4 Transition to Adulthood: The Occupations and Performance Skills of Adolescents

Key terms
Adolescents-
Psychosocial development-
Peer relationships- offer social integration and a sense of belonging or acceptance, significantly contributes to
social and emotional adjustment in adolescents.
Body image- a positive attitude towards ones body, dynamic perception of ones body, affects the persons
emotions, thoughts, and behaviors and influences both public and intimate relationships
Identity- develops through recognition of ones abilities, interests, strengths, and weaknesses by the self and
others continues to dictate how identity formation is viewed in research and clinical practice

Adolescence- generally defined as the high school years (between 12 and 18),
-a period of learning, experimentation, and experiences that affect individuals choice of
long-term occupations and their physical and psychological well-being
-an age of transition

Effective occupational therapy interventions : begin with an evaluation of physical, cognitive,

and psychosocial factors associated with adolescents development and the quality of their
occupational performance. Includes:

o Standardized criterion-referenced (based on performance expected of an adolescent)

o Norm-referenced (based on actual performance of other adolescents)
*assessments that evaluate client factors and performance.

THE CHANGES DURING ADOLESCENCE

Labile emotions-shift moods rapidly, vacillating between happiness and distress and
self-confidence
Personal Identity- a time when teenagers begin to explore and assert their personal identities.
During this developmental period, teenagers engage in a process of searching for where they fit in with
peers and society at large
Peer Relationships- relationships with peers begin to take precedence over relationships with the
family. Family interactions are still important and essential for a teens development, adolescents often
place a stronger emphasis on their friends perceptions and values
Independence and Testing Boundaries -test parents and teachers rules and boundaries. This
behavior is driven by the adolescents need to develop autonomy, experience new activities and earn
more independence
Self-centered Attitudes- difficultly for adolescents to look at circumstances from other peoples
perspectives. This apparent lack of empathy is normal and typically resolves itself once a teen reaches
the end of adolescence.

PHYSICAL DEVELOPMENT AND MATURATION

Puberty: term used to define the maturation of the reproductive system; is variable and begin to notice
these changes from ages 8 to 14 years. Stimulus for this physical growth and physiologic maturation of
reproductive systems is a complex interaction of hormones. It can start as early as 9 years of age and may continue
in some adolescents to age 17.
Motor performance peaks for males in late adolescence around 17 to 18 years of age. Girls typically show an
increase in motor performance, including enhancements in speed, accuracy, and endurance, around the age of 14.

Adolescent Growth Spurt: the rapid increase in physical growth that marks the beginning of
adolescence.

CHANGES IN PUBERTY

Rapid growth/Weight Gain

Further development of gonads
Secondary sexual characteristics
Changes in muscle/fat compositions
Changes in circulatory & respiratory systems
Physical Development: the phys. Growth from birth to adulthood & development of both gross and
fine motor control of the body. Also means the progress of a childs control over his body including
control over muscles, phys. coordination, and ability to sit and stand.
FACTORS:
1. Heredity: genes of parents define phys. personality of child
2. Environment: fresh air, sunlight, hygienic surroundings help in good dev. of the child
3. Balanced diet: gives nourishment to the body and helps keep body from disease
4. Daily Routine: daily sched of sleep play and eat. Proper timings shud be maintained for all act.
5. Sleep and rest: maintained but not oversleep
6. Love: vital factor that influence childs all round dev. w/o which he dev. criminal tendency.

Maturation: seq. of phys. changes related to genetic influence

independent on the env. but timing can be influenced by env. factors
rate at indv. growth and dev. is highly individualized, seq. can be predictable or
unpredictable
Factors Inluencing Growth and Development
Genetic: determine char. such as sex, phys., status, and race
Environmental: affect indvs. growth and dev. (fam. religion, climate, culture, school, comm.,
nutrition

Physical Activities and Growth: Teenagers with Disabilities

Regular physical activity promotes growth and development and has multiple benefits for physical,
mental, and psychosocial health that undoubtedly contribute to learning. Physical activity can improve
mental health by decreasing and preventing conditions such as anxiety and depression, as well as
improving mood and other aspects of well-being

COGNITIVE DEVELOPMENT
Cognition - term used to define the mental processes of construction, acquisition, and the use of
knowledge, as well as perception, memory, and the use of symbolism and language. It is the set of all
mental abilities and processes related to knowledge.
Thinking
Learning
Understanding
Remembering

Quality of thinking changes in adolescence. Piaget referred to this cognitive development as logical
thinking (formal operations), which involves functions such as symbolic thought and hypothetical-
deductive reasoning. Adolescents ability to think becomes more creative, complex, and efficient in
both speed and adeptness.
Sensorimotor
Preoperational
Concrete Operational
Formal Operational

Hypothetical deductive reasoning does not require actual situations. A person identifies and
explores many imagined possible outcomes to determine the most likely outcome to a particular
situation or problem, as well as the relationship between present actions and future consequences.
Hypothetical-deductive reasoning is essential for problem-solving, and for the process of arguing.
-The development of cognitive abilities enables adolescents to achieve independence in thought and
action

PSYCHOSOCIAL DEVELOPMENT
It is useful to view adolescent psychosocial development in three phases.
Phase one is early adolescence, which encompasses the middle school years between ages 10 and 13.
Phase two is middle adolescence, which occurs during the high school years between ages 14 and 17.
Phase three is late adolescence, 17 through 21.

The middle years of adolescence are the most intense period of psychosocial development. In this
phase, peers displace parents as the significant influence in the adolescents life. Conformity with peer
groups is desirable, and the opinions of friends and peers matter.

Late adolescence is a period of consolidation. Adolescents ideally are developing into responsible
young adults who can make decisions, have a stable and consistent value system, and can
successfully take on adult roles, such as an employee or a contributing member of the community. A
stable, positive sense of self and self-knowledge of ability enable late adolescents and young adults to
establish healthy relationships.
The Search for Identity: Identity Formation
-period of exploration in adolescence as the process that will result in young adults who have defined
themselves as individuals, can problem-solve, take responsibility for their actions, self-regulate their
emotions and behaviors, and demonstrate commitment to a set of values congruent with the social
norms and values of their community.

Self-identity has two elements

1. Individualistic component(Who am I?)
2. Contextual component (Where and how do I fit in my world?).
The individualistic sense of identity is the internalized, stable self-concept from which a person
interacts with the world. The contextual component of self-identity allows a person to understand
his/her values, beliefs, interests, and commitments to a job or career and social roles such as daughter
or friend. The contextual aspect of a persons identity is visible to others and is shaped by society.

Erik Erikson (1980) first proposed that acquiring a sense of identity (identity formation) is a critical task
of adolescence. His theory of how identity develops through recognition of ones abilities, interests,
strengths, and weaknesses by the self and others continues to dictate how identity formation is viewed
in research and clinical practice. He proposed that identity formation is the optimal outcome of a crisis
resolution process in which exploration and experimentation leads to a commitment (i.e., an
investment in a set of values, beliefs, interests, and an occupation) to a positive sense of identity.

Developmental theorist Marcia describes four states of identity:

identity diffusion
moratorium
identity foreclosure
successful identity achievement.

Identity diffusion, common in early adolescence, is a state in which a person has an ill-defined sense of
identity.
Moratorium is a state, common to early and middle adolescence, of actively exploring and developing
a sense of identity.
Identity foreclosure is the state in which an adolescent appears to have achieved a sense of identity
but has actually avoided self-exploration and experimentation by making premature decisions about
career, relationships, and interests, and thereby committing to an identity.
Successful achievement of a sense of identity through the healthy resolution of experimentation and
exploration is coherence between a persons identity and his/her self-expression and behaviors.

Sexual Orientation: Gender Identity

Sexual orientation refers to an individuals pattern of physical and emotional arousal towards other
persons of either the opposite or the same sex.

Self-Concept and Self-Esteem

Self-concept- the feelings and perception of ones identity consisting of stable values, beliefs, and
abilities. Self-concept is multifaceted. It includes self-acceptance, which is associated with many areas
of the adolescents life
Self-esteem- the global self-evaluation of values and positive and negative qualities (i.e., how a
person feels about oneself).

Adolescence and Mental Health

Mental health is defined as the successful performance of mental functions, resulting in productive
activities, fulfilling relationships with others, and the ability to change and cope with adversity.

AREAS OF OCCUPATION: PERFORMANCE SKILLS AND PATTERNS

This section describes adolescent development and participation in four domains
Work
IADL
Play and leisure
Social participation

Work is a general term associated with a job (work undertaken as a means of earning money) or a
career (an organized life path that often involves a formal occupation or vocation). Occupational
identity combines interests, values, and abilities into a realistic choice of a job or career path.
IADLs support daily life within the home and the community and, although the tasks can appear
mundane, competency in the performance skills associated with everyday living is essential.
Leisure and play activities are the discretionary, spontaneous, and organized activities that provide
enjoyment, entertainment, or diversion in social environments that may be different to school and
work settings
Social activities, friendships, and the behaviors associated with these activities and roles that
characterize and define individuals within society are salient to adolescents development of Social
participation.

THE ENVIRONMENTS OF ADOLESCENCE

The environment is a significant determinant of an adolescents choice of activities and success.
The social (e.g., friends, team members, family, and social groups), cultural (e.g., race, religion), and
socioeconomic and physical (e.g., home, school, and community) environments in which the
adolescent lives influences his or her development. Environments can encourage positive behaviors
and provide opportunities, or conversely fail to provide the adolescent the support and resources
needed for healthy development.

The multidimensional influence of context is considered in all intervention programs. Family

contexts that value and facilitate the development of peer partnerships, and participation in
extracurricular activities, and mentoring by caring adults promote healthy adolescents.

ENVIRONMENT OF ADOLESCENCE IN THREE STAGES:

Early adolescence, generally ages eleven to fourteen;

Middle adolescence, ages fifteen to seventeen;
Late adolescence, ages eighteen to twenty-one.

Instrumentalism in Occupational Therapy (IOT)

The model is based on the postulation that the mind is an instrument for human adaptation to the
environment. Use of this instrument is dependent on the beliefs about self, others, and the world.

PHASES OF IOT
Phase 1: Belief Establishment
Phase 2: Action
Phase 3: Appraisal of consequences

Clarity of Desired Adult Life (CDAL)

0 = Lack of clarity (No details of desired adult life)
1 = Some clarity (Some details of desired adult life provided but not clear)
2 = Complete clarity (Enough details provided to indicate that the participant has a vivid image of
DAL)

Clarity of plan to achieve DAL

0 = No clear plan (No details of a plan to achieve DAL)
1 = Somewhat clear (Some details of a rudimentary plan provided but no clear, logical, realistic, step
by step articulation of the plan)
2 = Clear (There is a detailed, logical, realistic, step by step plan of how to achieve DAL).

STAGES OF ADOLESCENCE
Physical Development
-Puberty is defined as the biological changes of adolescence.
Intellectual Development
-capacity to solve complex problems and to sense what others are thinking has sharpened
considerably
Emotional Development
-social circle ripples outward to include friendships with members of the same sex, the opposite sex,
different social and ethnic groups, and other adults, like a favourite teacher or coach
Social Development
-asserting their independence; marching toward autonomy

Environmental and Contextual Factors of Healthy Adolescent Development

o SUPPORT
o EMPOWERMENT
o BOUNDARIES AND EXPECTATIONS OF ADOLESCENTS

SUMMARY

Adolescence is a distinct developmental stage

1. growth and maturation,
 2. the refinement of skills,
3. self-determinism,
4. relative individuation
5. development of a sense of identity culminates in a positive self-concept as a healthy adult

The desired outcomes of adolescence

o sense of personal identity,
o autonomy,
o independent decision-making
o adequate life skills for adulthood

5 Working with Families

Families are complex systems
A reason to study families explicitly is to circumvent the inclination to reference ones own
family experiences as a template for the way families operate
A third reason to study families is that the involvement of family members is central to the
best practice of occupational therapy.

THE FAMILY: A GROUP OF OCCUPATIONAL BEINGS

Cultural model-a habitual framework for thinking about events, for determining which activities
should be done and when, and for deciding on how to interact

Family Resources
Family resources: Properties family members use to engage in a balanced pattern of needed and desired
activities in a way that enables them to fulfill the family functions.
Financial: Remuneration from productive activities that enable the family to acquire material things such as a
place to live, food, and clothing. May also determine what types of community activities are available for family
members.
Human: The knowledge and skills family members bring to activities. For example, a teenager who learns to use
the Internet at school brings this skill home and can help her parent learn how to pay bills online.
Time: Minutes/hours/days to engage in activities that enables families to fulfil their functional roles.
Emotional energy: Experiencing close interpersonal relationships during shared activities.

Family : functions as a dynamic system in which its members, comprising subsystems, engage in occupations
together to fulfill the functions of a family.

Interdependent Influences: The activities of one person can influence the activities of another member of the
family.

An effective family system organizes itself into predictable patterns of daily and weekly activities
and familiar ways with special events. Guided by their cultural models, and often organized through
unspoken family rules, families settle into daily routines.

daily routines : include interactive rituals that take on symbolic meaning and seem so matter of
course that people do not think of doing them any other way, and they resist changing them.

Family traditions: such as cooking special food for birthday celebrations or sharing leisure activities
on Sunday afternoons, help families develop a sense of group cohesion and emotional well-being for
family members.
Celebrations: are predictable patterns of doing activities, such as religious rituals, that are shared
with members of the community.

FAMILY SUBSYSTEMS
Parents
Siblings
Extended Family

FAMILY LIFE CYCLE

Family systems undergo metamorphosis and adapt as family members change.

1. Early Childhood- identifying a child as being at risk for health or developmental problems is
usually a complicated process.
2. School Age
3. Adolescence- a challenging and potentially stressful time for all families, as the development of self-
identity, sexuality, and expectations of emotional and economic autonomy herald the transition to
adulthood.

FAMILY RESOURCES AND THE CHILD WITH SPECIAL NEEDS

1. Financial Resources
2. Human Resources (education, practical knowledge, and problem-solving ability)
3. Time Resources- daily and weekly activities, by their very definition, require time investment.
4. Emotional Energy Resources

SOURCES OF DIVERSITY IN FAMILIES

3 sources of family diversity:

Ethnic background,
family structure,
socioeconomic status and parenting styles and practices.

Ethnicity- a term used to describe a common nationality or language shared by certain groups of
families.
Ethnic groups- share cultural practices that can determine who has the authority to allocate family
resources and a value system that sets priorities for family routines and special events.
Acculturation : this is the process of selectively blending their traditions in how things are done, what
activities are important, and interactive styles with the cultural practices of the majority group.

Family structure- are factors described as the presence of children in the household, marital status,
sexual orientation and age/ generation.
Kinship care- is a way to preserve family ties that might be lost if children are placed in foster homes

Socioeconomic status- reflects a composite of different factors: social prestige of the family
members, the educational attainment of the parents, and the family income
Education- influences parenting practices by affecting how an adult incorporates new ideas about
healthy life style and child development into these practices.

PARENTING STYLE AND PRACTICES

Parenting style- the emotional climate between parent and child.

Parenting practices- goal directed activities parents do in raising their children.

Ecological and transactional perspective- encourages therapists to consider family resources and
the adults psychological background, personal history and personality which are in constant
interaction with characteristics of the child being parented.

SOCIALIZATION AND PARTICIPATION IN SOCIAL ACTIVITIES

Socialization :an important mechanism for preparing family members to enter their
cultural group and participate in community activities.

FAMILY ADAPTATIONS, RESILIENCE, AND ACCOMMODATION

Adaptation- it starts when a family recognizes the state of affairs, interruptions in their activities, or a
loss of emotional wellbeing.
Resilience- families display resilience when they draw on resources to reconstruct their routines or
create new ones that enable them to continue to fulfil family functions.

Resilience Factors - Families draw on their own resources, such as religious beliefs and the
emotional support of each other, and then reset their definition of how they would live or operate as a
family.
Affective communication members give each other role assignments, establish schedules, make
decisions, and resolve conflicts.

PARTNERING WITH FAMILIES

Parent professional partnership grows from an appreciation that by working together, both the OT and
the parent can share important expertise and knowledge that will make a difference in the childs life.

Family Centered Services- refers to a combination of beliefs and practices that define particular
ways of working with families that are consumer driven and competency enhancing.

3 Complementary Models for family-centered services

1. Family Support- designed to bolster a network of social support to enhance the familys
natural strengths and family functions.
2. Direct services- provided when the therapist engages a child in an activity with the goal of
promoting the childs skill acquisition and minimizing the consequences of a disability.
3. Family collaborative education- has a number of purposes and should be individualized to
the families interests, learning styles, and knowledge levels.

ESTABLISHING A PARTNERSHIP
Trust building : associated with nonverbal language, words, and mutual respect.

Providing Helpful Information

Providing Flexible, Accessible, and Responsive Services
Respecting Family Roles in Decision Making

COMMUNICATION STRATEGIES

Effective communication is built on trust and respect; it requires honesty and sensitivity to what the
parent needs to know at the moment.
Occupational therapists communicate with parents using a variety of methods: formal and informal,
written, verbal, and nonverbal.

HOME PROGRAMS: BLENDING THERAPY INTO ROUTINES

Hinojosa
Case-Smith and Nastro
Segal and Beyer
Tetreault and colleagues

WORKING WITH FAMILIES FACING MULTIPLE CHALLENGES

1. Families in Chronic Poverty

Beyond the diversity issues discussed under Socioeconomic Status, chronic poverty has a pervasive
effect on family and child experiences.

2. Parents with Special Needs

Parents themselves may have special needs that require an emphasis on supportive services. Parents
who face physical or sensory challenges may need help in solving problems, such as monitoring the
activity of an active child or being alerted to the cry of an infant.