p JBERTY: AN OVERVIEW

The Endocrine System

What Triggers Puberty?
How Hormones Influence Adolescent Development

SOMATIC DEVELOPMENT
Changes in Stature and the Dimensions of the Body
Sexual Maturation

THE TIMING AND TEMPO OF PUBERTY

Variations in the Timing and Tempo of Puberty
Genetic and Environmental Influences on Pubertal Timing

THE PSYCHOLOGICAL AND SOCIAL IMPACT OF PUBERTY

The Immediate Impact of Puberty
The Impact of Specific Pubertal Events
The Impact of Early or Late Maturation

OBESITY AND EATING DISO~RDERS

Obesity
Anorexia Nervosa, Bulimia, and Binge Eating Disorder

PHYSICAL HEALTH AND HEALTH CARE IN ADOLESCENCE

The Paradox of Adolescent Health
Causes of Mortality in Adolescence

Promoting Adolescent Health

~RTl

TheFunda~enta l

Changes of Adolescence

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

ACCORDI G TO AN OLD JOKE, t here are only two

viewed and t reated by ot hers. Yet the social environ-

things rn life that one can be sure of death and taxes.

ment exerts a tremendous impact on puberty and its

To this brief list. we might add puberty

the physical

psychological and social consequences; indeed, as you

for. of all the developments

wi ll read in th is chapter, the social envi ronment even

that take p lace d uring the second decade of life, the

affects the timing of puberty (that is, whether a person

on ly truly inev1tabl e o ne is physical maturation. Not all

mat ures early or late). In som e societ ies, pubertal matu-

ado lescents experi ence identity crises, rebel against

rat ion bnngs with it a series of comp lex and public ini-

the1r parents, or f all madly in love, but v irtually all un -

t iation rites that mark the passage of the young person

dergo the bi o logi cal transitions associ ated wi th matu-

into adulthood 1 socially as w ell as physically. In other

ration into adult reproductive capabilit y.

societies. recognition of the physical transformation

changes of adolescence

Puberty. however. is cons iderably affect ed by t he

from chtld into adult takes more subtle forms. Parents

context in w hich it occurs. Physical develo pment is in-

may merely remark, UOur little boy has become a man."

fl uenced by a host of envi ro nmental fact o rs. and t he

when they discover that he needs to shave. or ''Our little

timi ng and rate of pubertal gro wth vary across reg io ns

girl has grown up:' w hen they \earn that she has gotten

of the w orld, socioecono mic c lasses. ethnic groups,

her fi rst period. Early or late maturation m ay be cause

and historical eras. To day, in contemporary Am eri ca,

for ce lebration o r cause f or concern, depending on w hat

the average girl reaches menarche

the time of first

is admired o r derogated in a g1ven peer group at a given

at about age 12. But among the Lumi

point in ti me. T he fifth-grade r who is developing breasts

people of New Guinea. the t y pical girl does not reach

m ight be embarrassed , but t he ninth-grader w ho has not

menarche unti l after 18 years of age (Eveleth & Tanner,

developed breast s might be equally self -conscious.

menstruation

1990). Imagine how that five-year difference transforms

In sum. even the most universal aspect of adoles-

the nature of adolescence. Picture how different high

cence

school would be if sexual maturation did not occur un-

the young person. In th is chapter, we examine just how

til after graduation'

and why the environment in which adolescents de-

Physical and sexual maturation profoundly affects

the ways in which adolescents view themselves and are

puberty

is hardly u niversal in its impact on

velop exerts its influence even on something as fundamental as puberty.

Puberty: An '~verview
Puberty derives fron1 the Latin word pubertas, \hich
means adult." Technically, the tern1 refers to the period
during which an individual becomes capable of sexual
reproduction. ~1ore broadly, however, puberty encotnpasses all the physical changes that occur in the growing
girl or boy as the individual passes from childhood into
adulthood (Dorn & Biro, 2011 ).
Puberty has three chief physical manifestations:

(sex glands), which results in hormor1al changes

that ultimately enable reproduction.
3. The developn1ent of secondary sex characteristics,
including changes in the genitals and breasts, and
the growth of pubic, facial, a11d body hair.

menarche

Each of these sets of changes is the result of developrnents in the endocrine and central 11ervous systen1s,
many of which begin years before the external signs of
puberty are evident son1e occur even before birth.
Puberty 1nay appear to con1e on suddenly, judging
fron1 its external signs, but i11 fact it is part of a gradual
process that begins at conception (Sustnan & Dorn,
2009). You n1ay be surprised to learn that no new hortnones are produced and no new bodily systen1s develop at puberty. Rather, so1ne hortnones that have
been present since before birth increase, and others
decrease.

endocrine system

The system of the body that produces,

circulates, and regulates hormones.

THE ENDOCRINE SYSTEM

hormones

The endocrine system produces, circulates, and regulates levels of horn1ones in the body. Horn1ones are

1. A rapid acceleration in growth, resulting in dra-

Inatic increases in both height and weight.

2. The development of prirnary sex characteristics,
including the further development of the gonads

The time of first menstruation, one of the most

important changes to occur among females during puberty.

Highly specialized substances secreted

rocnne glands.

by one or more

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CHAPTER l

Hypothalamu
'L--~- ~-~~--

LI I RF (lut iniztng hormonerelea sing factor) and FSH-RF

(follrcle-strmulcting hormonereleastng fact or) stin"lulate
pituitary gland.

ltypoth larnus
mon rtors Ievc.: Is
o f androgens
and trogens.

Ptturtary

gland
LH (luteinizing hormone) and FSH
(foil icle-stimulating hormone)
stimulate gonads.

(lestes in males.
ovaries in females)

Gonads
J

'

Androgens
Estrogens
FIGURE 1.1 Levels of sex hormones are regulated by a
feedba ck system (the HPG axis) composed of the hypothalam us, pituitary gland, and gonads. (Grun1bc1eh, Roth, Kaplan, &
Kelch, 1974)

Biological Tran~1t tons

23

fc.lls belt)\\' thi leveL Sin1iJ, rly, ,,,ben a pat~6cu.lar horrnonal level in your body dips belovv the end JCrinc
systcn1' set point for that hon11011C, & cretion of the
horn1one increases; \\'hen the level rca h s th et point,
secret ion ten1porarily stops. And, , s is the ca e with a
lhenuoslat, the setting level, or set point, for a pa.rticu lnr horn1one can be adjusted up or down, depending on
environn1ent.al or internal bodily condition .
Such a feedback loop beco1nes increasingly in1portant at the onset of puberty. Long before early adolescence in fact, before birth a feedback loop develops

involving the pituitary gland (vvhich controL hor1none

level in general), the hypothalamus (the part of the
brain thal controls the pituitary gland~ and where there
is a concentration of GnRH neurons), and the gonads
(in tna lcs, the testes; in fe1nales, the ovarjes), \vh ich
release the ((sex" hortnones androgens and estrogen s. T'his feedback loop is known as the HPG axis (for
H ypo thahunus, Pituitary) Gonads) (see Figure l.l ). Although you n1ay think of androgens as "rnale)) hormones
an d est rogens as '<female), horn1ones, both types ofhorn1oncs are produced by each sex, and both are present

Organs that st imulate particular parts of the body to

respond in specific ways to particular hormones.

glands

Specialized
neurons that are activated by certain pubertal hormones.

gonadotropin-releasing hormone (GnRH} neurons

highly specialized substances that are secreted by one or

rn ore endocrin e glands and then enter the bloodstream
and travel thro ughout the body. Glands are organs that
stin1ulate particular parts of the body to respond in
specific ways. Just as specialized hormones carry ((Inessagcs,, to particular cells in the body, so are the body's
cells designed to receive horn1onal messages selectively.
Many of the hormones that play i1nportant roles at puberty carry their instructions by activating very specific
types of neurons in the brain, called gonadotropinreleasing hormone (GnRH) neurons (Bogin, 2011;
Novaira et aJ., 2011 ).

I The Hormonal Feedback Loop The endocrinc syste1n receives its instructions to increase or decrease circulating levels of particular hormones from
the central nervous systen1, mainly through the firing
of GnRH neurons i11 the brain. The system works like a
thermostat. Hormonal levels are "set" at a certain point,
\vhich may differ depending on the stage of develop.
ment, just as you might set a thermostat at a certatn
temperature (and use different settings during different
seasons or different times of the day). By setting your
room's thermostat at 60F, you are instructing your
heating system to go into action when the temperature
~~~~~~~~~~~~~~~~~~~~~

set point

A physiological level or setting (e.g .. of a specific

hormone) that the body attempts to maintain through a selfregu lat_j ng system.
feedback loop

A cycle through which two or more bodily

fun ctions respond to and regulate each other, such as that formed
by the hypothalamus, the pituitary gland, and the gonads.
One of the chief glands responsible for regu\at\ng
levels of hormones in the body.

pituitary gland

hypothalamus A part of the brain that controls the functioning of

the pituitary gland.
The glands that secrete sex hormones: in males, the testes~
in females, the ovaries.

gonads

testes

The male gonads.

ovaries The female gonads.

A class of sex hormones secreted by the gonads, found
in both sexes, but in higher levels among males than females
following puberty.

androgens

A class of sex hormones secreted by the gonads, found

in both sexes, but in higher levels among females than males

estrogens

following puberty.
HPG (hypothalamic-pituitary-gonadal) axis The
neurophysiological pathway that involves the hypothalamus, the
pituitary gland, and the gon~a~
ds~~~~~~~~~~~~~

24

PART 1 The Fundamental Changes of Adolescence

a
arld
The t l1yro1

adrenal cortex, in turn, secrete h

.
or~
t cause various bodily changes to take place
tnones tha
.
h
at
1y feelings f
search
also
indtcates
t
at
ear
pub erty. Re
. d' 'd
o
on
to
other
n1ost
rn
1v1 uals, in An-.
t
sexua l attrac 1
.
-taJer.
d
nd the vvorld., report that the1r first sex:u
"
.
a1
1ca an aro u
.
took
place at the n1ag1cal age of 1O,n befo
attraction
.
re
they went through puberty may be stimulated by
. 1 of the adrenal g1ands, called adrenarch
natura t 101
.
.
e
1

Early foe lings ofsexual attraction to others are sttmulated by

adrenarche. the maturatton of the adrenal glands, which takes
place before the outward stgns ofpuberty are evrdent.

in males and females at birth. During adolescence,

however, the average male produces more androgens
than estrogens, and the average female produces more
estrogens than androgen s (S usn1an & Dorn, 2009).
The hypothalam us responds to the levels of sex hormones circulating in the b ody. Your HPG axis is set to
maintain certain levels of androgens and estrogens.
When these levels fall below the set points, the hypothalamus no longer inhibits the pituitary, thus permitting it to stimulate the release of sex hormones by the
gonads, and other puberty-related hormones by the
adrenal gland. When sex hormon e levels reach the set
point, the hypothalamus responds by inhibiting its
stimulation of the pituitary gland. As you will see,
puberty occurs when it does because several different

signals genetic as well as environmental instruct the

brain to change the set point (Sisk & Foster, 2004). Just
as you n1ight change the setting on your heating thermostat automatically every November 1, or when your
utility biii has becon1e too expensive, your brain is constantly monitoring a variety of signals and adjusting
your 11or1nonal set points in response.

I Adrenarche During and just before puberty, the

pituitary also secretes horn1ones that act on the thyroid
and 011 the adrenal cortex as well as horn1ones that
stin1 ulate overall bodily gro\vt11. The release of these
substances i also under the control of the hypothalan1us.

adrenarche The maturation of the adrenal glands that takes place

dunng adolescence.
cortisol

A hormone produced when a person is exposed to stress.

(Herdt & McClintock, 2000):_whl~h contnbu~es ~0 the

developrnent of body odor, slgnahng the beginnlng of
sexual maturation to others (Campbell, 201 1). Changes
at puberty in the brain system that re?u~ates the a~rena)
gland are also important because tlus 1s the bram system that controls ho\-v we respond to stress (Del G1udice,
Angeleri, & Manera, 200?~ One reason adolescence is a
period of great vulner~b1hty for the onset of many serious n1 ental disorders 1s that the hormonal changes of
puberty make us more responsive to str~ss (Sontag,
Graber, Brooks-Gunn, & Warren, 2008; Steinberg et al.,
2006; Stroud et al., 2009; E. Walker, Sabuwalla, & Huot,
2004; Worthman, 201 1) . This leads to excessive secretion of the stress hormone cortisol, a substance that at
high and chronic levels can cause brain cells to die
(Gunnar, Wewerka, Frenn, Long, & Griggs, 2009). Keep
in mind that there is a difference between saying that
adolescence is an inherently stressful time (which it is
not) and saying that adolescence is a time of heightened
vulnerability to stress (which it is) .

MAKING THE PERSONAL CONNECTION

Do you remember your first fee\ings of sexual attraction for someone? How old were
you?

WHAT TRIGGERS PUBERTY?

Although the HPG axis is active before birth, it is relatively quiet during 1nuch of childhood. Something happens during middle childhood, though, that rea,vakens
the HPG axis and signals it that the body is ready for
ptlberty. Son1e of this is due to a clock whose "puberty
alarm" is set very early in life by information coded in
the genes (as you will read, the age at which someone
goes through puberty is largely inherited). But son1c of
the reawakening of the HPG axis at puberty i due to
n1ultiple signals that tell the brai11 it is tin1c to ''g t tht
childbearing show on the road.'., Thes signal~ indit,lh'
1
whether there are sexually n1ature n1ati ng partn r i~
the environment\ whether there are suff1cient nntntional resources to up port a pregnancy, an l whdh r tht'
i11dividual is physically n1ature and healthy t nougb h)
begin reproducing.

25

nn

dr

f
I
nd n

m tur

he
8

th th m u

d '
T n r 2 3
d1ff r nt s g
tton

(s

nd

h d

r n

r n t

rl 20

nd

~,t=

'

Gonadarche
10

12

14

16

18

20

Age

e ;. 111 pJe, c-. on1e evjdcnce "ugge t tJ1at ri ing

l c::J fa protein produ cd by fat c Jls> leptin, tnay be
t11 n1 t in1 portant ignal, at ftast in fen1ales (Susn1an &
I ern, 2009). Thi idea L con ~isten t v.rith observa tions
that individual n1ay not go through pubert y until they
have accuJnuJated a certain an1 ou nt of body fa t. Reear cJ, also sho,vs that streo; , illness, nutritional deficiencie" ' exce ~sive exercjse, a nd excessive thinnes~ can
, 11 delay the on et of puberty (Sustnan & Darn, 2009 ).
The signal carried by ri ing levels of leptin instructs the
hypotl1alamus to sto p doing things that have been inhibi ting p uberty ( isk & Foster, 2004). As a result of
the.se gen etic and signaling processes> the GnRH neuro ns are excited, and the hypothalan1us initiates a cascade of horrnonal events that ultimately results in
ex ual n1 aturation ( ~ce Figure 1.2).
f

HOW HORMONES INFLUENCE

ADOLESCENT DEVELOPMENT

Horn1ones play tvvo very different roles in adolescent

develop1nent: an organizational role and an activationaJ role (Sisk & Foster, 2004). Most people understandably think that changes i11 behavior at puberty
result from changes in horn1ones that occur at tl1at
tin1e. But this is only partially correct. Long before
adolescence jn fact, before birth hor1nones shape,
or organize, the braii1 in ways that n1ay not be manifested in behavior until childhood or even adolescence.
Generally, until about eight weeks after conception) the
human brain is "feminine" unless and until it is exposed
to certain ('masculinizing'' horn1ones, like testosterone.
Because levels of testosterone are higher a1nong males
than females while the brajn is developing, n1ales
usually end up with a more "masculi11ized, brain than
females. This sex difference in brai11 organization

predetern1ine certain p ttcrn

b h 'i r, nl n'
of which n1ay n ot actuall appear until 1nuch l, ter
( Collaer & 1-Tine", 1995). tudie f
dift r n c in
aggre "ion, for exan1ple, h ' th t e't en th ugh n1e
of these differences rna r not appear until d lt:~ ence,
they likely result from the impact of pren tal h rn1 ne ~
rather than fron1 hormonal change at puberty.
In other words, the pre ence or ab~ence f certain
horn1ones earlv in life may "program , the brain nd tllt:
central n ervou svsten1 to develop in ertain wc.-1ys nd
according to a certain tin1etable later on ( i..k & Po ter
2004). Because \Ve n1ay n ot see the re ulting change in
behavior until a dole cenct: , it i a -y to conclude, n1i takenly, that the behavior"' re\J\llt from horn1onal
changes that take place at the tin1e of puberty. In reality,
ho\\'eYer\ expo ure to certain horn1 ne~ before birth
may et a sort of alarm clock that doe n ot go off unt il
adole cence. Ju t becau e the alarn1 clock rings at the
arne tin1e that puberty begin doe " not n1ean that puberty caused the alarm to go off.

I\1any changes in behavior at adole"cence o ccur

hovvever, because of change in hormone level\ at puberty; these hormonal changes are aid to activate the
change in behaYior. For instance, the increa e in certain hormones at puberty is thought to tin1ulate the

leptin A protein produced by the fat cells that may play a ro\e in
the onset of puberty.
organizational role {of hormones) The process through which
early exposure to hormones. especially prenatally. organizes the
brain or other organs in anticipation of later changes in behavior o
patterns of growth.

activational role (of hormones) The process through which

changes in hormone levels, especially at puberty, stimulate chang
in the adolescent's behavior, appearance, or growth.

26

PART 1 The Fundamental Changes of Adolescence

developn1ent of secondary sex characteristics, c.,uch as

the grO\\th of pubic hair. Other horn1onal changes at
adole cence, controlled by the adrenal gland, n1ay ~tinl
ulate an increa~e in individuab' sex drive (~1cClintock &
Herdt, 1996 ) . There is also gro\ving evidence that the
hortnonal changes of puberty affect the brain in '"'ay
that increase adoles(cnts' desire for highly re\varding,
sensation-seeking activities, \vhich tnay lead son1e teenagers to engage in riskv behavior (Forbes & Dahl, 201 0;
Op de ~facks et al., 20 11 ) .
Still other change~ during pubertv are likely to be
results of an i1lteraction bet,veen organizational and actiYational effects of honnones Collaer & H inc', 1995)
Hormones that are pre~cnt during the deYcloptnent of
the fetus may organize a certain "et of bchJYior~ (fo r
exan1ple, our brc1in~ n1a} be .. et up to have us later engage in sexual behavior), but certain chan ges in those
hormones at puberty 1nay be needed to activ,1tc the pattern; that is) indi\ idunL 1nay not becon1e rnoti\'ated to
engage in se\. until puberty.
1

RECAP

Puberty has three main physical manifestations: a

rapid acceleration in growth, the development of
primary sex characteristics, and the development
of secondary sex characteristics.
Puberty is regulated by a hormonal feedback loop
that includes the hypothalamus. the pituitary gland,
and the gonads.
Many important changes at puberty involve a
process called adrenarche, which involves the regulation of the adrenal gland rather than the
gonads.
The onset of puberty is triggered by several factors,
includtng a biological "alarm'' that is coded in the
individual's genes and vanous environmental signals, which let the body know that it is ready to

begin reproduction.
Physical and behavioral changes at puberty result
from two different hormonal processes: organizational. which take place long before adolescence. and activational, which result
from changes in hormones
when puberty
takes place.

adolescent growth spurt

The dramatic increase in height and

weight that occurs during puberty.

peak height velocity

The point at wh ich the adolescent is

growing most rapidly.

The closing of the ends of t he bones, which terminates
growth after the adolescent growth spurt has been completed.

epiphysis

Somatic Development
f
the
horn
onal
changes
of
puberty
on
the
1
Thee f1ects o
.
'
.
.
boci)'
are
ren1arkable.
Consider
th~
drat
a d o 1escen s
'
.
h

pl
ysical
appearance
that
occur
dur1
n1atic c anges 1n
. . .
. g ear1y ad o1es. c t:,nee rhe Individual enters puberty
111
looking like a child but \Vithin four years ?r so ~as the

elrance
of
a
young
aduJt.
Durtng
th1s
rdap hyc;tca1app '
. . .
0 d the average 1ndiv1dual grows about
.
t

f
er
1
t1ve1y 1r1e p
,
r

l1eS taller, 01 atures~ sexually,. and develops an

10 li1C
. orti'oned
bod)'
w1th many other .orad u 1t-p1op
,'
. Along
.
.
n
chanoes
n
s1ze,
structure)
and
function
1
b
oan , t 11e 1 a1
o
,
.

~
b
t
a
se

ries
of
developn1ents
at pu er y,
Chapter 2.

\Ve

11 d1 cuss in

CHANGES IN STATUR AND

THE DIMENSIONS OF THE BODY
1 The Adolescent Growth Spurt The sin1ultaneou release: of gr()\Vth hormone.., thyroid horn1ones,
and androgens stin1ula tes rapid acceleration in height
and \Neight. Thi<; dran1atic increase in stature is referred
to ac; the adolescent growth spurt. \~Vhat is n1ost incredible about the adolescent gro,vth spurt is not so
111 uch the absolute gain of height and \veight that typiL,111y occur but the ~peed \"'ith which the increa~es take
place. Think for a n1o1nent of bo\v quickly very young
children grow. At the time of p eak h eight velocityth e titne at vvhich the ,1dolescent is growing n1ost rapidly h e or she i growing at the same rate as a toddler.
For boys, peak height velocity averages about 4 inches
( 10.3 centimeter~) per year; for girls, it\ about 3.5
inches (9.0 centin1 etcrs) . ()ne marker of the conclu~ion
of puberty is the closing of the ends of the long bones
in the body, a process called epiphysis, \vhich lenninates growth in height. Puberty is also a tin1c of significant increase in weight nearly half of on e~s adult
body weight is ga ined dur ing adolescence (Susn1an &
Dorn, 2009).
Figure 1.3 shows just how ren1arkable the grovvth

"purt is in tern1s of height. T'he graph on the left sho\VS

changes in ab~olute ht:ight and indicates, as you \vould
expect, that the average individual gro\vs throughout
infancy) childhood, and adolescence. As you can se~,
there is little gain in height after age 18. But look no,vat
the ri ght-hand graph, which shows the average incrc.1se
in height per year (i.e., th e ra te of change ) over the san1c
age span. Here you can see the acceleration in height at
the ti1ne of peak height velocity.
rigure 1.3 also indicate . that the gro\vth spurt 0 cur , on average, about t\\ 0 years earlier an1ong girl "
than boys. In general, a. you can see by con1paring the
t\vo graphs, boys tend to be son1e\.vhat taller thnn irls
before age 11; then girls tend to l)c taller th,tn b l)'S le
tween ages 11 and 13; and finally, boy~ tt'nd to b~ tnlh:r
than girls fron1 about age 14 on. )'ou Jn,\y r~nlt'nlbt;;r
1

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CHAP'TER 1

r 10

()

B1ologtcal Transtt1ons

27

(b)

24

22

190
180
170
160

e'"
u

Boy

20

G1d

18
*

150
140
130

'-

tO
QJ

16

>...

..u

,....

120

..c.
2.0
110
QJ
:c 100

14

12

ra

:_c 10

Boy

00
QJ

:c

90
80

G1rl

8
6

70
60
50

2
1

9
11
Age

13

15

17

19

11

13

15

17

19

Age

FIGURE 1.3 (a) Height (in centimet~ers) at different ages for the average male and female youngster. (b) Gain in height
per year (in centimeters) for the average male and female youngster. Note the adolescent growth spurt. (Adapted from
Mar hall, 1978)

\Vhnt this was like during the fifth and sixth grades. Sex

differences in height can be a concern for many young

adoJe cents vvhen they begin socializing with members
of tJJe opposite sex, especially if they are tall, earlyrnaturing girls or short, late-n1aturing boys.

MAKING THE PERSONAL CONNECTION

Think back to a time when the girls in your
elementary school class tended to be
taller than the boys. What impact, if any,
did this have on relationships between the
sexes?

Much of the height gain during puberty results fron1

an increase in torso length rather than in leg length. The
sequence in which various parts of the body grow is
fairly regular. Extremities the head, hands, and feetare the first to accelerate in growth. Then accelerated
gro\vth occurs in the arms and legs, followed by torso
and shoulder growth.
Young adolescents often appear to be out of proportion physically as though their nose or legs were
growing faster than the rest of them. This is because
different parts of the body do not all grow at the same
rate or at the sa1ne time during puberty. This can lead
to an appearance of awkwardness or gawkiness in the

young adolescent, who n1ay be en1barrassed by the

disproportionate growth of different body parts. It is
probably little consolation for the young adolescent
going through the a\vkward phase to be told that an at-

tractive balance probably \vill be restored 'vithin a fe\v

years, but fortunately, this is \vhat u ually happens.
I Sex Differences in Muscle and Fat The spurt
in height during adolescence i accompanied by an increase in weight that results fro1n an increase in both
muscle and fat, but there are in1 portant sex differences
in body con1position. Before puberty, there are rela-

tively fe\v sex differences in n1uscle development and

only slight sex differences in body fat. In both sexes,
1nuscular development is rapid during puberty, but
n1uscle tissue gro\vs faster in boys than girls (Bogin,
2011) (see Figure 1.4). In contrast, body fat increases
for both sexes during puberty, but more so for fen1ales
than for males, especially during the years just before
puberty. For boys, there is actually a slight decline in
body fat just before puberty. The e11d result of these
sex differences is that boys finish adolescence \Vith a
n1uscle-to-fat ratio of about 3 to 1, but the comparable
ratio for girls is approximately 5 to 4. This has in1portant implications for understanding why sex differences
in strength and athletic ability often appear for the first
time during adolescence. According to one estin1ate,
about half of the sex difference in athletic performance
during early adolescence results simply from the difference in body fat (Smoll & Schutz, 1990).

28

PARl 1

I h rund m rita I Ch ng .s of Ado I sccr"'c:

180
170

"" '

Body Dissatisfaction Among Adotesc

.
.
.
b
d
f
ent
Girls The rap1d 1ncrc..:ase 1n o y at that oc

t=~ Boy

Girl

160

25

..u .

24
23
140

130

'

120

30
28
26

Lean arm 22
ctrcumference

21
20

. .E..

~
~
"'-

19

18

17

16

proJnpt yoLu1g .girls to become overl~ concerned

about their wc1ght even when the1r weight .
c
h h .
lS
within the norn1al range ~.or t etr e1ght and age
(Snlolak, Levine, & Gralen, 199~). As .you will rtad
later in this chapter, n1any studte potnt to adolescence as the period of greatest risk for the developnlent of eating disorders such as anorexia and
buli1nja.
Although the 1najority of girls diet unnecessarily during this time in response to the increase
in body fat) the girls who are most susceptible to
feelings of dissatisfaction with their bodies dur~

ing this phase of development are those who ma15

ture early, begin dating early, and come from
..-14
relatively
more
affluent
families
(Sm
olak
et
al.,
E
Sum o f 3
E 24
1993 ). Girls who spend a lot of t ime talking
..........
skin fo lds
"'0
about their looks with their friends are especiallv
-0 22
c 20
vulnerable
to
feelings
of
body
dissatisfaction.
1~
V")
fact, for girls, it is comparing t h e m selves with
18
their friends, and not just being exposed to Ine16
dia portrayals of thinness, that leads to dissatis14
6 7 8 9 10 11 12 13 14 15 16 17 18
faction (Carlson Jon es, 2004) . In contrast, boys'
Age (years)
feelings about how th ey look revolve around
FIGURE 1.4 Sex differences in body composition after puberty, on
how muscular they are and do not seem to be
average leave males taller, leaner, and more muscular than females.
affected by comparisons w ith peers. There are
(Bogin, 20 I I)
also important ethnic and cross-cultural differences in the ways in which adolescent girls feel about
their changing bodies (Jones & Smolak, 2011; Yates,
It is tempbng to attribute sex differences in athletic
Edman, & Aruguete, 2004) . In many parts of the
performance purely to changes in body fat and to
world, including North and South America, Europe,
h ormonal factors, because androgens, which increase
during puberty in males at a much faster rate than in
and Asia, there is strong pressure on girls to be thin
females>are closely linked to growth in aspects of the
(Jones & Smolak, 2011 ). Black adolescents seem less
body tl1at influence athletic ability. But with age, envivulnerable to these feelings of body dissatisfaction
ronn1ental factors like diet and exercise become inthan other girls (Nishina, Ammon, Bellmore, &
creasingly important influences on sex differences in
Graham, 2006), and consequently they are less likely
physical performance (Smoll & Schutz, 1990). There
to diet, in part because of ethnic differences in conare strong social pressures on girls to curtail <<mascuceptions of the ideal body type (Granberg, Simons, &
line" activities including some fortns of exercise at
Simons, 2009 ).
adolescence, and studies show that girls are more likely
than boys to markedly reduce their physical activity in
preadolescence, with a very large proportion of adolescent girls faili11g to meet national guidelines for exercise
(Goran et al., 1998; Savage & Scott, 1998). Moreover,
MAKING THE PRACTICAL CONNECTION
adolescent girls' diets, especially those of Black girls, are
Given the nature of sex differences in the physical
generally less adequate nutritionally than the diets of
changes of puberty, is body disboys, particularly in important minerals like iron
satisfaction inevitable among
(Johnson, Johnson, Wang, Smiciklas-Wright, & Guthrie,
adolescent girls? Can we
1994). Both factors could result in sex differences in
learn anything from studies
exercise tolerance. In other words, sex differences in
of ethnic or cross-culphysical ability are influenced by a variety of factors, of
which hormonal differe11ces are but one part of a comtural differences in body
plex picture.
dissatisfaction that might
4-

be helpful?

www.mhhe.com /st einberglO

TABLE 1.1

CHAP1ER 1

BJologtcal frans1t1ons

The sequence of physica l changes at puberty

----------------=B~
oy~s~L----

- =~-

Age of l~irs t
CJutracteristic
A
..___ _ ____..-=-------=-~--~---=-~'--=--"~ ppca ranee (Year )
1.

29

trowth of testes ,

10 13lh

M... rotn I S4lC

.... Gn.>wth of pubic hair

3. Body growth
4. Growth of penis
5. Change in voice
(g ro,vth of larynx)
6. Facial and
underarm hair

7. O il- and S\veat prod ucing glands,

acne

10- 15
I 0 1h-l6

l1 - l4 V2

About the san1e tin1e

as penis gro\th
About t\.-vo years after
pubic hair appears
About san1e tin1e
as underann hair

Ag of I ir&l
Appearance (Year )
I . Growth of breasts

7- 13

2. Growth of pubic hmr

7- 14

3. Body growth

9 V2-14 V2

4. Menarche

10-16 1/ 2

5. Underarn1 hair

About t\vo years

after pubic hair

6. Oil- and sweatproducing glands

About san1e time

as underann
hair

Source: B. Gold tein , 1976.

SEXUAL MATURATION
Puberty brings with it a series of developments associated with sexual maturation. In both boys and girls,
the development of the secondary sex characteristics
is typically divided into five stages, often called Tanner
stages, after the British pediatrician who devised the

categorization system.
Sexual Maturation in Boys The sequence of
developments in secondary sex characteristics among
boys is fairly orderly (see Table 1.1). Generally, the first
stages of puberty involve growth of the testes and scrotum, accompanied by the first appearance of pubic
hair. Approximately one year later, the growth spurt in
height begins, accompanied by growth of the penis
and further development of pubic hair now of a
coarser texture and darker color. The five Tanner stages
of penis and pubic hair growth in boys are shown in
Figure 1.5.
The emergence of facial and body hair are relatively
late developments. The same is true for the deepening
of the voice, which is gradual and generally does not
occur until very late adolescence. During puberty, there
are changes in the skin as well. The skin becomes
rougher, especially around the upper arms and thighs,
and there is increased development of the sweat glands,
which often gives rise to acne, pimples, and increased
oiliness of the skin.
During puberty, there are slight changes in the
male breast to the embarrassment of many boys.
Breast development is largely influenced by the estrogen hormones. As noted earlier, both estrogens and
androgens are present i11 both sexes and increase in
both sexes at puberty, although in differing amounts.

In the male adolescent, the areola (the area around the

nipple) increases in sizt, and the nipple becomes more
prominent. Some boys show a slight enlargement of
the breast, although in the majority of cases this is
ten1 porary.
Other, internal changes occur that are important elements of sexual maturation. At the time that the penis
develops, the seminal vesicles, the prostate, and the bulbourethral glands also enlarge and develop. The first
ejaculation of seminal fluid generally occurs about one
year after the beginning of accelerated penis growth,
although this is often determined culturally rather than
biologically, since for many boys first ejaculation occurs as a result of masturbation ( J. Tanner, 1972). One
interesting observation about the timing and sequence
of ~ube~tal changes in boys is that boys are generally
fertile (1.e., capable of fathering a child) before they
have developed an adultlike appearance (Bogin, 2011).
As you will read in the next section, the opposite is true
for girls.

I Sexual Maturation in Girls The sequence of

d~velopmen~ of secondary sex characteristics among
g1rls (shown m Table 1.1) is less regular than it is among
boys. Generally, the first sign of sexual maturation in
girls is the elevation of the breast the emergence of

secondary sex characteristics The manifestations of sexua\

maturity at puberty, including the development of breasts, th
growth of facial and body hair, and changes in the voice.
Tanner stages A widely used system that describes the five
of pubertal development.

30

PART 1

The Fundamental Changes of Adolescence

'

Pe n is a nd Sc rotum

'-

~"'' 1~

'

Penis

-Scro tum
Glans (Head)

\
I

Testes

1
2
3
.
h" t '
.
.
.
f
bi rt h unti l puberty begins. Dunng t IS tme
Stage 1: The rnfa nt de stat e that pe rsrsts. ro m
. . tl
hange in general appearance.
1
t he genitalia inc rease slight ly in overa ll srze but there I S Jt e c
,
.
h

some
reddening
and
C11ange
rn
Stage 2: The scrotum has begun to enlarge. an d t ere IS
I

texture of the scrotal skin.

maller increase in breadth. There

5
h
d
Stage 3: The penis has increased in length an t ere rs a
has been further growth of the scrotum.
h
Stage 4: The length and breadth of the penis have increased further and thellakns as
developed. The scrotum is further enlarged and the scrotal skin has become ar er.

d
h
Th
ranee
of
the
genitalia
may
Stage 5: The genitalia are adu lt in srze an s ape.
e appea
h
.
d

I Ill

IJII

II/ I

satisfy the crit eria for one of t hese stages fo r a considerable time before t e pents an
scrotum are sufficiently d evelo ped to be class ified as belong ing to the next stage.

Pubic Hair

'

'

'

,I

Stage 1: Th ere is no true pubi c hair, altho ugh there may be a fine velus over t he p ubes
similar to th at o ver other parts of th e abdomen.
Stage 2: Sparse growth of lightly pigmented hair, which is usually straight or o nly slightly
curled. Th is usually begins at either side of the base of the penis.
Stage 3: Th e hair spreads over the pubic symphy sis and is considerably darker and coarser
and usually more curled.
Stage 4: The hair is no w adu lt in character but covers an area considerably smaller than in
m o st adults. There is no spread to the med ial surface of the th ighs.
Stage 5: The hai r is d istributed in an inverse t ri angle as in the female . It has spread to the
medial surface o f the th ighs but not elsewhere above the base of the triangle.

FIGURE 1.5

The five pubertal stages for penile and pubic hair growth. (From Morris & Udry, 1980)

the so-called breast bud. In about one-third of all adolescent girls, ho\vever, the appearance of pubic hair precedes breast developn1ent. The development of pubic
hair in females follows a sequence similar to that in
1nales generally, from sparse, downy, light-colored
hair to denser, curlier, coarser, darker hair. Breast development often occurs concurrently and generally proceeds through several stages. In the bud stage, the arcola
\vi dens, and the breast and nipple are elevated as a sn1all
n1ound. In the middle stages, the areola and nipple beconle distinct from the breast and project beyond the
breast contour. In the final stages, the areola is recessed
to the contour of the breast, and only the nipple is elevated. The female breast undergoes these changes at
puberty regardless of changes in breast size. For this

reason, changes in the shape and definition of the areola and nipple are far better indicators of sexualtnaturation an1ong adolescent girls than is breast gro\~th
alone. The five Tanner stages of breast and pubic hair
growth in girls are shown in Figure 1.6.
As is the case for boys, puberty brings in1portant internal changes for adolescent girls that are associated
with the development of reproductive capacity. In girls,
these changes involve developn1ent and growth of the
uterus, vagina, and other as11ects of the reproducti\~e
system. In addition, there is enlargen1ent of the labla
and clitoris.

1
As is apparent in Table 1.1, the growth spurt s
likely to occur during the early and middle stages of
breast and pubic hair development. Menardw, the

CHAPTER 1 B1ologtcat Trans1t~ons

www.mhhe.com/ ste1nberglOe

Breasts
1

Stage 1: No breast development

Stage 2: The first sign of brea~t development

has appeared. This stage IS somet1mes
referred to as the breast budding
stage. Some palpable breast t1ssue
under the nipple: the flat a1 ea of the
nipple (areola) may be somewhat
enlarged.

Stage 3: The breast 1s more dtstinct although

there is no separation between
conto urs of the two breasts.

Stage 4: The breast is further enlarged and

th ere is greater contour distinction.
The n ipple, including the areola, forms
a se condary mound on the breast.

Stage 5: Size may vary in the mature stage. The

breast is fu lly d eveloped. The contours
a re d istinc t and the areola has receded
into t he gene ral contour of t he breast .

Pubic Hair
1

Stage 1: No pubic hair.

Stage 2: There is a small amount of long pubic
hair chiefly along the vaginal lips.

Stage 3: The hair is darker, coarser, and curlier

and spreads sparsely over the ski n
around the vaginal lips.
Stage 4: The hair is now adult in type, but the
area covered is smaller than in most
adults. There is no pubic hair on the
inside of the thighs.
Stage 5: The hair is adult in type, distributed as
an inverse triangle. There may be hair
on the inside of the t highs.

FIGURE 1.6

The five pubertal stages for breast and pubic hair growth. (From ~1arshall & Tanner, 1969 )

beginning of menstruation, is a relatively late developnlent that reflects the culn1ination of a long series
of hor1nonal changes (Dorn et al., 1999). Generally,
full reproductive function does not occur until several
years after menarche, and regular ovulation follows
menarche by about two years (Bogin, 2011; Hochb~rg, Gawlik, & Walker, 20 II ). Unlike boys, therefore,
girls generaJly appear physicaJJy mature before they
are fertile.

MAKING THE SCIENTIFIC CONNECTION

Think about the changes in secondary

sex characteristics that take place at
puberty in humans. Why might we have
evolved so that puberty occurs outside
as well as inside the body?

31

32

PART 1

The Fundamental Changes of Adoles<.ence

RECAP

The adolescent growth spurt. wh ich takes place

about two years earli er among gi rl s than boys,
rnvo tves a rapid increase in height and weight.
Puberty brings with it changes in ratio of muscle to
fat, wrth marked gender differences in the way in
whrch body composition changes. The increase in
fat, which is greater among females than males, is a
source of concern to many girls.
Sexual maturation in both sexes is measured
according to Tanner stages, which are used
to chart the development of
~..
secondary sex
characteristics.

far more strongly correlat~d with ~eight and Weight

.
h'ldhood
than
w1th
the
tltn1
ng
of
pub
dunng c 1
etty .
. tilainen et al., 2001).
'
(p
however Ie
h . .
. the United States, there are et n1c. d1ffcrcn ces.
.1t 111n
W
. . and rate of pubertal maturatLon Sev
in the ttmtng
. . era1
udies
of
U.S.
youngsters
1nd1cate
th
St
large-sea1e
.
a~
,
mature significantly earher than Mex1c
5
1
Black tema e
.
an
.
ls who in turn, mature earher than \Art..
American gtr '
'
.
YV n1te
girls (Chumlea et al., 2003; Herm.an-GJ~den s et al.,
).
Although
the
reasons
for
th1s
ethntc
difference
1997
1 does not appear to be due to ethn
1
Wn
are not kn o ,
.
1c
differences in income, welght, or area of residence
(S. E. Anderson, Dallal, & Must, 20.03). One possible
explanation for the earlier maturation of non- \Vhit~
girls is that they may be more freq~ently exposed to

chemicals in the environment that strm~late ~arher pusuch

as
animal
hormones
contamed
1n
certain
b er ty'
h. h
b
hair care products, although t 1s as not een studied
systematically (Susman & Darn, 2009) .

The Timing and Tempo

of Puberty
You may have noted that, thus far, no mention has been
n1ade of the ''normal" ages at which various pubertal
changes are likely to take place. This is because variations in the timing of puberty (the age at which puberty
begins) and in the tempo of puberty (the rate at which
maturation occurs) are so great that it is misleading to
talk even about average ages.

VARIATIONS IN THE TIMING

AND TEMPO OF PUBERTY
The onset of puberty can occur as early as age 7 in girls
and 9~ in boys, or as late as age 13 in girls and 13 1h in
boys. In girls, the interval between the first sign of puberty and complete physical maturation can be as short
as a year and a half or as long as six years. In boys, the

comparable interval ranges from about two to five years

(J. Tanner, 1972). Think about it: Within a totally normal
population of young adolescents, some individuals will
have completed the entire sequence of pubertal changes
before others have even begun. In more concrete terms,
it is possible for an early-maturing> fast-n1aturing
youngster to complete pubertal maturation by age 10 or
11 two years before a late-maturing youngster has even
begun puberty, and seven years before a late-maturing,
slow-maturing youngster has matured completely!
There is no relation between the age at which puberty begins and the rate at which pubertal development proceeds. The timing of puberty may have a small
effect on one's ultimate height or weight, however, with
late maturers, on average, being taller than early maturers as adults, and early maturers, on average, being
somewhat heavier at least among females (St. George,
Willian1s, & Silva, 1994). Adult height and weight are

GENETIC AND ENVIRONMENTA L

INFLUENC ES ON PUBERTAL TIM ING
Why do some individuals mature relatively early and
others relatively late? Researchers who study variability
in the onset and timing of puberty approach the issue in
two ways. One strategy involves the study of differences
among individuals (i.e., studying why one individual
matures earlier or faster than another) . The other involves the study of differences among groups of adolescents (i.e., studying why puberty occurs earlier or more
rapidly in certain populations than in others). Both sets
of studies point to both genetic and environmental factors (Ge, Natsuaki, Neiderhiser, & Reiss, 2007).

Individual Differences in Pubertal Maturation

Differences in the timing and rate of puberty among
individuals growing up in the same general environment result chiefly, but not exclusively, from genetic
factors. Comparisons between individuals who are genetically identical (identical twins) and individuah
who are not indicate that the timing and tempo of ar
individual's pubertal maturation are largely inherite<
(Mustanski, Viken, Kaprio, Pulkkinen, & Rose, 2004).1
specific region on chromosotne 6 has been identified <
one of the markers for pubertal timing in both bo:
and girls (Bogin, 2011).
Despite this powerful influence of genetic facto'
the environment plays an important role. In all like
hood, every individual inherits a predisposition to c
velop at a certain rate and to begin pubertal mahtrati
at a certain time. But this predisposition is best thoul
of as an upper and lower age limit, not a fixed absoh
Whether the genetic predisposition that each per!
has to mature around a given age is actually re,lli~
and when within the predisposed age bou11darics sh

CHAPTER 1

hc ,H. 1u .Ill 1 gl l es f h ru II!' h 1 ll h ' r t )', i .., s u bj l t t n 1h c i n fl u ~lctll.JI 1\1 hu s. In this r ~s p cc t , th e tin1 11 ,( ll1.H1
1n H .ll HI I 1((.;' ' ) r p II h r (.\I U1 ,It lll d ( i 0 n '"' rc t h c prod ll c l 0 f
t

.u1 rntcr".h. t ion hL'' ' "('t n nttlllr'\' tJnd nurturl', beh~'ce n
0 ne \ A nc t i rn .11 t' 11 p .111 d 1hc l! n vi r o n nl c n t a 1 c 0 1H.l i _

oo n ~

und ~ , \Vhi"'h nne

[;~r

th e 1\VO

h t1S

d(!vcloped.

influ lfHC~ on pubcrLtllll.lturntiotl are nutrition and hcaJth.

r uhcrr ' ch.:~urt.J e.1rlier nrnong individunls who are bett r no tu ished ,tnd gro \v 1nore throughout their prenat 1i, inl:tnf, .uh.f ~hildhoo f yenrs ('f'erry, Ferris,'rehranifar,
\ i, d Fll 111, 2009 ). 1o l u rprisi ngJy, then, whereas
,,rJ ,,,ho , re taller or heavier th( n their peers n1atwe
Ll rlicr ( ~ L .eorgc ct a I. , 1994), delayed puberty is 111 ore
hl cl) to oc u r an1ong ind ivi duab \Vi t h a history of prot in and/ or calori c deficiency. hronic iJiness during
~hildh oo f and ~ldolcsccntc is also associated \'Vith dclt.l)'Cd pubert y, as is excessive exercise. For cxan1plc, girls
in ba11et on1panies or in other rigorous tTaining progr,lfll ofr t:n rnature Ja ter than their peers (Frisch, 1983).
Generally, then, after genetic f~1 ctors, the most itnpo.rtnn t detcn11inant of the ti1ning of puberty is the overal1
ph}' i al '''ell-being of the individual fron1 conception
through preadoJes(ence (Susn1an & l)orn, 2009).
lllO S I

itnpnrlnlll CllVif(H1111e11ltiJ

Fami lial Influences on Pubertal Timing In teTestingly, a number of studies suggest that social factors in the home environn1ent 1nay influence the onset
of n1aturation, especially in girls; in contrast, boys' pubertal Inaturation has not been consistently linked to
fnn1 ily functioning. Puberty occurs somewhat earlier
~uno ng girls who gre\v up in father-absent families, in
less cohesive or more conflict-ridden households, or
with a stepfather (Ellis, 2004); early puberty is also
more con1mon among girls who were physically or
sex ually abused during childhood (Mendle, Leve, Van
H.yzin, Natsuaki, & Ge, 2011; Trickett, Noll, & Putnam,
201 1). One explanation for the finding that family
conflict may accelerate pubertal maturation is that
tension in the family may induce stress, which, in turn,
1nay affect hormonal secretions in the adolescent
(Arim, Tramonte, Shapka, Dahinten, & Willms, 2011;
Belsky, Steinberg, Houts, & Halpern-Felsher, 2010;
Belsky et al., 2007), especially among girls who are geneticaJJy susceptible to this influence (Ellis, Shirtcliff,
I

Boyce, Deardorff, & Essex, 2011; Manuck, Craig, Flory,

Halder, & Ferrell, 2011). In addition, the presence of a
stepfather may expose the adolescent girl to pheromones (a class of chemicals secreted by animals that
stimulate certain behaviors in other members of the
species) that stimulate pubertal maturation. In general,. a~ong humans and other mammals, living in
proximity to one's close biological relatives appears to
slow the process of pubertal maturation, whereas
exposure to unrelated members of the other sex may
accelerate it.

Btologteal Transitions

33

AI! bough it may seem urprisi ng that omethi_ng as

biologi , I a'l puberty can be influenced by factors m the
soL ial c nvir on n1ent, s ient i l have long kn0\\'11 that ~ur
sol'ial rela tionships can indeed affect our biolog~c~l
fun ctioning. O n e of the best-known examples of t1_11S IS
that \-vom en '"rho live together
uch as dorinttory
roon1n1ates find that their tncnstrual periods begin t o
synchronize over t ime (C. Grah am , 199 1; McClint ocl,
1980).

I Group Differences in Pubertal Maturation

H.esearchers ty pically study group djfferences in puberty
by con1paring average ages of n1en arch e in different regions. Most of th ese studies h ave indicated that gen etic
factors play an extre n1ely srn all role in detern1ining
group differences in pubertal m aturation (Eveleth &
11tnner, 1990) . Differences among countries in the average rate and timing of puberty ar e more likely to reflect

differences in their environn1ents t11an differences in

their populations' gene pools (Bogin, 2011 ) .
'The influence of the broader environment on the
timing and tempo of puberty can b e seen in more concrete terms by looking at two sets of findings: ( 1) con1parisons of the average age of n1enarche across countries
and (2) changes in the average age of menarche over
time. (Although menarche d oes not signal the onset of
puberty, researchers often use the average age of menarche when comparing the timing of puberty across
different groups or regions, because it can be measured
tnore reliably than other indicators. )
First, consider variations in the age of menarche
across different regions of the world. Menarche generally is earlier in countries \Vhere individuals are less
likely to be malnourished or to suffer from chronic disease (Bogin, 2011 ). For example, in western Europe and
in the United States, the median age of menarche ranges
from about 121/2 to 13 1/ 2 years. In Africa, however, the
~edian ag.e ranges from about 14 to 17 years. The range
ts much wtder across Mrica because of the greater variation in environmental conditions there.

MAKING THE CULTURAL CONNECTION

Puberty occurs much earlier in industrialized countries than in developing
ones. How might this make adolescence vary around the globe?

The Secular Trend We can also examine envi-

~onmental influences on the timing of puberty by look-

Ing at changes in the average age of menarche over the

past two centuries. Because nutritional conditions have
p~eromones _A class of chemicals secreted by animals tha
st1mulate certatn behaviors in other members of the s ecies

34

PART l

The Fundamental ChangPs of Adolescence

The age at menarche

has declined considerably over the
past 150 years. This decline is known
as the secular trend. ( t\daptcd from
FIGURE 1.7

...__-.I _

-~

--~

17.0

L~velc th & ra nncr, 1990)

---

.....-.-

Germany
Norway
Sweden
Denmark
United St at es
Finland

16.0

--ro
V)
\....

Q)
~

--Q)

...c.

u
\....

15.0

ro

Q)

E
..._,

14. 0

ro
I
I

~ 14.0

<(

13.5

ij

I
13.0
13.0

12 0
1840

1860

1970

1960

1950
1880

1900

1920

1940

1960

1980

Year of menarche

unproved during the past 150 years, \Ve VvOuld e>..1)eCt tO

find a decline in the average age at n1 cnarche over titne.
This is indeed the case, as can be seen in Figure 1.7. This
pattern, kno,vn as the secular trend, is attributable not
only to in1proved nutrition but also to better ~anitation
and better control of infectious diseases. In most European countries, rnaturation has becoJne earlier by about
three to four Inonths per decade. For ex,nnple, in Nonvay
150 year~ ago, the average age of menarche n1ay have
been about 17 years. Today, it is behveen 12 and 13 years.
Sin1ilar decline have been observed over the same period in other industrialized nations and, n1ore recently,
i11 developing countries as 'veil (l\1a et al., 2009). The
secular trend is less \vell docun1ented an1ong boys, in

part becatrse there is no easily n1easured marker of puberty, like menarche. One unusual factoid that is consistent vvith the decli11e in the age of puberty an1ong boys
over many centuries, though, is the observation that the
average age at which boy experience their voice breaking

(a sign of male pubertal developn1cnt), based on reports

fro1n European children's choirs, dropped fro1n about 18
in the mid-1700s to around 10 1h today (l\1endle & Ferrero, 2012). The drop in the age of 1nale puberty appears
to be continuing, and has fallen during the past three
decades (Hern1an-Giddens et al., 20 I2).

secular trend The tendency, over the past two centuries, for
rndividuals to be larger in stature and to reach puberty earlier,
pnmarily because of improvements in health and nutrition.

The average age of rnenarche among American girls

dropped by about two and a half months benveen the
1960s and 1990s, most probably because of increased
rates of obesity (Salsberry, Regan, and Pajer, 2009); exposure to certain man-made chemicals in cosmetics,
food, and the environment that affect hormonal development (Hochberg et al., 2011 ) ; and changes in diet
(Rogers et al., 2010). The decline has been especially
marked a1nong Black girls (Salsberry et al., 2009). Scientists disagree about whether this trend toward earlier female puberty has continued in the United States
in recent years (Susn1an & Darn, 2009). There is evidence of a continued decline in the age of puberty
among girls as indexed by breast development and

n1enarche, but not as indexed by genital maturation or

the appearance of pubic hair (Aksglaede, S0rensen,
Petersen, Skakkebrek, & Juul, 2009; Biro et al., 2010).
One reason for these discrepancies is that puberty can
be 1neasured in Inany ways (Dorn, Dahl, Woodward, &
Biro, 2006), and what we conclude about the average
age of puberty depends on what indicator is used. Because the development of pubic hair (\vhich is influenced by a11drogens) is affected by different factors
than is menarche (which is int1uenced by estrogen and
progesterone), patterns of change over tin1e in each
would not necessarily be identical, especially if exposure to environ1nental chen1icals was driving the

change . since the san1e chcnliLals can have Efferent

effects on different horn1ones (Biro, Hunng ~t tlL
1
2006). In general, though, n1ost sLientists ,\gree tht\

w"vw rnhh

C!IAPTER l

om/5t mb 1glO

.ul} '"" h.HJ~' 's ill rhc:.-- .tvt r.t~ 1 e .1gc of 1 ub ,rty h.t ve bcell
nuadl lcY'i dr.tnl.Jtk in rc~ nt d .td s thnn they were in

rhc ctlrl} 20th L nlury, \Vhen th e vcrage age uf ne n.n"he drop f cd h>' .tho111 lour n1onth:; ev'C) ry dec<tdc
( Htt''> ll er .d., 20 I 0).
L

l NG THE SCJENTIFIC CONN ECTION

Some studies indicate that the secular

trend has been r11ore dramatic among
females than males. Why might this
be the case?

AP
The timing of puberty. as well as the rate at which
it occurs, is highly variable.
The timing of puberty is influenced by both genetic
and environmental factors. Among the most
important environmental influences are health and
nutrition. Generally, individuals who are healthier
and better nourished begin puberty at a relatively
younger age than their less healthy or more poorly
nourished peers.
Some evidence suggests that girls growing up
in single-parent families, stepfamdres, or families
in whrch there is a high level of conflict go
through puberty somewhat earlrer than their
peers.
The age at which puberty occurs has declined
over time, a phenomenon known as the llsecular
trend." This trend continues today in

The Psychological an~

Social Impact of Puber y
Pubert y can , ffect the ndolcsc nt'~ b "'h, vior and psychological funclioning in a nurnbcr nf ways (Brook::;Gunn, ,raber, & Paikoff, 1994) (sc(; Figure 1.8). I~irst,
the biological changes of puberty can have a direct effect on behavior. 1ncreases in testo terone at puberty
are directly linked, for exan1pJe, to an increase in sex
dri ve and . exual activity an1ong adolescent boys
(I Ialpern, Udry, & Suchindran, 1996). Cfhe in1pact of
honnonal change on girls' sex drive and sexual activity
is rnorc.:: con1plicated, as yod'H see in Chapter 11.)
Second, the biological changes of puberty cause
cha n ge~ in the adolescent's self- in1age, which, in turn,
n1a y affect how he or sh e behaves. Fo r cxan1ple, a boy
who has recently gone through puberty may feel more
grown up as a result of his more adultlike appearance.
rhis, in turn, rnay make hjn1 seek n1ore independence
fron1 his parents. He may ask for a later curfew, a larger
allo,.vance, or the right to make decisions about things
that previously were decided by his parents. As v-.re 'vill
see later in th is chapter, the physical changes of puberty
often spark conflict between teenagers and their parents, in part because of the \vays in which puberty affects the adolescent's desire for autonomy.
Finally, bio logical ch an ge at puberty transforms the
adolescent's appear an ce, which, in turn, may elicit
changes in h ow others react to the teenager. These
ch anges in reaction s may p rovoke changes in the adolescenfs behavior. An adolescent girl who has recently
matured physically m ay fi nd h erself uddenly receiving
th e atten tion of older b oys wh o h ad not previously paid
h er n1uch h eed. Sh e m ay feel n ervous about all t h e extra
attentio n and confused ab out h ow sh e should respond

to it. M oreover, she must n ow m ake d ecisio n s ab o ut

h ow much tilne she wish es to d evote to d ating and h ow
sh e sh ould b eh ave wh en ou t on a date.
Young people's reactio n s to the ch ru1ges b rought o n
by puberty, and oth ers' reactio ns to th em, are influ en ced

the United States and other

industrialized
countries.

FIGURE 1.8 The biological

changes of puberty can
affect the adolescent's
behavior in at (east three
ways.

Blo\og1cal lwnstons

35

Changes in
adolescent's
behavior

Hormonal

changes

Hormonal
chtnp&

Hormonal
changes

Changes in

Changes in

adolescent's
appearance

adolescent's
self-image

Changes in
adolescent's
appearance

Changes in
reactions of
others

Changes in
adolescent's
behavior

Changes in
adolescent's
behavior

36

PART I

fh f md rn

r t

t Ch n

of Adol

<'.n<

~c llO'\'cve r~ the hort tcnn consequences

'( U \\' I I SC ,
h d l
Of
)
, b e n1orc ta ing on t e a o e cent's farnl
puberty 111 } _
~1 y
than on th e dole... cent.

.II

I ' the huJ.adcr ~o j,,J c.::ll\ itonnunt, in v.rhilh n1~ '-~tgl!"

~1hflul ph ~~ ic~1l tlllf,lcth , rlc~.s, ~ u.tlit ',, nd t' uol nlatul.lth. n h.)ngc, nftcnrn.arl cdJ)' hnn1 ctrl ll> era. Although
it is ~-.iifll\.'1111 l t) irnngine .111 CJ"tl in \vhi'--h adole ~~nt~, cs1
0
p ci.tll}f girl:-;, did no t ob~t:s abou t their hape, .S IZl\. ~ d
1
~cx~al . lh11 .'' .tdolc ~ent females' preoc upatwn"' ~~
th r bod , 1 o rchltavely recent. phenon1cnon, ct ca~c
largely by n1nrk~etcrs of dothing, undenvcar, co 1netJc ,
\ eight lo .. prograJn "', and "fetnininc" product ( Brunlb rg, 1997). ~Contenlporary society's vie'v of pubert?'
and phy, i~caf rnaturation are expressed through tel:vt~ion con1n1ercial ro, ne\"' paper and 1nagazine advert' e-

n1ents, and depiction of }'Oung adolescents in fiJn1s and

other Jnedia. People cannot help but be influenced b}'
fhese in1ages, and th e expectations they associate with
puberty, ct$ '-veJI as the tnea ning they give it, detennine
the reactions puberty brings out in them.
Researchers have gcncralJy taken nvo approaches to
studying the psychologica I and social consequences of
puberty. 011e approach is to look at individuals who are
at variou ~ stages of puberty) either in a cross-sectional

study (in ' "hich groups of individuals are corn pared at

different stages of puberty) or in a longitudinal study
(in lvhich the san1e individuals are tracked over tin1e as
they znove through the different stages of puberty).
Studies of this sort exatnine the impact of puberty on
young people's psychological development and social

relations. Researchers n1ight ask, for example, whether

youngsters' self-csteen1 is higher or lower during puberty than before or after.
A second approach compares the psychological development of early and late maturers. As noted previously, there is large variation in pubertal tin1ing, and
individuals of the same chronological age, who are in
the same grade in school, may be at very different stages
of puberty. Researchers have been tremendously interested in whether the tin1ing of puberty affects the adolescent's psychological development. The focus of these
studies is not so much on the absolute impact of puberty as on the effects of differential timing of the
changes. Here, a typical question n1ight be whether
early maturers are n1orc popular in the peer group than
late maturers are.

THE IMMEDIATE IMPACT OF PUBERTY

Studies of the psychological and social impacts of puberty indicate that physical maturation, regardless of
whether it occurs early or late, affects the adolescent's
self-image, mood, and relationships with parents. As

. . .

study . A study that compares two or more groups

of tndrvrduals at one potnt in time.

~~~inal study A study that follows the same group of

lnd1v1duals over time.

nd
Self-Esteem
Although
resea
1
a
t
u
er
y
.
rcn
b
P
~
tllat
)uberty
ca
n
b
a
potcnttal
tressor
v~
t
th
ugge lS ~- 1
.
. .
dvcrse J'S)'chologJca 1 c nscqucncc , this.
tcn1po1arya
:.
.
. .
1~
t 15 couJJlcd w1 th other change tll
l
en
1
1
true on)'
.

at
I ,,.,
"t te adJ'ustrnent. In th iS respect, the tmpact or
nece- 1 a (

,
.
fu
.
.
1
en1
p
)rchologica
nctJOnlng 1s t
C
adole
'lU b erty on
"
.
.
.
o
p
xt lt sllaped by the social context 111 which Pu
a great e ei .
.
,
berty takes place ( usman & D?rn, ; oo9). The tmpact
of puberty on 111 enta1 health varies b) gender and aero
ethnic groups, with gi~ls n~ore ad~rersely affected than
with
vVhite
grrl
,
tn
particular,
at
greate
t ri k
and
S
t10y.. ) '

.
for developing a poor body 1111~ge (J. SJegel, Yancey,
Aneshensel, & Schuler, 1999). G1ven the prcitl;1u 1n in
conteinporary An1erican society placed on thinne ,
the increase in body dissatisfaction among \t\Thite girls
that takes place at puberty is, not surprisingly, linked
to specific concerns that girls have about their hips,
thighs, \Vaist, and \.veight (Ro enblum & Le\vis, 1999).
Interestingly, the way adolescents feel about their phys-

ical appearance when they begin adolescence retnains

remarkably stable over time, regardless of \vhether their
actual attractiveness changes (Rosenblun1 & Le\vi ,
1999).

1 Puberty and Adolescent Moodiness Although

an adolescent's self-image can be expected to change
during a time of dramatic physical developn1ent, as you
will read in Chapter 8, self-esteem or self-image is reasonably stable over time, with long and sturdy roots
reaching back to childhood. For this reason, some researchers have turned their attention to the impact of
puberty on more transient states, such as mood. One
reason for this focus is that adolescents are thought to
be n1oodier, on average, than either children or adults.
One study, in which adolescents, moods were monitored repeatedly by electronic pagers, for example,
sho,ved that their moods fluctuate during the course of
the day more than the moods of adults do (Csikszentmihalyi & Larson, 1984). Many adults assume that
adolescent moodiness is directly related to the hormonal changes of puberty (C. Buchanan, Eccles, &
Becker, 1992). Is there any scientific evidence that the
hormonal changes of puberty cause adolescents to be
moody or, for that matter, that these hormonal changes
affect the adolescenfs psychological functioning or
behavior at all?
According to several comprehensive reviews of research on hormones and adolescent mood and behavior, the direct connection between hormones and mood
is not very strong (C. Buchanan et al., 1992; Flannery,
Torquati, & Lindemeier, 1994). When studies do find a

connection between hormonal changes at puberty and

I
w w mhh

om/:

tnb r 10

John un ( ,,

I tJ J 1 I ,
1)1(111

lrl

ntnod

1n

If

I II

ul tl

Hit

p1ohl 111 111 I f I I

pl.t) ,, f " " '' r r lr , r
lh.Ju d' horrn u I
I
I' tl orr 19)
" tl rl
onL h
I n
r 1 1 I
tl
"unt 111HI lo \ I I
t I J
('u w .tl 1 rr u 1 ' I
rIJ11ollhiJ ( holl
In Ill 1 ord tl
(Hiolt'
111
11HH hr
'~ tor rn nnd 't r
of r'"h

cl

of

Lt)', c\

Ill{'

IHl L. I\ to h.1pprr1

in

r Hltty I J{t

JHOOd r1J1J' Ct:H to

tol l ivit i ~s

i~tl~tudij

e)<lt

1h n

t , <Hl

d wh

h
11

Ill

'

fr

to

adolescent mood or behavior, the effects are strongest

early in puberty, when the process is being '(turned on"
and when hormonal levels are highly variable. As we
will see in Chapter 2, there is increasing evidence that
pubertal hormones affect brain systcrns responsible for
en1otional arousal in ways that n1ake adolescents more
responsive to what is going on aro und them (Forbes,
Phillips, Silk, Ryan, & Dahl, 201 1; Masten et al., 20 11 ).
For exarnple, studies indicate that rapid increases in
many of the hormones associated with puberty such

as testosterone, estrogen, and various adrenal androgens n1ay be associated with increased irritability, impulsivity, aggression (in boys) and depression (in girls),
especially when the increases take place very early in
adolescence. One interpretation of these findings is
that it is not so much the absolute increases in these
hormones during puberty but their rapid fluctuation
early in puberty that may affect adolescents' moods.
Once the hormone levels stabilize at higher levels,
later in puberty, their negative effects appear to wane
(C. Buchanan et al., 1992).
Most researchers agree that the impact of hormonal change on mood and behavior in adolescence is
greatly influenced by environmental factors (A. Booth,

fi

11

lu<;~,happywh~nht

and . ngr)' wl n M ' " 1

re t( urar t than With rnt rn I
(S hneidcr ct al., 200 }.

Contrary to widespread belief, there is little evidence that the

hormonal changes ofpuberty contribute in a drama ft c way to
adolescent moodiness.

t r

r
J

Puberty and Change in Pattern o 51 ep

C) n c f, 1s i n a t i n g fi n di n g on hor n1 ) n
n d b h
r
in adolescence concern dole nt ' 1 prt: r n .
Mttny parents Lotnplain th( t their tecna cha\ r--n ...__
to bed too lc tc in the evening and 1 p in t
I
111
the rnorning, a pattern that b gin t
in rl
adolescence (.. ce Pigure 1.9). It no
pp r h t tl1
en1ergcnce of thi p ttern c II d
d I y d ph e
preference is driven by the bi logi I ch n c o puberty, and it i een not only in human , but in oth r

mamtnals as \-veil (Car kadon, 2011 ).

Falling asleep is caused by a c n1bin tion of biol gical and environmental fact rs. ne of the 1n t important is the sec retion of a horn1one in the brain called
melatonin. Ivlclatonin level chang naturally over the
course of the 24-hour day, n1ainly in re pon e to the
an1ou nt of light in the envir nn1ent. l. eeling of leepincs incr a and deer , \vith n1e\atonin level a
n1clatonin ri es, \Ve feel leepier, and a it fall , \\re ~eel
Inorc a\-vake. Over the cour""e of the day, '"'e foll w' a
s]ccp- wake cycle that i calibrated to change in light
and regulated by melatonin ecretion.
During puberty, the time of night at \vhich melatonin
levels begin to rise change , becoming later and later a
individuals Inature phy ically. In fact, the nighttime increase in tnelatonin tart. about t\1\'0 hour later among

delayed phase preference

A pattern of sleep characterized by

later sleep and wake times, which usua\\y emerges during puberty.
melatonin

sleepiness.

A hormone secreted by the brain that contributes to

38

PART 1

The Fundamental Chnnges of Adolescence

12:30
~
~

11:30

- -, Weekday bedtrme
- -, Weekend bedtime
- - Weekday wake trme

Q)

-~
~

Weekend wake time

10 30

8:30

Q)

E
.......
-o
QJ

cO

7:30
6:30

11

13

15

17

Child's age in years

Ch ildren's weekday and weekend bedtimes

and wake t imes, by age. (Ada1 Led frotn Snell el al., 2007)
FIGURE 1.9

adolescents '"ho have con1pleted puberty than atnong

tho')e who ha\e not ret cnten.:d puberty (Car kc1don (.; ..
Acebo, 2002).l\ a result of thi hift, indi,yiduaL becotne
able to stay up later before feeling JeepY. In fact, \vhen
aJlO\\ed to regulate their O\\'n sleep schedule (a lO
weekends), most teenager " \Viii stay up until around
1:00 A.l\L and Jeep until about 10:00 A . ~t. Becaust: th~
whole cycle of melatonin secretion is shifted later at puberty, this also Inean<; that once adoJc 'cent have gone
through puberty, they an: nore leep} eJrly in tht Jnorning than they lvere \I\'hen they vvere prepubertaL

Palling asleep is affected by .the environ1nent a

kno\\' it i Jnuch ea 1er to fall asleep h
we Jl as you
'
.
. I
'" en
.
d
rk
than
\4/hen
it 1 l r1g 1t. But when prA d
.1 roonliS a
'
...a 0
'
t into bt:d at night, they tend to fall a 1 ,
Jescents ge
.
.
eep
. k1
even if there IS son1et 111ng that they
very qutc Y
.
.
Want
c r
because
their
n1elaton1n
level
ar
to stay up l l0
e a\,
.ea d y 111g
h . After going through
puberty,
though
l
~
, )e .
.
.
1
1
elayed
titning
oft
1c Increase tn melno .
d
cause o fthe
c.
n111
.tt .ts caster
or individuals to stay up later, so that if th ere,
is sonlething n1orc exciting to do s~rf_ the Internet)
v.ouTube
talk
on
the
phone
lt Is not diffi
strearn a 1,
'

cu1t
to renlain a\Vc:lkt: craylor, jennJ., Acebo, & Car kadon
),
and
e
cientj~t
belie,~e
that
many
adole
~
50111
2005
ent , sleep deprivation sten1 directly from overu
of computers and cell phone (Punamaki, Walleniu:
Nrgard, aarni, & Ritnpela, 20_07), although the notio~
that adolescents' lack of leep 1.. due to overstin1ulation
at bcdtin1 c is at least 100 years old ( Matricciani, Olds
Blundcn, Rigney, & Williams, 2? 12). Thus, th_e tendenc;
for adolescents to stay up la tc ts due to the 1nteract ion
of biology ('\Nhich dt:la}'S tJ1e onset of sleepines ) and
the t:nvironincnt ( \vhich provide an impetus to tay
up). T'hi hift in sle p prefer nee", to a later bedtitne
and a later \\rake titne, begin to reverse around age 20,

at a ~lightly earlier age a n1ong fen1ale .. tl1an n1ale (Frev,

I3alu, Greusing, l~ot hen, & ajochen, 2009; Roennebc;g
et al., 2004) .
If gettin g up ea rly the nex t day were not an i~sue
staying up late wo uld not be a probletn. Unfortuna tely, n1ost tee nagers need to get up early on school
day , and the con1binati o n of stayin g up late and getting up early leads to ~ l cep depr ivation and daytime
lee pi ne ' . . T he shift in th e tin1ing of thl
melato nin cyL lc co ntrib ute to thi , because th e de rea'>c in melatonin that take~
pldcc in th e n1iddle of the night h,1ppen
late r aft er puberty than before. Thi~
)

mean) that when teenagers get out of bed

earl y in th e n1orning, their n1clatonin
levels are relatively higher than they are
at th sa n1e ti rn c of day fo r preadole cents. Indeed , one tudy found that ado1 Cl' nt w ' re 1 a t alert bet\veen t\} hour
of 8:00 and 9:00 .~1 . ( vvhen n1o t chool
tart ) and were n1ost alert after 3.00 P.M.
\vhcn th school day is over (R. Allen &
Mirnbell , 1990 ) . Sleep researchers estimate that , b' a use of early '"choo\ sttHt

time'-, ( dol s en ts get t\\'O ft: ,~l' r h nH.

of sl ep JJ r night wh n th
h lOl ' d'
b gin . than th ey di l lurin th l r l d1ng un1n1~ r 111 nth , ( ll a n ~e n J, n. ~ n,
s(hi ff, z t I l1 h c0 \Tich) 0 ). 1 hi"
has l ron1pte l ~Oll1 t; H1ll1llll1it its h> "lt
lay lhtir . hool start in tin1 or tl' 'nagtr
(Mitru , 1illrt o t,
1,lt eik, , _oo ).

Important changes in the sleep cycle take I

preference" causes adolescents tow I pace after puberty. Th,s "delayed phase
rnore tired tn the early morning I a~ to stay up later at night and makes thern jl't?l
lOUrs.

www.mhhe.com/steinberglOe

Intcrc~ti ng] y, the tendency lor i1aiividlhlls to go to

bed later d~ lhey bcco rne teenagers has bcctune stro nger
over the past 30 ye~1 r~ (lg lo\vs tein, h.'nni, Ivlo]inari ) &
Largo, 2003), p~rh,lps beca use th e ~1vailabi lit y of tclcv j _

sion. tht.' Int<:rnec ,ln? other 111ass n1cdia during latenight and early-nJorntn g houJ s has incrcctsed (Van den
Buick, 2004). rhi~ su gge 'ts thclt the late-night hours
1ept by n1any adolescents are at least sotnewhat volun ttJr y, rna de easier by the changes in the sleep centers of
the brain. (There is also evidence that exposure to light
depresses _n1clatonin secretion, so that staying up late

vith the hghts on or even staring at co1nputer o r TV

. reens \Vi lJ delay the rise in tnelatonin even n1ore.)
\i\Thatever the explanation, because teenagers, wake
tinte has not changed, but their bedtin1e has gotten
later, today's teenagers get significantly less sleep than
their co unterparts did several decades ago. Excessive
daytime sleepiness is ran1pant an1ong American teenagers, a finding that has been replicated in several countries, including Japan and Taiwan (Gau , Soong, &
Merikangas, 2004; Ohida et al., 2004).
Although individuals' preferred bedtime gets later
as they move from childhood into adolescence, the
amount of sleep they need each night remains constant, at around nine hours. Yet, one study of more
than 14,000 American high school students foun d that
fewer than 10% of the students got at least n ine hou rs
of sleep on an average school night and that m ore th an
two-thirds got seven hours or less (Eaton et al. , 20 10)
(see Figure 1.10). There is now a clear consen su s
among scientists that m ost teenager s are n ot getting
enough sleep and that inadequate sleep is associated in
adolescen ce with p oorer m ental health (Fuligni &
Hardway, 2006; Galambos, Dalton , & Maggs, 2009;

CHAPTER 1

Brological Trans1t1ons

Wa l k~r, 2009), 1norc d elinquency (Clinkenbeard, Sin1i,

bvans, & Anderson, 20 1 1), Jnore frequent injuries
(La n1 & Yang, 2007 ), being overweight (Seegers et al.,
20 1 1), and poorer school perforn1ancc (Fredrikse 1~ et
al. , 2004). ln one study, students who were earn1ng
grades of C or 10\ver were going to bed 40 min~tes
later and sleeping about 25 minutes less each nlght

than their classmates whose grade point averages were

B or better (Wolfson & Carskadon, 199RJ. l 'he stude nts with poorer grades also reported staying u~ a lot
later on weekends than they did on school ntghts;
other studies find higher rates of proble1n behavior
arnong adolescents who prefer to stay up later (SusIn an et al., 2007) .
Despite rnany adolescents, belief that catching up
on their sleep on weekends will make up for sleep
deprivation during the week, research indicates that
having markedly different bedtimes on weekends
versus weekdays contributes to further sleep-related
problems (Wolfson & Carskadon, 1998 ). (Actually,
the best thing teenagers can do to avoid problems
waking up on school days is to force themselves to

get up at the same time on the weekend as on school

days, regardless of how late they have stayed up. ) Not
surprisingly, sleep-related difficulties among teenagers are also linked to the consumption of caffeine
(Pollack & Bright, 2003) and tobacco (Patten, Choi,
Gillin, & Pierce, 2000), both of which are stimulants.
Ab out lOo/o of teen agers report chronic insomnia
(E. Johnson , Roth, Schultz, & Breslau, 2006 ), which
increases the risk of other p sychological problems
(R. Roberts, Roberts, & Duong, 2008 ) and for continued sleep difficulties in adulthood (Dregan &
Armstrong, 2010) .

MAKING THE .P RACTICAL CONNECTION

Some policymakers have called for delaying the time at
which the high school day begins, in view of new studies
on changing patterns of
sleep during adolescence.
Do you think this is a good
idea? Or should parents
just insist that their teenagers go to sleep earlier7

12th

11th

lOth

9th

40

80
100
60
Percent
Optimal ( ~ 9 h)
Borderline (8 h)
20

Insufficient ($;7 h)

FIGURE 1.10 Very few U.S. high school students get

enough sleep. (Eaton et al., 2010)

I Puberty and Family Relationships Research

into the impact of puberty on family relationships has
pointed to a fairly consistent pattern, namely, that puberty appears to increase co11flict and distance betwee11
parents and children. You should be aware, however,
that the "distancing, effect of puberty on adolcsce11tparent relationships is not as consistently ol)served i11

40

'

PART 1 The Fundamental Changes of Adolescence

eth n1c
tnlnorrty

cJanlthes
.
(Molina & Chassin, 1996;
Sagrestano, McCorn1ick, Paikoff, & I-Iohnbeck, 1999).
Atnong White farnilie~> however, several studies sh ow
that as yo ungsters n1ature frotn childhood toward the
middle of puberty, e1notional distance between thetn
and their parents increases, and conflict intensifies, especially between the adolescent and his or h er Inother
(La ursen, Coy, & Collins, 1998; Ogletree, Jones, & Coyl,
2002) . The change that takes place is reflected in an increase in '<negatives (e.g., conflict, con1plaini11g, anger)
a11d, to a lesser extent, a decrease in ((positives" (e.g.,
support, smiling, laughter) (e.g., Flann ery et al. , 1994;
Holmbeck & Hill, 1991). Although n egative interchanges may din1inish after the adolescent growth
spurt, adolescents and their parents do not iininediately
become as close as they were before the adolescents en tered puberty. Interestingly, puberty increases distance
between children and their parents in 1nost species of
monkeys and apes, and sotne writers have suggested

that the pattern seen in human adolescents may have

some evolutionary basis it h elps ensure that once they
m ature sexually, adolescents will leave home and mate
outside the family (Steinberg & Belsk)', 1996).
Because this connection between pubertal n1.atura tion and parent-child distance is not affected by the
age at which the adolescent goes through puberty in
other words, the pattern is seen an1ong early as vvell as
late maturers it suggests that something about pub erty in particular n1ay transfor1n the parent- child
bond. To date, we do not know whether this effect res ults from the hormonal changes of puberty (which
may make young adolescents more testy), fro m changes
in the adolescent's physical appeara11ce (which n1ay
change the way p arents treat their adolescent), or from
changes in adolescent psychological functioning that,
in turn, affect family relationships. Moreover, because
few studies of family relationships at puberty have examined multiple aspects of adolescent development
simultaneously, it is difficult to say whether the patterns of change in family relationships that 1nany studies have found do, in fact, result from puberty and not

from some other change taking place at tl1e same time

in the adolescent (starting junior high school) or in the
parent (going through a midlife crisis) (Paikoff &
Brooks-Gunn, 199 I ).
Whatever underlying mechanisn1 is involved, one
interpretation of these studies is that developments occurring around the time of puberty can upset interpersonal balances that are established during childhood,
causing temporary periods of disruption in the family
system. During a son's or daughter's childhood, families develop patterns of relationships that are comfortable and workable, but they 1nay find that puberty
disrupts the patterns to which they have grown accustomed. They have developed a certain way of disct1ssing
things a11d a certain way of including the childre11 i11

discus'iions. But as th e ch il(h cn ~~o tluough pul,.

they 1nay want to be treated n1orc J1kc adt~lt " and l \ " Y.
., I . .
l
l,IVt
f" .. 1;\
g reater say in fatnt y c ccts1ons. ...<.) llSl:qu<:ntly,
I
~'nll\l
may experien ce a tctnporary pcrtol of '-Onfl tc l OJ' t .
sion when sons and da ughtC'rs enter ca dy acl ol ~s . en

1 . l' . 1 I
Cl.:ncc
It rna~ take sonle tJn~ ~ t c~~ t 1C ll~C lV tL ua. and the r~lll1il ,
to achieve a new eqtuhbrtli iTI t.bct l L ke0 Jn\() H( Cot
Y
ll1\ thr
changes brought on by puhc rl y.

Pubertal Maturation and Peer Relatr

ships Puberty n1ay have an effect on relaticnl "}on..
.
} ll \)\
in the peer group, too. Boys and g1tls who arc ph .
'} 1 I
} .
YSJ.
cally mature arc n1orc lt <C y t 1an t 1e1r I t~~ 1nat \tre
peers to be involv:cd in c ros5-sex rotnantic activiti
such as having a boyfri end or girlfriend or going 0 :~
0 11 date 5 (Com pian, Gowen , & 1-laywa rd, 2004 L a\.
though this depends on the social norm<; of the ado.
}escent's peer group and the prevajling expectation s
about t11e age ~t which teenagers should begin dating
(Gargiulo, Att1e, Brooks-Gunn, & Warren, 1987). Pu .
bertal maturation is not associated with havin g pla.
tonic relationships with other-sex peers, however
(Co1npian et al., 2004) .
THE IMPACT OF SPECIFIC
PUBERTAL EVENTS
Several studies h ave focused specifically on adolescents' attitudes toward and reactions to particular
events at puberty, such as girls' reactions to menarche
or breast development and boys' reactions to their first
ejaculation.
In general, most adolescents react positively to the
biological changes associated with puberty, especially
those associated with the development of secondary sex
characteristics. One study of adolescent girls' attitudes
toward breast development, for example, found that the
majority of girls greeted this change positively (BrooksGUI1n, Newman, Holderness, & Warren, 1994).
Adolescent girls' attitudes toward menarche are less

negative today than they appear to have been in the past

(J. Lee, 2008), a cha11ge that may be attributable to the

increase in information about n1enstruation provided
in schools and in the media (Merskin, 1999). In general,
among today's adolescent girls, menarche is typically
accompanied by gains in social maturity, peer prestige, and self-esteen1 as well as by heightened selfconsciousness (Brooks-Gunn & Reiter, 1990). Nevertheless, 1nany young women have developed a negattve
image of menstruation before reaching adolescenl:e,
and they enter puberty with an1bivalent attitudes about
menarche a mixture of exciten1ent and fear (S. Moore,
1995). Generally speaking, girls whose n1others ,,n:
l1elpful and tnatter-of-fact in their response to nlrt~
arche report the n1ost positive n1en1ories of the (X pen
ence (J. Lee, 2008).

41
www. mhhc.com /st einberglO

Jntcn.'~ t i n g l '~ o n ~ s L n f !' lud ic.~s i11d ic .tt ~-:s that a

~tro n g JH?~. l t ivc.? hi~ts to \v,nd Ill (;; n.stru,ltion befo re n1e n .lf'- ht" Ill.l} .lt t u,1 1Jy be <1 !--~Lh.htted wi th g r eate r n1 enstrual
di,u Hnf~>rt.. l\.1c ns t rua J ~y n1 pton1s are reported to be

rnor e s~ ' t) ' c "l rn o ng \\ o n1cn \vho expect n1 cnstru ation

to h ttnLotnfo rtJ ble, a n1o n g g irls whose n1 o the rs lead
th 111 to bel ieve thtlt 111enstruatio n will be an unpleas,u11 or utH.. Onl f(Jrlc.l blc exp erience, and i n cultures that
J, 1hcl rncn~t ruation as an in1porta nt event. In Mexico
1nd in China, for exan1ple, \Vh ere atti tudes to ward
n 1 en~Jn:he n1ay be especially an1bivalent, n1enarchc 1n ay
h,n c a n adverse effect on girls' n1 enta l health, an effect
not generally o bserved in the United States (Bcnjet
&

Jfcrna ndez-Gu7rnan, 2002; Tan g, Yeun g, & Lee, 2003 ).

In addition , girls who experien ce 1nenarche early, relative to their p eers, who are othervvise unp repared for
puberty report 1nore n egative reactions to the event
(Koff & Rierdan , 1996; Tang, Ye ung, & Lee, 2004) .
Far less is known about boys' reactions to their first
ejaculation , an experience that we might consider analogous to m en arche in girls. Altho ugh most boys are not
very well prepared for this event by th eir parents or
other adults, first ejaculation does not appear to cau se
undue an xiety, em barrassmen t, or fear. Interestingly,
however, in contrast to girls, wh o gen erally tell th eir
mothers shortly after t h ey h ave begun m en struating
and tell their girlfriends soon thereafter, b oys, at least in
th e United States, d o not discuss their first ejaculation
with either paren ts o r friends (J. Stein & Reiser, 1994).
In other cultures, the even t m ay be experien ced somewhat differently. For example, o n e study of first ejaculation am on g ad olescent boys in N igeria found not only
that boys were n o t upset by the event but also that they
told their friends about the exp erien ce very soon after it
occurred (Adegoke, 1993 ). Cultural differen ces in boys'
responses to their first ejacula tion are likely related to
differen ces in how cultures v iew masturbation. As is the

case with girls and menarche, b oys' reactions to their

first ejaculation are more positive when they have b een
prepared for the event (]. Stein & Reiser, 1994).

THE IMPACT OF EARLY

OR LATE MATURATION

Adolesce11ts who 1nature relatively early or relatively late

stand apart from their peers physically and may, as a
consequence, elicit different sorts of reactions and expectations from those around them. Moreover, individual adolescents may be all too aware of whether they are
early or late relative to their age-mates, and their feelings about themselves are likely to be influenced by their
comparisons. One study found that early-maturing adolescents were more likely to be ((pseudomature"wishing they were older, hanging around with older
peers, less involved in school, and more oriented toward
their peers (Galambos, Barker, & Tilton-Weaver, 2003).

Because ofw ide vanabifity in the timing and tempo ofpuberty,

individuals of the same chronological age can have very different
physical appearances.

Indeed, adolescents' perceptions of whether they are an

early or a late m aturer are m o re stron gly related to their
feelings about th eir physical maturation than whether
th ey actually are early or late (Dubas, Gr aber, & Petersen,
1991). Further, adolescen ts' behav ior is related to h ow
old they feel, n ot simply to h ow physically mature they
are (Galambos, Kolaric, Sears, & Maggs, 1999) . Never theless, early and late m aturer s are o ften treated diffe rently by other s and vi ew them selves differ ently, a nd
they may, as a r esult, behave differently. As we sh all
see, however, early and late m aturatio n h ave differ ent
consequences in the immediate present a nd in the
long run, different consequences in different context s,
and, most in1portant, different con sequences fo r boys
and girls.

Early Versus Late Maturation Among Boys

Over the past 60 years, research on boys' pubertal

timing has usually found that early-maturing boys
feel better about themselves and are more popular
than their late-maturing peers (Graber, Lewinsohn,
Seeley, & Brooks-Gunn, 1997; M. C. Jones & Bayley,
1950; Richards & Larson, 1993), although a few studies
have found elevated rates of depression and anxiety
among early-maturing boys relative to their on-time
peers (Mendle & Ferrero, 2012; Negriff & Susman,
2011 ) and among boys who go through puberty especially rapidly (Mendle, Harden, Brooks-Gunn, &
Graber, 2010). Interestingly, however, although all adolescents are adversely affected by being bullied by their
peers, the impact of victimization is greater for early
maturers, perhaps because being picked on when one is
larger than average is all the more embarrassing
(Nadeem & Graham, 2005).

42

PART 1 The Fundame ntal Changes of Ado lese encc

1
. .1 f
n11t !' o

j)Ubcrt
y
earl
y
n"ttur
.
rs
experience 1..,..,
the
'
(>r(
,
t
c
i
11 t c n s c t c n 1 per t a fil t r u n1 !-i a nd
0
1
111
l
frcqucn ,llH.
.
<tc
.
(<

,
J'rod
y
(
~on
ger,
Suuon:-),
&
Murry
l ()(
pres~ ton
,c' >
'
)
>2
c;e cl nl. , 2003).
A

Early Versus Late M aturation in Girts In

tl 1c rni xed i1 npa ct thi:tt. earl y maturat1()n

ha s on th e psycbo)ogica l wcll -? etng <~ f boy), early..
.
g
gi
'
rJ
"
have
more
etn
ot1onal
d
tffi
cultJcs
tha
1nal ur1n
n
their peers, jncludin g J o~ered sel ~- tma~e and higher
rates of dcprc~~i o n , an x1cty, eat1ng d1 ~ord crs, and
panic ntta cks (Negriff & Su~m~n, 20 11 ~ . These diffi.
cultics secrn to have less to do w1th the dtrcct effects of
honnon e~ and n1 ore to do with th_e ways in which
standing apart fron1 their peers physically .affects girls)
feelings about th eir appearance an d soctal rela tion ~
ships with other adolescents (Mend] e et aL, 2007).
One recent study found , for example, that the impact
of early n1aturation was wo rse on girls wh o were
heavier than on their thinn er peers (Tanner-Smith,
20 1o) . There is also evidence that early maturation
in girls is associated with higher emotional arousal
(Graber, Brooks-Gunn, & Warren, 2006).

con t ras l

t()

:1

Although they are often more popular than thetr peers, early
maturing g1rls ore at greater risk for wide range ofemotional
and behavioral problems.

Although results of research on the psychological

effects of early maturation are mixed, it is quite clear
that early-maturing boys are more likely than their
peers to get involved in antisocial or deviant activities,
including truancy, minor delinquency, and problems
at school (Negriff & Susman, 2011 ). They are also
more likely to use drugs and alcohol and engage in
other risky activities (Dick, Rose, Pulkkinen, & Kaprio,
2001; Drapela, Gebelt, & McRee, 2006; Kaltiala-Heino,
Koivisto, Martutunen, & Frojd, 2011; Wichstr0m,
2001), even as young adults (Biehl, Natsuaki, & Ge,
2007). One explanation for this is that boys who are
more physically mature develop friendships with older
peers and that these friendships lead them into activities that are problematic for the younger boys (Negriff,
Ji, & Trickett, 20lla). Once involved with these older
peer groups, the early maturers' higher rate of delinquency and substance use increases over ti1ne through
their social contacts (Silbereisen et al., 1989).
Clearly, early-maturing boys enjoy some psychological advantages over late n1aturers with respect to
self-esteem and admiration fron1 peers during early
adolescence, when some boys have matured physically
but others have not. But what about later during adolescence, when the late maturers have caught up? At
least one study points to some interesting advantages
for late-n1aturing boys, despite tl1eir initially lower
popularity. Although early and late 1naturers exhibit
similar psychological profiles before they enter adolescence, during the time of pubertal 011set, and one year
later as well, late maturers show significantly higher
rati11gs on measures of i11tellectual curiosity, exploratory behavior, and social initiative. While they are in

Given the role of social factors in linking early maturation and girls' psychological distress, it is no surprise
that the ultimate itnpact of early maturation on the
young girl's feelings about herself appears to depend on
the broader context in which maturation takes place.
For example, studies of American girls generally find
that early-maturing girls have lower self-esteem and a
poorer self-image, because of our cultural preference
for thinness and our ambivalence about adolescent sexuality (Brooks-Gunn & Reiter, 1990). The negative
effects of early maturation on girls' mental health vary
across ethnic groups, however, with more adverse consequences seen amo11g White girls than their Black or
Hispa11ic peers, presumably because puberty is more
likely to lead to body dissatisfaction among White girls
(Negriff & Susman, 2011 ).
The ii11pact of physical maturation also depends on
the social context in which teenagers live (Negriff &
Susman, 2011). One study of suburban Chicago
youngsters, for example, found that girls' body image
was significantly higher in one community than in
another despite co1nparable levels of physical maturation between tl1e two groups. One factor that differentiated the two communities was cliquishness": In
the n1ore cliquish high school, girls were less satisfied
with the way they looked, perhaps because cliqui~h
girls place n1ore emphasis on physical appearance In
determining popularity (Richards, Boxer) Petersen, &
Albrecht, 1990). One recent study of both boys and girls
found that the adverse consequences of early pube~ty
were lin1ited to adolescents who can1e fro1n high-nsk
households (Lynne- Lands1nan, Graber, & Andrews,
2010b).

CHAPTER 1 Biological Transitions

www.mhhe.com /steinber g1Oe

Althoug h so n1 e early-1naturing girts 111ay have ~e.tf

irn,1gc difficulties, the ir popul ~trit y 'vith leer is not
jcop 1rdized . Indeed, son1c studies indicate that earl y
111 ,1turers ~tre n1ore popu lar than other girJs, especially)
a~ }ou \VOlt Jd expect, ' vhcn th l: ind ex of popularity
in Judes pop ularity \vith boys (S in1n1 ons, Blyth, &
~1tKinn '}', l98 3). llowcver, carly- n1aturing girls not
on I}' enj<>}' rnore popularity \Vith bo)'s, but are often the
1 tin1s of rtunors and gossip ( Reynolds & Juvonen,
2tH 1; Sontag, Graber, & C le n1ans, 201 1) and are n1ore
Jiker} to sutler from social anxiety ( Bhunenthal et al.,
201 1). Ironically, then, it n1ay be in part beca use the
earlv n1aturer is 1nore popular \vith boys
that she re.
4

orts
tnore
en1otional
upset:
Early
pres~ure
to
date
and,
1
perhaps, to be involved in a ~cxual relationship n1ay take
jt toll on the adolescent girrs 1nental health. Consistent
'.IVith this, research indicates that early- n1aturing girls

n1ore vulnerable to en1otional distress '~hen th ey

have relatively n1ore other-sex friendships (Ge, Best,
Conger, & Sin1ons, 1996) and \Vhen they are in schools
are

v.rith older peers (for example, sixth -graders who are in

a --chool that has seventh- and eighth-graders, too )
(Blyth, Simn1ons, & Zakin, 1985 ).

Psychologists have offered several explanations for

the fact that early maturation appears to be harder on
girls than boys (Negriff & Susn1an, 2011 ). One explanation is the ((maturational deviance" hypothesis. Simply
put, youngsters who stand far apart fron1 their peersin physical appearance, for instance may experience
more psychological distress than adolescents who blend
in more easily. Because girls n1ature earlier than boys,
on average, early-maturing girls n1ature earlier than
both their male and female peers. This makes them
stand out at a time when they would rather fit in and, as
a result, may make then1 more vulnerable to emotional
distress. This explanation would also account for the
lower self-esteem of late-maturing boys, who deviate
toward the other extreme.
A second explanation for the sex difference in the
impact of early maturation focuses on ((developmental
readiness." If puberty is a challenge that requires
psychological adaptation by the adolescent, perhaps
younger adolescents are less ready to cope with the
challenge than older ones. Because puberty occurs
quite early among early-maturing gir]s, it may tax their
psychological resources. Early maturation among boys,
because it occurs at a later age, would pose less of a
problem. This also helps to explain why late-maturing
boys seem better able than early maturers to control
their temper and their impulses when they are going
through puberty: They are relatively older and psychologically more mature (Peskin, 1967). If the developmental readiness hypothesis is true, both girls and boys

should experience more difficulty if they are early maturers than if they are on time or late, but the difficulty
should be temporary. This appears to be the case among

43

bov (for \vhoJn the negative effects of early puberty

.
.
If
b
1
cade)
but
not
for
occur dunng puberty I1St:: , ut t 1en Ji
,
gi rl (for \\'hon1 the negative effects of early puberty

persist ) (Ge et al., 2003)

. d
A final explanation for the relatively greater d1sa vantage of early tnaturation for girls concerns the cult ural desirability of different body types. (Pcters.en,

J988). Early tnaturation for girls 1neans leav1ng beh1n~

the culturally admired state of thinness. As not~d prev1~
ously, an1ong girls, the ratio of fat to tnuscle 1?creases
dnunaticalJy at puberty, and 1nany girls are d1stressed
\vhen they n1ature because they gain '"'eight. Early mat urers experience this weight gain at a time \vhen n1ost

of their peers are still girlishly thin. One interesti_ng

study showed that in ballet co1npanies where thlnness is even n1ore in1portant than in the culture at
large late n1aturers, who can retain the ((ideal" shape
n1uch longer than earlier tnaturers, have fe\ver psychological problems than even on-tin1e girls (BrooksGunn & Warren, I 985). In contrast, at puberty, boys

frotn a culturally undesirable state for males

(short and scra\vny) to a culturally admired one (tall
and n1uscular). Early n1aturers enjoy the special advantage of being tall and muscular before their peers a
special benefit in a society that values males, athletic
prowess and therefore are more likely to react well
to puberty. The fact that the effects of early maturation
on girls' self-esteem vary across cultures suggests that
contextual factors need to be taken into account in
explaining this pattern of sex differences.
Whatever the explanation, it's important for parents and school counselors to bear in mind that earlymaturing girls are at heightened risk for psychological
probletns, at least in the United States. Unfortunately,
as long as our culture overvalues thinness and encourages the view that females should be judged on the basis
of their physical appearance rather than their abilities,
values, or personality, the risks of early puberty will
probably endure. Adults can help by being supportive,
by helping the early-maturing girl recognize her
strengths and positive features physical and nonphysical alike and by preparing her for puberty before it takes place.
Like their male counterparts, early-maturing girls
are also more likely to become involved in problem behavior, including delinquency and drugs and alcohol
use; are more likely to have school problems; and are more
likely to experience early sexual intercourse (Boden,
Fergusson, & Horwood, 2011; Dick, Rose, Viken, &
Kaprio, 2000; Negriff & Susman, 2011) (see Figure 1.11).
This is true in Europe and the United States (Silbereisen
et al., 1989) and across ethnic groups within the United
States (Deardorff, Gonzales, Christopher, Roosa, &
Millsap, 2005). These problems appear to arise because
early-maturing girls are more likely to spend time with
n1ovc

older adolescents, especially older adolescent boys, who

44

FIGURE 1.11

E..vly- m3tLH ing

girl s ar:e rnor~ likely to use
toba cco, ( lcohol. and o ther
drugs than grrls who rrmture
on trrnc or late. ( F1 "'u' 1>it: k tt
.d., 2000)

70
U()

weekly
Nevc.;;:r

60

t:

E
V'l

50

00

c:
t"

40

0..

--

VI

......

30

0 .0

4-

+-'

c
(1)

20

10

~ 10

11

initiate them into activities that tnight otherwise be delayed (Haynie, 2003; Ncgriff et aJ., 2011 b ). One recent
study suggests that the link between early maturation
and girls, problen1 behavior n1ay be partly due to common genetic influences (i.e., genes that influence both
the tin1ing of puberty and involvement in delinquency)
(Harden & Mendle, 20llc). Another found that early
tnaturation leads to early sexual activity, which in turn
leads to delinquency (Negriff, Susman, & Trickett,
20llb).

Again, however, it is important to consider the role

of context in interaction with pubertal change. Although early-Inaturing girls generally are more likely to
engage in delinquent behavior than their late-maturing
peers, a study of New Zealand youngsters indicates that
this may hold true only for girls who attend coeducational high schools (Caspi, Lynam, Moffitt, & Silva,
1993). Early-maturing girls in all-female schools are no
more likely than late maturers to be involved in delinquent activities, presumably because there are far fewer
opportunities for delinquency in same-sex schools.
Thus, while early puberty may predispose girls toward
more frequent and earlier deviance, this predisposition
may be realized only in an environment that permits
the behavior such as a school or out-of-school setting
that places early-maturing girls in close contact with
older boys (Stattin, Kerr, & Skoog, 2011). Similarly,
among both boys and girls~ the impact of early maturation on problem behavior or depression is accentuated
when adolescents have many stressful life events, have
harsh and inconsistent parents, or live in disadvantaged
urban neighborhoods (Ge, Brody, Conger, Simons, &
Murry, 2002; Ge, Conger, & Elder, 2001; Obeidallah,
Brennan, Brooks-Gunn, & Earls, 2004). This helps
explain why the impact of early maturation on problem behavior is relatively greater among minority
adolescents, who are more likely to live in poor commu-

12
13
Age at menarche

14

~15

nities (Negriff & Susman, 2011), because studies that

take community context into account sometimes find
that early maturation has no adverse effects on Black
girls (Carter, Caldwell, Matuska, Antoinucci, & Jacksonl
2011; DeRose, Shiyko, Foster, & Brooks-Gunn, 201 1).
The earlier involvement of early-maturing girls in
problem behavior may adversely affect their long-term
educational achievement and mental health. In one
study of Swedish girls, the researchers found that the
school problems of early-maturing girls persisted over
time, leading to the development of negative attitudes
toward school and lower educational aspirations. In
young adulthood, there were marked differences between the early- and late-maturing girls' levels of education; for example, the late-maturing girls were twice
as likely as early-maturing girls to continue beyond
the compulsory minimum number of years of high
school (Magnusson et al., 1986). In a different study of
American girls, researchers found that won1en who had
been early maturers reported higher levels of psychological distress and were more likely than others to have
experienced a serious mental disorder at some point
in adolescence or young adulthood (Graber, Seeley,
Brooks-Gunn, & Lewinsohn, 2004).

MAKING THE CULTURAL CONNECTION

Consider the research on the

psychological consequences of early
versus late maturation in males and
females. Most of this research has
been done in the United States. Are
the effects of being early, on time,
or late likely to be similar in different
parts of the world?

ww mhhe co111/ s t lnberglOc

RECAP
Although gotng through pub r ty 1r1 and of 1ts If 1s
not ord1n r1l stressful. sorn ev tdence suggests
that dolesc nts rnay b rnoodier durtng p nods
f rap1d ch n es in pub~- r tal ho rn1ones. In general,
thou h. stre s 1n the envlrontnent 1s a much
tronger influence on adolescent mental health
than IS puberty.
fmpor tant c hanges in pat terns of sleep t ake place
at puberty. As the result of the emergence of a
delayed phase preference,'' after puberty. adolesents tend to stay up later at night and s leep later
1n the morning.
Family relationships frequently become temporarily
more strained and distant during the early stages of
pubertv.
Among boys. early mat uration is associated with
popularity. htgher self-esteem: and more selfconfidence. but also w1th higher rat es of problem
beha tor.
Among gJrls. early maturation is associat ed with
higher rates of pro blem behav io r, w it h psychological
distress. and with emotional difficulties.
In both sexes, the impact of early or late
maturation depends on the
social context in
which it t akes

place.

Obesity and Eating

Disorders
Although a variety of nutritional and behavioral factors
can lead to weight gain during adolescence, weight gain
sometimes results directly from the physical changes of

puberty. Not only does the ratio of body fat to muscle

increase markedly during puberty, but the body's basal
metabolism rate the minimal amount of energy one
uses when resting also drops about 15/o. A person's
weight is partly dependent on this rate.
Because adolescence is a time of dramatic change in
physical appearance, teenagers' overall self-image is very

much tied to their body image. In light of the tremendous emphasis that contemporary society places on being thin, particularly for females, the normal weight
gain and change in body composition that accompany
puberty leads many adolescents, especially girls, to become extremely co11cerned about their weight.

OBESITY

Many adolescents, of course, have legitimate concerns

about being overweight. The easiest way to determine

\vh e th er o n1eone i~ o,erweight is to calcolate. h_i . or

her body rna s inde" (BMJ ), vlhich i~ don~ by d iVJdtn g

d
.
k'l
ngran1s
b)'
the
the pet sons '"' c 1ght, 1neasure u1 1 c
,
squar~ of the l crson',., height, n1ea<;ured in n1et.crs. lndi vjd u" Is are con,idercd ob c if th ir BMl 1~ at or
above the 95th ptrc ntile for people ot .the sa~e age
1
, nd gcnd~r, at gr .. at risk for obc ity if ~eJr ~ 1[ ~ at or
above th e 90th percentile, and over'"''ttght 1f their B Ill
is at or a bove the 85th percentile (Zametki n, Zoon,
Kl ein & ~1 u nson. 2004 ). (Charts showing the BM l cutoffs for n1ale.s and fe1nales of different age can ~e
found at WW\v.cdc.gov/gro\vthcharts.) Using this definitio n , n1o re t han one-sixth of adolescent in the
United States are obese (Ogden, Carroll, & Flegal,
2008) and an oth er 150ft) are at great risk for obesity, a
rate that has increased substantially over t he past 30
years (Spruijt-M etz, 2011) (see Figure 1.1 2) . Conl -

pared to their peers in the mid-1960s, the average

IS -year-old boy to d ay is 15 pounds heavier, a nd the
average 15-year-old girl is 10 p o u n d s h eavier increases that are far greater than coul d possibly be due
to ch anges in height. Obesity is no\A~ considered the

single most serious public health problem afflicting

American teen agers, and, unfortunately, there is no
evidence that the situation is getting any better (thankfully, it isn't worsening, either) (Ogden, Carroll, Cu rtin , Lamb, & Flegal, 201 0; Spruijt-Metz, 2011 ). By som e
estimates, the adolescent obesity epidemic '\.vill cost the
United States more than $250 billion as a result of
obese individuals' lost productivity and direct medical
costs in adulthood (Lightwood, Bibbins-Domingo,
Coxson, Wang et al., 2009). Th e increase in adolescent
obesity has been especially dramatic am on g Black
females (H. Lee, Lee, Guo, & H arris, 2011 ). The adolescent obesity epidemic is by no m eans limit ed to the
United States, however, and has b een documented in
many other industrialized and developing n atio n s
(Jesser, Turbin, & Costa) 2010).

Correlates and Consequences of Obesity

Current research indicates that obesity is a result of
the interplay of genetic and environmental factors
(Zametkin et al., 2004). Recent neuroimaging studies
find that individuals at risk for obesity show relatively
greater activation of the brain's reward centers in general, heightened responses to images of food, and
poorer impulse control (Batterink, Yokum, & Stice,
2010; Stice, Yokum, Burger, Epstein, & Small, 2011) .

basal metabolism rate The minimal amount of energy u

the body during a resting state.

body mass index {BMI)

A measure of an individual's bod

ratio of weight to height; used to gauge overweight and o

46

PAH r 1

1h(? r t~ndc m nwl Ch ng

of Ado I ~',',)'"

45 ~=-

Th rnte of obe~ity
among Am(\rican adolesc nts has
rts ~n steadily over the past sevFIGURE 1.12

--~--------------~.---:~W:r:,it=e----~~-----~

~~~~~~~~
H~is~n~ic~/~La~t~
m~O~=--r~--~
Afr tcan AnH~ r rcan

40

35-----------------;~--

eral decades. (!'pruqt l\h' t7, lO ll )

30--------------J..J

cQ)

(i)

25----20 ----r--r-

0-

15
10

50-

1986

Obesity is especially prevalent among poor youth and

an1ong Black, Latino, and Native Alnerican adolescents
(Burdette & Needham, 20 12; Huh, Stice, Shaw, &
Boutelle, 20 12; Miech et al. , 2006; K. A. T. Wickrama,
Wickrarna, & Bryant, 2006 ). There is also worrisome
evidence that, with each successive generation born in
the United States, Latin o youth show increasingly
poorer nutrition (M. L. Allen et al., 2007) .
Research on the psychological co11sequences of obesity has not led to consistent conclusions, in part
because the psychological correlates of being overweight vary across ethnic groups, with more adverse
correlates seen among 'White and Hispanic than among
Black adolescents (BeLue, Francis, & Colaco, 2009;
Leech & Dias, 2012 ). And while some studies show
higher levels of psychological distress (such as depression and low self-esteem) among obese individuals,
many studies show no such effect, and some research
indicates that depression leads to obesity, rather than
vice versa (Zametkin et al., 2004). In addition, the longterm psychological consequences of obesity in adoles-

cence appear to be greater for females than n1ales,

perhaps because overweight girls are teased more than
overweight boys (M. Merten, Wickrama, & Willia1ns,
2008; Taylor, 2011; Vogt Yuan, 2010). This harassment,
like other forms of bullying, can disrupt adolescents'
academic performance; one study found, for example,
that obese girls were less likely to enter college than
other girls, but that no such pattern existed among boys
(Crosnoe, 2007). Nevertheless, because nearly 80/o of
obese adolesce11ts will be obese adults, obesity during
adolescence places the individual at n1ucl1 higher risk
for other health problems, including hypertension
(high blood pressure), high cholesterol levels, diabetes,
and premature death (Institute of Medicine, 2006;
. landers, Ward, & ]emal, 2011). The good news is
that the long-term health consequences of adolescent

1990

1996

1999 -oo

2001-02

2003-06

2007-oa

obesity disappear among individuals who are not obese

as adults (Juonala, Magnussen, & Berenson, 2011 ).
Although genetic factors are important contributors, the dramatically increased prevalence of adolescent obesity over su ch a short time period indicates
that the problem has strong environmental causes.
Indeed, it is not at all difficult to understand why so
many American ad olescents today are overweight.
Studies show that too many adolescents eat far too
much high-calorie, low-fiber food (drinking far too
many sugary soft drinks and consuming far too much
junk food), and too few are physically active, spending
far too much titne with television, vid eo games, or the
computer (Barnett et al., 2010) and not enough time
playing sports (Olds, Ferrar, Schranz, & Maher, 2011).
One recent study of American youth (Nader, Bradley)
Houts, McRitchie, & O'Brien, 2008) found that the
amount of time individuals spend in moderate-tovigorous physical activity falls from 3 hours per day
at age 9 to only 49 minutes on weekdays and only
35 1ninutes on weekend days at age 15 (see Figure

1.13). In addition, as noted earlier, inadequate sleep

also contributed to weight gain, and greater nighttime technology use, which we will look at in Chapter
7, has led to i11creases in the numbers of adolescents
who are sleep-deprived. The combination of poor nutrition, insufficient exercise, and inadequate sleep is a
recipe for obesity (Spruijt-Metz, 2011). And because
adolescents tend to affiliate with peers who share their
tastes and interests, obese teenagers are relatively more

likely to have obese friends, which may reinforce bad

behavioral habits (Vale11te, Fujimoto, Chou, & SpruijtMetz, 2009). Indeed, one recent study found that attending a high school where a large proportion at
juniors and seniors were obese significantly increased
4

the likelihood that the freshn1en and sophon1ores

would be obese, too (Leatherdale & Papadakis, 2011).

W\

Cti AP l 1 R 1

\\.mhh .com / st inbc rg lOt

a1o logtcal

fransttions

100

l90

W rkdays

180
170

Boys

Gtr Is
Weekend clays

160
"')

\.C:P

1 tO

BO

~
0
V'l

~
c

-=x==

J '-10

Boys

- - Gtr Is
- - Daily recommended
MVPA for children

1)0
110
100
90

E ao
~

(])

70

60 - - - - - - - - - - 50

----------------

40
30
20
10

10

11

12

13

14

15

Age (years)
FIGURE 1.13 Between ages 9 and 15, there is a dramatic decline in the amount of time individuals spend in moderate-tovigorous physical activity (MVPA). (Nader et al. , 2008)

Much recent
attention has focused on the availability of unhealthy
foods and beverages in and near American schools
(Rovner, Nansel, Wang, & Iannotti, 2011) . One study of
500,000 California adolescents found that students
attending schools that were in close proximity to fastfood restaurants were significantly more likely to be
overweight (B. Davis & Carpenter, 2009) . Manufacturers of high-calorie and high-fat foods also have been
criticized for marketing these products to younger children, because food preferences are known to develop
largely during early childhood (Institute of Medicine,
2006). Of course, although schools and advertisers undoubtedly influence what children and adolescents eat
and drink, the bulk of what children and adolescents
put into their mouths comes from their own homes,
and studies suggest that obesity is less likely to develop
among adolescents who have good relationships with
their parents, probably because they are more likely to
share family meals where healthy food is served (Berge,
Wall, Loth, & Neumark-Sztainer, 2010; Hammons &
Fiese, 2011). In addition, the availability of parks and
recreational facilities is linked to lower rates of obesity,
as is parental encouragement of exercise (Spruijt-Metz,
2011). Taken together, these studies indicate that
preventing obesity will require multifaceted efforts
involving parents, the mass media, food and beverage
manufacturers, restaurants, schools, and communities.
I

Preventing and Treating Obesity

Cross-cultural studies show that, although rates of

obesity may differ from country to country, the factors

that contribute to obesity are similar in different parts
of the world (Jessor et al., 2010).
Research has also evaluated a variety of approaches
to individual weight loss, including behavioral therapy
designed to gradually alter patterns of diet and exercise and medications designed to promote weight loss.

Obesity is by far the most common eating disorder among-.

adolescents.

48

PART 1 The Fundc1mental Changes of Adolescence

~r~d ('\ ,duation"' indicatl: th<ll the (011Jbination of

belhn tor nlodttic~.ltion ,1nd \vcight loss rnedication is.
nlo' c ett"ccti' c than either co1nponcnt by itself
s\.\ \

~ B('rk{_n' itz, \\ "1dden, TershtlkoYec, & Cronquist, 2003;

""h,lnOine, HatnpL Jensen, Boldrin, & I Iauptn1an,
~005 ). .~!though there is eYidencc suggesting Lhat
L)flle '"-eight lo~~ progran1s work, there is vvide van abilitv in .. ucces r~te . depending on the nature of the
progran1 ( ... ar" rer & Dill'"!>, 2012; Stice, Shaw, & l\1drtt,
200b ). Radical \1pproaches to \Veight control fad
diet Jnd the like actually increase, rather than decrea --e, obesity ( eun1ark- ztainer, V\'all, Story, &
tandi "h, 201 ~; tice, Pre~nelL h,n,y, & Rohde, 2005;
Zhang et al., 2011 a).
~

ANOREXIA NERVOSA, BULIMIA,

AND BJNGE EATING DISORDER
Health care prote .. ~ionals are concerned not only abou t

a dole cent . ,,ho are obese but also about adolescents

\ \7 ho
have unhealthv attitude t01\'ard eating and
tO\\'ard their body in1age ( . French, tory, Downes,
Re nick, & Blun1, 1995 ). Onlv' about one-fourth of
An1erican adolescents are highly satisfied \Vith their
body (A. Kelly, \\Tall, Eisenberg, tory, & eumarkztainer, ~005 ) . Egged on by advertisers, 'vho pron1ote
the idea that ((thin is beautiful," n1any adolescents respond to norn1al bodily changes at puberty by dieting,
often unnecessarily (Brumberg, 1997). 1-fore than half
of all adolescent girls consider then1selves over\veight
and have attempted to diet (.l\-1. Fisher et al., 1995). One
study found that 14o/.o of fen1ale college undergraduates
\Vere o concerned about eating that they were embarrassed at buying a chocolate bar in a store (Rozin,
Bauer, & Catanese, 2003)! Gender differences in concerns about \Veight en1erge long before adolescence
(Phares, Steinberg, & Thotnpson, 2004) .

Psychologists use the term

disordered eating to refer to unhealthy eating attitudes
and behaviors. Disordered eating can range fron1 unnecessary preoccupation with weight and body i1nage
I

Disordered Eating

disordered eating

Mild, moderate, or severe disturbance in eating

habits and attitudes.

anorexia nervosa

An eating d isorder found ch iefly among

young women. characterized by d ramatic and severe self-induced
weight loss.

bulimia

An eating d isorder found primarily among young women,

characterized by a pattern of binge eating and extreme weight loss
measures, including self-induced vomiting.
An eating d isorder characterized by a
pattern of binge eating that is not accompanied by drastic attempts
to lose weight.

binge eating disorder

to fu ll-blown clinical eatin g disorder~, s~ch as anorexia

. .~ Research shows that d1so t d ered eahn .
and bu 1illlhL
l d
g Is
. d 'th range of stress-re clte psycholog1
associate w1 a
.
d
.
cal
.
-luding
poor
body
nnage,
epress1on
ale
en1s,
u1c
.
.
'
a
.
ro
bl
P
.
use
and
poor
1nterpe1
sonal
relatio
Co
hoi an d tob ac
'
n..
.
(E'
h
Conner
Daly,
&
Fauber,
20 12~ Grab
sh 1ps 1C en,
'
.
er)
_
G
Paikoff
& War ren, 1994; Neumark
Broo k s- unn, '
'
.
..
.
Story Dixon, & Murray, 1998 ). It 1s not dear
\S
. zta1ner,
,
,
d
1
,.,
er
these
prob
etns
prece
e
or
fon
0
ho\vever, w l1 eth
fron1 disordered eating (Leon , Fulkerson, Perry, Keel, &
Y'f

Kltunp, 1999)
.
Studies of magazines atnle~ at women an~ adoles ..
cent girls reveal clear and coi:stste~t tnessa~es m1plying
that women can not be beaut1ful w1thout be1ng shm and

promotin g a range of weight loss products (Davison &

McCabe, 201 1). Between 1970 and 1990, Inoreover, iinages presented in these n1agazines' advert~sements
changed, with the ''ideal" body shape becomrng slim..
1ner and less curvaceous (Guillen & Barr, 1994). Exposure to con1 n1ercials containing images of females with
idealized thin bodies increases girls) dissatisfaction with
their own bodies (Hargreaves & Tiggemann, 2003). Interestingly, among Hispanic girls, those who are 1nore
acculturated ('(Americanized,) are significantly more
likely to develop disordered eating than those who are
less acculturated (Gowen, Hayward, Killen, Robinson, &
Taylor, 1999). Girls whose mothers have body in1age
problerns are especially likely to engage in extreme
weight loss b ehaviors (Ogle & Dan1horst, 2003), as are
those who report more negative relationships with
their parents (Archibald, Graber, & Brooks-Gunn,
1999).

Son1e young women become so concerned about

gaining weight that they take drastic and dangerous measures to remain thin. In the more severe
cases, young women who suffer from an eating disorder
called anorexia nervosa actually starve themselves in
an effort to keep their weigl1t down. Others go on eating binges and then force themselves to vomit or take
laxatives to avoid gaining weight, a pattern associated
with an eating disorder called bulimia. Adolescents
with these sorts of eating disorders have an extremely
disturbed body in1age: Tl1ey see themselves as overweight when they are actually underweight. Sotne anorexic youngsters may lose between 250/o and 50;o of

their body weight. As you might expect, bulin1ia and

anorexia, if untreated, lead to a variety of serious physical problems; in fact, nearly 20o/o of anorexic teenagers
inadvertently starve themselves to death.
A newly identified disorder, called binge eating
disorder, has recently been defined (Stice, Shavv, &
Ocl1ner, 2011 ). Individuals with this disorder binge eat
and feel distressed about doing so, but do not tr}' to
con1pensate for their binges through ext rcn1c \vcight
loss Ineasures. As a consequence, individuals '''ith hin~e
eating disorder are at high risk for dt'vcloping obesity.

CHAPTER 1

lkt.t t t s~o' th ~ d1 ~o rd er h a~ l)nl y bel'll def1 ncd rece ntl y,

1hen i.~ vc,.y I i tl k rcsca rd1 n 11 its L .tuses, co rrd a te~ , or
r 1<..'~I Ill l<;.' J1t.

1\norcx in .uHf hulir11ia each bega n to receive a gr cnl

Je. 1 1 ~, ( pop uf ~tJ' :tll cntio n du d ng the 1980s, because of
thci1 drn 1natic n.llurt and lhei r frequ ent n.ssociatio n in
thr: n1.1ss JlH_di ;l \vi th c.clcbr iti cs. Pe rh ~1 p s been usc of this
,1flcn tio n, initi,1l report s ch nrnc..tcrizccl th ese en ting disorders ~l ~ bei ng of cpidcn1it pro po rti on. Although un heldt h}' e: ~ttin g nnd unn cce~~a ry dieti ng are prevalent
:H11ong lt:cnagcrs, C41rcful studies indicate that the incjdencc of t linically defi ned anorexia a nd bulin1i a is
Ml1:1 JJ (Stice ct aJ., 20 1 1). Fewer than l 0!0 of ad olescents
t~rc ;t norr xic, dnd only about 3/o a rc bulitn ic (Sti ce

et a1., 20 11 ) . Rates Jn1 ong fcn1 alcs arc substantially

higher tha n an1 on g n1 alcs anorexia and bulitnia are
10 r in1rs rnorr prevalcn t a1non g adolescent girls than
bo}'S (Stin.~ ct ~:11. , 20 11 ) , altho ugh the fetn ale-to-tnale
ratio i~ substantially sm aller wh en less severe fortn s of
these disorders are considered (Muise, Stein, & A rbess,
200.3; Ricciardelli & 1v1cCabe, 2004). Unlike an orexia
and bulitnia, binge eatin g disorder is only slightly n1ore
prevalent arr1 ong fc1n ales than 1nales, which suggests
that it tnay h ave an entirely differ ent etiology.

I Body Dissatisfaction Although the incidence

of anorexia and buliin ia is small, the prop ortion of adolescents who are unhappy with their body shape or
wejght is not. In one study, for exa1nple, m ore than onethird of girls whose weight was considered normal by
medical and health standards believed that they were
overweight including 5% who actually were underweight by medical criteria. (In contrast, fewer than 7o/o
of norn1al-weight boys and no underweight boys described themselves as being overweight.) In this study,
1nore than 70% of the girls reported that they would
like to be thinner than they are (as opposed to one-third
of the boys), and more than 80o/o said that being thinner

would make then1 happier, more successful, and more

popular (Paxton et al., 1991 ). Dissatisfaction with body
shape and weight is likely to lead to the development of
eating problems (Attie & Brooks-Gunn, 1989), depression (Stice & Bearman, 2001; Stice, Hayward, Cameron,
Killen, & Taylor, 2000), and the initiation of smoking
(Austin & Gortmaker, 2001; Fulkerson & French, 2003;
Stice & Shaw, 2003). More than half of high school girls
have engaged i11 some form of unhealthy behavior (e.g.,
fasting, smoking, vomiting after eating, using diet pills)
in order to lose weight (Croll, Neumark-Sztainer, Story, &
Ireland, 2002). Taken together, these findings have led
son1e writers to suggest that we think about disordered
eating on a continuum, ranging from dieting that may

be p~rfectly sensible and healthy, to disordered eating

that Is unhealthy but not psychopathological (i.e., at a
level requiring treatment), to full-blown anorexia or
bulimia (Tyrka, Graber, & Brooks-Gunn, 2000).

Biological Transitions

49

.1. , 1 eight during puU n fort unatcly, n1any gu s gau w .

glJt
1 b
g over\el
be rt y and for early adolescent gtr s, eln
. b
,
. b
~
as unattractive Y
is highly correlated w1th eing seen
.
d lt ,
. 1999) Despite a u s
others (Rosenblu n1 & Lewts,

.. .
b .
.
h nphasis on etng
wishes that girls n ot place so muc ei.
d b 1. f
.
d'
h
t the \.vtdesprea
e
Ie
thh1 resear ch 111 1cates t a
. .
'
.
b

lin
w1ll
tncrease
1
5
a 1n on g adolescent g1rls t 11at etng
d.
f; t base tn
their popularity, especially with boys, IS u: ac
reality (H alpern , Udry, Cainpbell, & Suchtndranl 1999).
(.
.
h.
der to
That 1s, the pressure gtrls feel to be t ~~ .In or
.
attract b oys does not just come from televtston, n1?vtes,
and m agazines it comes from their actual expene~~:
5
Indeed, o ne ana1y<;is foun d that, regardless of a g1r ,
cth nicjty, each 1-point increase in a young won::an s
BMl (an index of the degree to \-vhich she is over"':e.1ght)
was associated with a 6o/o decrease in the probab1lit~ of
her b eing in a romantic relationship (Halpern, K1ng,
Oslak, & Udry, 2005). In that study, a 5-foot 3-inch girl
who weigh ed 110 pou nds was twice as likely to date a~ a

girl of the same h eight and level of pubertal n1atur1ty

wh o weigh ed 126 pounds.
Fewer studies h ave examined body dissatisfaction
among adolescent b oys, althou gh it is clear that there is
an idealized, muscular, m ale body type that many boys
aspire to. As is the case with girls, boys wh o d o not fit
this image report more body dissatisfaction, but the relation between appearance and body dissatisfaction
among 1nales is somewhat more complicated than it is
among females. Whereas being heavy is the main source
of dissatisfaction among girls, being heavy or being thin
are both sources of dissatisfaction among boys (see
Figure 1.14). In fact, boys are more likely to be teased for

being underweight (and underdeveloped) than for being overweight. As is the case among girls, being teased
by peers about one's body is a significant source of distress for boys as well (Lawler & Nixon, 2011) .
Prevalence and Causes of Anorexia and Bulimia
Although it is widely believed that eating disorders are
especially common among affluent, suburban, White,
and Asian American girls, systematic studies do not
support this contention. Disordered eating and body
dissatisfaction have been reported among poor as well
as affluent teenagers and among Black and Hispanic as
well as Asian and White youngsters (Jacobi et al., 2004).
Although less is known about the causes and consequences of body dissatisfaction among adolescent
males, evidence suggests that many contemporary adolescent boys feel pressure to be especially muscular and
engage in unhealthy behaviors, such as anabolic steroid
use, in order to develop an appearance that is more

similar to the idealized male body type (Ricciardelli &

McCabe, 2004). Moreover, body dissatisfaction is
predictive of dieting, unhealthy weight control behaviors, and binge eating among males as well as females,
regardless of whether they are actt1allv ov~rwPioht

50

PART 1 1lt rundJm ntal Ch n

s of Ado! .sc ncc

100

90
80

...., 70
c:
V)

Q)

QJ

"U

ro

60

so

4-1

40

C1J

u
._

&. 30
20
10 0Underwetght
gi rIs

. ht

underweight
boys
Want t o

FIGURE 1.14

Average weight
gi t Is

1,

boys

Overweight

ls
gtr

oys

want to be smaller

be bigger

Body satisfied
l
d boys (I awler & Nixon, 20 11)
.
f
Body dissatisfaction by BMI classification or gtr s an

Eisenberg, Story, & :\fcun1ark-Sztaincr, 2006;

1\eumark-Sztainer, Paxton, Hannan, Haine~, & Story,
2006). Recent ~tudies of adolescents in China have
found sin1iJar pattern~ (Jack on & Chen, 2011 ).
Historical and cross-cultural trends in the prevalence of anorexia and bulin1ia points to in1portant differences benveen the two disorders (Keel & Klump,
2003 ). Whereas anorexia has been observed all over
the ""rorld, bulin1ia has been reported almost exclusi\'ely in \'\'estern cultures or in cultures exposed to
strong \\'estern influences. And \-vhereas anorexia has
increased in prevalence steadily over time, the prevalence of bulimia increased significantly between 1970
and 1990 but has declined somewhat since theninterestingly, paralleling trends in females, reported
body dissatisfaction, which also peaked in the early
1990s, despite the fact that individuals, BMI continued
to increase (Cash, Morrow, Hrabosky, & Perry, 2004).
This suggests that buli1nia is a much more culturally
detern1ined disorder than is anorexia. Consistent with
this, the degree to which anorexia is an inherited disorder is far more comparable fron1 one culture to another than is the case for bulin1ia.
Several theories have been proposed to account for
the onset of anorexia and bulin1ia during adolescence
(Stice et al., 2011). Although it had once been theorized
that eating disorders were caused by dysfunctional
family relationships, evidence in support of these theories is sparse, and the san1e fan1ilial factors that have
been proposed to cause eating disorders have been
shown to influence a wide variety of psychological disorders (Jacobi et al., 2004). In addition, longitudinal studies have shown that negative family relationships often
follow from, rather than precede, the onset of disordered
eating, raising questions about which causes which
(Archibald, Linver, Graber, & Brooks-Gunn, 2002).
(Cr0\\

Average wetg

Overweight

Instead, experts now vie"'' eating disorders a part of

a more general syndrom e of psych ological di tre .
Many studies have pointed to links benveen eating di orders and other seriou mental health problen1 , uch
as depression, obse sive-compulsive disorder, or substance abuse; many anorexic and bulimic won1en di play such psychological problems along with their
eating disorder (Granillo, Grogan-Kaylor, Delva, &
Castillo, 2011; Jacobi et al., 2004; Stice, Burton, & haw,
2004). These studies suggest that anorexia and bulitnia
may be best understood not as independent or unique
disorders, but as particular n1anifestations of a more
general underlying psychological problen1 called
<<internalized distress, that can be displayed in a variety of ways. (As you,ll see in Chapter 13, many different
psychological disorders in adolescence occur together,
or are ((coinorbid.,) In support of this view, some evidence suggests that the san1e medications that are uccessful in treating depression and obsessive-compulsive
disorder are useful in treating bulimia (but, intere tingly, not anorexia) (B. Walsh et al., 2006).
In addition, because anorexia and bulimia are 10
times more common in females than males, broader social forces are probably a main factor in the developrnent of these eating disorders (Keel & Klu1np, 2003).
Research indicates, for example, that girls who are early
rnaturers and early daters are likely to report greater
dissatisfaction with their body and to be at greater risk
for disordered eating (Cauffn1an & Steinberg, 1996;
Stnolak, Levine, & Gralen, 1993; Swarr & Richards,
1996); that girls who perceive that they are under pressure
to be thin or \vho have accepted thinness as an ideal
toward which to strive are more susceptible to eating
disorders (Stice & Whiten ton, 2002); and that girls who
turn to popular magazines, such as Seventeen, Twist, and
Glarnour, for information about dieting and appearance

CHAPTER 1

w ww.mhhe com / st einbergl Oe

are n1ore likely to have a high drive tor thinn ess, lo\\'
body satisfactio n, a nd disturbed patterns of eating (D. .
Jones, Vigfusd o ttir, & Lee, 2004; tv.t. Levine, Sn1o lack, &
lla)'dcn, 1994 ). As noted ea rlie r, cu ltural influen ces o n

RECAP

. About one in six American adolescents are obe~e,

and another one in six are at great risk for ob~stty.
Obesity is associated with a wide array of senous

the de-vclopn1ent of bu1irnia c1re especially strong.

Adolescents' beliefs abo ut ideal body types arc also
haped by the people they ~pend tin1e with. Girls' attitudes to\vard eating and dieting are influenced by the
attitudes of their parents (especially their n1others) and
[I iends (Eisenberg, & . 'cun1 a rk-Sztainer, 20 1 0 ~ 1-iutchin-

h~a lth problems.

Ano rexia and bulimia are eating disorders t hat .do

not appear until adolescence and that are 10 ttmes
more prevalent among females tha~ ma~es. A newly
identified disorder, called binge eattng dtsorder, also
erllerges during adolescence, but its female-to-male

on, Rapee, & Taylo r, 20 10; E. R. lviackev & La G reca,

200~ ~eumark-S?taincr,

Bauer, lrie nd, Hannan, Story,

& Berge, 20 10; alafia <.; '" Gon doli, 20 ll ). Being teasc:d
about on e's \Veight is e pecially likely to lead to disor-

rat io is much smaller.

M any girls with anorexia or bulim~a dev.elop the
disorder as a result of dissatisfactton w1th the way
in w hich their body has changed following puberty,
especial ly within a culture that idealizes th inness

dered eating, as \vcll a sy n1pto n1 ~ of depressio n (M.

Eisenberg, Neu1nark-S7taincr, Hl1incs, & Wall, 2006;

l :Iaines, Neun1a rk-S1taincr, E i~cnbcrg, & H annan, 2006 ).
Just becau se cultural co nditio ns contribute to t he
develop1nent of di. ordered eating doesn't m ean th a t individual ch ar acteri t ic do not play a role as \Vell. Cul-

t ural condition , n1ay predi po e fem ales more than

n1ales to\vard anorexia and bulitnia, and girl~ and
yo ung \\>Om en \\rho ha\e certain genetic vulnerabilities
(eating disorder are partly heritable), psychological
traits (such as pronene to depression or lo\\ selfesteem), physical characteristics (such as early pubertal

maturation), fa1nilial characteristics (such as strained

relations ' vith parents), or social concerns (such as a
strong interest in dating) n1ay be n1ore likely to develop
proble1ns (e.g., Cauffn1an & teinberg, 1996; S. Frank &
Jack on, 1996; Ricciardelli & lvlcCabe, 2001 ). The on et
of eating disorders, like . o many aspects of adolescent
development, is likely the product of a complex interaction betvveen individual and contextual factors.
A variety of therapeutic approaches have been
employed successfully in the treatn1ent of anorexia and
bulimia, including individual psychotherapy and cognitive behavioral therapy, group therapy, family therapy, and, more recently, antidepressant medications
(Stice et al., 2011 ). The trcatn1ent of anorexia often requires hospitalization initially in order to ensure that

starvation does not progress to fatal or near-fatal levels

(E. l'v1itchell, 1985). The treatn1ent of bulimia, especially \Vith cognitive behavioral therapy, has proven far
more successful than the treatn1cnt of anorexia.
MAKING THE PRACTICAL CONNECTION
What might be done to counter the impact of cultural
pressures that encourage the
development of eating disorders among young
women? Is the spread of
Western media around the
world likely to contribute
to rising rates of eating disorders in other countries?

Biological Transitions

51

among women.
.
Ano rexia and bul im ia are often accom pan ted by
other emotional problems, such
as depression. an xiety, or
obsesstve-compulsive
dtsorder.

Care in Adolescence
Although puberty is undoubtedly the most important
biological development of adole cence, concerns about
the physical health and \Vell-being of young people are
far broader than those involving reproductive maturation. In the past hvo decades, the field of adolescent
health care has grown rapidly, as health educators and
health care practitioners have come to better understand that the health care needs of adolescents differ
fro1n those of children and adults in important respects
( P. Williams, Hohnbeck, & Greenley, 2002).

THE PARADOX OF ADOLESCENT HEALTH

Adolescence is a paradox as far as physical health is concerned. On the one hand, adolescence is one of the
healthiest periods in the life span, characterized by a
relatively low incidence of disabling or chronic illnesses
(such as asthma or cancer), fewer short- term l1ospital
stays, and fewer days in which individuals stay hon1e
sick. Nonetheless, in the United States, nearly 1 in
15 adolescents has at least one disabling chronic illness, with the main causes of disability being n1cntal

adolescent health care A field of study and health care dev

to understanding the health care needs of individua\s during t
second decade of life.

52

1);\R1 1 l h f und u nt I h n

s.

iII
Ill' t~
h.h
G c.k] II..!S~lOll, ll~pu~t (.I)
j
t 1J lislH de1 s sue 1 4.1
i
I
I
Jllll"' ul,u ,Jfll ~ J,; c ' \J

n
) 1 l

t [) .

disorc.krs ~lH.h
,)::, a:-;lhrn.l, .llld
.u thr rri ( )leJ & h\vin. 2009 ). 1 nrtundtCI>t. 111 lhf.: l :
11
.
1
.,
.
,

ultrng
fnllll
l
1
I
I
0 e,u r\ h . s (ll d Jth . llh:. 1..1 ll )I I\
f
f ,,
1 c hl\c de\..rea cc
,

1h. ~ ,tnd dr t::ast.' dur1ng :lt o csccr

'
....
.
,. 1uHJ 1t >oics
nd beth.:l
1
ul ~~~1ntinll , .llh.l ne'' n1 "'< rc,t 1 kL
t" ..
~
. r 1ltl e llllj)lOVC

. ,.d Lllc J1h)'slcal '''t.: 11IH'.lfth care deliver

h('ing of children, e pe --i.lll}' tho e \Vi th chronic ill nesses
'-!

.
. rne ltc,
. I on d tllOils

(0 UJu nert Ron1ero,

dnd chsnbltng
..
Ki1nl ~rg, Bla~k\vell, & ruz, 20 II ). Adolescents are tar

Je~s likel r th,tn individu~1Js of unv other age ~o se~~ and

nlcdJc,tl
. care t11roug11 trJCII
rt ton(~ll {:1ffict: v1s1t
to
recetv<.::
.
pr41ctitioners, hovvcver; and there are large soctnccol . o1~pant1es
J

':lCCe
s to
non11. and t.:llntc
tn
a d I L~ -ents'
L
"
...
health can.-, \vith poor and ethnic tni n ority yo uth fa r
lc"~ Jikcly to have . ldcqu atc hcn1tb insurance and hcal_th
care acce\S tha n afHuent or \ Vh itc) ouths (()7cr & l r\V111 ,
2009 ) .

T'he n1ost virulent thH~at to ddole5ccnt health co n1 cs

fro n1 un he.1lth) behaviors (such as drug use), violenc.c
(both elf-i ntli<.. ted and inflicted by other~), and ri&ky
Jctivitv (such as unprotected scxucll intercourse or
rec kl es~ d rivin g) (P. \ Villian1 et al., 2002). In ~orne
....
.

sen es, then, n1any of the in1prove1nents in prevcnt1ng

and treati na0 the traditional n1 edical problems of the
period those having to do \Vith chronic illnesses
have been offset by what some scientists call the '(new
morbidity and mortality" of adolescence. Contributors
to this new morbidity and mortality include accidents
(especially auton1obile accidents), suicide, homicide,
substance abuse (including tobacco and alcohol use),
and sexually transmitted diseases (including AIDS).

CAUSES OF MORTALITY IN ADOLESCENCE

The contrast between the old and new mortalities of
adolescence is readily apparent. Fifty years ago, illness
and disease accounted for n1ore than twice as n1any
deaths among teenagers as violence or injury, but the
reverse is true today. Unintentional injuries are th e
leading cause of death worldwide, followed by AIDS,
infectious disease, h on1icide, and suicide, in that order
(Blum & Nelson-Mmari, 2004). Approximately 45o/o of
all teenage deaths in the United States result fro1n car
accidents and oth er unintentional injuries, and another
27o/o are a res ult of homicide or suicide (Ozer & Irwin,

2009). Adolescents are involved in more driving accidents than adults, primarily because they are less experienced behind the \Vheel (at any age, new drivers are
more likely to have accidents than seasoned drivers),
but also because they are n1ore likely to take chances

graduated driver licensing

A licensing system in wh ich full adult

driving privileges are not granted all at once to teen drivers, but
phased in over time.

. .

c nol Md nn, & n~

~ ~'ootli~J-r ~l> 0) ...1\\'o ofth~n,at,,
.. novich ,

,,,bile dJI\'tng (
0 1 I ee & I van .. .c..
'

<)st
. 0 ' 1.t 11t L. on t n.1., u t o 1s 10 ~CJ i us .c;,tr acc1dent~ invc}
,, v
. .s n rc.:. d 1 i\ i 11 g t n t gh t , n d d r i vi ng \'\'1h
.ll n Po a 1g'"' d nver
l
tng tct:n" t
.
.
the
r
(
in'lOI'l'\ turton. 1 htrt<
2
I ,.r te ""nager.. 111
l I d
'
Otlc
20(>5) r-1hi. 1tnding 1c l: ll1t\11}'Stat.
.
.
.
.
c
I c4..1f, & Prcu""er, ; duntcd
drtv r hccns1ng progran1
111 11lcrnent grt~ '

to ~
~ t ion on \Vhen nd wtth \vhon1 tcc 11
l1Jch place r st rtL
.
rc: .
\V
til the)' have g, 1ncd su tl Cient exp ri
1
b"l
g ers can ortve un
a .
have redu ed , u ton1o 1 c fat litic
1
11
ence; these progr .
(Sin1ons-Morton 2011 ) .
. .

then
it
The consen u;"\ '
'~

ficant
thrt:(
t
to
the
health
of
todav'
that the nloSt agni '
.
;
.
f
psycho~o
1al
rather
than
fron1
natu.
1
youths an e ron ..
.
~
&
Irwin
2009).
nltke
son1e
other
p
.
(
n.ll cluse 0 zer
,
: d' f h l'fc
1 SI)an (s uch ' in fancy or old ag L\4Jhcn
.
no s 0 t e
d 'll
we are more Vllll,,~er ( ble to d1sea can 1 nt:s , tn ado.
lth
nroblerns
are
preventable.
Moreea
1
1
t
Iescence mos
r
.
.
of
cliet
drug
use,
i1nd
exerc1se
establ1
hed
t
over) pat ern~
, . .
r .
duri ng adolescence perstst tnto adulth.~od ( P. \1\ 1lhams
:;) 1 2002) . As a result of this recognttton, the focu 1n
t: t a .,
h 'f. d
f
th e field of adolescent healtb ha
1 te avvay rom traditional n1 edical models (in which the etnpha i i on
the assessment, diagnosis, and treatn1ent of di ea e)
and toward more community-or~e~ted educational
approaches (in \vh jch the emphasts IS on _the prevention of illness and injury and the promotton of good
health ) (National Research Co uncil and Institute of
Medicine, 2009).
C'

a1110ng health c< rc:: e pert ,

co

MAKING THE PRACTICAL CONNECTION

Although most adolescent health problems are

caused by t eenagers' own behavior. getting
ado lescents to change
how t hey live has proven
remarkably d iffi cult. Why
do you t hi nk t his is the
case? What strategies
would you suggest to
discourage underage
drinki ng o r smoking?

In other vvords, in tead of asking ho\v \ve can best

treat sick adolescents> experts in adolescent health care
are now asking how we can encourage adole cents to
take the steps necessary to prevent illness and di ability.
Current efforts include providing teenagers \vith education about alcohol and drug use, accident prevention,
safe sex, and proper nutrition, as well as encouraging
health care professionals to do more direct screening
for risky health practices among their adolescent patients. As one group of experts put it, '(Don't ask, they
won't tell" (Blutn, Beuhring, Wunderlich, & Resnick,
1996, p. 1767).

HAPTER 1 Btologtcal Translttons

N
nl ..un

,t tn

' ~I ' Its P~ til l \lllt

hf\ tlth l ch,l\ icu 1s 1n tlu

~t nuanh('t ' f th to1 s, l t '''hi h ) 11 l\' IL"dg ~ is

H. l l' \ ~ tH h.tf c' J t'l':-;[ 1, 111 ,

" \ . h,tn g ~ Jll th " t t:\lltl' l in '''hich ldolcs"ents
~. 'u"'h_ ,~ ~ th ' ,h~ es~i bilit y l>f h,llh.i gun~ < r lhc ,n ,1 ill t\ f tnb,t" l), ,lk'\)lH l. ,u1d ill:iLit drugs) 111 n ~t
n11 ..111' . -h~.t.n~ ~ ~n .tdolt:~Le llt$' ln o,v)edge ,1nd
d\i,rsl,111 hng 1f t1 ' tJng h~~llth protnotio n i, t< , e
1111~ h~h t'd 1 ,lll\'ll ct al., 1 00J ). l-4 or L \.unpl t\ i nv~s
.111 n~ nf the 11111, --t l f hanging ont tlern nt of the
. .tJar ~ nt xt (. f adl'k'~LL'llt he~.llth the leg,1l drinkln"T a
h . n found that r . 1is1ng the age le,1d:" to ,1 si''nr ant "lin~ in ,\((id ' tHai d~.:,Hh rat~s among yt ur~g
,1 ton1obJ1 ~ drnt'rS .1nd pl'd~~trian"' . 1~ "~'11 a in the
1 ..1t '~. ~f unintentlondl inJuries not 111\ olYtng C(lrs and
hOlllk tdes l .. . Jo~lC \ Ptcp er, & Roht'rtson, 199 2 ~ r, pri
et ,1l., -0~ ). " untlarh, .the "ingle n1o.. t effe~ ti\ ~ pnliLy
for n.-:dth.tng teen .sn1ok1ng has b 'en raising the price of
cigarette~ t l~ruber J Zinn1t.H1l 2001 )\and the prevalen ce
of ado lescent . . Inoking i ~ ..1 direct fu nction of the nun1 btr of ret~i1 outlet elling tobacco in their in1n1ediate
1
neighborhood t 0\''ak, Reardon:~ Raudenbush, & Buka,
_ 0~6) . J ~~e,v ~e t:~trch also indicates that positive psycholog! -al tunctiontng ha a beneficial in1pact on physical
health amo11g adole cents, as is the case an1ong adults
(Hoyt Cha e-Lansdale, ~fcDade, & Adam, 2012 ).
. Inl~ro,ring the health of young people is an especiall) Important concern among those "\Vorking with
adolescents \Vho are poor or from ethnic minority
groups, because the e youngsters are at greater risk for
n1any of the old and nev1 morbidities and mortalities of
adolescence (Ozer & Ir,vin, 2009 ). Non-White youngI

tlll .'

t)llll

'l!lt'll I

( t' . ,

sters, for example, are relatively more likely than White

youngsters to suffer from a chronic illness (Ozer &
Ir,vin, 2009), to be obese or to have high blood pressure
or high cholesterol levels (National Heart, Lung, and
Blood Institute Growth and Health Study Research
Group, 1992), to be physically inactive (Wolf et al.,
1993), to be victims of violent crimes (Earls, Cairns, &
1!ercy, 1993), to contract AIDS (Sells & Blum, 1996), to
die from drowning (Warneke & Cooper, 1994), and to
be murdered (Sorenson, Richardson, & Peterson, 1993).
Homicide is the leading cause of death for Black
adolescents, accounting for almost half of all deaths

,1111011~ Bl.ld , ,, uth .

mc1 ic.1n Indian/ la ka ative

n1,1l 's l'hl\'e ,1 su iL ide ratl h ighc r l b,in th, t of an) other
t\ h:i,d/ethni " groUJ. ) c.;'t, d~s1 itc th<!ir gen rally poorer
h \tlth ~ n1inorit . _ un{~ ters are lc s lil..ely o have access
to~ u rces 1nediLcll ,1r "les~ lil ely to visit the doctor
'''ht'n ill , ,1nd k Ii lt:d , to h, Vt: health in ur(1nc ( Ozer &

lr'''i n, 2009).

1"'he c rnbination of poor health and lhnited access

to he,tlth cart i cvtn tnore ( <1 ncentrated an1ong the
siz,1bh.-: p roport ion of adolescents vvho live in poverty,
t.l d ispn l < rt i nate nun1ber of \v honl are fron1 ethnic
7
n1inorit ' backg ro unds (KJern1an, 1993) . T h ere is 110\\
convin cin g evid ence that the li nks bet\veen health and
, ocioeconon1ic s t atu~ are strong and pervasive across
diftt: rent sort ~ of hea lt h probJen1s, vvith p hysical and
tnen tal health pro bl e1ns increasing lin early as one
tnoves do\vn the socioecon o1nic ladder (Adler et al. ,
1994; Keating & H ertzn1an, 2000). Because in creases
in the si7e of the adolescent populati on over the next
several decc1des worldvvide w ill be con centrat ed
an1ong poor and minority youth (Fussell & Greene,
2002 ), the most daunting challenge facing health care
providers and policyn1akers will be finding ways of
n1inin1izing or even eliminating the socioeconomic
and ethnic disparities in health and health care that
currently exist around the world (Call et al., 2002;
Ozer & Irwin, 2009 ) .
'W

RECAP

The most important physical health problems afflicting adolescents have behavioral rather than
natural causes.
The leading cause of mortality among adolescents around the world is unintentional
accidents.
~xperts in adolescent health care argue that it is

Important to focus on changing adolescents'

behavior in order to prevent healthcompromising activities and
encourage healthpromoting ones.

53