The Perils of the PreTeen Girl Understanding the

The Perils of the Pre-Teen Girl: Understanding the Challenges Girls Face in Adolescence Elise De. Vore Berlan, MD, MPH The Ohio State University College of Medicine Nationwide Children’s Hospital

Road Map • Normal Adolescent Development • Transition to Adolescence • Pitfalls for Girls • The Power of Good Parenting

Adolescents!!!

What is adolescence? • Not a disease or disorder!!! • Time period – roughly the second decade of life • It is a biological and cultural phenomenon experienced differently across time and culture. • Adolescence ≠ Puberty

Critical Tasks of Adolescence • Development of adult body • Attain sexual maturity • Acquire mature thinking and planning • Identity development • Personal • Sexual • Vocational • Moral

Puberty involves… • Growth spurt • Weight gain • Adult body composition • Secondary sexual development (breasts, pubic hair, genital development) • Menstrual periods and sexual maturity

Normal Pubertal Development Characteristic Breast development begins Age Range 8 -13 years Breast development complete 12 -18 years Pubic hair appears 8 -14 years Growth spurt begins 9 -14 years Menarche 10 -16 years

Developmental Stages of Adolescence • Early Adolescence: 11 -14 years • Middle Adolescence: 14 -17 years • Late Adolescence: 18 -21 years

Snapshot: Pre-adolescent Girl • Unique is in 5 th grade at a charter school. She enjoys school and wants to be a pediatrician when she grows up. She is in a dance group, and is involved in activities at church. Sometimes she attends sleep over parties with other girls. She likes to read and dream about her future. • She attends a local after school program called Girls Inc. , and loves it. She especially loved a recent unit they did on anatomy. • She hasn’t thought much about puberty and boys, although she says she knows “what’s what”.

Snapshot: Early Adolescent • Shala is a 7 th grader. She is taller than most of the boys in her class, and physically resembles a grown woman. Boys have started to tease her about her breasts. She had previously been on the basketball team, but because the girls were being mean to her and spreading rumors, she switched to volleyball where she likes the girls better. • She mostly hangs out with her girl friends (BFFs), and still spends evenings at home with her mother. She spends hours talking on her cell phone, texting, and on My. Space.

Snapshot: Early Adolescent • She says she has a good relationship with her mother, but doesn’t want to talk with her about periods, puberty, boys, and sex. • On a run with her mother, she said, “Mom, do you mind not talking to me when we run together? ” • Another time, when her mom was standing in the rain watching her play soccer, she came over and asked her not to wear her raincoat with the hood up. ☺

Early Adolescence Cognitive Development • Concrete thinking – or – in the “here and now” • Difficulty reflecting on others’ points of view • Extreme concern with own needs, and assumption that these needs are equally important to others!!! • Tendency to magnify one’s personal situation

Early Adolescence Cognitive Development • “Imaginary Audience” – always on stage • Frequent daydreaming • Greater need for privacy – writing in diaries, etc. • “Personal Fable” – no one knows what it’s like to be me… • Sense of invulnerability • Inability to perceive long-range implications of current decisions and actions • LACK OF IMPULSE CONTROL

Early Adolescence Psychosocial Development • Rapid physical changes lead to preoccupation with physical appearance and changes in body. • Seek constant reassurance of their own normalcy. • AM I NRML? • Increased interest in sexual anatomy and physiology: • Periods, nocturnal emissions, masturbation, breast and penis size • Attractiveness

Early Adolescence Psychosocial Development • Begin separation from parents. • Exploration and definition of independence boundaries. • Less interest in parent/family activities • Reluctance to tacitly accept parental advice • Realizes the parent isn’t perfect!!!

Early Adolescence Psychosocial Development • Importance of peer group and conformity with peers increases. • Search for new people to love in addition to parents. • Intense, idealized same-sex relationships common (BFF) • Limited capacity for intimacy given cognitive constraints.

Early Adolescence Psychosocial Development • Wide mood and behavior swings. • Erratic movement into and out of childhood world. • Childish coping skills ineffective in adult situations.

Snapshot: Middle Adolescent • Asia is 16. She is overweight, and has tried dieting a couple times (skipping meals, no big deal, right? ). She eats fast food frequently for lunch since she can leave campus with friends. • She has a lot of stress related to attending a private girls school, and is frequently upset because her parents don’t get along well. She is not doing well in math since starting high school.

Snapshot: Middle Adolescent • She has been going out with her boyfriend for a couple months and is confused about becoming sexually active. When she gets stressed out sometimes she cuts herself, but usually listens to music or writes in her journal. She is into fashion, and plans on going to art school after high school.

Middle Adolescence Cognitive Development • Begin the gradual realization that others have needs of their own. • Idealism and commitment to social causes common. • Further ability to use abstract thinking, but inconsistently applied. • May revert to more concrete levels at times of stress. • May lead to inconsistent or “irrational” behavior. • Persistence of sense of immortality.

Middle Adolescence Psychosocial Development • Increase in intensity of emotions • Peak of child-parent control battles. • Able to conceive of “ideal” parents, contrast with own parents. • Intermittent seeking and rejection of parental support.

Middle Adolescence Psychosocial Development • Peer group becomes primary means of social support, buffering the separation process. • Peers are “everybody” and define “everything”. • Peer group allows forum for testing new identities. • Role experimentation, limit-testing, risk-taking fostered by persistent sense of invulnerability.

Middle Adolescence Psychosocial Development • Re-establishment of body image. • Strong emphasis on being attractive. • (Clothes, makeup) • Increasing sexual interest, curiosity, experimentation, partnerships.

Snapshot: Late Adolescent • Maria is a sophomore at Columbus State. She lives with her mom and step-father, and gets along well with them. She has been dating her boyfriend for several years, and uses birth control. She’d like to get married and have a family someday. She works at Wendy’s about 20 hours a week. She plans to continue at Ohio State when she can afford it. • She is still on her mother’s health insurance, but manages her own finances. She has a small group of close friends and spends time with them on the weekends.

Late Adolescence Cognitive Development • Improved sense of time and the future. • Ability to assess the long-term consequences or benefits of actions. • More able to think ideas through and express herself in words. • Greater ability to delay gratification.

Late Adolescence Psychosocial Development • Acceptance of body image. • Consolidation of personal identity. • Further steps toward emancipation. • Practical vocational goals • Beginnings of financial independence • Re-establishment of relationship with parents (“adult-adult” interaction).

Late Adolescence Psychosocial Development • Decreased need for peer affiliation. • Increased emphasis placed on individual friendships. • Increased capacity for intimacy and movement toward more stable relationships.

Perils of the Pre-Teen Girl Decline in Self Esteem • The transition into adolescence is challenging for many girls. • Many girls experience a precipitous decline in self-confidence and self-esteem by the age of 12, whereas boys self-esteem increases with age.

Perils of the Pre-Teen Girl Decline in Self-Esteem • Low self-esteem in girls has been linked to: • • • Impaired academic performance Mood problems such as depression Early alcohol and substance use Dieting and disordered eating Early sexual activity Decreased interest in math and science

Perils of the Pre-teen Girl Relational Aggression • What is it? • Dirty looks, spreading rumors, social isolation or exclusion, mean jokes, cyber-bullying • Girls are skilled in navigating relationships. • Relationships are very important to girls. • Girls get mixed messages about what kind of behavior is “ideal”. They are expected to be passive and powerful at the same time.

Perils of the Pre-teen Girl Relational Aggression Examples of words that describe qualities of the “ideal girl” – from 28 girls aged 13 – 17, ¼ were non-white Ideal • Very thin • Pretty • Fake • Stupid • Fit • Popular • Smiling • Helpless • Superficial conflicts (solved easily) • Dependent • Manipulative • Sex=Power From Odd Girl Out by Rachel Simmons, 2002 Anti-Girl • Athletic • Brainy • Opinionated • Pushy • Not skinny • Professional • Promiscuity (slut) • Masculine • Unrestrained • Strong • Independent • Artsy • Bookish

Perils of the Pre-teen Girl Relational Aggression • Girls use relationships as weapons against each other, given that other aggressive behaviors are not socially acceptable. • Relational aggression is more common among late elementary and junior high age girls.

Perils of the Pre-Teen Girl Relational Aggression • The line between bully and victim is often blurred, and roles are frequently reversed. • This behavior is often invisible to adults. • Youth involved with bullying are at risk for: • • Health problems Depression and suicidal ideation Alcohol use Poor school achievement

Perils of the Pre-Teen Girl Nutrition Challenges • As girls enter adolescence, they become very focused on physical appearance and attractiveness. • Girls are avid consumers of the media, and are bombarded with re-touched, unrealistic, sexualized images of females. • The average % body fat of an actress is 10% lower than that of a healthy woman. • Consequently, it is no surprise that girls are more likely than boys to perceive themselves as overweight.

Perils of the Pre-Teen Girl Nutrition Challenges • In a study in the UK, 50% of females said their bodies disgust them • In the US, almost ½ girls in 5 th-12 th grade have been on a diet, and about 10% report binge-purging daily. • Girls are likely to think they need to lose weight, even when they are at a healthy weight. • Girls often equate thinness with happiness

Perils of the Pre-Teen Girl Nutrition Challenges • Troublesome decline in dairy and nutrient consumption • Increased consumption of unhealthy foods • Unfortunately, overweight adolescents are very likely to become overweight adults.

Perils of the Pre-Teen Girl Other Pitfalls • Girls become more sedentary as they enter adolescence. • Adolescent girls are more than twice as likely as boys to experience depression, and more likely to attempt suicide.

Perils of the Pre-Teen Girl Other Pitfalls • By senior year in high school, 2/3 of girls are sexually experienced. • 1 in 3 will experience an unplanned pregnancy by age 20 • Many sexually transmitted infections disproportionately affect adolescents • Teen birth is on the rise • Most parents are unaware of their adolescent’s sexual activity

Perils of the Pre-Teen Girl Other Pitfalls • More adolescent girls than boys smoke cigarettes. • In 2004, more girls than boys started using alcohol, tobacco, and marijuana. • Teen girls outnumber boys in the misuse of prescription drugs. • Accidental overdose recently surpassed car accidents as the number one cause of accidental death in Ohio

Parents – The Answer • The importance of parents cannot be overstated!!! • Strong parental support helps provide girls a firm foundation as they enter adolescence. • Parental monitoring and supervision decrease youth involvement in many high-risk behaviors. • Adolescents want and need parents, and other adults who care, in their lives. • Stayed tuned for more on this topic from Dr. Ginsburg…

Thank you!