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INTRODUCTION

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Psychological, physical, and social-role changes—shaped by social determinants and by other risk and protective factors—affect behavior during adolescence. Adolescence is a time of navigating new social challenges and adjusting to physical, cognitive, and emotional changes. Given the strong association between pubertal maturation and a wide array of social, behavioral, and emotional changes during adolescence, the psychosocial effects and opportunities associated with puberty are first briefly reviewed. This is followed by a discussion of psychological/psychosocial development during the stages of adolescence/young adulthood and, finally, an overview of changes in the social/environmental context during adolescence, with a primary focus on the healthcare system.

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PSYCHOSOCIAL EFFECTS OF PUBERTY

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The onset of puberty creates hormonal changes—including dramatic increases in the secretion of adrenal androgens, gonadal steroids, and growth hormone. Androgens have been implicated as related to many of the behavior changes associated with the adolescent period. Increased levels of testosterone in adolescent boys are associated with aggression, risk-taking, and initiation of sexual intercourse; and during peak height velocity, boys tend to experience more conflict with their parents. Likewise, in pubertal girls, rising levels of estradiol are believed to be related to parental conflict, lessened behavioral inhibition, engaging in sexual activity, and increased risk-taking.

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Specific psychosocial effects have been correlated with the timing of pubertal maturation. Earlier maturation for girls is associated with greater dissatisfaction with physical characteristics, lower self-esteem, and general unhappiness. Early-developing girls tend to associate with older adolescents. The early-maturing girl shows increased interest in sexuality, early identity crises, and more problem behavior in school with decreased interest in academic activities. Early pubertal maturation in boys is less consistently associated with adverse outcomes and may be advantageous in some respects. However, early puberty in boys has been found to be associated with hostility, aggression, risk-taking behavior, physical victimization, and early sexual intercourse. On the other hand, adolescent boys who perceive themselves to be developing later than their peers may be more prone to negative body image. In general, late-developing adolescents, both male and female, are less prone to risk-taking than those developing on time or early, perhaps because the social environment may provide greater support to later-developing adolescents.

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Emerging evidence suggests that puberty and the broader period of adolescent brain development present a unique window of opportunity for social experiences to shape neural systems in enduring ways. Adolescence is a period of significant neural plasticity; thinking and learning transform the brain’s physical structure and functional organization. As a result of developmental changes, adolescents experience new attractions, motivations, and desires for novel experiences. The neural changes that underpin the complex developmental processes of adolescence are leading to scientific advances at the nexus of cognitive neuroscience, social neuroscience, and developmental science. This increased understanding holds promise for addressing health risks and problems that emerge in adolescence, including increased rates of accidents and injuries, substance use, risky sexual activity, the onset of mental health ...

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