it has some significant influence on the kind of adult the individual will become in future. Parents, caregivers, educators, and society at large should be concerned on how these changes events affect the teenagers and their response. In this phase, there are multiple changes that impact how they think, feel, and interact with other as will be highlighted below.
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Biological
It is evident that the developmental stage of middle adolescence is one that comes with multiple biological changes but not as much as the preceding phase. For majority of the girls, the physical changes including growth of pubic hair, enlargement of the breast, menstrual cycle, and broadening of hips to adult size have all occurred. These physical characteristics are particularly important particularly for girls who may not have achieved full maturity in comparison to their peers. They begin to feel more insecure about their physical appearance and may at times seek affirmation from the opposite sex (Tummala-Narra, & Claudius, 2015). Weight gain is another biological change common due to increased appetite from the onset of puberty. The maturation of the brain is usually at full growth enabling abstract thinking and understanding of hypothetical issues. This development makes them understand the significant criticisms of the society around them which may make them feel insecure or that they do not fit in with set expectations.
On the other hand, the boys may still be experiencing the significant physical changes of puberty including enlargement of genitals, growth of pubic hair, deepening of the voice, broadening of shoulders, increased appetite along with rapid weight and muscle gain, and achieving full adult height (Van der Graaff et al., 2014). The fact that few boys will have achieved majority of the biological changes is primarily due to the early onset of puberty in girls. As a result, not all of them will experience the insecurities associated with the middle adulthood. Some of the internal changes may include maturation of sex organs enabling the production of sperm (Van der Graaff et al., 2014). In reaction to this, the child will experience cases of wet dreams which may make them feel insecure. Based on Freud’s psychosexual development the middle adolescence is at the beginning of puberty as the genital stage. In this regard, sexual and aggressive drives may begin for majority of the boys as they begin to find partners of the opposite sex as they wish to experience coitus.
Social
Middle adolescence comes along with multiple social changes that may be common in both girls and boys with some exclusive to each sex. The maturation of the brain almost to the adult size enables awareness of social cues and behaviors that helps the individual during social interaction (Van der Graaff et al., 2014). These teenagers will actively seek to establish platonic relationships. As a result, the stage brings a lot of insecurities when a child does not establish friendships. The events in this phase present instances of adolescents searching for a sense of self identity (Schwartz, Lansford, Dodge, Pettit, & Bates, 2015). According to Erikson’s developmental stages, the teenager begins to find the values, beliefs, and personal goals through a process of exploration. The critical nature of this stage is evident by their understanding of the roles they play in the society (Schwartz et al., 2015). For instance, the individual recognizes the importance of compassion and showing others why they matter in the society. This may result in the child dedicating their lives to presenting such behavior to all members particularly those who have been marginalized.
The period of middle adolescence may be influenced by the peer relations. As the child actively seeks to establish relationships with their friends, they may feel the need to emulate their behavior. It is evident that the adolescent is seeking to establish a clear role on what is expected from them by the society (Tummala-Narra, & Claudius, 2015). Despite the full maturation of the brain, it is evident that the immediate environment of the child is a clear influence on the behavior. For instance, the child may take note of the fact that consumption of alcohol is a societal practice that is acceptable for all (Chan, Kelly, & Toumbourou, 2013). Some of the friends with whom the teenager associates with may be practicing the same. Such occurrences may prompt the child to experiment with some behaviors which may drastically affect their future lives (Tummala-Narra, & Claudius, 2015). Supervision by parents and educators is an important factor towards providing the child with guidance on the appropriate values and goals along with habits to avoid.
Cultural
It is important to note that successful achievement of this identity hinges on the successes of previous stages. The preceding stage per Erickson’s view is the struggle between industry and inferiority where success is depicted by achieving competence. Specific skills are taught with an unstated demand to master them, from reading and writing to athletic sports. However, if a child does not succeed a feeling of inferiority develops (Tummala-Narra, & Claudius, 2015). This state may progress into the next stage. The lack of competence may prompt the child to believe that they do not belong and that he or she lacks a definitive measure of identity. The society may demand that educational goals match sex roles in the society and when they do not, an identity crisis occurs (Tummala-Narra, & Claudius, 2015). This is evident where traditional views may indicate that girls cannot become engineers despite the individual’s love and performance in mathematics and physics.
Culture is a critical issue in middle adolescence whereby the acceptable beliefs in the society influence numerous teenagers at this stage as they seek to find their identity and place. The child thinks critically of their future as an adult with a view of gaining independence. Studies have shown that many adolescents will feel pressured to answer questions about their careers and goals in life. In this stage, the child will require guidance from the society to achieve an appropriate identity (Schwartz et al., 2015). There are cases where the individual begins to present strong identification with an admired adult figure. The matured cognitive capability may help the child realize injustices in the society hence present an identity similar to a well known politician. Such a child may explore student leadership as a means of reassuring themselves that it is an appropriate identity (Tummala-Narra, & Claudius, 2015). Positive reinforcement from adults and acceptance from peers may cement the identity of the individual.
Socio-emotional
Teenagers between the age of 14 and 16 are likely to express themselves emotionally in their interactions with friends, family, and the society at large. There is a high desire to feel accepted in different or particular groups with whom they feel they share similar interests. In the modern society, children of this age may emulate dressing and behavior to feel they belong. Whenever new apparel comes into the market, they will demand that their parents purchase these clothing so that they can keep up with the trends (Van der Graaff et al., 2014). Their advanced cognitive development will make them aware that money is an important factor to maintaining such behavior. Socio-economic factors such as poverty may curtail the individual’s ability to achieve success at this stage (Van der Graaff et al., 2014). They may feel that if they are recognized as poor they will become unpopular among friends.
The children at this stage are also very sensitive to praise and criticism with a high probability of having their feelings hurt. The middle adolescence is a stage caught between childhood and adulthood. The individual may not always present their insecurities to the various people they interact with as a means of presenting the more desirable act of confidence. The biological changes are the most likely cause of insecurity. Boys, for instance, as they may experience slow maturity may feel they are more likely to be rejected when they pursue romantic relationships with their peers. Sexual and aggressive emotions may prompt them to portray negative behaviors like violence. Studies show that rebellious behaviors may be depicted as a means of hiding these insecurities (Van der Graaff et al., 2014). Unfortunately, this may torment the lives of others which could bring about numerous cases of depression.
Problem Description
One of the major problems affecting the middle adolescents is depression usually associated by the numerous changes that occur. It is evident that the emotional insecurities, sensitivities to recognition, biological changes, and fear of rejection are some of the major factors that may lead to the development of depression. Recent research has shown that the middle adolescents are at a high risk of developing depression in the long-term. In this case, out of the 2516 7th – 9th grade students provided with questionnaires to determine incidence of depression 90% completed (Fröjd et al., 2008). Approximately 18.4% of the girls and 11.1% of the boys were classified as suffering from depression. The incidence of depression among these children is a cause for alarm and could have numerous negative effects on their lives. Teachers and caregivers alike should take great caution to identify and take action to prevent the disorder from becoming severe during adulthood.
Majority of the teenagers in this developmental stage usually go unnoticed for their life threatening mental disorder. It is evident that even years later after the initial diagnosis of depression, the individual continues to be affected. A study conducted by Naicker, Galambos, Zeng, Senthilselvan, and Colman, (2013) showed that middle adolescents who were diagnosed with depression had persistent effects after follow-up ten years later. The symptoms included migraines, poor self-rated health, higher severity of symptoms, and low social support levels (Naicker et al., 2013). The study asserts that these effects did not affect their personal income, education attainment, employment status, or marital status. Nevertheless, these findings are a clear indicator that more caution should be taken in diagnosis of depression at this age (Heikkilä et al., 2013). The developmental stage is characterized by moodiness among the teens due to numerous emotions being felt and the high desire for affection.
The incidence of depression among middle adolescent boys and girls could trickle down to the education of the child. Recent studies have shown that the teenagers are more likely to experience depression which may have significant impact on the grade point average (GPA). The students who reported low GPAs or a higher decline from the previous semester were more likely to be experiencing depression (Fröjd et al., 2008). In this case, the mood disorder was associated with difficulties in social relationships, concentration, self-reliant school performance, writing, and reading. Additionally, such students would perceive that schoolwork is too tasking. This occurrence is expected where middle adolescence is a stage where individuals feel pressured about their future. Both boys and girls will experience the high pressure with some very likely to succumb to failure and unable to cope. Fröjd et al., (2008) identified that variables of school performance were evident for both sexes in demonstrating association with depression. However, there were significant gender differences when looking into severe depression.
The social aspects of the lives of the teenagers at these ages are critical factors in predicting the development of depression in the individual. As previously mentioned the boys and girls in middle adolescence begin to value friendships and develop a significant fear for rejection (Schwartz et al., 2015). Furthermore, the physical changes that have taken place may affect their perception of how the world views them and feel the need to hide away. Recent research has shown that the experiences of previous developmental stages have a significant impact on the developing issues occurring in the middle adolescence stage (Schwartz et al., 2015). In this case, victimization by peers during earlier years in childhood may result in internalizing of problems. The intense emotions felt during the mid-teenage years may be overwhelming to the child and may result in a modest link to unipolar depressive disorders (Schwartz et al., 2015). The destructive behaviors such as bullying may cause negative outcomes among the individual students. Both the victim and perpetrators are likely to develop depression either immediately or in later life.
Interventions Relevant to Problem
Depression in adolescents in general affects at least 1-6% of the total population in each year. However, majority of the teenagers are likely to be under diagnosed and undertreated. This incidence has been demonstrated in numerous community studies and suggested that the rate of occurrence is higher among adolescents than in adults (Thapar, Collishaw, Pine, & Thapar, 2012). There are multiple issues that come to the fore in the treatment data of adolescents with depression. It is evident that there is a significant variation between the treatment choices between patients below the age of 18 years and adults (Thapar et al., 2012). As a result, the best practices and clinical guidelines in this instance may bring a lot of controversy as there are differences between countries in the use of antidepressant drugs to administer treatments for these middle adolescents. The recommendations provided are merely based on consensus rather than empirical evidence (Thapar et al., 2012). The recent research also shows the short-term effectiveness of the psychological treatments and medication, but few speak of the long-term benefits as it relates to recurrence of depressive episodes. The following are some of the interventions for addressing the problem.
Psychotherapy treatments are believed to have the most effective impact on the child in reducing the effects of depression. Two of the most extensively studied treatment options include cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT). There have been mixed findings on the use of CBT as an appropriate approach for helping adolescents cope with depression (Heikkilä et al., 2013). One meta-analysis of the use of CBT suggests that it could appropriately help adolescents with depression. However, the size of the population used is modest and cannot be generalized to a national population. One of the largest randomized controlled trial (RCT) using adolescents with moderate to severe depression demonstrated similar moderate effective treatment in the use of both CBT and placebo groups with 43% to 35% response rate (Thapar et al., 2012). An alternative large study showed that the use of CBT in addition to antidepressant medication could have more positive effects to treatment-resistant depression. In this regard, the use of CBT could have more beneficial outcomes for the individuals with mild forms of depression. However, the intervention fails to produce similar effective outcomes when offered to patients with moderate to severe depression. This incidence has raised concerns among social workers as they question its applicability and its general benefits to the patients.
An alternative intervention for middle adolescents who present multiple depressive episodes is the use of pharmaceutical drugs. Numerous studies have been systematically reviewed on their effectiveness of treating adolescents with the above mood disorder (Heikkilä et al., 2013). Selective serotonin reuptake inhibitors (SSRIs) have been evaluated in various studies whereby some reviews have shown that fluoxetine is a more effective treatment as opposed to placebo drugs with a 41-61% to 20-35% response rate (Thapar et al., 2012). It is important to note that the relative risk posed to the child in question is significantly high a clear indicator that it could pose a major threat to the life of the young patient.
Aggressive behavior has been closely linked to development of depression among teenagers whereby it affects teens who are victimized and those who are the perpetrators of the destructive behavior. In this regard, it is important to develop an effective intervention that will help prevent the incidence of aggressive behavior which would lead to depression. The recent studies have shown that adolescents are more resistant to interventions that may aim at reducing aggressive behavior (Yeager, Trzesniewski, & Dweck, 2013). Based on the general characteristics of middle adolescents, many of them have developed stronger beliefs that an individual is less likely to change their personal characteristics (Heikkilä et al., 2013). These perceptions will highlight that if an individual is aggressive, he or she is more likely to maintain similar behavior into the future and they will not be able to portray any behavior contrary to that. The field experiment by Yeager and colleagues tested the impact of incremental theory where it emphasizes the belief in potential personal change through a six-session intervention (2013). The findings compared the impact on a no-treatment group and a coping skills control group with the latter showing less aggressive behavior and pro-social one month after the experiment (Yeager, Trzesniewski, & Dweck, 2013). Additionally, there were fewer cases of conduct behavior three months after the intervention. While this intervention shows an appropriate measure for dealing with one of the factors that could lead to depression, it does not address all issues that may be the cause of the mood disorder.
Engagement
In an effort to provide beneficial outcomes to the individual middle adolescent and the rest of community at large, it is important that the problem is first addressed at the home level. In this case, engaging the child and the family on the presenting problem of depression is particularly essential to ensure that recurrent episodes do not take place (Wang & Kenny, 2014). The family setting is a critical foundation for addressing the issue of depression that is currently affecting the child. In this case, the caregivers’ behavior towards each other and the child could be the cause for the depressive episodes. Therefore, the engagement process will involve the family as a whole as they seek to help the child in reducing the chances of recurrent symptoms (Wang & Kenny, 2014). Numerous studies have shown that the parents who used harsh verbal discipline for their teenage children could have significant development of conduct problems and depressive symptoms (Wang & Kenny, 2014). In the engagement of the family as a whole, education will be provided on the impact of adolescent depression and associated impairment it could cause to the child. The social worker should seek to identify if members of the family are willing to participate in various behavioral measures to prevent the adverse outcomes of the problem in question.
The engagement of the family and the child separately is an alternative measure to enhance the outcomes of the intervention to the parties involved. In this measure, the 15 year old child is able to identify the importance of undertaking the significant coping skills to prevent the recurrence of depressive symptoms. The teenager should note that while there is pressure from the society to achieve independence during the transition from childhood to adulthood, he should develop a positive attitude towards life struggles (Väänänen, Marttunen, Helminen, & Kaltiala-Heino, 2014). It is important for the child to also note that while there is need to engage in communication with parents and other adults who may be in their life like teachers. Through active interaction with such individuals they can appropriately ease the anxiety and stresses in their lives.
On the other hand, engagement with the family separately is critical to the successful transition of the child from adolescence to adulthood. In this case, the parents are required to pay attention to the child’s behavior (Väänänen et al., 2014). This is particularly important as it will help the caregivers recognize the changes that have taken place for instance being sad or depressed in many occasions (Heikkilä et al., 2013). Talking with the child in a calm and non-judgmental manner will help them open up and they could seek professional help if necessary. Showing interest in the teen’s school and extracurricular activities will also help boost self-esteem and feel that they have the support of their parents (Väänänen et al., 2014). Complimenting the child is another important practice that parents should employ to celebrate their achievements and efforts made in activities like schoolwork, art, sports, and theater. They should be cautioned on the significant risks that they could encounter in interactive social media and influences from peers like experimenting with alcohol and other substances (Chan, Kelly, & Toumbourou, 2013).
Assessment
The family assessment form (FAF) is an effective tool to identify specific areas that should be addressed in the process of implementing an intervention for the child’s depressive symptoms (Saulsberry et al., 2013). The FAF can be used to assess family functioning and behavioral concerns regarding the children. There are multiple dimensions that will be taken into consideration as an effective means of recognizing the dysfunctional nature of members’ relation to one another and the environment (Ponnet, 2014). Family functioning will take a critical look at caregiver history and their personal characteristics. In this case, mental health history may demonstrate a high likelihood of the adolescent developing moderate to severe depression and will help in developing appropriate intervention for the same. The living and financial conditions may also be used in the assessment as different socio-economic circumstances have a direct impact on the adolescent outcomes (Ponnet, 2014). Low-income families may inflict stress on the teenagers resulting in problem behaviors as depicted by recent research.
The social worker may incorporate collateral sources that will help bring about a more informed view of the family towards the behavioral outcomes of the child. Police reports of the caregivers will help develop a critical assessment of the relation between the parent and the child. In this regard, cases of domestic violence directed towards the mother or the child will show a father’s character towards the struggles of the child (Saulsberry et al., 2013). Medical reports can also present appropriate information that can be used to identify whether a child has been abused before. School reports from teachers and administrators will highlight information on the engagement of the child in education and extracurricular activities, behavior presented towards authority and peers, along with the involvement of the parents in the child’s schooling activities.
Conclusion
The middle adolescence developmental stage is a critical period as the teenager experiences a transition from childhood into adulthood. There multiple pressures from the society and others internally, which may pressure the child to achieve a certain standard of goals. It is important to have all involved parties to pay close attention to the child as an effective measure of ensuring a smooth transition. The numerous biological, social, cultural, and socio-emotional changes are likely to cause development of problematic issues in the well-being of the child. In this case, depression may arise from the high level of sensitivity presented by the adolescent. Fortunately, there are multitudes of literature on the problem, which offer effective ways of diagnosing the problem and developing interventions to address the impact. Through the implementation of proposed measures the family, child, and associated stakeholders can help in improving the quality of life while reducing possibility of adverse impacts.
References
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