pediatrics
Behavior Problems in Adolescents
Introduction
Adolescence is a time for developing independence. Typically, adolescents exercise their independence by questioning or challenging their parents' (or guardians') rules, which at times leads to rule breaking. Parents and health care practitioners must distinguish occasional errors of judgment, which are typical and expected, from a degree of misbehavior that requires professional intervention. The severity and frequency of infractions are guides. For example, recurrent binge drinking and engaging in recurrent truancy or theft are much more significant than isolated episodes of the same activities. Warning signs that suggest a disruptive behavior disorder is impairing functioning include deterioration of performance at school and running away from home. Of particular concern are adolescents who cause serious injury to themselves or others or who use a weapon in a fight. Because adolescents are much more independent and mobile than they were as children, they are often out of the direct physical control of adults. In these circumstances, adolescents' determine their own behavior, which may be influenced by maturity and executive functioning. Parents guide rather than directly control their children's actions. Taking risks, engaging in extreme behaviors, and testing abilities are all normal actions during adolescence. Adolescents who feel warmth and support from their parents are less likely to develop serious problems, as are those whose parents convey clear expectations regarding their children's behavior and show consistent limit setting and monitoring. Authoritative parentingis a parenting style in which children participate in establishing family expectations and rules. This parenting style, as opposed to harsh or permissive parenting, is most likely to promote mature behaviors. Authoritative parents typically use a system of graduated privileges, in which adolescents initially are given small bits of responsibility and freedom (eg, caring for a pet, doing household chores, purchasing clothing, decorating their room, managing an allowance, going to social events with friends, driving). If adolescents handle a responsibility or privilege well over a period of time, more privileges are granted. By contrast, poor judgment or lack of responsibility leads to loss of privileges. Each new privilege requires close monitoring by parents to make sure adolescents comply with the agreed-upon rules. Authoritative parenting involves limit setting, which is important for healthy adolescent development. Some parents and their adolescents clash over almost everything. In these situations, the core issue is really control. Adolescents want to feel in control of their lives, but parents are not ready to give up that control. In these situations, everyone may benefit from the parents picking their battles and focusing their efforts on the adolescent's actions (eg, attending school, complying with household responsibilities) rather than on expressions (eg, dress, hairstyle, preferred entertainment). Adolescents whose behavior is dangerous or otherwise unacceptable despite their parents' best efforts may need professional intervention. Drug and Substance Use in Adolescents are a common trigger of behavioral problems, and substance use disorders require specific treatment. Behavioral problems also may be a symptom of learning disabilities, depression, or other mental health disorders. Such disorders may require treatment with medications as well as counseling. If parents are not able to limit their child's dangerous behavior, they may request help from the court system and be assigned to a probation officer who can help enforce reasonable household rules. 