Trying to Understand Teenagers Part I: Psychosocial Development

According to Erik Erikson’s theory of psychosocial development, during the ages of 12 to 18, teenagers are mostly focused on the questions “Who am I?” and “What do I believe and stand for?”

Identity versus confusion is thought to be the psychosocial crisis that teens are dealing with and many of us will probably agree that the teen years are full of trying out different roles and groups of friends to see where we fit in. This is natural and healthy as it helps us develop a sense of self, independence, a sense of belonging and a sense of individualism. If dealt with in an unhealthy way, this stage leads to feelings of confusion, and insecurity about themselves and where they fit into the world. At its worst it can lead to social and psychological impairments such as personality disorders, mood disorders, eating disorders and substance abuse.

Social relationships become the outmost important things to teenagers, which again is natural because humans are social beings and we need to learn how to get along with others and work together, but often times teens will put such great importance into their social relationships that everything else takes a back seat including familial relationships and academics. I see teens all the time whose biggest concern to them is their three month old relationship and not their failing grades and trying to get them to understand what should be important to them is more likely to give me gray hairs than it is to change thier point of view. Teens often sacrifice their relationship with parents to fulfill their needs for social relationships and usually don’t quite understand why we adults won’t just leave them alone to do what they want to do. A teenage girl I work with in individual and family counseling often cries to me that she just wants her mom to leave her alone and stop being worried about her. This young girl has been brought home at two in the morning by the police on a school night when her mom thought she was asleep, has been caught drinking and smoking marijuana and is failing school, yet she wants her mom to just let her “live my life”. This young girl is currently suspended from school after being caught having sexual contact with a boy in a restroom on campus.

It is natural for teens to try on different roles, friends, activities and behaviors to see what fits them and what doesn’t. This at times can be scary for those of us who watch the teens we know and love morph into and out of different roles and characters on their quest of finding their own identity and sense of direction.

With healthy and appropriate encouragement, reinforcement and support during this stage, teens will emerge with a strong sense of who they are, a feeling of independence, confidence and control over their lives. Those who come out of this stage unsure of who they are, what they want and what they believe are at a higher risk of developing the psychological impairments mentioned above as well as continue to feel insecure and confused about who they are into their adult years.

Teen Mom Wants to Have Another Baby ASAP

What if your 18 year old daughter who is in the 11th grade of high school, already has a two year old child, told you she was planning on having another child by her new boyfriend in order to not be selfish?

Working with teenagers it’s rarely anything I see or hear these days that shock me, however, there are plenty of things I see and hear that leave me dumbfounded, including when one of my favorite teenage clients, who already has a child, told me that she plans to stop taking her birth control so she can get pregnant by her new boyfriend of only about three months. What?!?!

She told me that she thought it was UNFAIR to her son that he didn’t have a sibling and unfair to her new boyfriend that she didn’t have a child by him and that she felt like she was being selfish to everyone by WAITING until the right time (oh, let’s say after she finished high school, started a career, got married) to have another child. I sat listening to her, almost hoping that I had falling off into a daydream and that this was just all part of my imagination, but it wasn’t. This high school junior, soon to be senior, with one child at home already was telling me that she was planning on getting pregnant again as soon as possible! She is already raising this child without the father’s involvement and I shouldn’t say she is raising her child because her parents are actually the ones taking care of her and her current child, yet she wants to go and get pregnant again!

I know part of the psychology of why she wants to get pregnant again is to keep her current boyfriend around. She is thinking that if she gets pregnant by her current beau, they will stay together forever. I am sure she had that same delusional fantasy with her current child’s father who she hasn’t seen in over two years. You would think she would have learned, but the delusional, fantasy world and mind of a teenager is a hard shell to crack, no matter how many times the world gets dropped on it.

As I listened to her, I actually felt a great deal of heartache for her because she was about to go and do something dumb… at least in my professional opinion. The chances of her being 18 with two kids, barely a high school degree, and being successful aren’t in her favor, especially coupled with her history of alcohol and drug use and her impulsive behavior that often leads her to be in dangerous situations.

I tried and hope I spoke some sense into her. I told her that she isn’t being selfish by waiting for the right time (and person) to have another child. I told her that it is OKAY for her to be selfish when it comes to her life. A lot of times we are told so many times about not being selfish that we forget that sometimes being selfish is a form of self-care and self-preservation. I also told her that it wouldn’t be fair to her, her current child or her future children if she once again got pregnant by a man who wouldn’t be around to help her raise the child(ren) they produced together. I definitely tried to convince her that waiting until after high school, after college (which she plans to attend), and hopefully after getting married, would be the time for her to have more children if she so chose to do that. Being a high school senior next year with two kids her and her parents are raising together is not the situation she wants to be in.

I really hope I convinced her that having a child right now, with a guy she’s only known for three months, is not a rational decision, but a large majority of the teenage mind functions irrationally. Their brains are just wired differently at this age and we’ll explore that in a future post. The bottom line is, every high school girl I’ve worked with that got pregnant to keep a boy NEVER ends up with that boy more than a year or so later. Does it happen? I’m sure it does, but I haven’t seen it. Still, it doesn’t stop them from thinking otherwise and even if they already had a child and that child’s father disappeared shortly after the birth of the child, some of them will still be convinced, as this young lady is, that it won’t happen again.

This isn’t the first time I had to deal with something similar to this. Not too long ago one of my high school clients who had a baby less than a year ago, wanted to have another baby right away because that is what her boyfriend (the babys’ father) wanted. A month or so later they broke up because he wasn’t helping her take care of the baby they already had. Imagine if she would have gotten pregnant with a second child like she wanted.

Not Catching the Ball: A Form of Self-Care

I’m not the first to say this. Matter of fact, I heard this from one of my mentors who is a successful therapist, but even before her, I can swear I might have heard it on Oprah or somewhere, but the fact remains it is a powerful statement that has helped me in many situations.

Often in life we get swamped with obligations that we’d rather not do. I don’t mean the things that we have to do like take care of our kids or pay the bills, but I mean things such as running an errand for a friend that would really inconvenience us, or dealing with someones emotional instability that we know will suck us of any energy we have, but we may feel obligated to listen, or help, or volunteer, or say “yes” when we really want to say “no”.

The thing is, these things asked of us by friends, family, neighbors, co-workers, or who ever, is like them throwing a ball to us and we often feel obligated to catch it, but we don’t have to. We can say no, we can politely turn down that invitation to a Christmas party we really don’t want to go to, quite simply, we can just let the ball pass or bounce on by us instead of feeling obligated to catch it.

I had to explain this to a client recently who gave a guy her number when she didn’t really want to, but didn’t know how to say no, and now when he calls she doesn’t really want to answer, but does so to not be rude. I had to tell her that just because he was throwing the ball to her, didn’t mean she had to catch it. The same goes for someone giving you a bad attitude, negative energy or whatever. Just because they throw that negative ball your way, you don’t have to catch it and throw it back, you can just let it pass on by you.

Many times we feel the need to, and sometimes out of habit (or reflex) catch balls we really shouldn’t and sometimes even throw them back. People will always throw balls at us and if we try to catch them all we’ll eventually end up dropping everything.

So I think it’s important from time to time to practice not catching the ball, which will allow us more time and energy for what we feel is most important to us.

Saving the Lives of Butterflies: Part 2

It’s been a few months since I first introduced The Butterfly Project to the high school kids I work with (if you haven’t already, you can check out my post entitled “Saving the Lives of Butterflies”). Well I’m happy to report that over the past two weeks I’ve had a number of them come up to me and show me the butterflies that they drew on themselves in efforts to refrain from cutting themselves! I was so happy to see one or two of them do this, but was overwhelmed to see nearly all of the ones who have issues with self-injury trying this technique and so far it appears to be helping! Some of them even name their butterflies and they have been encouraging each other. It’s a small step, but I am so thrilled by it’s success so far that I just had to share some of the pictures!

With summer coming up, I am really worried about all of the teens I work with at the high school, especially the ones who self-injure, but I am really hoping that everything I’ve taught them over the summer, including cognitive behavioral interventions, emotional self regulation strategies and now the Butterfly Project, will help them make it through whatever they encounter and that they will emerge stronger and more confident. I will also be worried about the ones who use drugs, the ones who make irrational decisions, the ones with anger issues and the ones with severe depression and anxiety. Pretty much, I’ll be worried about all of them, but I have to hope and trust that I’ve helped them all enough or at least did my part in preparing them to better handle life.

On Childhood Disintegrative Disorder


We conclude our discussion on the Pervasive Developmental Disorders with a brief overview of Childhood Disintegrative Disorder.

Introduction

Childhood Disintegrative Disorder (CDD), is also known as Heller’s Syndrome and Disintegrative Pschosis.  It is a rare Pervasive Developmental Disorder that affects about 1 in 100,000 children. CDD resembles many of the other disorders on the Autism spectrum in the fact that it involves developmental delays, impairment in communication and social functioning, but most closely resembles Rett syndrome in that it almost exclusively affects boys whereas Rett syndrome almost exclusively affects girls. New research suggest that while CDD affects boys more than girls at a rate of 4 to 1, it is thought that girls diagnosed with CDD most likely should have been diagnosed with Rett. There is also further talk that in the future Rett and possibly even CDD won’t be separate diagnosis, but that they will both be collapsed into the Autistic category as low functioning forms of Autism.

Symptoms

Children with CDD develop normally up until about ages 2 to 4 years of age (rarely there are cases of delayed onset up to 10 years of age), and then start regressing, losing previously acquired developmental skills with in a few months to years, including language, non-verbal communication skills, motor skills and social skills.

Symptoms include:

    • Delay or lack of spoken language
    • Impairment in nonverbal behaviors
    • Inability to start or maintain a conversation
    • Lack of play
    • Loss of bowel and bladder control
    • Loss of language or communication skills
    • Loss of motor skills
    • Loss of social skills
    • Problems forming relationships with other children and family members

Causes

There are no known causes of CDD although abnormal electroencephalograms (EEG), epilepsy, Lipid storage diseases (excess build up of toxic fats in the brain and nervous system), Tuberous sclerosis (benign tumors that may grow in the brain and other vital organs) and Subacute sclerosing panencephalitis (chronic infection of the brain due to a form of the measles that damage the brain) all appear to be associated with CDD.

Treatment

There is no cure for Childhood Disintegrative Disorder and the treatment for it is similar to the treatment for all of the Pervasive Developmental Disorders with the addition of trials with steroid medications to try to slow down the progress of the disorder.

Diagnosis

Physicians will use some of the same assessment tools used to diagnose the other Pervasive Developmental disorders with the inclusion of all the symptoms listed above and impairment in normal function or impairment in at least two of the following three areas:

  • Social interaction
  • Communication
  • Repetitive behavior & interest patterns

The main symptoms to look for in diagnosing CDD is the loss of previous learned skills in at least two of these areas:

  • Expressive language skills (being able to produce speech and communicate a message)
  • Receptive language skills (comprehension of language – listening and understanding what is communicated)
  • Social skills & self-care skills
  • Control over bowel and bladder
  • Play skills
  • Motor skills

If your child has any developmental delays or starts to lose developmental functions previously learned, it is vital to talk with your physician in order to rule out  CDD or any of the Pervasive Developmental Disorders or mental retardation. The faster any illness is discovered and treatment begins, even if there is no cure, the better the prognosis or at least the slowing of the progress of the disorder. Some children with similar, yet less severe symptoms may have a learning disability or something much less serious than a Pervasive Developmental Disorder, but it is important to have everything ruled out for the best care of your child.

Excellent post!

help4yourfamily

Written by, Kate Oliver, MSW, LCSW-C

Get ready to laugh and tell me I’m wrong!  I have heard many versions of this affirmation but the person I got it from is the mother of affirmations herself, Louise Hay.  This week’s affirmation is:

Everything is happening at just the right time.

I know you do not believe me but give me a minute to talk you through it.  I know it feels like things happen too slow, too fast, or at just the wrong time!  This affirmation requires a little faith that there is a plan for us.  Even if you are not a believer in a higher power, doesn’t it just make life simpler to believe that everything is happening at just the right time?  I use this affirmation when I am running late and, I’m happy to tell you that when I use it, and believe it, everything does…

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On Rett Syndrome

An Introduction to Rett Syndrome

 What separates Rett syndrome from the other Pervasive Developmental Disorders is that it almost exclusively affects girls, whereas Autistic Disorder affects boys at a much higher rate than girls.

Worldwide Rett Syndrome affects 1 in every 10,000 to 15,000 females of all races and ethnicity. Prenatal testing is possible for families who have had a child born with Rett, but since the chances of developing Rett is so low, the chances of a family having two children born with Rett is less than 1%. Most boys born with the genes thought to be responsible for Rett often die shortly after birth. Because Rett syndrome is thought to be caused by a mutation to the X chromosome, girls are thought to be more able to compensate for the mutation because they have two X chromosomes where boys only have one and aren’t able to compensate.

In Rett Syndrome, similar to Asperger’s, there is normal early development and then a slowing of development, distinctive hand movements, lack of purposeful use of hands, and slowed head and brain growth. Problems walking, seizures and intellectual disability are usually also present. This disorder was first described by Dr. Andreas Rett, an Austrian physician in 1966, but it wasn’t until later in 1983 that it was recognized as a disorder after an article about it was written by Swedish researcher Dr. Bengt Hagbeg.

Like all of the Pervasive Developmental Disorders, the severity of symptoms in Rett varies from child to child, but they all start with relatively normal development, although loss of muscle tone (hypotonia), jerkiness in limb movements and difficulty feeding are often noticeable even in infancy. Gradually more apparent physical and mental symptoms become apparent such as the inability to talk and loss of purposefully movement of hands which is followed by compulsive hand movements such as wringing and washing.  Other symptoms such as problems walking, crawling and lack of eye contact may also be early signs. This period of regression is often sudden. The inability to perform motor functions (Apraxia) is one of the most severe disabilities of Rett syndrome, it effects body movement, eye gaze and speech.

Early stages of Rett syndrome often resemble Autistic disorder or one of the other Pervasive Developmental Disorders.  Some symptoms may also include walking on toes, awkward gait, difficulty chewing, teeth grinding, slowed growth, sleep problems, breathing problems, air swallowing, cognitive disabilities and apnea (holding breath)..

Diagnosis

Rett is typically diagnosed by a developmental pediatrician, pediatric neurologist or clinical neurologist using many of the same neurological, physical and psychological assessments used to diagnose the other Pervasive Developmental Disorders with the inclusion of genetic testing to look for the MECP2 mutation on the child’s X chromosome.

The Diagnostic and Statistical Manual of Mental Disorders also has these criteria for diagnosing Rett Disorder.

  • All of the following:
    • apparently normal prenatal and perinatal development
    • apparently normal psychomotor development through the first 5 months after birth
    • normal head circumference at birth
  • Onset of all of the following after the period of normal development:
    • deceleration of head growth between ages 5 and 48 months
    • loss of previously acquired purposeful hand skills between ages 5 and 30 months with the subsequent development of stereotyped hand movements (i.e., hand-wringing or hand washing)
    • loss of social engagement early in the course (although often social interaction develops later)
    • appearance of poorly coordinated gait or trunk movements
    • severely impaired expressive and receptive language development with severe psychomotor retardation

Causes

According to research, nearly all cases of Rett syndrome are due to a mutation in the metyl CpG binding protein 2 (MECP2) gene. The gene was discovered in 1999 and controls many other genes. It may also be responsible for some of the other Pervasive Developmental Disorders. This gene is needed for brain development and helps other genes increase or decrease their own unique expressions and proteins. This genes malfunction causes other genes to become abnormal. The puzzling thing is, not everyone with MECP2 mutation has Rett syndrome, so other genetic mutations are also thought to be responsible and research is ongoing. Rett syndrome is not thought to be genetic. Only about 1% of Rett syndrome cases are thought to be inherited, which means that in the overwhelming majority of cases, the gene mutations are random.

Treatment

Just like all the other Pervasive Developmental Disorders, there is no cure for Rett Syndrome and treatment is pretty similar including medication and therapy to help control and minimize many of the disabling features of Rett syndrome.

Although Rett syndrome can be very disabling, many people with Rett live to be in their 40’s and 50’s and perhaps even longer . 

Resources

International Rett Syndrome Foundation: www.rettsyndrome.org

National Institute of Child Health and Human Development (NICHD): www.nichd.nih.gov

Office of Rare Diseases: www.rarediseases.info.nih.gov

Rett Syndrome Research Trust: www.rsrt.org