Normal Adolescent Development Research Articles

Benefits And Challenges for Young Australians with Epilepsy Transitioning Into Adult Healthcare: A scoping review

Transitioning from paediatric healthcare into an adult healthcare system is a high-risk time for people with complex epilepsy. This can be a period of significant upheaval as a young person moves away from familiar and safe paediatric environments into unfamiliar adult healthcare. This is compounded by normal adolescent development, the challenges of epilepsy and the lifestyle conditions it demands, including restrictions on driving and levels of independence. Such factors can contribute to suboptimal health engagement which result in increased seizure activity, hospital admissions and reduction in community participation. Effective, well implemented transition programs are key to reducing risks, however little is known about which features of transition pathways define success or best practice. A scoping review was used to examine a broad range of peer-reviewed literature published between 2017 and 2022. This review examined evidence-based literature relating to experiences of people with epilepsy as they transitioned between paediatric and adult healthcare environments. Specifically, exploring practices that offered benefits, recognising barriers, and identifying findings to inform future research and advance transition practices. This review found that key to reducing transition-related health impacts for young people was patient-centred, engaging care that acknowledges their psychosocial and mental health needs specific to their level of development. Evidence suggests that engagement is built through multidisciplinary clinics that facilitate education and self-management. This review found that successful programs can deliver this by focusing on four key areas; relationships and continuity, capacity building, processes, and health services and systems. At a paediatric level this involves timely, age-appropriate preparation that builds skills and knowledge through tailored care-plans. At the transfer phase this means coordinated teams that work together across systems to ensure handover continuity, reduce stressors, and to aid navigation. At the adult level, care-teams that welcome young patients with protocols for continued capacity building are required.

Perspectives of Adolescents and Young Adults with Sickle Cell Disease and Clinicians on Improving Transition Readiness and a Videogame Intervention

Background Adolescents and young adults with sickle cell disease (AYA-SCD) have higher rates of mortality and the highest rates of healthcare utilization compared with older and younger SCD patients. The transition period between pediatric and adult care for AYA-SCD is well recognized as a critical window because it represents the intersection of normal adolescent development, change in healthcare access and increased clinical manifestations of disease. Interventions that support AYA-SCD during this time are crucial to improving outcomes. Hallmarks of transition readiness amongst AYA-SCD include self-efficacy (i.e., patients' ability to manage their disease), active participation in shared decision-making (SDM), and adequate disease specific knowledge. Although videogames have been shown to positively affect adolescents' behavior and health outcomes, there has been no study evaluating this technology for improving transition readiness in AYA-SCD. Our objective was to learn AYA-SCD patients' and clinicians' experiences with AYA-SCD managing their disease at home and making medical decisions as they transition from pediatric to adult care, including whether a videogame intervention can positively impact these skills. Methods We conducted individual, semi-structured interviews with purposively sampled patients (AYA-SCD ages 15 to 26 with any genotype of SCD) and clinicians who provide care or support to AYA-SCD (pediatric and adult hematology providers, pediatric and general emergency medicine physicians and nurses, child life specialists) at an urban, quaternary care hospital. Interviews elicited patients' and clinicians' experiences with AYA-SCD in the clinic, emergency department, and/or hospital, including the transition from pediatric to adult care, barriers and facilitators to successful home management, and their perspectives on SDM and a videogame intervention. To identify themes related to patients' and clinicians' experiences with AYA-SCD managing their disease at home and making medical decisions, we conducted an inductive analysis following the principles of grounded theory until data saturation was reached for both groups. For patients' and clinicians' perspectives on a videogame intervention, we used a deductive analysis. Three investigators independently coded all transcripts to identify themes, with discrepancies resolved by consensus. Results We interviewed 16 patients and 21 clinicians. Participants identified two main themes: 1) self-efficacy to manage their disease successfully as they transition from pediatric to adult care, and 2) the importance of patient engagement in making medical decisions (Table 1; representative quotations). Sub-themes were environmental, clinician, and patient factors that served as barriers and facilitators to achieving self-efficacy and patient engagement in decision-making. Facilitators including having social support, the importance of education about SCD and SDM before adolescence, clinicians having good communication, building trust, listening, and involving patients in medical decisions, and patient self-advocacy by voicing their needs and being empowered to actively participate in medical decisions. Barriers included lack of support and resources, adolescent behaviors/traits, co-dependency on a parent/caregiver, pediatric vs. adult culture, and stigma/implicit bias/provider judgement (Figure 1; conceptual model). Participants were supportive of a videogame intervention to improve self-efficacy and engagement in decision-making (Table 1), with the primary goal being education and insight into SCD, and the secondary goal being distraction during pain crises. Conclusions AYA-SCD patients and their clinicians identified self-efficacy in successful disease management and patient engagement in medical decision-making as two primary areas of importance in the transition from pediatric to adult care. Several barriers and facilitators to achieving self-efficacy and patient engagement are potential targets for interventions to improve these skills in AYA-SCD. Overall, patients and clinicians supported the concept of a videogame to support self-efficacy and patient engagement to improve transition readiness. Future studies will focus on the design, development, and implementation of a videogame intervention which centers the key themes identified in this study.

Axon Initial Segment GABA Inhibits Action Potential Generation throughout Periadolescent Development.

Neurons are remarkably polarized structures: dendrites spread and branch to receive synaptic inputs while a single axon extends and transmits action potentials (APs) to downstream targets. Neuronal polarity is maintained by the axon initial segment (AIS), a region between the soma and axon proper that is also the site of action potential (AP) generation. This polarization between dendrites and axons extends to inhibitory neurotransmission. In adulthood, the neurotransmitter GABA hyperpolarizes dendrites but instead depolarizes axons. These differences in function collide at the AIS. Multiple studies have shown that GABAergic signaling in this region can share properties of either the mature axon or mature dendrite, and that these properties evolve over a protracted period encompassing periadolescent development. Here, we explored how developmental changes in GABAergic signaling affect AP initiation. We show that GABA at the axon initial segment inhibits action potential initiation in layer (L)2/3 pyramidal neurons in prefrontal cortex from mice of either sex across GABA reversal potentials observed in periadolescence. These actions occur largely through current shunts generated by GABAA receptors and changes in voltage-gated channel properties that affected the number of channels that could be recruited for AP electrogenesis. These results suggest that GABAergic neurons targeting the axon initial segment provide an inhibitory "veto" across the range of GABA polarity observed in normal adolescent development, regardless of GABAergic synapse reversal potential.Significance Statement GABA receptors are a major class of neurotransmitter receptors in the brain. Typically, GABA receptors inhibit neurons by allowing influx of negatively charged chloride ions into the cell. However, there are cases where local chloride concentrations promote chloride efflux through GABA receptors. Such conditions exist early in development in neocortical pyramidal cell axon initial segments (AISs), where action potentials (APs) initiate. Here, we examined how chloride efflux in early development interacts with mechanisms that support action potential initiation. We find that this efflux, despite moving membrane potential closer to action potential threshold, is nevertheless inhibitory. Thus, GABA at the axon initial segment is likely to be inhibitory for action potential initiation independent of whether chloride flows out or into neurons via these receptors.

Risks of flavored nicotine and nicotine-free substances on adolescents

Nicotinic substances, tobacco, and vape pods have been widely used in electronic cigarettes that have been increasing in global popularity among adolescents. Global rise in electronic cigarettes and vaping devices are mainly being promoted through social media platforms such as Instagram advertisements and TikTok commercials1,2. Particularly, the inhalation (vaping) of electronic cigarettes contains toxic particles such as nicotine combined with various flavors that are delivered to the lungs and brain. Chronic vaping of toxic particles can cause addiction, dyspnea, cough, chest pain, and increased risks of hypoxemia3,4. Recent commercials promote non-nicotine (0 mg) vape pods consisting of harmful particles that target adolescents to smoke electronic cigarettes and to keep up with current societal norms1,4. Ultrafine particles found in vaping products can harm vital organs such as the lungs, and gastrointestinal tract, and cause neurological dependence on flavored nicotinic substances3,4. A recent study by Smith and colleagues includes computed tomography images of the lungs when exposed to 90 days of smoking electronic cigarette particles to cause acute lung injury. The computed tomography images show ground-glass opacities associated with consolidation in the lungs that can clinically manifest as hypersensitivity pneumonitis, alveolar hemorrhage, and/or respiratory bronchiolitis interstitial lung disease3. Flavored inhalation of nicotine or nicotine-free substances increases the risks of lung injury and can cause oxidative stress in the body. A similar study by Caporale and colleagues emphasizes the toxicity of non-nicotine electronic cigarettes to impact the endothelial function of a healthy nonsmoker. Specifically, the study highlights when nonsmokers went through magnetic resonance imaging before and after inhaling nicotine-free cigarette aerosol, there was vascular resistance in the arterioles which resulted in lowering venous hemoglobin saturation that may be a result of hypoxemia. Regardless of smoking, nicotine or nicotine-free substances some microparticles can penetrate the blood-brain barrier, which can cause adverse reactions such as neuroinflammation and neurotoxicity4. Therefore, limiting electronic cigarettes in the market should be implemented to promote the healthy development of adolescents. Should the government implement school classes to educate adolescents about the dangers of electronic cigarettes? The benefits of public awareness about the toxicity of vaping outweigh the potential government spending that may be required. Educating the youth about the dangers of vaping can limit its usage and can promote normal adolescent development. However, there is a rise in non-nicotine vape pods, which were originally introduced to assist chronic smokers in quitting conventional cigarettes. Now nicotine-free vape pods are being used as a stepping stone for young individuals to start vaping and potentially use products with nicotine. Some suggestions to counter the rise of vaping can be to increase the prices of electronic cigarettes, raise taxes on each purchase, increase the minimum age to buy vaping devices, and monitor social media advertisements. Another way to curb and limit the usage of nicotine vaping devices in the community is to dispense electronic cigarettes with medical prescriptions. Moreover, a common problem that educational institutions may face is the rise in social media trends that use vaping as a way for students to bond with one another. To counter this trend, institutions should ensure healthier social groups by introducing clubs such as sports, gaming, drama, art, and cooking, or promoting any gathering of students’ interest that avoids inhalation or ingestion of toxic microparticles. Therefore, electronic cigarettes should be difficult to purchase for adolescents and further research is necessary on non-nicotine vaping devices and the potential pathologic problems that could cause chronic diseases or halt normal development. Ethical approval None. Sources of funding None. Author contributions T.Z.: conceptualization, literature review, writing—original draft, writing—reviewing and editing of the manuscript. A.A.S.: literature review, writing—original draft. D.R.: literature review, revising, and editing of the manuscript. M.M.: literature review and revising the manuscript. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Guarantor Tayyab Zahoor. Consent None.

Healthy adolescent development and the juvenile justice system: Challenges and solutions

AbstractAdolescents are developmentally distinct from adults in ways that merit a tailored response to juvenile crime. Normative adolescent brain development is associated with increases in risk taking, which may include criminal behavior. Juvenile delinquency peaks during the adolescent years and declines in concert with psychosocial maturation. However, current U.S. approaches to juvenile justice are misaligned with youth's developmental needs and may undermine the very psychosocial development necessary for youth to transition out of crime and lead healthy adult lives. In this article, I discuss empirically supported and efficacious responses to juvenile crime in the United States, as well as opportunities for further developmental reform of the juvenile justice system. Developmentally appropriate responses to juvenile crime prioritize community‐based corrections and engage youth's social context in the rehabilitative process. The juvenile justice system shares the responsibility to prepare youth to live fulfilling, productive adult lives; that responsibility can be achieved by partnering with developmental scientists to inform juvenile justice practice and policy.

A Transdisciplinary Perspective on the Adolescent Consent-Abuse Binary

Recently, there have been a plethora of judgments from courts across India, on the issue of adolescent consent for sexual decision-making and the POCSO Act’s criminalization of the same. This article begins with a brief overview of the socio-legal underpinnings of POCSO’s age of consent, the imperatives informing legislative intent to abstain from a lower statutory age, and crucially, ‘close-in-exceptions’ to legal consent. Subsequently, the authors discuss the implications of these age requirements, for POCSO’s implementation, from a child protection and criminalization perspective, and furthermore, highlight the imperative for the law to accommodate normative adolescent sexual development in its approach to consensual sexual engagement, as well as for consideration of the complexities of informed vis-à-vis manufactured consent in adolescent sexual engagements. The article concludes by highlighting the need for the application of transdisciplinary approaches, to developing methodologies, that assess adolescent consent in ways that resolve the consent-abuse dilemma.

On a Possible Basis for Metaphysical Self-development in Natural and Artificial Systems

Recent research into the nature of self in artificial and biological systems raises interest in a uniquely determining immutable sense of self, a “metaphysical ‘I’” associated with inviolable personal values and moral convictions that remain constant in the face of environmental change, distinguished from an object “me” that changes with its environment. Complementary research portrays processes associated with self as multimodal routines selectively enacted on the basis of contextual cues informing predictive self or world models, with the notion of the constant, per-vasive and invariant sense of self associated with a multistable attractor set aiming to ensure personal integrity against threat of disintegrative change. This paper proposes that an immutable sense of self emerges as a global attractor which can be described as a project ideal self-situation embodied in frontal medial processes during more or less normal adolescent development, and that thereafter serves to orient agency in the more or less free development of embodied potentials over the life course in effort to realize project conditions, phenomenally identified with the felt pull towards this end as purpose of and source of meaning in life. So oriented, life-long self-development aims to embody solutions to problems at different timescales depending on this embodied purpose, ultimately in the service of evolutionary processes securing organism populations against threats of disintegrative change over timespans far beyond that of the individual. After characterizing the target sense of self, research circling this target is briefly surveyed. Self as global project and developmental neural correlates are proposed. Then, the paper discusses some implications for research in biological and artificial systems. Building from earlier work in cognitive neurorobotics, discussion affirms the value of reinforcement rituals including prayer in metaphysical self-development, considers implications for value alignment and rights associated with free will in the context of artificial intelligence and robot religion, and concludes by emphasizing the importance of self-development toward project ideals as source of meaning in life in the current social-political environment.

Dignity of Risk in Adolescent Development: A Neuropsychological Perspective.

Although the notion of "dignity of risk" has primarily been used in reference to adolescents with disabilities, this concept can be applied to all adolescents, as parents and guardians are challenged by how to balance adolescents' need for self-determination with the need for safety and supervision. In the context of maturing cognitive and emotional neural circuits, normative adolescent development involves temporal shifts in social and environmental factors that are inherently associated with both higher risk-taking and opportunities for growth and new learning. The challenge for parents of balancing risk and opportunity is influenced by social, cultural, and environmental factors, previous experience, personality, and the perceived capability of the adolescent. When perceived capability is lower, the challenge becomes even more acute, such as when an adolescent has a developmental, physical, or psychiatric disability that impacts cognitive, emotional, or adaptive functioning. This article reviews the literature on normative brain development from the perspective of balancing risk and self-determination in adolescence and discusses the implications for families and clinicians across a range of ability and disability. Potential approaches to fostering self-determination are discussed.

Health, social and economic implications of adolescent risk behaviours/states: protocol for Raine Study Gen2 cohort data linkage study.

Risk-taking behaviours are a major contributor to youth morbidity and mortality. Vulnerability to these negative outcomes is constructed from individual behaviour including risk-taking, and from social context, ecological determinants, early life experience, developmental capacity and mental health, contributing to a state of higher risk. However, although risk-taking is part of normal adolescent development, there is no systematic way to distinguish young people with a high probability of serious adverse outcomes, hindering the capacity to screen and intervene. This study aims to explore the association between risk behaviours/states in adolescence and negative health, social and economic outcomes through young adulthood. The Raine Study is a prospective cohort study which recruited pregnant women in 1989-91, in Perth, Western Australia. The offspring cohort (N = 2,868) was followed up at regular intervals from 1 to 27 years of age. These data will be linked to State government health and welfare administrative data. We will empirically examine relationships across multiple domains of risk (for example, substance use, sexual behaviour, driving) with health and social outcomes (for instance, road-crash injury, educational underachievement). Microsimulation models will measure the impact of risk-taking on educational attainment and labour force outcomes. Comprehensive preventive child health programmes and policy prioritise a healthy start to life. This is the first linkage study focusing on adolescence to adopt a multi-domain approach, and to integrate health economic modelling. This approach captures a more complete picture of health and social impacts of risk behaviour/​states in adolescence and young adulthood.

Identifying Clusters of Adolescents Based on Their Daily-Life Social Withdrawal Experience.

Social withdrawal is often presented as overall negative, with a focus on loneliness and peer exclusion. However, social withdrawal is also a part of normative adolescent development, which indicates that groups of adolescents potentially experience social withdrawal differently from one another. This study investigated whether different groups of adolescents experienced social withdrawal in daily life as positive versus negative, using experience sampling data from a large-scale study on mental health in general population adolescents aged 11 to 20 (n = 1913, MAge = 13.8, SDAge = 1.9, 63% female) from the Flemish region in Belgium. Two social withdrawal clusters were identified using model-based cluster analysis: one cluster characterized by high levels of positive affect and one cluster characterized by high levels of negative affect, loneliness and exclusion. Logistic regression showed that boys had 66% decreased odds of belonging to the negative cluster. These results show that daily-life social withdrawal experiences are heterogeneous in adolescence, which strengthens the view that, both in research and clinical practice, social withdrawal should not be seen as necessarily maladaptive.

Neuroanatomical markers of psychotic experiences in adolescents: A machine-learning approach in a longitudinal population-based sample

It is important to identify accurate markers of psychiatric illness to aid early prediction of disease course. Subclinical psychotic experiences (PEs) are important risk factors for later mental ill-health and suicidal behaviour. This study used machine learning to investigate neuroanatomical markers of PEs in early and later stages of adolescence.Machine learning using logistic regression using Elastic Net regularization was applied to T1-weighted and diffusion MRI data to classify adolescents with subclinical psychotic experiences vs. controls across 3 timepoints (Time 1:11–13 years, n = 77; Time 2:14–16 years, n = 56; Time 3:18–20 years, n = 40). Neuroimaging data classified adolescents aged 11–13 years with current PEs vs. controls returning an AROC of 0.62, significantly better than a null model, p = 1.73e-29. Neuroimaging data also classified those with PEs at 18–20 years (AROC = 0.59;P = 7.19e-10) but performance was at chance level at 14–16 years (AROC = 0.50).Left hemisphere frontal regions were top discriminant classifiers for 11–13 years-old adolescents with PEs, particularly pars opercularis. Those with future PEs at 18–20 years-old were best distinguished from controls based on left frontal regions, right-hemisphere medial lemniscus, cingulum bundle, precuneus and genu of the corpus callosum (CC).Deviations from normal adolescent brain development in young people with PEs included an acceleration in the typical pattern of reduction in left frontal thickness and right parietal curvature, and accelerated progression of microstructural changes in right white matter and corpus callosum. These results emphasise the importance of multi-modal analysis for understanding adolescent PEs and provide important new insights into early phenotypes for psychotic experiences.

A Kalirin missense mutation enhances dendritic RhoA signaling and leads to regression of cortical dendritic arbors across development

Normally, dendritic size is established prior to adolescence and then remains relatively constant into adulthood due to a homeostatic balance between growth and retraction pathways. However, schizophrenia is characterized by accelerated reductions of cerebral cortex gray matter volume and onset of clinical symptoms during adolescence, with reductions in layer 3 pyramidal neuron dendritic length, complexity, and spine density identified in multiple cortical regions postmortem. Nogo receptor 1 (NGR1) activation of the GTPase RhoA is a major pathway restricting dendritic growth in the cerebral cortex. We show that the NGR1 pathway is stimulated by OMGp and requires the Rho guanine nucleotide exchange factor Kalirin-9 (KAL9). Using a genetically encoded RhoA sensor, we demonstrate that a naturally occurring missense mutation in Kalrn, KAL-PT, that was identified in a schizophrenia cohort, confers enhanced RhoA activitation in neuronal dendrites compared to wild-type KAL. In mice containing this missense mutation at the endogenous locus, there is an adolescent-onset reduction in dendritic length and complexity of layer 3 pyramidal neurons in the primary auditory cortex. Spine density per unit length of dendrite is unaffected. Early adult mice with these structural deficits exhibited impaired detection of short gap durations. These findings provide a neuropsychiatric model of disease capturing how a mild genetic vulnerability may interact with normal developmental processes such that pathology only emerges around adolescence. This interplay between genetic susceptibility and normal adolescent development, both of which possess inherent individual variability, may contribute to heterogeneity seen in phenotypes in human neuropsychiatric disease.

Randomized Clinical Trial of Primary Care Based Online Depression Prevention Intervention: Impact on Adolescent Modifiable Factors and Behaviors

The developmental period of adolescence can pose a risk for the onset of depressive disorders, but is also a time when potentially modifiable factors and behaviors related to depressive episode onset can develop. An online health intervention can provide an opportunity to reach at-risk adolescents in between primary care visits and could impact these modifiable factors and behaviors to support healthy development. We explore the Competent Adulthood Transition with Cognitive-Behavioral, Humanistic, and Interpersonal Therapy (CATCH-IT), a self-directed online cognitive behavioral therapy prevention intervention, and its impact on modifiable factors and behaviors related to: (1) program completion, (2) normative adolescent development, (3) coping, (4) family relations, (5) general health behaviors, and (6) externalizing behaviors, in a primary care sample of adolescents at intermediate to high risk of developing depression. Adolescents were enrolled into either CATCH-IT or Health Education (HE) control group and followed for 24 months. CATCH-IT improved some factors related to program completion (e.g., motivation, recommendation to peers for depression prevention, and physician positive relationship), coping (e.g., perceived behavior change), and family relations (e.g., parental psychological control, sibling relative status) as compared to HE. HE improved normative adolescent development (e.g., health and loss life events) as compared to CATCH-IT. CATCH-IT utilized in primary care may benefit some at-risk adolescents in selective factors and behaviors.

OPENING PANDEMIC’S BOX: SUPPORTING DEVELOPING ADOLESCENTS

Developmental tasks of adolescence involve identity formation, building relationships, and achieving independence. This session will highlight some important aspects of adolescent development: sports/athletics, racial identity and racism, school and learning, and digital media. Special focus will be given to challenges with COVID-19, including activity cancellation, school changes/virtual schooling, increased awareness of racial and social disparities, and the role of media in social connections. Effects on mental health and well-being and the role of child and adolescent psychiatrists will also be discussed. Presentations will review the relevant literature and data with didactics, videos, case examples, polling, and interactive discussion. Raymond Pan, MD, child and adolescent psychiatrist, will discuss the role of athletics in adolescence, stressors involved with athletics, and issues related to concussions. Brandon Newsome, MD, psychiatry resident, will approach racial identity and racism in adolescence and how COVID-19 has influenced social determinants of mental health. Desiree Shapiro, MD, early-career child and adolescent psychiatrist, will discuss school- and learning-related mental health and explore disparities and injustices. Meredith Gansner, MD, early-career child and adolescent psychiatrist, will discuss media use and screen time in adolescence, effects of the pandemic, and potential risks of excessive digital media while maintaining interpersonal connectedness. Discussants Eugene Beresin, MD, and Liwei Hua, MD, PhD, both of whom are child and adolescent psychiatrists, will synthesize the material presented and facilitate discussion. Participants will: 1) recognize the role of sports, racial identity and racism, school and learning, and digital media in the context of normal adolescent development as they relate to identity and relationship formation, as well as independence; 2) learn about risks to these areas of development in the context of the pandemic; and 3) identify the role of child and adolescent psychiatrists in addressing the effects on mental health associated with the pandemic’s disruption of expected adolescent developmental milestones. The session focuses on topics relevant to adolescent life (sports/athletics, racial identity and racism, school and learning, and digital media) from a developmental perspective and seeks to educate clinicians on issues related to the topics.

Mechanisms Underlying Neurocognitive Specialization in Adolescence

Psychopathologies including psychosis, mood disorders, and addiction predominantly emerge in adolescence as cognitive and reward processing, which undergo unique maturation at this time, are undermined. Thus, characterizing the mechanisms underlying specialization in normative adolescent neurocognitive development has the potential to inform the range of variability of normative trajectories, and thus help identify impaired trajectories. Evidence will be presented linking developmental changes in cognition and reward processing to specialization of critical brain connectivity, and neurotransmitter changes using multimodal neuroimaging approaches including task and resting state functional Magnetic Resonance Imaging (fMRI), Diffusion Tensor Imaging (DTI), Positron Emission Tomography (PET), and Magnetic Resonance Spectroscopic Imaging (MRSI).

Addressing Emotional Issues in an Adolescent with Vitiligo and Early Child Sexual Abuse-Therapeutic Challenges.

Chronic medical conditions in children and adolescents have a significant impact on development and quality of life. Children with vitiligo experience depression, anxiety and guilt, body image concerns, and conflicts of acceptance–rejection among peers. Understanding issues of relevance through a developmental perspective is pivotal. Here, we report the experiences of working with an adolescent who presented with depressive symptoms, mood dysregulation, and self-harm, in the background of vitiligo and child sexual abuse. We describe the unique therapeutic challenges, focusing on the interplay between depressive psychopathology, childhood trauma, and normative adolescent development. Therapeutic strategies for patient-centered psychological interventions are discussed. The therapy processes focused on a narrative approach, with the active involvement of the family.

Teens' Experiences with Sexting: A Grounded Theory Study.

To explore and understand the relationship between sexting behavior and adolescent mental health and well-being. A constructivist grounded theory study was conducted. Seventeen 18-22-year-old participants provided recollective and reflective accounts of sexting experiences throughout their adolescence. Engaging in the Culture of Teen Sexting materialized as the central process and title for the grounded theory that emerged. Six primary processes included Engaging in the Culture of Teen Sexting, Identifying Motivating Factors, Forming Perceptions and Feelings, Acknowledging and Managing Risks, Connecting Mental Health and Sexting, and Finding a Sexual Self. The findings suggested sexting is part of teen culture and normal adolescent sexual growth and development. Acknowledging sexting as a culture and normal part of sexual growth and development will assist pediatric nurse practitioners in engaging teens in conversations about sexting, helping them to navigate the risks of sexting and find healthy ways to manage sexting behavior.

Primary Headache Associated with Sexual Activity in Adolescents: Illustrative Cases

AbstractPrimary headache associated with sexual activity (PHASA) is well described in adults, but reports in adolescents are lacking. PHASA is likely underreported in adolescents. A delay in or an absence of timely and adequate treatment has the potential to negatively impact normal adolescent psychosexual development. Physicians should consider this disorder in adolescents presenting with headaches, and understand the characteristics, diagnosis, and treatment. We reported two cases of PHASA in adolescents and review the epidemiology, presentation, and management.

The Role of Borderline Personality Symptoms for Psychosocial and Health Related Functioning among Adolescents in a Community Sample

Borderline personality symptoms include emotional dysregulation, high levels of impulsivity leading to self-harm and suicidality, an unstable sense of self, fears of abandonment, extremely turbulent relationships, and psychic pain. They are considered to disrupt normative adolescent development however their unique contribution to different domains of functioning is important to understand among community adolescents. This study aimed to analyze the specificity of the relationship between borderline personality symptoms and psychosocial and health-related functioning during adolescence in a community sample. A community sample consisted of 379 adolescents aged 11–18. Borderline personality questionnaire, Youth self-report, Satisfaction with life scale, questions addressing academic performance, and social relationships were used to assess the different domains of functioning. Data from the present study revealed that there is a substantial part of adolescents from a community sample (19.71%) who endorse significant levels of borderline personality symptoms. Adolescents from this group as compared to peers face more difficulties in all spheres of functioning. Furthermore, borderline personality symptoms uniquely predicted social problems, academic achievement, health concerns, and life satisfaction of adolescents above and beyond internalizing and externalizing difficulties. Higher levels of borderline personality symptoms were associated with poorer psychosocial and health-related functioning among adolescents at the community level. Considering that adolescence is a sensitive period for the development of personality disorder, findings of this study add up to the empirical evidence that borderline personality pathology should be integrated as a target for prevention and early intervention.

The Development of Health Self-Management Among Adolescents With Chronic Conditions: An Application of Self-Determination Theory

PurposeThe purpose of the study was to better understand the progressive development of health self-management among adolescents and emerging adults (AEAs) with chronic medical conditions in order to identify opportunities to prepare AEA for transition to adult-based care. MethodsTwenty-three AEA aged 17–20 years with renal, inflammatory bowel, or rheumatologic diseases, and their parents, completed individual semistructured interviews describing each AEA's health self-management. Self-Determination Theory was used to frame interview questions, including the constructs of competence, autonomy, and autonomy support. Transcripts were analyzed using directed content analysis. ResultsFour themes emerged: Development of Competence in Self-Management; Autonomy: Motivations to Self-Manage; Ways Important Others Support or Hinder Independence; and Normal Adolescent Development. AEA's competency and autonomy increased as they progressed from lack of knowledge about self-management to having knowledge without doing tasks, and, ultimately, to independent completion of tasks. Motivations to self-manage included avoiding sickness/weakness and wanting to engage in activities. Parents and providers supported AEA's autonomy through teaching and transferring responsibility. Parental fear/lack of trust in AEA's ability to self-manage hindered development of AEA's autonomy, producing anxiety. Normal adolescent development impacted timing of self-management task mastery. ConclusionsAs AEA gain competence in increasingly complex self-management tasks, they assume greater responsibility for managing their health. Competence and autonomy are facilitated by a feedback loop: AEA successful self-management increased parent trust, enabling the parent to transfer responsibility for more complex tasks. Conversely, parents' fear of the AEA doing wrong hinders transfer of responsibility, limiting competence and autonomy. Health-care providers play an important role in fostering autonomy.