What is adolescence?
Adolescence (10-19 years) is a phase of life which has recently gained recognition as a distinct phase of life with its own special needs. This phase is characterized by acceleration of physical growth and, psychological and behavioural changes thus bringing about transformation from childhood to adulthood.
Adolescence has been described as the transition period in life when an individual is no longer a child, but not yet an adult. It is a period in which an individual undergoes enormous physical and psychological changes. In addition, the adolescent experiences changes in social expectations and perceptions. Physical growth and development are accompanied by sexual maturation, often leading to intimate relationships. The individual’s capacity for abstract and critical thought also develops, along with a sense of self-awareness when social expectations require emotional maturity.
Adolescents are defined as individuals in the 10-19 year age group, “youth” as the 15-24 year age group. The Government of India, however, in the National Youth Policy defines youth as the 15-35 age group and adolescents as 13-19 years.
“Adolescence” is recognised as a phase rather than a fixed time period in an individual’s life.
It is important to note that adolescents are not a homogenous group. Their needs vary with their sex, stage of development, life circumstances and the socio-economic conditions of their environment.
Developmental Characteristics of Adolescents
Adolescence, the transition between childhood and adulthood, is a stressful period of life characterised by discernible physical, mental, emotional, social and behavioural changes.
Rapid and dramatic physical development and growth mark adolescence, including development of sexual characteristics. Marked morphological changes in almost all organs and systems of the body are responsible for the accelerated growth and the changes in contours and sexual organs. In case of boys, active acceleration in growth of coarse pubic hair and facial hair usually precede other signs of puberty such as voice changes. In girls, development of breasts, broadening of hips and rapid growth in height usually begins about two and a half years before menarche.
Adolescents have to cope, not only with changes in their physical appearance, but also with associated emotional changes and emerging and compelling sex urges. Bodily changes cause emotional stress and strain as well as abrupt and rapid mood swings. Getting emotionally disturbed by seemingly small and inconsequential matters is a common characteristic of this age group.
Hormonal changes are likely to result in thoughts pertaining to sex, irritability, restlessness, anger and tension. Attraction to the opposite sex leads to a desire to mix freely and interact with each other. However, in reality, this may not always be possible, partly due to societal restrains on pre-marital sexual expressions and also because of other priority needs in this period, viz. education, employment, etc. Hence, it becomes almost necessary for adolescents to learn how to face and deal patiently with the turbulence they face. It requires development of a sense of balance and self-imposition of limits on expression of one’s needs and desires. An inability to express their needs often leads adolescents to fantasize and daydream that helps them to at least partially fulfil their desires.
Adolescence is also marked by development of the faculty of abstract thinking that enables them to think and evaluate systematically and detect and question inconsistencies between rules and behaviour. Parents as well as service providers often overlook this development, one of the basic reasons for the popularly known ‘generation gap’.
Socially, adolescence consists in shifts from dependency to autonomy, social responses to physical maturity, the management of sexuality, the acquisition of skills and changes in peer groupings. The need to be a part of a gang or a large group is replaced by a preference for maintaining fewer, more steady and binding relationships.
|Stage with Age||Early Adolescence (ages 11-13 years)||Middle Adolescence (ages 14-15 years)||Late Adolescence (ages 16-18 years)
Puberty: Rapid growth period
Secondary sexual characteristics begin to appear
Secondary sexual characteristics further develop
95% of adult height reached
Physical maturity and reproductive growth levelling off and ending
|Intellectual / Cognition
Concrete thought dominates “here and now”
Cause and effect relationships are underdeveloped
Stronger “ Self” than “Social awareness”
Growth in abstract thought
Reverts to concrete thought under stress
Cause and effect relationships are better understood
Abstract thought established
Future oriented; able to understand, plan and pursue long term goals
Philosophical and idealistic
Challenge the authority of family structure
Wide mood wings
Begins to reject childhood likings
Argumentative and disobedient
Conflict with family predominates due to ambivalence about emerging independence
Emancipation: Vocational/ technical/college and/ or work
Preoccupied with physical changes and critical of appearance
Anxiety about secondary sexual characteristics
Peers are idealized as a standard for normal appearance (comparison of self with peers)
Less concern about physical changes but increased interest in personal attractiveness
Excessive physical activity alternating with lethargy
Usually comfortable with body image
Intense friendship with same sex
Contact with opposite sex in groups
Strong peer allegiances- fad behaviours
Sexual drives emerge and adolescents begin to explore ability to date and attract a partner
Decisions /Values less influenced by peers
Relates to individuals more than to peer group
Selection of partner based on individual preference
"Am I normal?"
Vocational goals change frequently
Begin to develop own value system
Emerging sexual feelings and sexual exploration
Desire for privacy
Magnify own problems: "no one understands"
Experimentation - Sex, drugs, friends, jobs, risk-taking behaviour
Pursue realistic vocational goals or career employment
Relates to family as adult
Begin to distinguish their imaginations from real
Establishment of sexual identity, sexual activity is more common
- Searching for identity, influenced by gender, peer group, cultural background and family expectations
- Seeking more independence.
Seeking more responsibility, both at home and at school
- Looking for new experiences. May engage in more risk-taking behaviour.
- Thinking more about 'right' and 'wrong'.
- Influenced more by friends' behaviour- sense of self and self-esteem
- Starting to develop and explore a sexual identity
- Communicating in different ways. Communication with peers through internet, mobile phones and social media
Problems during adolescence
Adolescents today are more vulnerable to health implications due to their nature of experimenting and exposure to limited information regarding issues affecting their health and development. Problems in this age are related to their physical and emotional development and search for identity and risky behaviour.
Normal growth - anxiety and tension
Increase in height and weight-malnutrition and anaemia
Breast development –stooping of shoulders, abnormal posture and back pain
Skin becomes oily –acne
Body image –requirement for protein, energy, prevalence of malnutrition
|Sexual Development Changes
Desire to have sex -unsafe sex, unwanted pregnancy, RTI/STI, HIV/AIDS
Ejaculation-fear, guilt, myths and emotional problem
Masturbation –myths, confusion, inadequate knowledge
Menstruation–menstrual disorder, unhygienic practices leads to RTI/STI
|Emotional and Psychological Changes
Development of self-identity-confusion
Curiosity –risk taking behaviour , eating behaviour and life style disorders such as smoking, alcohol and drugs
Relationships –peer pressure , parental relationships and sexual relationships
Priority health problems of Adolescents and role of health workers
- Nutritional problems
- Psychosocial problems
- Acute and chronic diseases
- Substance abuse
Role of Health workers to attaining maintaining the optimum health
- Provide necessary and adequate information to adolescents parents and public
- Collaboration with teachers, parents, institutions to help adolescents
- Use of IEC (Information, edu, Communication)
Profile of Adolescents in India
- Adolescents comprise a sizeable population - there are 243 million adolescents comprising nearly one-fifth of the total population (21.4%).
- Composition varies by age and sex - Of the total population, 12.1% belong to 10-14 age group and 9.7 % are in the 15-19 age group. Female adolescents comprise 46.9% and male adolescents 53.1 % of the total population.
- At national level 27% of 15-19 year old girls (33% rural and 15% urban) are already married as compared to only 4% rural and 1% urban men in same age group According to NFHS-3, 47% of currently married women aged 20-24 were married before 18 years of age..
- Maternal mortality rate due to teenage pregnancy is 9% (2007-2009) – A high risk of pregnancy and childbirth results in a high level of female mortality in the reproductive age group. Maternal mortality of teenage mothers is a grave cause for concern. TFR amongst 15-19 yrs old is 14% in urban and 18% in rural of the total fertility (NFHS 3)
- There are marked inequalities in education among adolescents in India. 53% dropout during class 1 - 10, only 2.35% adolescent continue higher secondary education with high dropout rate for both girls and boys.
- Economic compulsions force many to work - Nearly one out of three adolescents in 15-19 years is working - 20.6 % as main workers and 11.7 % as marginal workers. Economic compulsions force adolescents to participate in the workforce. Despite adult unemployment, employers like to engage children and adolescents because of cheap labour.
- Findings from (NFHS 3) indicate that as many as 56% of females and 30% of males in the 15 - 19 age group are anemic. In 15 - 19 yrs age group 47% females and 58% males are thin and 2.4% females and 2% males suffer from obesity.
- More than 33% of the diseases burden and almost 60% of premature deaths among adults can be associated with behaviors or conditions that began or occurred during adolescence for ego Tobacco, alcohol use, poor eating habits, sexual abuse and risky sex (WHO 2002).
- Crimes against adolescents are prevalent - Sexual abuse of both boys and girls cuts across economic and social classes. According to a survey, in 84 % cases, the victims knew the offenders and 32 of the offenders were neighbours. Crimes against girls range from eve teasing to abduction, rape, prostitution and violence to sexual harassment. Unfortunately, social taboos prevent these crimes from being registered. Even when registered, prosecution rarely takes place.
- Unmet need for contraceptives - The contraceptive knowledge is quite high among adolescents but there are high gaps between knowledge and usage. Only 23% of married girls reported use of any contraceptive method.
- Trafficking and Prostitution has increased - Extreme poverty, low status of women, lax border checks and the collision of law enforcement officials has lead to increase in prostitution. Expansion of trafficking and clandestine movement of young girls has also increased across national and international borders. Misconceptions about HIV/AIDS are widespread - There is a high level of awareness about HIV among young people especially among those who are more literate. As per (NFHS 3) awareness of STls’ and HIV/AIDS was limited in 15-24 yrs age group. Just 19% of young men and 15% of young women reported awareness of STI.
- Rashtriya Kishor Swasthya Karyakram - Resource Book by Ministry of Health and Family Welfare
- Rashtriya Kishor Swasthya Karyakram - Facilitator Guide by Ministry of Health and Family Welfare