Puberty

A set of anatomical and physiological changes.

• Period of life during which a person undergoes physical and hormonal changes that mark the transition from childhood to adulthood.

• Secondary sexual characteristics and, under normal circumstances, reproductive capacity appear.

• It is a UNIVERSAL FACT

Adolescence

Developmental transition between childhood and adulthood involving major physical, cognitive and psychosocial changes.

✔Between 11-19/20 years old.

✔Adolescence as a social construct.

✔PERIOD OF TRANSITION AND EXPERIMENTATION

Changes in adolescence

Cognitive changes

physical changes

psychosocial changes

Physical changes

GROWTH

MUSCLE STRENGTHENING

SHOULDER BROADENING

HORMONAL DEVELOPMENT

CHANGE OF SEXUAL ORGANS

in which stage does the NEED FOR SEPARATION OF FAMILY IDENTITY occur?

• Adolescence

It is a psychosocial change in adolescence

Characteristics of PSYCHOSOCIAL CHANGES

NEED FOR MATURITY

NEED FOR SELF-IDENTITY

PSYCHOLOGICAL SEPARATION FROM PARENTS

MORE SOCIAL BONDING (FRIENDSHIP)

SOCIAL PROBLEMS

LEARNING TO TAKE RISKS

NEW DANGERS

Characteristics of cognitive changes

• LOSS OF SYNAPTIC CONNECTIONS (PRUNING)

• MIND REACHES NEW DOMAINS AND CAPACITIES

• MYELINISATION

• VULNERABILITY

• CONFUSION

Stages of adolescence

• EARLY ADOLESCENCE 11-14 YEARS

• MIDDLE ADOLESCENCE 14-16 YEARS

• LATE ADOLESCENCE 17-18 YEARS

EARLY ADOLESCENCE 11-14 YEARS

• BEGIN TO GROW PHYSICALLY

• BEGIN TO DEVELOP MORE COMPLEX COGNITIVE ABILITIES

• ALSO GREATER CAPACITY FOR SOCIAL RELATIONSHIPS

• INCREASED SELF-AWARENESS

MIDDLE ADOLESCENCE 14-16 YEARS

PHYSICAL GROWTH CONTINUES

INCREASED SOCIAL CHALLENGES

GREATER INTIMACY IN COUPLE RELATIONSHIPS

PARENT-CHILD RELATIONSHIP CHANGES

first sexual exploration

LATE ADOLESCENCE 17-18 YEARS

PHYSICAL GROWTH STABILISES

PSYCHOSOCIAL CHANGES STABILISE

what is the known PHYSICAL DEVELOPMENT IN ADOLESCENCE

Puberty

Puberty

•  Process leading to sexual maturity or fertility

→ ability to reproduce.

• Resulting from the production of certain hormones.

  → dramatically increase of hormones in our body is responsible for change

Hormonal changes

• Concentrations of certain hormones increase dramatically: oestrogen (key in female development) and testosterone (predominant in male development).

• Hypothalamic-pituitary-gonadal axis

Hypothalamic-pituitary-gonadal axis

HYPOTALAMO = Gonadotropin-releasing hormone (GnRH)

→

HYPOPHYSIS = Gonadotrophins (Gn) > luteinising

hormone (LH) and follicle stimulating hormone (FSH)

→

GONADS = Oestrogen, progesterone,

testosterone.

• Hypothalamus
  → A part of the brain that starts the process.
  → It sends a signal called GnRH (gonadotropin-releasing hormone).

• Pituitary Gland
  → A small gland under the brain.
  → It receives the signal and releases two hormones:

  • LH (luteinizing hormone)

  • FSH (follicle-stimulating hormone)

• Gonads
  → Testes in males, ovaries in females.
  → These respond by making sex hormones:

  • Testosterone (mainly in males)

  • Estrogen and progesterone (mainly in females)

Hormonal changes in men and women (photo)

Two stages of hormonal changes

First stage → 6-8 years = Activation of the adrenal glands

Second stage→ Maturation of sexual organs

First stage → 6-8 years

Activation of the adrenal glands

▪ Adrenal glands → ↑ androgens (dehydroepiandrosterone, DHEA):

• growth of pubic, axillary and facial hair

• faster body growth, increased skin fat

• development of body odour.

Second stage→ Maturation of sexual organs

Females: ovaries → ↑ oestrogens = growth of female genitalia and

development of breasts and pubic and axillary hair.

▪ Males: testes → ↑ androgens = male genitalia growth, increased

muscle mass and body hair development.

Sexual characteristics

Primary sexual characteristics

secondary sexual characteristics

• necessary for reproduction

Primary sexual characteristics

• Organs necessary for reproduction: during puberty they

enlarge and mature.

• Females: ovaries, fallopian tubes, uterus, clitoris and

vagina.

• Males: testicles, penis, scrotum, seminal vesicles and

prostate.

Secondary sexual characteristics

• Physiological signs of sexual maturation that do not

directly involve the sexual organs:

• Females: breasts.

• Males: broad shoulders.

• Other signs: changes in voice and skin

Main external Signs of puberty

• Females: breast tissue and pubic hair.

• Males: enlargement of the testicles.

Other signs of puberty

• Pubic hair > coarse, dark and curly.

• Voice > deeper, especially in males.

• Skin > thicker and oilier.

Maturation of reproductive organs generates:

Male sperm > first ejaculation as a sign of sperm production.

• Average: 13 years.

Menarche in females > first menstruation resulting from monthly shedding of the lining of the uterus.

• Average range: 10-16 years.

Timing of menarche in females

“Individual differences”

• Genetic: age of menarche of the mother.

• Physical: prepubertal fat and body weight (obesity).

• Contextual: toxins (maternal smoking during pregnancy).

• Emotional: chronic stress (family conflict, cold and distant relations with parents, family breakdown).

Secular growth trend

• Decreasing age of onset and attainment of adult height and sexual maturity.

  • = Kids are starting puberty and reaching their full adult height and sexual maturity at younger ages than before.

Factors for secular growth trend in adolescence

• Possible cause → better quality of life (diet, health...).

• Others point out that it could be due to harmful factors (too much fat and a sedentary lifestyle, which increase obesity, as well as endocrine disruptors = toxins that act like hormones)

Timing in puberty

1. Early or late puberty has been linked to physical (obesity), health (cancer, polycystic ovaries) and psychosocial (anxiety, depression, early pregnancy) effects.

2. It is difficult to generalise because the psychological effects of the onset of puberty will depend on how the adolescent and those close to him or her interpret the changes.

3. The effects of early or late maturation are more likely to be negative when adolescents development is much higher or lower than that of their peers, when they do not see the changes as advantageous, and when several stressful events (onset of puberty and transition to secondary school) occur at the same time.

Adolescent growth

Rapid increase in height, weight, muscle and bone growth that occurs during puberty.

• Girls: 10 years / Boys: 12-13 years.

Eating disroder

Disorders associated with excessive preoccupation with weight control (fear of gaining weight) and body image (body dissatisfaction).

Abnormal patterns of food consumption

• Among the contextual factors, parental attitudes and images in the media and social networks are of great importance.

• Prevalence studies indicate wide differences according to age group and gender, being much higher in adolescent and young women.

• However, it also occurs in men and at other ages

Anorexia self-starvation

• Eating disorder characterised by the cessation of eating.

• Intense fear of gaining weight.

• Distorted body image → belief of being too obese.

• Body weight and body build are the only or the main referents that condition self-assessment.

• Significant risk of chronicity, presenting situations of high psychiatric and somatic severity, possibly leading to death.

• It has one of the highest suicide rates among psychiatric disorders.

Bulimia

• Recurrent episodes of binge eating with a sense of lack of control.

• Recurrent inappropriate compensatory behaviours to avoid weight gain: induction of vomiting, inappropriate use of laxatives or diuretics, fasting or excessive exercise.

• Self-assessment is unduly influenced by body build and weight.

• Distinguish from binge eating disorder: there is binge eating without compensatory behaviours. In contrast to bulimia, they are usually overweight.

PHYSICAL AND MENTAL HEALTH IN ADOLESCENCE

Health problems will affect lifestyle

Common health problems in young people

headaches, and stomachaches; anxiety and feelings of tiredness, loneliness or depression.

socio-economic resource relate to health

• In many countries, adolescents from poorer families have poorer health and more frequent symptoms.

• Better-off families eat healthier and are more physically active.

health problems might be prevented by

• As a result of lifestyle.

✔ Adolescents are generally healthy: they will feel the effects later in life.

✔ The lifestyle is largely consolidated in adolescence

Adolescent health problems are related to

PHYSICAL VARIABLES

PSYCHOSOCIAL VARIABLES

PHYSICAL VARIABLES related to problems in adolescence

Physical condition, sleep needs, inadequate nutrition.

PSYCHOSOCIAL VARIABLES related to problems in adolescence

Feelings of loneliness, rejection, not belonging to a group

PHYSICAL ACTIVITY

• Sport participation during childhood and adolescence increases the likelihood of being physically active in adulthood and receiving its physical and mental health benefits.

• Adolescence is a key period for young athletes to either become regular practitioners or, on the contrary, to abandon this activity.

• In adolescence, there is a drastic decrease in participation rates in physical activity and sport. Higher in girls than in boys.

• Importance of studying the factors involved and designing strategies to promote physical activity and to prevent sedentary lifestyles.

Benefits associated with regular physical activity

Increased strength and endurance.

✔ Healthier bones and muscles.

✔ Weight control.

✔ Reduction of anxiety and stress.

✔ Improvement of self-esteem and well-being.

✔ Improved academic performance.

✔ Reduction of risky behaviours.

Problems associated with a sedentary lifestyle

✔ Increased risk of mental health problems.

✔ Increased risk of obesity and type II diabetes.

✔ Heart disease and cancer in adulthood.

Recommendations WHO (activity) Young people 5-17 years old

• At least 60 minutes per day of moderate to vigorous intensity physical activity.

• Intense aerobic activities at least 3 days/week.

Recommendations WHO (activity) Adults → 18 years old

• Minimum 150-300 minutes per week of aerobic physical activity, or

• moderate intensity 75-150 minutes of vigorous aerobic physical activity, or a combination.

• Muscle strengthening activities minimum 2 days/week.

Sleep recommendation

sleep at least 8-10 hours a day

what are some common inapporate sleep habits when getting older

• Going to bed late and sleeping < 8 hours on weekdays.

• Sleeping more at weekends to "compensate" (but it doesn't compensate).

Consequences of sleep deprivation during adolescence

• Decreased motivation.

• Increased irritability.

• Impairment of concentration and school performance.

• More traffic accidents.

• Increased risk of obesity and diabetes.

• Lower mental health.

Why do adolescents stay up late?

• Duties: they have to do homework.

• Pleasures: they want to talk or send messages to their friends, surf the internet.

• Imitation: looking older.

• Biological changes: melatonin secretion later in the night → need to wake up later.

How can these bad sleep habits be resolved?

Synchronise secondary school programmes with students' biological rhythms: start activities later or offer more complicated subjects later in the afternoon.

NUTRITION AND EATING HABITS

Related to nutrition and overweight/obesity

Overweight and obesity in Spanish adolescents and young adults (16-30 years), Spanish Obesity Society (SEEDO, May 2021) survey

• 1 in 4 (24.7%) are overweight or obese.

• 61.1% consume processed food on a daily basis, just over 15% do sport every day and nearly 40% admit to spending more than 6 hours/day in front of a screen.

• Attempts to lose weight are most often made without professional guidance and on the basis of unscientific products and advice.

what do we have to take into account when reading data about overweight?

• biological factors - Metabolism

• Charbohydrates are super important for our brain functions “neat”- type of daily activity which might help reduce overweight (taking the stairs instead of the elevator)

Causes of overweight in adolescence

• Biological factors: genetics, inefficient regulation of metabolism.

• Emotional factors: depressive symptoms, anxiety, etc.

• Environmental factors: sedentary lifestyle, imbalanced calorie intake/expenditure, family behaviours.

Substance use and abuse in adolescence

harmful use of alcohol and other drugs

Substance abuse

• Harmful use of alcohol and other drugs that can lead to physiological and/or psychological addiction.

• Increased likelihood of continuing into adulthood.

Drugs particularly harmful to adolescents 

stimulation of parts of the brain that continue to develop during adolescence.

Trend in drug use

• Alcohol, tobacco and cannabis → drugs most commonly consumed by Spanish students.

• They are followed by hypnosedatives (prescription and non-prescription), cocaine, ecstasy, methamphetamines, hallucinogens, opioid painkillers, magic mushrooms, volatile inhalants, amphetamine, heroin, GHB and anabolic steroids.

• More widespread use of illicit drugs among men.

• More widespread use of legal drugs (tobacco, alcohol and hypnosedatives) among women.

Studies from estudes 2021 vs 2023

• Increased use of alcohol, hipnosedantes, extasis

• decreased use of tobacco, cannabis

Studies from estudes males vs female

• Males abuse more illegal drugs such as extasy, cocaine, cannabis

• females abuse less dangerous drugs such as alcohol, tobacco, hypnosedantes (valium)

What does consumption of drugs do with our heatlh?

• Potent, mind-altering drug with implications for physical, emotional and social well-being.

• Consumption is a serious problem in many countries.

• With a still developing brain, adolescent are more vulnerable to the harmful effects of alcohol.

• Trend in alcohol consumption (ESTUDES, 2023): decrease in alcohol consumption.

Alcohol consumption and abuse

Excessive alcohol consumption in adolescents can affect thinking & memory.

• Two brain areas particularly vulnerable to alcohol abuse in adolescents → frontal lobes and hippocampus.

• Frontal lobes → decision making and impulse control.

• Hippocampus → memory formation and learning.

• Structural changes in the brain:

✔ Reduced volume of grey matter & reduced integrity of white matter (less neuronal production leading to lower neuronal connections).

✔ Changes in prefrontal areas involved in executive control (cognitive flexibility).

✔ Changes in areas involved in reward mechanisms.

Trend in tobacco consumptio

Decrease in tobacco consumption (2023).

• 38.2% have ever smoked tobacco in their lives.

• 30.7% have smoked tobacco in the last year.

• 23.9% in the last 30 days.

• 9% smoke tobacco daily.

Initiation of tobacco use

• As a sign of rebellion and the passage from childhood to adulthood > desired image compensates for the initial unpleasantness of the first puffs.

• Peer influence > acceptance of peer group uniformity.

• Influence of family > older siblings and parents.

• Influence of the media and social networks

Short term Effects of tobacco use

susceptibility to respiratory diseases, reduced physical fitness, acne, hair loss, premature ageing of the skin, reduced growth, bad breath.

Long term Effects of tobacco use

increased likelihood of cancer, especially lung cancer, chronic lung diseases and brain diseases (stroke).

Cannabis use and abuse

• Most widely used illegal drug.

• Low perception of the risk associated with their use.

• However, its effects are very detrimental to health.

✔ Addiction.

✔ Some of their brain sequelae may be chronic.

✔ It changes the person's lifestyle.

Trends in cannabis use (ESTUDES, 2021)

✔ 28.6% reported having used at some time in their lives.

✔ 22.2% in the last year.

✔ 14.9% in the last month.

Effects of excessive cannabis use

• Damage to the brain, heart, lungs and immune system.

• Nutritional deficiencies, respiratory infections.

• Decreased motivation → amotivational syndrome: apathy, lack of desire and little interest in tasks and social relations.

• Interference with daily activities, family problems.

• Increased depression, anxiety, psychosis.

• Impaired memory, speed of thinking, learning and school performance.

• Impaired perception, increased reaction time, decreased alertness, attention span, judgement and motor skills necessary for driving and increased likelihood of traffic accidents.

CAUSES OF DEATH IN ADOLESCENCE

• Main causes of death → traffic accidents, AIDS, suicides.

• Other causes → respiratory infections and violence.

Death in adolescence: suicide

One of the leading causes of death in adolescence.

• There is a certain upward trend.

• According to the Spanish Suicide Observatory, 341 people aged

between 15 and 29 took their own lives in 2022.

• The statistics reflect deaths and not suicide attempts (20-25 by

suicide) or suicidal ideation.

• Higher risk of death by suicide in men. Higher risk of attempt in

women. This is related to the method of use.

AIDS (Acquired Immunodeficiency Syndrome)

• One of the world's leading causes of death among young people.

• In Spain, around 1000 young people are infected each year.

• Adolescents are the only group in which the mortality rate is not decreasing.

HIV attacks more CD4 molecules over year leading to HPV

Percentage of affected people

in spain - people are mostly affected in ages of 50 years, might because there are not enough of people who test themselves for the virus before getting into affected stage which lead to clear symptoms approximately 10-12 years later from the day of infected.