Dr.

Erlinda Cuisa-Cruz

Adolescent Growth and Development

HUMAN DEVELOPMENT
OUTLINE
I.
II.

Introduction
Physical Growth and
Development
A. Early Adolescence
B. Middle Adolescence
C. Late Adolescence
D. Tanner
Staging/Sexual
Maturity Rating
E. Perils of Puberty
III. Cognitive Development

I.

IV.

Psychosocial
Development
A. Independence
B. Vocation
C. Sexuality
D. Self-Image
E. Psychosocial
Screening
V. Review Questions
VI. Relevant Quote
VII. Appendix

INTRODUCTION

Summer - season of adolescence.

This is the time when you are on top of everything
o Fittest in terms of your health
o Beginning of independence
o Doing
things
without
care
of
the
consequences.
Spring would be the period between birth to adolescence, fall
is early to middle adulthood and winter is old age.

Adolescent Growth and Development

Ultimate Goal of Child and Adolescent Health Care: to
help children become functioning and competent adults by
proceeding through various stages of development
An adequate knowledge of growth and development is
important to spot deviations from the path of normality and
to help correct them
If there were things that do not follow the normal trend
or pattern, then it would spell a big difference for that
person when he/she enters adulthood.
Adolescence: Transition stage from childhood into
adulthood
Essential Tenets of Adolescent Growth and Development
Physical Development
Cognitive Development
Psychosocial Development
These changes are all happening at one point in time and
can be confusing to the teenager experiencing it.
II.

PHYSICAL GROWTH AND DEVELOPMENT

Puberty
Period during which the adolescent experiences more
physical changes than in any other life stage except during
fetal life and infancy
May take 2-3 years, or as long as 6-7 years
Onset: 2 years earlier for girls
Completion: M=16-21y/o; F=10-14y/o

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Human Dev.

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3/21/2014

Puberty in Boys
Usually begins at approximately 12 years of age (9-13.5
years)
Biological changes vary in time of onset and duration
Sequence is very important. If the person does not follow it,
then there must be a problem.
Sequence: Beginning of growth spurt ! testicular
enlargement (first sign of puberty) ! lengthening of
penis ! appearance of pubic hair ! peak height
velocity
Puberty in Girls
Begins approximately 2 years on average before boys (8-13
years)
Sequence: beginning of growth spurt ! breast budding
nagbubukol (first sign of puberty) ! appearance of pubic
hair ! peak height velocity ! menarche
Biological changes vary in time of onset and duration
When girls get their menarche, its an indication that
puberty is near its end and that explains why late bloomers
(or girls who get their menarche at a later age) tend to be
taller.
Table 1. Comparison of puberty in boys and girls
Boys
Girls
Onset
9-13.5 years old
8-13 years old
First sign
Testicular growth
Breast budding
Completion
16-21 years old
10-14 years old
A. EARLY ADOLESCENCE (10-13 YEARS)
Development of underarm odor and faint genital hair
Pulsatile release of GnRH, LH and FSH during sleep
Increase in gonadal androgen and estrogen
Development of acne because of the androgens
Elongation of the optic globe
Makes adolescents prone to myopia.
Misalignments also happen because of the rapid
growth, which may cause astigmatism.
Dental changes
Male:
Seminiferous tubules, epididymis, seminal vesicles, and
prostate enlarge
Gynecomastia in 40-65%
"
Enlargement of mans breasts usually from
hormone imbalance
Enlargement of the larynx and lungs
"
Reason why voice pitch changes
Female:
Enlargement of the ovaries, uterus, labia and clitoris
Thickening of the endometrium and vaginal mucosa
Increased vaginal glycogen
"
whitish substance signaling menarche

B. MIDDLE ADOLESCENCE (14-16 YEARS)

Male:
Increase in lean body mass
Widening of the shoulders,
Spermarche
Penis lengthens and widens

B ASALLOTE , C ARANDANG , C ASAUAY , C O , H ERMO , L IM , M ELENDREZ , N AVAL , R UIZ , R UBY , O NG ,

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Female:
Subcutaneous fat accumulates
Widening of the hips
Menarche
Doubling in heart size and lung vital capacity
Increase in BP, blood volume and hematocrit
Physiologic increase in sleepiness
Acne and body odor
Start of when you can get pregnant or somebody pregnant.

Figure 1. Acne. The presence of acne is a clear sign of the early

and middle adolescence stage. Its appearance is due to the
sudden increase of androgens brought about by puberty.

C. LATE ADOLESCENCE (17 YEARS AND BEYOND)

Final stages of breast, penile, and pubic hair development
occur (by 17-18 years of age) in 95% of males and females
Growth of facial and chest hair
Important event: heralds the end of puberty in males
D. TANNER STAGING/SEXUAL MATURITY RATING
Assesses level of pubertal development
Also predicts peak height velocity, or growth spurt
Period during puberty in which an adolescents growth
rate accelerates
4-6 inches in height may be gained in a year or less
Growth spurt in girls: Tanner pubic hair stage 2 to 3
Growth spurt in boys: Tanner pubic hair stage 3 to 4
Preventive and therapeutic counseling efforts are also
enhanced by knowledge of Tanner stages especially
pertaining to growth failure or short stature

Figure 2. Tanner Stages of Sexual Maturity. The first and second

columns describe the stages in female breast development. The third
column describes the pubic hair growth of the female. The last column
describes the pubic and genital growth of the male.

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ADOLESCENT GROWTH AND DEVELOPMENT

E. PERILS OF PUBERTY
1. Acne

Common causes:
Androgens
Inflammation and occlusion of area/pores
Bacteria present
"
Propionibacterium acnes
"
Where intervention can be given

Acne should not be taken lightly. Acne scars left can cause
psychological problems to adolescents if not addressed
correctly.
2. Gynecomastia

Seen in 49% of adolescent males, during early or middle

stage

May be unilateral or bilaterial

Persists for 6-18 months

Persistent gynecomastia (>2 years) is usually idiopathic;

st
palpable tissue 2cm during 1 year

Can be because of genetics, nutrition, or obesity

What is important is to rule out certain causes:

Drug use (marijuana is a common cause of
gynecomastia)
Hormonal problems: hypogonadism, testicular tumors,
hyperthyroidism
3. Scoliosis

Accelerated progression of the degree of scoliosis as a result

of the growth of axial skeleton

Because of the accelerated growth of the spine, there is a

tendency to curve

Adams test: determines the degree of curvature

4. Myopia

Result of the growth in axial diameter of the eye

Astigmatism is also a common occurrence because of
uneven growth

Common complaints of teenagers: headache

5. Anemia

Very common among teenagers

Hemoglobin levels change as a function of gender and

pubertal stage
Start of menstruation and growth spurt increase iron
requirements
Most of the time, demands are not met in a normal
adolescent diet (Physiologic anemia)

Teenagers are also very picky eaters during this stage and
their unhealthy habits can increase the risk for anemia.
6. Sports related injuries

Also common among teenagers

During the height spurt, there is asynchronous growth of

the bones and muscles causing growth pains
The growth of the bones is very fast and muscles are
not able to accommodate.
Important that they should stretch before doing any
strenuous activity such as exercise

Sprains and strains are very common

Osgood Schlatter disease inflammation of tibial tubercle

apophysis

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a)

Pseudostupidity

The formal thinker can create but not prioritize

many possible solutions to problems that are really
simple or accidental.

Example: What is the solution to the traffic in Metro

Manila? They answer, Give love to one another
or Share the road.

They sound stupid because they cannot see what

is more important and simpler. They think their
answer is the best.

b)

Imaginary audience (On stage phenomenon)

Brought about by their egocentricity

They think that everyone is always looking at them

They think people are listening to whatever they

say: Everything that I say is important.

Examples:
I dont want to go to school because of my big
pimple. (This means the whole world to them.)
Me again? Always me? Why always me?
(Although others are also asked to do the same
chore.)
Apparent hypocrisy

Occurs when the adolescent can conceptualize

abstract rules but is unable to apply them
consistently to himself or herself
Sometimes they apply it but sometimes they
dont.

They know what the right thing to do is, but have

difficulty applying it.

Example: Having unprotected sex may get you

pregnant but thinks that it also is not probable.

Osgood-Schlatter Disease
Osgood-Schlatter disease is an inflammation of the bone, cartilage,
and/or tendon at the top of the shinbone (tibia), where the tendon
from the kneecap (patella) attaches. Most often only one knee is
affected.
OSD usually strikes active adolescents around the beginning of their
growth spurts, the approximately 2-year period during which they
grow most rapidly. Growth spurts can begin any time between the
ages of 8 and 13 for girls, or 10 and 15 for boys. OSD has been
more common in boys, but as more girls participate in sports, this is
changing.
Reference: Kids Health from
http://kidshealth.org/parent/general/aches/osgood.html

7. Dysfunctional Uterine Bleeding (DUB)

Abnormal uterine bleeding because of anovulatory cycle due

to immaturity of hormone release and ovarian function

Its common for teenage girls to have irregular cycles 2-3 yrs
after menarche

More than three years: abnormal

c)

8. Sexually transmitted disease (STD)

Common

69% of the STDs reported in the Philippines came from

adolescents
Because of the different changes (both biological and
behavioral)
Early start of sexual activity increases the risky
behaviors of teenagers
"
More prone to have multiple partners
During the 1st few years of menarche, there is
persistence of a transformation zone of columnar to
squamous epithelium cells on the exocervix.
"
Columnar cells: sites of infection for Chlamydia
"
Transformation zone: site of infection for Human
Papilloma Virus.
III.

d)

COGNITIVE DEVELOPMENT

The ability to think abstractly is the hallmark of adult

cognitive activity
Has four primary stages:
1) Sensorimotor: birth 2 years
2) Pre-operational: 2 - 7 years
3) Concrete: 7-12 years
4) Formal operational (abstract): > 12 years

1. Early adolescence

Concrete thinking

Some teenagers are still concrete thinkers. They have to see

it to understand it.
2. Middle adolescence

Beginning of abstract thinking but not full abstract thought

Personal fable

Personal fable is the feeling of "specialness" that

generates from adolescent egocentrism.

This feeling allows the adolescent to believe that

he or she is immune to the risk and
consequences that affect others.
Superman or superwoman

Examples:
If my friend will get pregnant, definitely not
me. I can handle it, and I will not get pregnant.
(But after a month, she does get pregnant.)
Driving under the influence: Who me? Im not
drunk. I wont get into accidents. I am special.

All of the components of cognitive development result to risk

taking behaviors among adolescents

Bad combination

Risky behaviors: use of substances like alcohol and

tobacco, drugs, early pregnancy, STIs, physical abuse,
injuries (whether self-inflicted or by other people), motor
vehicular accidents (number one cause of death among
adolescents)
IV.

3. Late adolescence

Able to think abstractly

Mastery of abstract thinking is not achieved in early and

middle adolescence thus producing several qualities in the
adolescents thinking such as:

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ADOLESCENT GROWTH AND DEVELOPMENT

PSYCHOSOCIAL DEVELOPMENT

Encompasses an adolescents ability to view himself and

to relate to others
How you project and relate yourself to other people
How you make other people view you as an individual

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4 tasks:
1. Achievement of effective separation or independence
from parents and family
Culturally, this is one of the problems of Filipinos. It
is normal to Filipinos live with our parents.
2. Achievement of realistic vocational goal
Being able to plan or choose a career for
yourself
3. Achievement of a mature level of sexuality
Being able to know if you are a male or a
female regardless of phenotypic presentation
Do I want to project myself as a male or a
female? How do I want other people to see
me?
It becomes a problem if you dont know who you
want to be.
4. Achievement of a realistic and positive selfimage
Being able to say who you are.
This is who I am, and I will accept who I
am.
It becomes problematic in adult life if this
is not mastered.
A. INDEPENDENCE

Early Adolescence (10-13 years)

Need to separate from the family is coupled with

increasing involvement in peer group

Avoidance of family activities

Wanting to go to Church with friends or eating out with
friends

Renunciation of family norms and values

Adults outside of the family as role models

Moderate reluctance to accept advice or criticisms
Adolescent has role models aside from parents, like
celebrities or coaches.
Example: Thats not what my coach said. I need to
diet.

Insists he can function without parental assistance

Example: Teenager wants to enroll in high school alone,
but later on blames the parent on her absence during
his enrollment
I need you but I dont need you.

Need for greater privacy

Bedroom and bathroom become haven (The time that
they are able to communicate with other people without
being seen or judged)

Telephone assumes extreme importance

Same gender peer group

Example: Girls are yucky.
Middle Adolescence (14-16 years)

Drive for independence demonstrated by the need to be in a

mixed gender peer group and by intense intellectual
testing of parents

Parental beliefs and opinions are challenged constantly

Peak of parental conflicts
This is the time when they are very rebellious: No!

Peak of peer involvement

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ADOLESCENT GROWTH AND DEVELOPMENT

Late Adolescence (17-20 years)

Peer group becomes less important

Reacceptance of parental advice and values

My family is not bad after all.
There is a going back to family.

Arrived at some conclusions as to the best way of being an

adult

Begins to make choices regarding behavior, friends and

recreation activities

Realistic planning of economic independence

By this time, they would have at least saved up money
for other things. There is budgeting for shoes, bags, etc.
without asking from parents.
Not necessarily physically independent
B. VOCATION
Early Adolescence

Idealistic vocational goals

An overshoot of what they can do

Example: astronaut, president of the Philippines, president

of the United States, flight stewardess
Middle Adolescence

Less idealistic vocational aspirations

Examples:
I cannot be a flight stewardess because I have
motion-sickness, so I choose to be a doctor instead.
I dont want to study that hard and I am not an
American citizen, so I cant be the president of the
United States.
Late Adolescence

Practical, realistic vocational goals

Example: This is exactly what I want, and what I can do.

These are my limitations and my strengths. Probably, Id be
best in this vocation.
C. SEXUALITY
Early Adolescence

Beginning interest in sex pornographic images

Both boys and girls may experience sexual excitement

from simply watching or being near someone they are
attracted to
They believe they are in a relationship, but in reality they
are not: non-existent relationships

Sexual fantasies are common

Emergence of sexual feelings often relieved by

masturbation

Ejaculation for the first time

Remember this: The bark is more than the bite. For

example, they flaunt, I have 10 girlfriends. or I have 20
suitors. But this doesnt necessarily translate to reality.
Middle Adolescence

Increased involvement in heterosexual relations dating

Romantic involvement is characterized by more selfish

motivations
Examples:
o
I need a ride home, so I get a boyfriend.
o I want to have lunch without asking money so I get
a girlfriend.

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Increased sexual activity and experimentation

Homosexual experimentation (same-sex sexual behavior)
common
Trying out all these sexual fantasies with whomever

Late Adolescence

More stable sexual identity

Selection of partner is based on mutual understanding

More commitment for each other
A time for intimate, giving relationship
D. SELF-IMAGE
Early Adolescence
Preoccupation with self Am I Normal?
A tendency to look at other people and see if I am like
everyone else
A blending with other people inconspicuously
Discomfort and concern about changes in his body and
feelings may cause emotional stress
Frequent comparison of own body with those of other
adolescents
Example: What is your cup size? How big is your
__?
Uncertainty about appearance and attractiveness
Example: There is something wrong with me.
Do not tell adolescents that they are abnormal. It will
stress them and lower their self-esteem.
Middle Adolescence
Greater acceptance and comfort with the body and is now
trying on ways to be an adult
Affiliation with a peer group is an important step in
confirming ones identity and self-image
Feeling of omnipotence and immortality leads to high risktaking behaviors
This is also part of knowing themselves.
Not advisable to tell them to not take risks; instead, they
have to channel the risks correctly (e.g. through sports).
Normal to experiment with different personas, changing
styles of dress, group of friends, and interests from month to
month
Late Adolescence
Has reconciled with the physical, emotional and cognitive
realities
Has established a set of body image
More stable sexual identity
Preoccupied with using his talents and abilities; should
know capabilities, limitations, boundaries
The adolescent would look into his talents, abilities,
limitations, and strengths, and accept them as they are.
Cognition tends to be less self-centered
Has learned to deal with the realization that he is not so
different from his parents and being similar to his parents
is not so bad
My family has both strong points and bad points, but
they are still my family.
More constant emotions

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ADOLESCENT GROWTH AND DEVELOPMENT

E. PSYCHOSOCIAL SCREENING
HEADSSS quick screening for risk-taking behaviors for
adolescents
Home home environment, discipline in the home, family
activities, relationships
Education/employment learning problems/difficulties
Activities anything outside the home and school, hobbies,
church activities
Drugs (ATOD) alcohol, tobacco and other drugs
Sexuality sexual preference, sexual activity, sexual
behavior, how they protect themselves
Safety how they cross the street, drink and drive, use a
motorcycle going home; do they feel the need to bring an
icepick or a taser when going home?
Suicide screen for depression and mental health
V.

RELEVANT QUOTE

Adolescence is a time of change, time of challenge, and time of

health risks.
VI.

REVIEW QUESTIONS

1. At what developmental stage does the male/female

experience spermarche and menarche respectively?
a. Early Adolescence
b. Middle Adolescence
c. Late Adolescence
2. What is the first sign of female puberty?
a. Pubic hair growth
b. Enlargement of breasts
c. Menarche
d. None of the above
3. At what stage can a teenager begin abstract thinking?
a. Early adolescence
b. Middle adolescence
c. Late adolescence
4. At what stage can a teenager finally establish his/her
body image?
a. Early adolescence
b. Middle Adolescence
c. Late adolescence
5. Which of these statements best exemplify personal
fable?
a. I need to dress up properly today. I dont want people to
judge my outfit for the day.
b. I know that smoking is bad, but so what. Im pretty sure
that I wont be affected by its negative effects.
c. I dont need to prepare for tomorrows test. I know that
Im smart enough to handle it.
d. Why is it always me? What did I do wrong?
Answers: B, B, B, C, C

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VII.

APPENDIX

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ADOLESCENT GROWTH AND DEVELOPMENT

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