Overview of Adolescent
Male and Female Physical and
Psychosocial Development
Dr. Betsy Pfeffer
Attending Physician
Adolescent Professor of Pediatrics
Topics
 PUBERTAL DEVELOPMENT
 TASKS OF ADOLESCENCE
 BRAIN DEVLOPMENT
Pubertal Development
Overview of Adolescent Pubertal
Development
 From a biologic perspective, the
beginning of adolescence is marked by
the onset of puberty
 Cultural influences on puberty include
nutrition, the quality of health care and
living conditions
Overview of Adolescent Pubertal
Development
 In the developed world the biologic age of
menarche has declined over the past
centuries from 16.6 years in 1840 to 12.5
years by 1980
 Data on boys, though less reliable,
suggest that they may be beginning
maturation earlier as well
.Sexual Maturity Ratings
Tanner developed a scale in 1962 that
divides the SMRs into 5 classes based on
pubic hair and breasts in females and
pubic hair and genitalia in males
Tanner Stages Females
Tanner Stages Males
Pubertal Changes in Males
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Gynecomastia
– Common transient breast enlargement
– Peak prevalence at age 14 years
– Usually resolves in 12-18 months
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Varicocele
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Can present between 10-15 years
Bag of Worms
More common on the left
Can impair fertility due to testicular
volume loss
Testicular discomfort can occur especially with sexually arousal
without ejaculation
Phimosis
Puberty
 The normal range in pubertal development is very broad
 Boys:
– Delayed puberty
• More common in boys than girls, usually constitutional delay
• Usually more difficult for boys than for girls
– Early developing males have greater self confidence and greater
likely hood of academic, social and athletic success
 Girls:
– Precocious puberty is more common in girls, usually idiopathic
and appears to be related to lower self esteem and more
concerns about body image
Delayed Puberty
 Boys
– No testicular development by age 14 years
 Girls
– Lack of thelarche (breast development) by age 13
years
– No menarche by 15 years
Sleep: A Complete Mystery
 Increased need for sleep at puberty
 Adequate sleep is essential to support healthy physical
development
 During puberty changes in melatonin secretion cause a
sleep delay leading to later sleep onset and later waking
times
 Adolescents need 9-9.5 hours of sleep/night
 Sleep enhances the consolidation of learning
 Insufficient sleep
– Irritability/Low frustration tolerance
– Difficulties with attention and self control
Hazen 2008
Dahl 2009
Tasks of Adolescence
 Physical Development/Puberty
 Psychosocial Development
 Cognitive Development
Stages of Adolescent Development
 In all countries adolescents go
through the same stages but
age ranges may vary
 Early Adolescence:
USA 10-13 years
 Middle Adolescence: USA 1416 years
 Late Adolescence: USA 17-21
years
Physical Changes:
Early Adolescence
Girls:
 Growth and growth spurts begins
 Beginning of pubertal changes
breasts/genitalia/pubic hair
 Accrual of muscle mass peaks at menarche,
thereafter the accumulation of fat predominates
(breasts, thighs and hips)
 Strength increases until menarche, there is no
consistent evidence of a strength spurt in girls
 Weight changes-body shape and size
– Hips widen/Waist narrows
Physical Changes:
Early Adolescence
Boys:
 Development of the testes and scrotum is
usually the first sign of puberty in boys
 Pubic hair
 Voice changes
 Gynecomastia common
.Physical Changes:
Early Adolescence
Boys and Girls:
 Wide range of normal
 Acne
 Body odor
 Girls tend to lose less of their body fat than boys
 An awkwardness as various body parts grow at
different rates
 Biologic changes in the brain causing dynamic
emotional changes
Physical Changes:
Mid Adolescence
Girls:
 Breast development
– Nipples swell , breasts may feel tender and
sensitive
– Breasts fill out over three to four years. One breast
may grow faster than the other
– One or both breasts may secret a small amount of
milky fluid
 Broadening hips leading to rounded feminine
figure
Physical Changes:
Mid Adolescence
Boys:
 Growth spurt in height usually occurs
 Strength spurt about one year after peak height
velocity
 Increase in muscle mass occur later than increase in strength
 Often the arms and legs lengthen before the trunk of
the body, can cause awkwardness
 Faster muscle growth in boys leads to greater
strength
 Penis growth
 Development of pubic, facial and body hair. Typically
facial and body hair appear about two years after
pubic hair
Physical Changes:
Late Adolescence
Females:
 By 16 years most young women have
completed puberty, the growth rate slows, there
is pubic and body hair, a rounded and curved
figure because of widened pelvis, hips and
breasts
 With a well established menstrual cycle, a
young woman at this point is physically able to
produce offspring
Physical Changes:
Late Adolescence
Males:
 By 16 to 18 years most males have completed
puberty, their growth rate begins to slow, their
shoulders have broadened, limbs and trunk are
muscular and they have adult body and facial
hair
 Produce sperm and are physically able to
produce offspring
Psychosocial Changes:
Early Adolescence
 Begin to separate from parents and identify
with peers
 Confrontational with parents
– Testing parental values
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Preoccupation with self
Preoccupation with being like peers
Conformity
Same gender in clique
.Psychosocial Changes:
Early Adolescence
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Interest in other gender for friendship
Curiosity about sexual matters begins
Travel in “packs”
Greater need for privacy
Still need “down-time”
Mood swings/Erratic behavior
Lack of impulse control
Psychosocial Changes:
Mid Adolescence
 Peak
– Parental conflicts
– Peer involvement
– Risk taking behavior
 Conformity with peer values
– Strong emphasis on peer group
 Feeling of omnipotence
 Egocentric
– Belief in own uniqueness
 Self centeredness and vanity
Psychosocial Changes:
Mid Adolescence
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Increasing independence
Sexuality is a major preoccupation
Less idealistic vocational aspirations
Questioning “who is the real me ?”
Behave differently with different people
Conflicting view of the self can be troubling
– Ability to recognize that they have different roles with
different people but don’t yet understand why and
this can be troubling
Psychosocial Changes:
Late Adolescence
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Integration of the diverse views of self
Less importance placed on peer group
May accept parental values or develop own
Realistic vocational goals
Less self centered
Decreased impulsivity and increased ability
to compromise and set limits
 Refinement of moral and religious values
Cognitive Development
 Much of modern thinking about cognitive development
in adolescence is gotten from the work of the Swiss
biologist/psychologist Jean Piaget (1896-1980)
 He outlined four main stages of cognitive development
from birth to adolescence
 The shift from the third stage of concrete thinking to
Piaget’s highest stage of cognitive formal operations
(the ability to think hypothetically and abstractly) begins
around age 11
 Correlates closely with age and experience versus
pubertal development
Cognitive Changes:
Early Adolescence
 Retain concrete thinking
 Begin to question authority and societal
standards
 Conformist morality of childhood
 Learning by trial and error
 Beginning abstraction
 Imaginary audience, on stage all the time,
others are thinking only about them
Cognitive Changes:
Mid Adolescence
 Thinking tends to be less childlike, more
abstract, introspective and analytic
 Begin to realize they are sexual beings
 Can consider facts and make better decisions
based on knowledge of the consequences of
their choices
 Sensitive to criticism
 Increased openness of feelings and sensitivity to
the feelings of others
 Continue to be influenced by peers
Cognitive Changes:
Late Adolescence
Conceptualize/verbalize thoughts
Full adult reasoning/identity
Ability for abstract thinking
Understanding consequences of
behavioral choices
Increased thoughts about more global
concepts such as justice, history, politics,
patriotism and their emerging role in adult
society
Brain Development
Brain Development
 There may be a biologic basis for the
increased risk taking and impulsivity in
adolescence
– The increase in risk-taking, sensation and
reward-seeking behavior, especially in the
presence of peers, is primarily linked to
changes in patterns of dopaminergic
activity that occur around the time of
puberty
Steinberg 2008
Hardwiring the Brain: Grey Matter
 According to Dr. Jay Giedd of the NIMH during
adolescence
– A second wave of overproduction of gray matter
peaks at about age 11 in girls and age 12 in boys
– A process called “pruning” occurs where connections
among neurons in the brain that are not used wither
away, while those that are used stay—the “use it or
lose it” principle
– Teens may actually be able to control how their own
brains are wired and sculpted
– The brain does not loss functionality, it becomes more
efficient (increased myelination, the reduction of
unused pathways)
Brain Development: White Matter
 Increase in the volume of white matter facilitating
connections between cortical regions occurs into the
twenties
National Institute of Mental Health 2001
 White matter connectivity that supports executive
control of behavior and self regulation are still immature
in adolescence
 The maturation of this system during adolescence is
likely a primary contributor to the decline in risk-taking
seen between adolescence and adulthood
Steinberg 2008
Decision Making
 The logical reasoning and basic informationprocessing abilities of 16-year-olds are
comparable to those of adults
 Adolescents
– Are knowledgeable, logical, reality-based, and
accurate in the ways in which they think about risky
activity
– Don’t think they are invincible-take risks despite fear
– Are susceptible to peer influence and have less
impulse control
Steinberg 2008
Decision Making
 Many important decisions are made by teens in
affectively charged environments and because
of incomplete myelination, executive brain
regions don’t modulate decision making and
poor decisions are made
Hazen 2008
Decision Making
 When challenges are presented to teens in less
emotionally charged settings, they make safer
decisions and use higher brain functions more
effectively
 True of adults too
 Importance of anticipatory guidance
Hazen 2008
Risk Taking
 From an evolutionary perspective risk taking is a
good thing, helps individuals learn to leave “the
nest”
 According to Dr. Giedd, the adolescent brain’s
plasticity allows adolescent to learn and adapt,
which paves the way to independence but it also
poses dangers: different rates of development
can lead to poor decision making and risk taking
 A profitable strategy might be to focus on limiting
opportunities for immature judgment and
consequently decreasing the possibility of harmful
outcomes
Courage is resistance to fear,
mastery of fear –
not absence of fear
Mark Twain
Take Home Lessons
Normal Adolescence Development
 Distinct stages of physical, cognitive and social
development
 Dynamic brain changes
 Adjustment to a changing body and new feelings related
to sexuality
 Finding a place with their peers, re-negotiating their
position in the family
 Risk taking behaviors
 Discovering an answer to the question “Who am I?”,
preparing for their future and defining their own value
system that serves to manage moral, ethical and
personal decisions
How Adults Can Help
We can help successfully guide our youth
community into making thoughtful and healthy
decisions along their journey into becoming
responsible and productive adults
Bibliography
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2004
Patton, G. “Pubertal Transitions in Health” The Lancet 2007
Hazen, E. et al “Adolescent Psychological Development: A Review” Pediatrics in Review 2008
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in review 2004
Ginsburg, K. “ Engaging Adolescents and Building on Their Strengths” AAP Adolescent Health
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2008
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New York Academy of Science s 2004
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Review 2008
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