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The Adolescent

A 15-year-old girl presents to your office for an annual visit. Menarche was at age 14, and for the last year she has had menses every 30 days. She has had no significant medical problems, and denies smoking, drinking alcohol, and taking other drugs. She does well in school and is involved in track and field. In further conversations with her, which of the following adolescent developmental milestones is mostly likely to be noted?

a. Preoccupation with her changing body

b. Conflicts with her family over control and independence

c. Ability to distinguish law from morality

d. Inability to perceive long-term outcomes for current decisions

e. Predominance of same-sex peer affiliations

The answer is b. (Hay et al, pp 127-128. Kliegman et al, p 927. Rudolph et al, pp 271-272.) The adolescent in the question seems to be developing normally. At her age (14-17 years) and her sexual maturity rating (likely to be 3-5 since she is menstruating regularly), conflict with her family over control and independence is likely to be an ongoing issue; this is a common feature of middle adolescence. Preoccupation with her changing body, predominance of same-sex peer affiliations, and inability to perceive long-term outcomes for current decisions are features of early adolescence (aged about 10-13 years with sexual maturity rating of 1-2). Late adolescence (ages about 18-21 years with sexual maturation scale of 5) includes the ability to distinguish law from morality.

A 12-year-old boy has scant, long, slightly pigmented pubic hairs; slight enlargement of his penis; and a pink, textured, and enlarged scrotum. He is most likely at which sexual maturation rating (SMR, also called Tanner) stage?

a. SMR 1

b. SMR 2

c. SMR 3

d. SMR 4

e. SMR 5

The answer is b. (Hay et al, pp 113-114. Kliegman et al, p 929. Rudolph et al, pp 265-266.) Normal sexual maturation during puberty follows a consistent pattern. The first sign of puberty in boys is scrotal and testicular growth; penis growth usually occurs about a year after. Pubic hair growth is more variable. In girls, the first sign of puberty is the development of breast buds. The SMRs are not synchronized. In that a girl with SMR 3, pubic hair does not always have SMR 3 breasts.

The description in the question is typical of SMR 2 in boys: sparse, thin, and long pubic hair ...

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