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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/05 15:29:49」(JST)
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"Teen" and "Teenagers" redirect here. For other uses, see Teen (disambiguation).
"Adolescents" redirects here. For the band, see Adolescents (band). For the song by Incubus, see Adolescents (song).
For the 1966 French documentary, see Adolescence (film).
Teenagers posing for a picture
Adolescence (from Latin: adolescere meaning "to grow up")[1] is a transitional stage of physical and psychological human development generally occurring during the period from puberty to legal adulthood (age of majority).[1][2][3] The period of adolescence is most closely associated with the teenage years,[3][4][5][6] although its physical, psychological and cultural expressions can begin earlier and end later. For example, although puberty has been historically associated with the onset of adolescent development, it now typically begins prior to the teenage years and there has been a normative shift of it occurring in preadolescence, particularly in females (see early and precocious puberty).[4][7][8] Physical growth, as distinct from puberty (particularly in males), and cognitive development generally seen in adolescence, can also extend into the early twenties. Thus chronological age provides only a rough marker of adolescence, and scholars have found it difficult to agree upon a precise definition of adolescence.[7][8][9][10] A thorough understanding of adolescence in society depends on information from various perspectives, most importantly from the areas of psychology, biology, history, sociology, education, and anthropology. Within all of these perspectives, adolescence is viewed as a transitional period between childhood and adulthood whose cultural purpose is the preparation of children for adult roles.[11]
The end of adolescence and the beginning of adulthood varies by country and by function, and furthermore even within a single nation state or culture there can be different ages at which an individual is considered to be (chronologically and legally) mature enough to be entrusted by society with certain responsibilities. Such milestones include, but are not limited to, driving a vehicle, having legal sexual relations, serving in the armed forces or on a jury, purchasing and drinking alcohol, voting, entering into contracts, finishing certain levels of education, and marriage. Adolescence is usually accompanied by an increased independence allowed by the parents or legal guardians and less supervision as compared to preadolescence.
In popular culture, many adolescent characteristics are attributed to physical changes and what is called raging hormones.[12][13][14] There is little evidence that this is the case, however. In studying adolescent development,[15] adolescence can be defined biologically, as the physical transition marked by the onset of puberty and the termination of physical growth; cognitively, as changes in the ability to think abstractly and multi-dimensionally; or socially, as a period of preparation for adult roles. Major pubertal and biological changes include changes to the sex organs, height, weight, and muscle mass, as well as major changes in brain structure and organization. Cognitive advances encompass both increases in knowledge and in the ability to think abstractly and to reason more effectively. The study of adolescent development often involves interdisciplinary collaborations. For example, researchers in neuroscience or bio-behavioral health might focus on pubertal changes in brain structure and its effects on cognition or social relations. Sociologists interested in adolescence might focus on the acquisition of social roles (e.g., worker or romantic partner) and how this varies across cultures or social conditions.[16] Developmental psychologists might focus on changes in relations with parents and peers as a function of school structure and pubertal status.[17]
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Biological development
Puberty in general
Main article: Puberty
Upper body of teenage boy. The structure has changed to resemble an adult form.
Puberty is a period of several years in which rapid physical growth and psychological changes occur, culminating in sexual maturity. The average onset of puberty is at 10 or 11 for girls and age 11 or 12 for boys.[18][19][20] Every person's individual timetable for puberty is influenced primarily by heredity, although environmental factors, such as diet and exercise, also exert some influence.[19][21][22] These factors can also contribute to precocious and delayed puberty.[10][22]
Some of the most significant parts of pubertal development involve distinctive physiological changes in individuals' height, weight, body composition, and circulatory and respiratory systems.[23] These changes are largely influenced by hormonal activity. Hormones play an organizational role, priming the body to behave in a certain way once puberty begins,[24] and an activational role, referring to changes in hormones during adolescence that trigger behavioral and physical changes.[25]
Puberty begins with a surge in hormone production, which in turn causes a number of physical changes.[19] It is also the stage of life in which a child develops secondary sex characteristics (for example, a deeper voice and larger adam's apple in boys, and development of breasts and more curved and prominent hips in girls) as his or her hormonal balance shifts strongly towards an adult state. This is triggered by the pituitary gland, which secretes a surge of hormonal agents into the blood stream, initiating a chain reaction. The male and female gonads are subsequently activated, which puts them into a state of rapid growth and development; the triggered gonads now commence the mass production of the necessary chemicals. The testes primarily release testosterone, and the ovaries predominantly dispense estrogen. The production of these hormones increases gradually until sexual maturation is met. Some boys may develop gynecomastia due to an imbalance of sex hormones, tissue responsiveness or obesity.[26][27]
Facial hair in males normally appears in a specific order during puberty: The first facial hair to appear tends to grow at the corners of the upper lip, typically between 14 to 17 years of age.[28][29] It then spreads to form a moustache over the entire upper lip. This is followed by the appearance of hair on the upper part of the cheeks, and the area under the lower lip.[28] The hair eventually spreads to the sides and lower border of the chin, and the rest of the lower face to form a full beard.[28] As with most human biological processes, this specific order may vary among some individuals. Facial hair is often present in late adolescence, around ages 17 and 18, but may not appear until significantly later.[29][30] Some men do not develop full facial hair for 10 years after puberty.[29] Facial hair will continue to get coarser, darker and thicker for another 2–4 years after puberty.[29]
The major landmark of puberty for males is the first ejaculation, which occurs, on average, at age 13.[31] For females, it is menarche, the onset of menstruation, which occurs, on average, between ages 12 and 13.[21][32][33][34] The age of menarche is influenced by heredity, but a girl's diet and lifestyle contribute as well.[21] Regardless of genes, a girl must have certain proportion of body fat to attain menarche.[21] Consequently, girls who have a high-fat diet and who are not physically active begin menstruating earlier, on average, than girls whose diet contains less fat and whose activities involve fat reducing exercise (e.g. ballet and gymnastics).[21][22] Girls who experience malnutrition or are in societies in which children are expected to perform physical labor also begin menstruating at later ages.[21]
The timing of puberty can have important psychological and social consequences. Early maturing boys are usually taller and stronger than their friends.[35] They have the advantage in capturing the attention of potential partners and in becoming hand-picked for sports. Pubescent boys often tend to have a good body image, are more confident, secure, and more independent.[36] Late maturing boys can be less confident because of poor body image when comparing themselves to already developed friends and peers. However, early puberty is not always positive for boys; early sexual maturation in boys can be accompanied by increased aggressiveness due to the surge of hormones that affect them.[36] Because they appear older than their peers, pubescent boys may face increased social pressure to conform to adult norms; society may view them as more emotionally advanced, despite the fact that their cognitive and social development may lag behind their appearance.[36] Studies have shown that early maturing boys are more likely to be sexually active and are more likely to participate in risky behaviors.[37]
For girls early maturation can sometimes lead to increased self-consciousness, though a typical aspect in maturing females.[38] Because of their bodies' developing in advance, pubescent girls can become more insecure.[38] Consequently, girls that reach sexual maturation early are more likely than their peers to develop eating disorders. Nearly half of all American high school girls' diet is to lose weight.[38] In addition, girls may have to deal with sexual advances from older boys before they are emotionally and mentally mature.[39] In addition to having earlier sexual experiences and more unwanted pregnancies than late maturing girls, early maturing girls are more exposed to alcohol and drug abuse.[40] Those who have had such experiences tend to perform less well in school than their "inexperienced" age peers.[41]
Girls have usually reached full physical development by ages 15–17,[3][20][42] while boys usually complete puberty by ages 16–17.[20][42][43] Any increase in height beyond the post-pubertal age is uncommon. Girls attain reproductive maturity about 4 years after the first physical changes of puberty appear.[3] In contrast, boys accelerate more slowly but continue to grow for about 6 years after the first visible pubertal changes.[36][43]
Approximate outline of development periods in child and teenager development. Adolescence is marked in red at top right.
Growth spurt
The adolescent growth spurt is a rapid increase in the individual's height and weight during puberty resulting from the simultaneous release of growth hormones, thyroid hormones, and androgens.[44] Males experience their growth spurt about two years later, on average, than females. During their peak height velocity (the time of most rapid growth), adolescents grow at a growth rate nearly identical to that of a toddler—about 4 inches (10.3 cm) a year for males and 3.5 inches (9 cm) for females.[45] In addition to changes in height, adolescents also experience a significant increase in weight (Marshall, 1978). The weight gained during adolescence constitutes nearly half of one's adult body weight.[45] Teenage and early adult males may continue to gain natural muscle growth even after puberty.[36]
The accelerated growth in different body parts happens at different times, but for all adolescents it has a fairly regular sequence. The first places to grow are the extremities—the head, hands and feet—followed by the arms and legs, then the torso and shoulders.[46] This non-uniform growth is one reason why an adolescent body may seem to be out of proportion.
During puberty, bones become harder and more brittle. At the conclusion of puberty, the ends of the long bones close during the process called epiphysis. There can be ethnic differences in these skeletal changes. For example, in the United States of America, bone density increases significantly more among African-American than white adolescents, which might account for decreased likelihood of African-American women developing osteoporosis and having fewer bone fractures there.[47]
Another set of significant physical changes during puberty happen in bodily distribution of fat and muscle. This process is different for females and males. Before puberty, there are nearly no sex differences in fat and muscle distribution; during puberty, boys grow muscle much faster than girls, although both sexes experience rapid muscle development. In contrast, though both sexes experience an increase in body fat, the increase much more significant for girls. Frequently, the increase in fat for girls happens in their years just before puberty. The ratio between muscle and fat among post-pubertal boys is around three to one, while for girls it is about five to four. This may help explain sex differences in athletic performance.[48]
Pubertal development also affects circulatory and respiratory systems as an adolescents' heart and lungs increase in both size and capacity. These changes lead to increased strength and tolerance for exercise. Sex differences are apparent as males tend to develop "larger hearts and lungs, higher systolic blood pressure, a lower resting heart rate, a greater capacity for carrying oxygen to the blood, a greater power for neutralizing the chemical products of muscular exercise, higher blood hemoglobin and more red blood cells".[49]
Despite some genetic sex differences, environmental factors play a large role in biological changes during adolescence. For example, girls tend to reduce their physical activity in preadolescence[50][51] and may receive inadequate nutrition from diets that often lack important nutrients, such as iron.[52] These environmental influences in turn affect female physical development.
Reproduction-related changes
Primary sex characteristics are those directly related to the sex organs. In males, the first stages of puberty involve growth of the testes and scrotum, followed by growth of the penis.[53] At the time that the penis develops, the seminal vesicles, the prostate, and the bulbourethral gland also enlarge and develop. The first ejaculation of seminal fluid generally occurs about one year after the beginning of accelerated penis growth, although this is often determined culturally rather than biologically, since for many boys first ejaculation occurs as a result of masturbation.[46] Boys are generally fertile before they have an adult appearance.[44]
In females, changes in the primary sex characteristics involve growth of the uterus, vagina, and other aspects of the reproductive system. Menarche, the beginning of menstruation, is a relatively late development which follows a long series of hormonal changes.[54] Generally, a girl is not fully fertile until several years after menarche, as regular ovulation follows menarche by about two years.[55] Unlike males, therefore, females usually appear physically mature before they are capable of becoming pregnant.
Changes in secondary sex characteristics include every change that is not directly related to sexual reproduction. In males, these changes involve appearance of pubic, facial, and body hair, deepening of the voice, roughening of the skin around the upper arms and thighs, and increased development of the sweat glands. In females, secondary sex changes involve elevation of the breasts, widening of the hips, development of pubic and underarm hair, widening of the areolae, and elevation of the nipples.[56] The changes in secondary sex characteristics that take place during puberty are often referred to in terms of five Tanner stages,[57] named after the British pediatrician who devised the categorization system.
Changes in the brain
The human brain is not fully developed by the time a person reaches puberty. Between the ages of 10 and 25, the brain undergoes changes that have important implications for behavior (see Cognitive development below). The brain reaches 90% of its adult size by the time a person is six years of age.[58] Thus, the brain does not grow in size much during adolescence. However, the creases in the brain continue to become more complex until the late teens. The biggest changes in the folds of the brain during this time occur in the parts of the cortex that process cognitive and emotional information.[58]
Over the course of adolescence, the amount of white matter in the brain increases linearly, while the amount of grey matter in the brain follows an inverted-U pattern. Through a process called synaptic pruning, unnecessary neuronal connections in the brain are eliminated and the amount of grey matter is pared down. However, this does not mean that the brain loses functionality; rather, it becomes more efficient due to increased myelination (insulation of axons) and the reduction of unused pathways.[59]
The first areas of the brain to be pruned are those involving primary functions, such as motor and sensory areas. The areas of the brain involved in more complex processes lose matter later in development. These include the lateral and prefrontal cortices, among other regions.[60] Some of the most developmentally significant changes in the brain occur in the prefrontal cortex, which is involved in decision making and cognitive control, as well as other higher cognitive functions. During adolescence, myelination and synaptic pruning in the prefrontal cortex increases, improving the efficiency of information processing, and neural connections between the prefrontal cortex and other regions of the brain are strengthened.[61] This leads to better evaluation of risks and rewards, as well as improved control over impulses. Specifically, developments in the dorsolateral prefrontal cortex are important for controlling impulses and planning ahead, while development in the ventromedial prefrontal cortex is important for decision making. Changes in the orbitofrontal cortex are important for evaluating rewards and risks.
Two neurotransmitters that play important roles in adolescent brain development are glutamate and dopamine. Glutamate is an excitatory neurotransmitter. During the synaptic pruning that occurs during adolescence, most of the neural connections that are pruned contain receptors for glutamate or other excitatory neurotransmitters.[62] Because of this, by early adulthood the synaptic balance in the brain is more inhibitory than excitatory.
Dopamine is associated with pleasure and attuning to the environment during decision-making. During adolescence, dopamine levels in the limbic system increase and input of dopamine to the prefrontal cortex increases.[63] The balance of excitatory to inhibitory neurotransmitters and increased dopamine activity in adolescence may have implications for adolescent risk-taking and vulnerability to boredom (see Cognitive development below). Development in the limbic system plays an important role in determining rewards and punishments and processing emotional experience and social information. Changes in the levels of the neurotransmitters dopamine and serotonin in the limbic system make adolescents more emotional and more responsive to rewards and stress. The corresponding increase in emotional variability also can increase adolescents' vulnerability.
Cognitive development
Adolescence is also a time for rapid cognitive development.[64] Piaget describes adolescence as the stage of life in which the individual's thoughts start taking more of an abstract form and the egocentric thoughts decrease. This allows the individual to think and reason in a wider perspective.[65] A combination of behavioural and fMRI studies have demonstrated development of executive functions, that is, cognitive skills that enable the control and coordination of thoughts and behaviour, which are generally associated with the prefrontal cortex.[66] The thoughts, ideas and concepts developed at this period of life greatly influence one's future life, playing a major role in character and personality formation.[67]
Biological changes in brain structure and connectivity within the brain interact with increased experience, knowledge, and changing social demands to produce rapid cognitive growth (see Changes in the brain above). The age at which particular changes take place will vary between individuals, but the changes discussed below generally begin at puberty or shortly thereafter and some skills continue to develop as the adolescent ages.
Theoretical perspectives
There are two perspectives on adolescent thinking. One is the constructivist view of cognitive development. Based on the work of Piaget, it takes a quantitative, state-theory approach, hypothesizing that adolescents' cognitive improvement is relatively sudden and drastic. The second is the information-processing perspective, which derives from the study of artificial intelligence and attempts to explain cognitive development in terms of the growth of specific components of the thinking process.
Improvements in cognitive ability
By the time individuals have reached age 15 or so, their basic thinking abilities are comparable to those of adults. These improvements occur in five areas during adolescence:
- Attention. Improvements are seen in selective attention, the process by which one focuses on one stimulus while tuning out another. Divided attention, the ability to pay attention to two or more stimuli at the same time, also improves.[68][69]
- Memory. Improvements are seen in both working memory and long-term memory.[70]
- Processing speed. Adolescents think more quickly than children. Processing speed improves sharply between age five and middle adolescence; it then begins to level off at age 15 and does not appear to change between late adolescence and adulthood.[71]
- Organization. Adolescents are more aware of their own thought processes and can use mnemonic devices and other strategies to think more efficiently.[72]
- Metacognition.
Hypothetical and abstract thinking
Adolescents' thinking is less bound to concrete events than that of children: they can contemplate possibilities outside the realm of what currently exists. One manifestation of the adolescent's increased facility with thinking about possibilities is the improvement of skill in deductive reasoning, which leads to the development of hypothetical thinking. This provides the ability to plan ahead, see the future consequences of an action and to provide alternative explanations of events. It also makes adolescents more skilled debaters, as they can reason against a friend’s or parent’s assumptions. Adolescents also develop a more sophisticated understanding of probability.
The appearance of more systematic, abstract thinking is another notable aspect of cognitive development during adolescence. For example, adolescents find it easier than children to comprehend the sorts of higher-order abstract logic inherent in puns, proverbs, metaphors, and analogies. Their increased facility permits them to appreciate the ways in which language can be used to convey multiple messages, such as satire, metaphor, and sarcasm. (Children younger than age nine often cannot comprehend sarcasm at all.)[73] This also permits the application of advanced reasoning and logical processes to social and ideological matters such as interpersonal relationships, politics, philosophy, religion, morality, friendship, faith, democracy, fairness, and honesty.
Metacognition
A third gain in cognitive ability involves thinking about thinking itself, a process referred to as metacognition. It often involves monitoring one’s own cognitive activity during the thinking process. Adolescents’ improvements in knowledge of their own thinking patterns lead to better self-control and more effective studying. It is also relevant in social cognition, resulting in increased introspection, self-consciousness, and intellectualization (in the sense of thought about one’s own thoughts, rather than the Freudian definition as a defense mechanism). Adolescents are much better able than children to understand that people do not have complete control over their mental activity. Being able to introspect may lead to two forms of adolescent egocentrism, which results in two distinct problems in thinking: the imaginary audience and the personal fable. These likely peak at age fifteen, along with self-consciousness in general.[74]
Related to metacognition and abstract thought, perspective-taking involves a more sophisticated theory of mind.[75] Adolescents reach a stage of social perspective-taking in which they can understand how the thoughts or actions of one person can influence those of another person, even if they personally are not involved.[76]
Relativistic thinking
Compared to children, adolescents are more likely to question others’ assertions, and less likely to accept facts as absolute truths. Through experience outside the family circle, they learn that rules they were taught as absolute are in fact relativistic. They begin to differentiate between rules instituted out of common sense—not touching a hot stove—and those that are based on culturally-relative standards (codes of etiquette, not dating until a certain age), a delineation that younger children do not make. This can lead to a period of questioning authority in all domains.[77]
Wisdom
Wisdom, or the capacity for insight and judgment that is developed through experience,[78] increases between the ages of fourteen and twenty-five, then levels off. Thus, it is during the adolescence-adulthood transition that individuals acquire the type of wisdom that is associated with age. Wisdom is not the same as intelligence: adolescents do not improve substantially on IQ tests since their scores are relative to others in their same age group, and relative standing usually does not change—everyone matures at approximately the same rate.
Risk-taking
Adolescents are widely considered to be prone to recklessness and risk-taking behaviors, which can lead to substance abuse or car accidents.
In light of the fact that most injuries sustained by adolescents are related to risky behavior (car crashes, alcohol, unprotected sex), much research has been done on adolescent risk-taking, particularly on whether and why adolescents are more likely to take risks than adults. The behavioral decision-making theory proposes that adolescents and adults both weigh the potential rewards and consequences of an action. However, research has shown that adolescents seem to give more weight to rewards, particularly social rewards, than do adults.[79]
During adolescence, there is an extremely high emphasis on approval of peers as a reward due to adolescents' increased self-consciousness. There may be evolutionary benefits to an increased propensity for risk-taking in adolescence—without risk-taking, teenagers would not have the motivation or confidence necessary to make the change in society from childhood to adulthood. It may also have reproductive advantages: adolescents have a newfound priority in sexual attraction and dating, and risk-taking is required to impress potential mates. Research also indicates that baseline sensation seeking may affect risk-taking behavior throughout the lifespan.[80][81]
Given the potential consequences, engaging in sexual behavior is considerably risky, particularly for adolescents. Be that as it may, some teens do engage in sexual activity in a variety of ways. Having unprotected sex, using poor birth control methods (e.g. withdrawal), having multiple sexual partners, and poor communication are some aspects of sexual behavior that make it risky. Some qualities of adolescents’ lives that are often correlated with risky sexual behavior include higher rates of experienced abuse, lower rates of parental support and monitoring.[82] Adolescence is also commonly a time of questioning sexuality and gender. This may involve intimate experimentation with people identifying as the same gender as well as with people of differing genders.
Psychological development
G. Stanley Hall
The formal study of adolescent psychology began with the publication of G. Stanley Hall’s Adolescence in 1904. Hall, who was the first president of the American Psychological Association, viewed adolescence primarily as a time of internal turmoil and upheaval (sturm und drang). This understanding of adolescence was based on two then new ways of understanding human behavior: Darwin's evolutionary theory and Freud's psychodynamic theory. He believed that adolescence was a representation of our human ancestors' phylogenetic shift from being primitive to being civilized. Hall’s assertions stood relatively uncontested until the 1950s, when psychologists such as Erik Erikson and Anna Freud started to formulate their own theories about adolescence. Freud believed that the psychological disturbances associated with adolescence were biologically based and culturally universal, while Erikson focused on the dichotomy between identity formation and role fulfillment.[83] Even with their different theories, these three psychologists agreed that adolescence was inherently a time of disturbance and psychological confusion. The less turbulent aspects of adolescence, such as peer relations and cultural influence, were left largely ignored until the 1980s. From the '50s until the '80s, the focus of the field was mainly on describing patterns of behavior as opposed to explaining them.[83]
Jean Macfarlane founded the University of California, Berkeley's Institute of Human Development, originally called the Institute of Child Welfare, in 1927.[84] The Institute was instrumental in initiating studies of normal development, in contrast to previous work that had been dominated by theories based on pathological personalities.[84] The studies looked at human development during the Great Depression and World War II, unique historical circumstances under which a generation of children grew up. The Oakland Growth Study, initiated by Harold Jones and Herbert Stolz in 1931, aimed to study the physical, intellectual, and social development of children in the Oakland area. Data collection began in 1932 and continued until 1981, allowing the researchers to gather longitudinal data on the individuals that extended past adolescence into adulthood. Jean Macfarlane launched the Berkeley Guidance Study, which examined the development of children in terms of their socioeconomic and family backgrounds.[85] These studies provided the background for Glen Elder in the 1960s, to propose a life-course perspective of adolescent development. Elder formulated several descriptive principles of adolescent development. The principle of historical time and place states that an individual's development is shaped by the time period and location in which they grow up. The principle of the importance of timing in one's life refers to the different impact that life events have on development based on when in one's life they occur. The idea of linked lives states that one’s development is shaped by the interconnected network of relationships of which one is a part; and the principle of human agency asserts that one's life course is constructed via the choices and actions of an individual within the context of their historical time period and social network.[86]
In 1984, the Society for Research on Adolescence (SRA) became the first official organization dedicated to the study of adolescent psychology. Some of the issues first addressed by this group include: the nature versus nurture debate as it pertains to adolescence; understanding the interactions between adolescents and their environment; and considering culture, social groups, and historical context when interpreting adolescent behavior.[83]
Social development
Identity development
Among the most common beliefs about adolescence is that it is the time when teenagers form their personal identities. Egocentrism is being performed by adolescents which then forms self-consciousness of wanting to feel important in their peer groups and having social acceptance of fitting into the group.[87] Empirical studies suggest that this process might be more accurately described as identity development, rather than formation, but confirms a normative process of change in both content and structure of one's thoughts about the self.[88] Researchers have used three general approaches to understanding identity development: self-concept, sense of identity, and self-esteem. The years of adolescence create a more conscientious group of young adults. Adolescents pay close attention and give more time and effort to their appearance as their body goes through changes. Unlike children, teens put forth an effort to look presentable (1991).[4] The environment in which an adolescent grows up also plays an important role in their identity development. Studies done by the American Psychological Association have shown that adolescents with a less privileged upbringing will have a more difficult time developing their identity.[89]
Self-concept
See also: Self-concept
Early in adolescence, cognitive developments result in greater self-awareness, greater awareness of others and their thoughts and judgments, the ability to think about abstract, future possibilities, and the ability to consider multiple possibilities at once. As a result, adolescents experience a significant shift from the simple, concrete, and global self-descriptions typical of young children; as children, they defined themselves with physical traits whereas as adolescents, they define themselves based on their values, thoughts and opinions.[90]
Adolescents can conceptualize multiple "possible selves" they could become[91] and long-term possibilities and consequences of their choices.[92] Exploring these possibilities may result in abrupt changes in self-presentation as the adolescent chooses or rejects qualities and behaviors, trying to guide the actual self toward the ideal self (who the adolescent wishes to be) and away from the feared self (who the adolescent does not want to be). For many, these distinctions are uncomfortable, but they also appear to motivate achievement through behavior consistent with the ideal and distinct from the feared possible selves.[91][93]
Further distinctions in self-concept, called "differentiation," occur as the adolescent recognizes the contextual influences on their own behavior and the perceptions of others, and begin to qualify their traits when asked to describe themselves.[94] Differentiation appears to be fully developed by mid-adolescence.[95] Peaking in the 7th-9th grades, the personality traits adolescents use to describe themselves refer to specific contexts, and therefore may contradict one another. The recognition of inconsistent content in the self-concept is a common source of distress in these years (see Cognitive dissonance),[96] but this distress may benefit adolescents by encouraging structural development.
Differentiation results in organization and integration of the self-concept.[97][98] The multifaceted self is understood to include several stable, if inconsistent, sets of traits applicable when the individual with different people and circumstances. This includes negative traits and weaknesses, which adolescents can now recognize and qualify: "consistent with this, adolescents who have more complex self-conceptions are less likely to be depressed".[99][100] Moreover, although only true in some circumstances, differentiated traits are contrasted with "false-self behavior," which is not representative of the "real" self.[101] Recognition of the inauthentic indicates that the adolescent is gaining a sense of continuous, overlapping, coherent sense of identity.
Sense of identity
Unlike the conflicting aspects of self-concept, identity represents a coherent sense of self stable across circumstances and including past experiences and future goals. Everyone has a self-concept, whereas Erik Erikson argued that not everyone fully achieves identity. Erikson’s theory of stages of development includes the identity crisis in which adolescents must explore different possibilities and integrate different parts of themselves before committing to their beliefs. He described the resolution of this process as a stage of "identity achievement" but also stressed that the identity challenge "is never fully resolved once and for all at one point in time".[102] Adolescents begin by defining themselves based on their crowd membership. "Clothes help teens explore new identities, separate from parents, and bond with peers." Fashion has played a major role when it comes to teenagers "finding their selves"; Fashion is always evolving, which corresponds with the evolution of change in the personality of teenagers.[103] Just as fashion is evolving to influence adolescents so is the media. "Modern life takes place amidst a never-ending barrage of flesh on screens, pages, and billboards."[104] This barrage consciously or subconsciously registers into the mind causing issues with self-image a factor that contributes to an adolescence sense of identity. Researcher James Marcia developed the current method for testing an individual’s progress along these stages.[105][106] His questions are divided into three categories: occupation, ideology, and interpersonal relationships. Answers are scored based on extent to which the individual has explored and the degree to which he has made commitments. The result is classification of the individual into a) identity diffusion in which all children begin, b) Identity Foreclosure in which commitments are made without the exploration of alternatives, c) Moratorium, or the process of exploration, or d) Identity Achievement in which Moratorium has occurred and resulted in commitments.[107]
Research since reveals self-examination beginning early in adolescence, but identity achievement rarely occurring before age 18.[108] The freshman year of college influences identity development significantly, but may actually prolong psychosocial moratorium by encouraging reexamination of previous commitments and further exploration of alternate possibilities without encouraging resolution.[109] For the most part, evidence has supported Erikson’s stages: each correlates with the personality traits he originally predicted.[107] Studies also confirm the impermanence of the stages; there is no final endpoint in identity development.[110]
Environment and identity
An adolescent's environment plays a huge role in their identity development.[89] While most adolescent studies are conducted on white, middle class children, studies have shown that the more privileged upbringing one has the more successful they will be in the development of their identity.[89] The forming of an adolescent's identity is a crucial time in their life. It has been recently found that demographic patterns suggest that the transition to adulthood is now occurring over a longer span of years than was the case during the middle of the 20th century. Accordingly, youth, a period that spans late adolescence and early adulthood, has become a more prominent stage of the life course. This therefore has caused various factors to become important during this development.[111] So many factors contribute to the developing social identity of an adolescent from commitment, to coping devices,[112] to social media. All of these factors are affected by the environment an adolescent grows up in. A child from a more privileged upbringing will be exposed to more opportunities as well as better situations in general. An adolescent from an inner city or a crime driven neighborhood is more likely to be exposed to an environment that can be detrimental to their development. Adolescence is a very sensitive period in the development process of one's life and exposure to the wrong things at that time can have a major affect on decisions someone will make. While children that grow up in nice suburban communities are not exposed to bad environments they are more likely to participate in activities that can benefit their identity and contribute to a more successful identity development.[89]
Sexual orientation and identity
Sexual orientation has been defined as "an erotic inclination toward people of one or more genders, most often described as sexual or erotic attractions".[113] In recent years, psychologists have sought to understand how sexual orientation develops during adolescence. Some theorists believe that there are many different possible developmental paths one could take, and that the specific path an individual follows may be determined by their sex, orientation, and when they reached the onset of puberty.[113]
In 1989, Troiden proposed a four-stage model for the development of homosexual sexual identity.[114] The first stage, known as sensitization, usually starts in childhood, and is marked by the child's becoming aware of same-sex attractions. The second stage, identity confusion, tends to occur a few years later. In this stage, the youth is overwhelmed by feelings of inner turmoil regarding their sexual orientation, and begins to engage sexual experiences with same-sex partners. In the third stage of identity assumption, which usually takes place a few years after the adolescent has left home, adolescents begin to come out to their family and close friends, and assumes a self-definition as gay, lesbian, or bisexual.[115] In the final stage, known as commitment, the young adult adopts their sexual identity as a lifestyle. Therefore, this model estimates that the process of coming out begins in childhood, and continues through the early to mid 20s. This model has been contested, and alternate ideas have been explored in recent years.
In terms of sexual identity, adolescence is when most gay/lesbian and transgender adolescents begin to recognize and make sense of their feelings. Many adolescents may choose to come out during this period of their life once an identity has been formed; many others may go through a period of questioning or denial, which can include experimentation with both homosexual and heterosexual experiences.[116] A study of 194 lesbian, gay, and bisexual youths under the age of 21 found that having an awareness of one's sexual orientation occurred, on average, around age 10, but the process of coming out to peers and adults occurred around age 16 and 17, respectively.[117] Coming to terms with and creating a positive LGBT identity can be difficult for some youth for a variety of reasons. Peer pressure is a large factor when youth who are questioning their sexuality or gender identity are surrounded by heteronormative peers and can cause great distress due to a feeling of being different than everyone else. While coming out can also foster better psychological adjustment, the risks associated are real. Indeed, coming out in the midst of a heteronormative peer environment often comes with the risk of ostracism, hurtful jokes, and even violence.[116] Because of this, statistically the suicide rate amongst LGBT adolescents is up to four times higher than that of their heterosexual peers due to bullying and rejection from peers or family members.[118]
Self-esteem
The final major aspect of identity formation is self-esteem, one's thoughts and feelings about one’s self-concept and identity. Contrary to popular belief, there is no empirical evidence for a significant drop in self-esteem over the course of adolescence.[119] "Barometric self-esteem" fluctuates rapidly and can cause severe distress and anxiety, but baseline self-esteem remains highly stable across adolescence.[120] The validity of global self-esteem scales has been questioned, and many suggest that more specific scales might reveal more about the adolescent experience.[121] Girls are most likely to enjoy high self-esteem when engaged in supportive relationships with friends, the most important function of friendship to them is having someone who can provide social and moral support. When they fail to win friends' approval or couldn't find someone with whom to share common activities and common interests, in these cases, girls will suffer from low self-esteem. In contrast, boys are more concerned with establishing and asserting their independence and defining their relation to authority.[122]As such, they are more likely to derive high self-esteem from their ability to successfully influence their friends; on the other hand, the lack of romantic competence, for example, failure to win or maintain the affection of the opposite or same-sex (depending on sexual orientation), is the major contributor to low self-esteem in adolescent boys.
Relationships
In general
The relationships adolescents have with their peers, family, and members of their social sphere play a vital role in the social development of an adolescent. As an adolescent's social sphere develops rapidly as they distinguish the differences between friends and acquaintances, an adolescent will often become heavily emotionally invested in their friends.[123] This is not a bad thing, however, if these friends expose an individual to bad situations, this is when peer pressure comes in. Adolescence is a vital period in social development because adolescents can be easily influenced by the people they develop close relationships with. This is the first time individuals can truly make their own decisions, which also makes this a sensitive period. Relationships are vital in the social development of an adolescent due to the extreme influence peers can have over an individual. These relationships become vital because they begin to help the adolescent understand the concept of personalities, how they form and why a person has that specific type of personality. "The use of of psychological comparisons could serve both as an index of the growth of an implicit personality theory and as a component process accounting for its creation.In other words, by comparing one person's personality charactenstics to another's, we would be setting up the framework for creating a general theory of personality (and,...such a theory would serve as a useful framework for coming to understand specific persons)." [124] Research shows that relationships have the largest affect over the social development of an individual. It is important for parents to make sure that adolescents are exposed to situations that they are capable of handling. With the social world developing quickly during adolescence, it is the role of the parent to make sure that their child is not exposed to bad situations that will be detrimental to their social development.
Family
See also: Sibling relationship
Adolescence marks a rapid change in one’s role within a family. Young children tend to assert themselves forcefully, but are unable to demonstrate much influence over family decisions until early adolescence,[125] when they are increasingly viewed by parents as equals. When children go through puberty, there is often a significant increase in parent-child conflict and a less cohesive familial bond. Arguments often concern minor issues of control, such as curfew, acceptable clothing, and the adolescent's right to privacy,[126][127] which adolescents may have previously viewed as issues over which their parents had complete authority.[128] Parent-adolescent disagreement also increases as friends demonstrate a greater impact on one another, new influences on the adolescent that may be in opposition to parents' values. Social media has also played an increasing role in adolescent and parent disagreements.[129] While parents never had to worry about the threats of social media in the past, it has become a dangerous place for children. While adolescents strive for their freedoms, the unknowns to parents of what their child is doing on social media sites is a challenging subject. Fear from parents for most parents is the increasing amount of predators on social media sites. Many parents have very little knowledge of social networking sites in the first place and these stories give nothing but bad impressions. Although conflicts between children and parents increase during adolescence, these are just relatively minor issues. Regarding their important life issues, most adolescents still share the same attitudes and values as their parents.[130]
During childhood, siblings are a source of conflict and frustration as well as a support system.[131] Adolescence may affect this relationship differently, depending on sibling gender. In same-sex sibling pairs, intimacy peaks during early adolescence, then steadily declines. Mixed-sex siblings pairs act in the opposite way; siblings drift apart during early adolescent years, but experience an increase in intimacy starting at middle adolescence.[132] Sibling interactions are children's first relational experiences, the ones that shape their social and self-understanding for life.[133] Sustaining positive sibling relations can assist adolescents in a number of ways. Siblings are able to act as peers, and may increase one another's sociability and feelings of self-worth. Older siblings can give guidance to younger siblings, although the impact of this can be either positive or negative depending on the activity of the older sibling.
A potential important influence on adolescence is change of the family dynamic, specifically divorce. With the divorce rate up to about 50%,[134] divorce is common and adds to the already great amount of change in adolescence. Custody disputes soon after a divorce often reflect a playing out of control battles and ambivalence between parents. In extreme cases of instability and abuse in homes, divorce can have a positive effect on families due to less conflict in the home. However, most research suggests a negative effect on adolescence as well as later development. A recent study found that compared with peers who grow up in stable postdivorce families, children of divorce who experience additional family transitions during late adolescence make less progress in their math and social studies performance over time.[135] Another recent study put forth a new theory entitled the adolescent epistemological trauma theory,[136] which posited that traumatic life events such as parental divorce during the formative period of late adolescence portend lifelong effects on adult conflict behavior which can be mitigated by effective behavioral assessment and training.[137] A parental divorce during childhood or adolescence continues to have a negative effect when a person is in his or her twenties and early thirties. These negative effects include romantic relationships and conflict style. Conflict style meaning as adults, they are more likely to use the styles avoidance and competing in conflict management.[138]
Despite changing family roles during adolescence, the home environment and parents are still important for the behaviors and choices of adolescents.[139] Adolescents who have a good relationship with their parents are less likely to engage in various risk behaviors, such as smoking, drinking, fighting, and/or unprotected sexual intercourse.[139] In addition, parents influence the education of adolescence. A study conducted by Adalbjarnardottir and Blondal (2009) showed that adolescents at the age of 14 who identifies their parents as authoritative figures, are more likely to complete their secondary education by the age of 22 as the support and encouragement from an authoritative parent motivates the adolescence to complete their schooling, in order to avoid disappointing the parent.[140]
Peers
Peer groups are essential to social and general development. High quality friendships may enhance children's development regardless of the characteristics of those friends. As children begin to gain bonds with various people and create friendships with them, it will later on help them when they are adolescent. This sets up the framework for adolescence and peer groups.[141] Peer groups are especially important during adolescence, a period of development characterized by a dramatic increase in time spent with peers[142] and a decrease in adult supervision.[143] Adolescents also associate with friends of the opposite sex much more than in childhood[144] and tend to identify with larger groups of peers based on shared characteristics.[145] It is also common for adolescents to use friends as coping devices in different situations.[146] A three factor structure of dealing with friends including avoidance, mastery, and nonchalance has shown that adolescent's use friends as coping devices with social stresses.
Peer groups offer members the opportunity to develop social skills such as empathy, sharing, and leadership. Peer groups can have positive influences on an individual, such as on academic motivation and performance. But they can also have negative influences, like encouraging experimentation with drugs, drinking, vandalism, and stealing through peer pressure.[147] Susceptibility to peer pressure increases during early adolescence, peaks around age 14, and declines thereafter.[148]
During early adolescence, adolescents often associate in cliques, exclusive, single-sex groups of peers with whom they are particularly close. Despite the common notion that cliques are an inherently negative influence, they may help adolescents become socially acclimated and form a stronger sense of identity. Cliques also have become somewhat as a "collective parent," i.e. telling the adolescents what to do and not to do.[149] Towards late adolescence, cliques often merge into mixed-sex groups as teenagers begin romantically engaging with one another.[150] These small friend groups break down even further as socialization becomes more couple-oriented.
While peers may facilitate social development for one another, they may also hinder it. In Spanish teenagers, emotional (rather than solution-based) reaction to problems and emotional instability have been linked with physical aggression against peers.[151] Both physical and relational aggression are linked to a vast number of enduring psychological difficulties, especially depression, as is social rejection.[152] Because of this, bullied adolescents often develop problems that lead to further victimization.[153] Bullied adolescents are both more likely to continued to be bullied and more likely to bully others in the future.[154] However, this relationship is less stable in cases of cyberbullying, a relatively new issue among adolescents.
On a larger scale, adolescents often associate with crowds, groups of individuals who share a common interest or activity. Often, crowd identities may be the basis for stereotyping young people, such as jocks or nerds. In large, multi-ethnic high schools, there are often ethnically-determined crowds as well.[155] While crowds are very influential during early and middle adolescence, they lose salience during high school as students identify more individually.[156]
Romance and sexual activity
Main article: Adolescent sexuality
See also: Adolescent sexuality in the United States
Romantic relationships tend to increase in prevalence throughout adolescence. By age 15, 53% of adolescents have had a romantic relationship that lasted at least one month over the course of the previous 18 months.[157] In a 2008 study conducted by YouGov for Channel 4, 20% of 14−17-year-olds surveyed revealed that they had their first sexual experience at 13 or under in the United Kingdom.[158] A 2002 American study found that those aged 15–44 reported that the average age of first sexual intercourse was 17.0 for males and 17.3 for females.[159] The typical duration of relationships increases throughout the teenage years as well. This constant increase in the likelihood of a long-term relationship can be explained by sexual maturation and the development of cognitive skills necessary to maintain a romantic bond (e.g. caregiving, appropriate attachment), although these skills are not strongly developed until late adolescence.[160] Long-term relationships allow adolescents to gain the skills necessary for high-quality relationships later in life[161] and develop feelings of self-worth. Overall, positive romantic relationships among adolescents can result in long-term benefits. High-quality romantic relationships are associated with higher commitment in early adulthood[162] and are positively associated with self-esteem, self-confidence, and social competence.[163][164] Adolescents often date within their demographic in regards to race, ethnicity, popularity, and physical attractiveness.[165] However, there are traits in which certain individuals, particularly adolescent girls, seek diversity. While most adolescents date people approximately their own age, boys typically date partners the same age or younger; girls typically date partners the same age or older.[157]
Some researchers are now focusing on learning about how adolescents view their own relationships and sexuality; they want to move away from a research point of view that focuses on the problems associated with adolescent sexuality. Lucia O’Sullivan and her colleagues found that there weren’t any significant gender differences in the relationship events adolescent boys and girls from grades 7-12 reported.[166] Most teens said they had kissed their partners, held hands with them, thought of themselves as being a couple and told people they were in a relationship. This means that private thoughts about the relationship as well as public recognition of the relationship were both important to the adolescents in the sample. Sexual events (such as sexual touching, sexual intercourse) were less common than romantic events (holding hands) and social events (being with one’s partner in a group setting). The researchers state that these results mean that researchers should focus more on the positive aspects of adolescents and their social and romantic interactions rather than put most of their focus on sexual behavior and its consequences.[166]
Adolescence marks a time of sexual maturation, which manifests in social interactions as well. While adolescents may engage in casual sexual encounters (often referred to as hookups), most sexual experience during this period of development takes place within romantic relationships.[167] Kissing, hand holding, and hugging signify satisfaction and commitment. Among young adolescents, "heavy" sexual activity, marked by genital stimulation, is often associated with violence, depression, and poor relationship quality.[168][169] This effect does not hold true for sexual activity in late adolescence that takes place within a romantic relationship.[170] Some research suggest that there are genetic causes of early sexual activity that are also risk factors for delinquency, suggesting that there is a group who are at risk for both early sexual activity and emotional distress. For old adolescents, though, sexual activity the context of romantic relationships was actually correlated with lower levels of deviant behavior after controlling for genetic risks, as opposed to sex outside of a relationship (hook-ups)[171]
Dating violence is fairly prevalent within adolescent relationships. When surveyed, 10-45% of adolescents reported having experienced physical violence in the context of a relationship while a quarter to a third of adolescents reported having experiencing psychological aggression. This reported aggression includes hitting, throwing things, or slaps, although most of this physical aggression does not result in a medical visit. Physical aggression in relationships tends to decline from high school through college and young adulthood.[148] In heterosexual couples, there is no significant difference between the rates of male and female aggressors, unlike in adult relationships.[172][173][174]
In contemporary society, adolescents also face some risks as their sexuality begins to transform. While some of these, such as emotional distress (fear of abuse or exploitation) and sexually transmitted infections/diseases (STIs/STDs), including HIV/AIDS, are not necessarily inherent to adolescence, others such as teenage pregnancy (through non-use or failure of contraceptives) are seen as social problems in most western societies. One in four sexually active teenagers will contract a STI.[175] Adolescents in the United States often chose "anything but intercourse" for sexual activity because they mistakenly believe it will reduce risk of STIs. Across the country, clinicians report rising diagnoses of herpes and human papillomavirus (HPV), which can cause genital warts, and is now thought to affect 15 percent of the teen population. Girls 15 to 19 have higher rates of gonorrhea than any other age group. One-quarter of all new HIV cases occur in those under the age of 21.[175] Multrine also states in her article that according to a March survey by the Kaiser Family Foundation, eighty-one percent of parents want schools to discuss the use of condoms and contraception with their children. They also believe students should be able to be tested for STIs. Furthermore, teachers want to address such topics with their students. But, although 9 in 10 sex education instructors across the country believe that students should be taught about contraceptives in school, over one quarter report receiving explicit instructions from school boards and administrators not to do so. According to anthropologist Margaret Mead, the turmoil found in adolescence in Western society has a cultural rather than a physical cause; they reported that societies where young women engaged in free sexual activity had no such adolescent turmoil.
Culture
Summary
There are certain characteristics of adolescent development that are more rooted in culture than in human biology or cognitive structures. Culture has been defined as the "symbolic and behavioral inheritance received from the past that provides a community framework for what is valued".[176] Culture is learned and socially shared, and it affects all aspects of an individual’s life.[177] Social responsibilities, sexual expression, and belief system development, for instance, are all things that are likely to vary by culture. Furthermore, distinguishing characteristics of youth, including dress, music and other uses of media, employment, art, food and beverage choices, recreation, and language, all constitute a youth culture.[177] For these reasons, culture is a prevalent and powerful presence in the lives of adolescents, and therefore we cannot fully understand today’s adolescents without studying and understanding their culture.[177] However, "culture" should not be seen as synonymous with nation or ethnicity; there are many cultures present within any given country and racial or socioeconomic group. Furthermore, in an attempt to avoid ethnocentrism, one needs to be careful that one is not defining culture’s role in adolescence in terms of one’s own dominant cultural beliefs.[178]
Autonomy
The degree to which adolescents are perceived as autonomous beings varies greatly by culture, as do the behaviors that represent this emerging autonomy. Psychologists have identified three main types of autonomy: emotional autonomy, behavioral autonomy, and cognitive autonomy.[179] Emotional autonomy is defined in terms of an adolescent’s relationships with others, and often includes the development of more mature emotional connections with adults and peers.[179] Behavioral autonomy encompasses an adolescent’s developing ability to regulate his or her own behavior, to act on personal decisions, and to self-govern. Cultural differences are especially visible in this category because it concerns issues of dating, social time with peers, and time-management decisions.[179] Cognitive autonomy describes the capacity for an adolescent to partake in processes of independent reasoning and decision-making without excessive reliance on social validation.[179] Converging influences from adolescent cognitive development, expanding social relationships, an increasingly adultlike appearance, and the acceptance of more rights and responsibilities enhance feelings of autonomy for adolescents.[179] Proper development of autonomy has been tied to good mental health, high self-esteem, self-motivated tendencies, positive self-concepts, and self-initiating and regulating behaviors.[179] Furthermore, it has been found that adolescents' mental health is best when their feelings about autonomy match closely with those of their parents.[180]
A questionnaire called the teen timetable has been used to measure the age at which individuals believe adolescents should be able to engage in behaviors associated with autonomy.[181] This questionnaire has been used to gauge differences in cultural perceptions of adolescent autonomy, finding, for instance, that White parents and adolescents tend to expect autonomy earlier than those of Asian descent.[181] It is therefore clear that cultural differences exist in perceptions of adolescent autonomy, and such differences have implications for the lifestyles and development of adolescents.
Social roles and responsibilities
The lifestyle of an adolescent in a given culture is profoundly shaped by the roles and responsibilities he or she is expected to assume. The extent to which an adolescent is expected to share family responsibilities is one large determining factor in normative adolescent behavior. For instance, adolescents in certain cultures are expected to contribute significantly to household chores and responsibilities.[182] Household chores are frequently divided into self-care tasks and family-care tasks. However, specific household responsibilities for adolescents may vary by culture, family type, and adolescent age.[183] Some research has shown that adolescent participation in family work and routines has a positive influence on the development of an adolescent’s feelings of self-worth, care, and concern for others.[182]
In addition to the sharing of household chores, certain cultures expect adolescents to share in their family’s financial responsibilities. According to family economic and financial education specialists, adolescents develop sound money management skills through the practices of saving and spending money, as well as through planning ahead for future economic goals.[184] Differences between families in the distribution of financial responsibilities or provision of allowance may reflect various social background circumstances and intrafamilial processes, which are further influenced by cultural norms and values, as well as by the business sector and market economy of a given society.[185] For instance, in many developing countries it is common for children to attend fewer years of formal schooling so that, when they reach adolescence, they can begin working.[186]
While adolescence is a time frequently marked by participation in the workforce, the number of adolescents in the workforce is much lower now than in years past as a result of increased accessibility and perceived importance of formal higher education.[187] For example, half of all 16-year olds in China were employed in 1980, whereas less than one fourth of this same cohort were employed in 1990.[187]
Furthermore, the amount of time adolescents spend on work and leisure activities varies greatly by culture as a result of cultural norms and expectations, as well as various socioeconomic factors. American teenagers spend less time spent in school or working and more time on leisure activities—which include playing sports, socializing, and caring for their appearance—than do adolescents in many other countries.[188] These differences tend to be influenced by cultural values of education and the amount of responsibility adolescents are expected to assume in their family or community.
Time management, financial roles, and social responsibilities of adolescents are therefore closely connected with the education sector and processes of career development for adolescents, as well as to cultural norms and social expectations. In many ways, adolescents’ experiences with their assumed social roles and responsibilities determine the length and quality of their initial pathway into adult roles.[189]
Belief system development
Adolescence is frequently characterized by a transformation of an adolescent’s understanding of the world, the rational direction towards a life course, and the active seeking of new ideas rather than the unquestioning acceptance of adult authority.[190] An adolescent begins to develop a unique belief system through his or her interaction with social, familial, and cultural environments.[191] While organized religion is not necessarily a part of every adolescent’s life experience, youth are still held responsible for forming a set of beliefs about themselves, the world around them, and whatever higher powers they may or may not believe in.[190] This process if often accompanied or aided by cultural traditions which intend to provide a meaningful transition to adulthood through a ceremony, ritual, confirmation, or rite of passage.[192]
Sexuality
Many cultures define the transition into adultlike sexuality by specific biological or social milestones in an adolescent’s life. For example, menarche (the first menstrual period of a female-bodied individual), or semenarche (the first ejaculation of a male-bodied individual) are frequent sexual defining points for many cultures. In addition to biological factors, an adolescent’s sexual socialization is highly dependent upon whether their culture takes a restrictive or permissive attitude toward teen or premarital sexual activity. Restrictive cultures overtly discourage sexual activity in unmarried adolescents or until an adolescent undergoes a formal rite of passage. These cultures may attempt to restrict sexual activity by separating males and females throughout their development, or through public shaming and physical punishment when sexual activity does occur.[193] In less restrictive cultures, there is more tolerance for displays of adolescent sexuality, or of the interaction between males and females in public and private spaces. Less restrictive cultures may tolerate some aspects of adolescent sexuality, while objecting to other aspects. For instance, some cultures find teenage sexual activity acceptable but teenage pregnancy highly undesirable. Other cultures do not object to teenage sexual activity or teenage pregnancy, as long as they occur after marriage.[194] In permissive societies, overt sexual behavior among unmarried teens is perceived as acceptable, and is sometimes even encouraged.[194] Regardless of whether a culture is restrictive or permissive, there are likely to be discrepancies in how females versus males are expected to express their sexuality. Cultures vary in how overt this double standard is—in some it is legally inscribed, while in others it is communicated through social convention.[195] The range of sexual attitudes that a culture embraces could thus be seen to affect the beliefs, lifestyles, and societal perceptions of its adolescents.
Legal issues, rights and privileges
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General issues
A sign outside a sex shop reads "Must Be 18 To Enter" in Chapel Hill, North Carolina.
Adolescence is a period frequently marked by increased rights and privileges for individuals. While cultural variation exists for legal rights and their corresponding ages, considerable consistency is found across cultures. Furthermore, since the advent of the Convention on the Rights of the Child in 1989 (children here defined as under 18), almost every country in the world (except the U.S. and Somalia) has legally committed to advancing an anti-discriminatory stance towards young people of all ages. This includes protecting children against unchecked child labor, enrollment in the military, prostitution, and pornography. In many societies, those who reach a certain age (often 18, though this varies) are considered to have reached the age of majority and are legally regarded as adults to be held responsible for their actions. People below this age are considered minors or children. A person below the age of majority may gain adult rights through legal emancipation. The legal working age in Western countries is usually 14 to 16, depending on the number of hours and type of employment under consideration. Many countries also specify a minimum school leaving age, at which a person is legally allowed to leave compulsory education. This age varies greatly cross-culturally, spanning from 10 to 18, which further reflects the diverse ways formal education is viewed in cultures around the world. In most democratic countries, a citizen is eligible to vote at age 18. In a minority of countries, the voting age is as low as 16 (for example, Brazil), or as high as 25 (Uzbekistan). The age of consent to sexual activity varies widely between jurisdictions, ranging from 13 to 20 years, as does the age at which people are allowed to marry.[196] Specific legal ages for adolescents that also vary by culture are enlisting in the military, gambling, and the purchase of alcohol, cigarettes or items with parental advisory labels. It should be noted that the legal coming of age often does not correspond with the sudden realization of autonomy; many adolescents who have legally reached adult age are still dependent on their guardians or peers for emotional and financial support. Nonetheless, new legal privileges converge with shifting social expectations to usher in a phase of heightened independence or social responsibility for most legal adolescents.
Alcohol and illicit drug use
Prevalence
Following a steady decline beginning in the late 1990s up through the mid-2000s, illicit drug use among adolescents has been on the rise in the U.S. Aside from alcohol, marijuana is the most commonly indulged drug habit during adolescent years. Data collected by the National Institute on Drug Abuse shows that between the years of 2007 and 2011, marijuana use grew from 5.7% to 7.2% among 8th grade students; among 10th grade students, from 14.2% to 17.6%; and among 12th graders, from 18.8% to 22.6%.[197] Additional, recent years have seen a surge in popularity of MDMA; between 2010 and 2011, the use of MDMA increased from 1.4% to 2.3% among high school seniors.[197] The heightened usage of ecstasy most likely ties in at least to some degree with the rising popularity of rave culture.
One significant contribution to the increase in teenage substance abuse is an increase in the availability of prescription medication. With an increase in the diagnosis of behavioral and attentional disorders for students, taking pharmaceutical drugs such as Vicodin and Adderall for pleasure has become a prevalent activity among adolescents: 15.2% of high school seniors report having abused prescription drugs within the past year.[197]
Teenage alcohol drug use is currently at an all-time low. Out of a polled body of students, 4.4% of 8th graders reported having been on at least one occasion been drunk within the previous month; for 10th graders, the number was 13.7%, and for 12th graders, 25%.[197] More drastic, cigarette smoking has become a far less prevalent activity among American middle- and high-school students; in fact, a greater number of teens now smoke marijuana than smoke cigarettes, with one recent study showing a respective 15.2% versus 11.7% of surveyed students.[197] This may be attributed to recent changing social and political views towards marijuana; issues such as medicinal use and legalization have tended towards painting the drug in a more positive light than historically, while cigarettes continue to be vilified due to associated health risks.
Different drug habits often relate to one another in a highly significant manner. It has been demonstrated that adolescents who drink at least to some degree may be as much as sixteen times more likely than non-drinkers to experiment with illicit drugs.[198]
Social influence
Peer acceptance and social norms gain a significantly greater hand in directing behavior at the onset of adolescence; as such, the alcohol and illegal drug habits of teens tend to be shaped largely by the substance use of friends and other classmates. In fact, studies suggest that more significantly than actual drug norms, an individual’s perception of the illicit drug use by friends and peers is highly associated with his or her own habits in substance use during both middle and high school, a relationship that increases in strength over time.[199] Whereas social influences on alcohol use and marijuana use tend to work directly in the short term, peer and friend norms on smoking cigarettes in middle school have a profound effect on one’s own likelihood to smoke cigarettes well into high school.[199] Perhaps the strong correlation between peer influence in middle school and cigarette smoking in high school may be explained by the addictive nature of cigarettes, which could lead many students to continue their smoking habits from middle school into late adolescence.
Demographic factors
Until mid-to-late adolescence, boys and girls show relatively little difference in drinking motives.[200] Distinctions between the reasons for alcohol consumption of males and females begin to emerge around ages 14–15; overall, boys tend to view drinking in a more social light than girls, who report on average a more frequent use of alcohol as a coping mechanism.[200] The latter effect appears to shift in late adolescence and onset of early adulthood (18–19 years of age); however, despite this trend, age tends to bring a greater desire to drink for pleasure rather than coping in both boys and girls.[200]
Drinking habits and the motives behind them often reflect certain aspects of an invidiual’s personality; in fact, four dimensions of the Five-Factor Model of personality demonstrate associations with drinking motives (all but ‘Openness’). Greater enhancement motives for alcohol consumption tend to reflect high levels of extraversion and sensation-seeking in individuals; such enjoyment motivation often also indicates low conscientiousness, manifesting in lowered inhibition and a greater tendency towards aggression. On the other hand, drinking to cope with negative emotional states correlates strongly with high neuroticism and low agreeableness.[200] Alcohol use as a negative emotion control mechanism often links with many other behavioral and emotional impairments, such as anxiety, depression, and low self-esteem.[200]
Research has generally shown striking uniformity across different cultures in the motives behind teen alcohol use. Social engagement and personal enjoyment appear to play a fairly universal role in adolescents' decision to drink throughout separate cultural contexts. Surveys conducted in Argentina, Hong Kong, and Canada have each indicated the most common reason for drinking among adolescents to relate to pleasure and recreation; 80% of Argentinian teens reported drinking for enjoyment, while only 7% drank to improve a bad mood.[200] The most prevalent answers among Canadian adolescents were to "get in a party mood," 18%; "because I enjoy it," 16%; and "to get drunk," 10%.[200] In Hong Kong, female participants most frequently reported drinking for social enjoyment, while males most frequently reported drinking to feel the effects of alcohol.[200]
Media
Body image
Much research has been conducted on the psychological ramifications of body image on adolescents. Modern day teenagers are exposed to more media on a daily basis than any generation before them. Recent studies have indicated that the average teenager watches roughly 1500 hours of television per year.[201] As such, modern day adolescents are exposed to vast amounts of images and ideas of what they are "supposed" to look like and act like. The concept of a person being unhappy with their own image or appearance has been defined as "body dissatisfaction". In teenagers, body dissatisfaction is often associated with body mass, low self-esteem, and atypical eating patterns.[202] Scholars continue to debate the effects of media on body dissatisfaction in teens.[203][204]
Media profusion
Because exposure to media has increased over the past decade, adolescents' utilization of computers, cell phones, stereos and televisions to gain access to various mediums of popular culture has also increased. Almost all American households have at least one television, more than three-quarters of all adolescents’ homes have access to the Internet, and more than 90% of American adolescents use the Internet at least occasionally.[205] As a result of the amount of time adolescents spend using these devices, their total media exposure is high. In the last decade, the amount of time that adolescents spend on the computer has greatly increased.[206] Online activities with the highest rates of use among adolescents are video games (78% of adolescents), email (73%), instant messaging (68%), social networking sites (65%), news sources (63%), music (59%), and videos (57%).
Social networking
Within the past ten years, the amount of social networking sites available to the public has greatly increased as well as the number of adolescents using them. Several sources report a high proportion of adolescents who use social media: 73% of 12-17 year olds reported having at least one social networking profile;[207] two-thirds (68%) of teens text every day, half (51%) visit social networking sites daily, and 11% send or receive tweets at least once every day. In fact, more than a third (34%) of teens visit their main social networking site several times a day. One in four (23%) teens is a “heavy” social media user, meaning they use at least two different types of social media each and every day.[208]
Although research has been inconclusive, some findings have indicated that electronic communication negatively affects adolescents' social development, replaces face-to-face communication, impairs their social skills, and can sometimes lead to unsafe interaction with strangers. Studies have shown differences in the ways the internet negatively impacts the adolescents' social functioning. Online socializing tends to make girls particularly vulnerable, while socializing in Internet cafés seems only to affect boys academic achievement. However, other research suggests that Internet communication brings friends closer and is beneficial for socially anxious teens, who find it easier to interact socially online.[209] The more conclusive finding has been that Internet use has a negative effect on the physical health of adolescents, as time spent using the Internet replaces time doing physical activities. However, the Internet can be significantly useful in educating teens because of the access they have to information on many various topics.
Transitions into adulthood
A broad way of defining adolescence is the transition from child-to-adulthood. However, the time frame of this transition varies drastically by culture. In some countries, such as the United States, adolescence can last nearly a decade, but in others, the transition—often in the form of a ceremony—can last for only a few days.[210]
Some examples of social and religious transition ceremonies that can be found in the U.S., as well as in other cultures around the world, are Confirmation, Bar and Bat Mitzvahs, Quinceañeras, sweet sixteens, cotillions, and débutante balls. In other countries, initiation ceremonies play an important role, marking the transition into adulthood or the entrance into adolescence. This transition may be accompanied by obvious physical changes, which can vary from a change in clothing to tattoos and scarification.[194] Furthermore, transitions into adulthood may also vary by gender, and specific rituals may be more common for males or for females. This illuminates the extent to which adolescence is, at least in part, a social construction; it takes shape differently depending on the cultural context, and may be enforced more by cultural practices or transitions than by universal chemical or biological physical changes.
Promoting positive changes in adolescents
At the decision making point of their lives, youth are susceptible to drug addiction, sexual abuse, peer pressure, violent crimes and other illegal activities. Developmental Intervention Science (DIS) is a fusion of the literature of both developmental and intervention sciences. This association conducts youth interventions that mutually assist both the needs of the community as well as psychologically stranded youth by focusing on risky and inappropriate behaviors while promoting positive self-development along with self-esteem among young adults.[211]
See also
| Wikimedia Commons has media related to: Adolescence |
| Wikibooks has a book on the topic of: Guide to Growing Up |
| Look up adolescence in Wiktionary, the free dictionary. |
- Adolescent medicine
- Children and adolescents in the United States
- Clique
- Emerging adulthood and early adulthood
- Ephebophilia - a sexual preference in which an adult is primarily or exclusively sexually attracted to mid to late adolescents
- Fear of youth
- Images of young people
- Juvenile delinquency
- Parental abuse by adolescents
- Parental abuse of adolescents
- Pedophilia (or paedophilia) - a psychiatric disorder in adults or late adolescents over 15 for whom prepubescent children are the primary or exclusive sexual object of their libido.
- Relational aggression
- Rite of passage
- Sex education
- Student voice
- Suitable age and discretion
- Teen Dating Violence
- Teen drama - (List of teen dramas)
- Teen film - (List of teen films)
- Teen idol
- Teen magazine
- Teen pop
- Timeline of children's rights in the United Kingdom
- Timeline of children's rights in the United States
- Young adult
- Youth
- Youth culture
- Youth voice
- Young worker safety and health
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| Wikimedia Commons has media related to: Adolescence |
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| Preceded by Preadolescence |
Stages of human development Adolescence |
Succeeded by Young adult |
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UpToDate Contents
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- 1. 青年の予防サービスに関するガイドライン guidelines for adolescent preventive services
- 2. 思春期の女性に生じる不正子宮出血：評価と診断法 abnormal uterine bleeding in adolescents evaluation and approach to diagnosis
- 3. 思春期の性 adolescent sexuality
- 4. 小児や青年への定期予防接種：概要 standard immunizations for children and adolescents overview
- 5. Nonalcoholic fatty liver disease in children and adolescents
English Journal
- The Tromsø Study: Fit Futures: a study of Norwegian adolescents' lifestyle and bone health.
- Winther A1, Dennison E, Ahmed LA, Furberg AS, Grimnes G, Jorde R, Gjesdal CG, Emaus N.
- Archives of osteoporosis.Arch Osteoporos.2014 Dec;9(1):185. doi: 10.1007/s11657-014-0185-0. Epub 2014 Jun 4.
- Bone mass achievement predicts later fracture risk. This population-based study describes bone mineral density (BMD) levels and associated factors in Norwegian adolescents. Compared with international reference ranges, BMD levels appear higher and physical activity levels are positively associated w
- PMID 24893722
- Risk factors of low vitamin D status in adolescent females in Kuwait: implications for high peak bone mass attainment.
- Alyahya K1, Lee WT, Al-Mazidi Z, Morgan J, Lanham-New S.
- Archives of osteoporosis.Arch Osteoporos.2014 Dec;9(1):178. doi: 10.1007/s11657-014-0178-z. Epub 2014 May 24.
- Risks of low vitamin D status in Kuwaiti adolescent girls are high parathyroid hormone (PTH), high waist/hip ratio, veiling and not having a private room. Low vitamin D status is likely to have a negative impact on their bone mass and accrual.INTRODUCTION: Low serum 25-hydroxyvitamin D (25OHD) level
- PMID 24858401
Related Pictures
★リンクテーブル★
| リンク元 | 「100Cases 33」 |
「100Cases 33」
- ☆case33 頭痛と混乱
- ■glossary
- accompany
- vt.
- (人)と同行する、(人)に随行する。(もの)に付随する。～と同時に起こる。～に加える(添える、同封する)(with)
- slurred n. 不明瞭
- 強直間代痙攣 tonic-clonic convulsion
- 意識消失とともに全身の随意筋に強直痙攣が生じ(強直痙攣期tonic convulsion)、次いで全身の筋の強直と弛緩とが律動的に繰り返される時期(間代痙攣期clonic convulsion)を経て、発作後もうろう状態を呈する一連の発作。
- ■症例
- 28歳、女性 黒人 南アフリカ 手術室看護師 ロンドン住在
- 主訴：頭痛と混乱
- 現病歴：過去3週間で頭痛が続いており、ひどくなってきた。現在も頭痛が持続しており、頭全体が痛い。友人曰く「過去六ヶ月で体重が10kg減っていて、最近、混乱してきたようだ」。発話は不明瞭。救急室にいる間に強直間代痙攣を起こした。
- ・診察 examination
- やせている。55kg。38.5℃。口腔カンジダ症(oral candidiasis)。リンパ節腫脹無し。心血管、呼吸器系、消化器系正常。痙攣前における神経検査では時間、場所、人の見当識無し。神経局所症状無し(no focal neurological sign)。眼底両側に乳頭浮腫有り。
- ・検査 investigation
- 血算：白血球増多
- 血液生化学：ナトリウム低下
- CT：供覧
- ■キーワード＆着目するポイント
- ・口腔カンジダ症(oral candidiasis)
- ・頭痛、精神症状、強直間代痙攣
- ・眼底両側に乳頭浮腫
- ・CT所見
- ・低ナトリウム血症は二次的なもの
- ■アプローチ
- ・口腔カンジダ症(oral candidiasis) → 細胞免疫低下状態(DM、免疫抑制、AIDSなど) or 常在細菌叢の攪乱(長期の抗菌薬の使用)
- ・The occurrence of thrush in a young, otherwise healthy-appearing person should prompt an investigation for underlying HIV infection.(HIM.1254)
- ・More commonly, thrush is seen as a nonspecific manifestation of severe debilitating illness.(HIM.1254)
- ・精神症状、強直間代痙攣 → 一次的、あるいは二次的な脳の疾患がありそう
- ・頭痛 → 漠然としていて絞れないが、他の症状からして機能性頭痛ではなく症候性頭痛っぽい。
- ・眼底両側に乳頭浮腫 → 脳圧亢進の徴候 → 原因は・・・脳腫瘍、ことにテント下腫瘍と側頭葉の腫瘍、クモ膜下出血、脳水腫など、そのほか、眼窩内病変、低眼圧などの局所的要因、悪性高血圧、血液疾患、大量出血、肺気腫などの全身的要因 (vindicate本のp342も参考になる)
- ・頭痛と脳圧亢進 → 頭蓋内圧占拠性病変、脳炎(IMD.274)
- ・CT所見 → ringformの病変、脳浮腫、脳圧亢進
- ・低ナトリウム血症 → 脳ヘルニアに続発して起こることがあるらしい。実際には下垂体にトキソプラズマによる病変が形成されることにより起こりうる。
- ・そのほか出身地、体重減少もHIVを疑わせる点
- パターン認識でHIV + 精神症状 + てんかん発作(強直間代痙攣) + 脳圧亢進 + CT所見 = 一番ありそうなのはToxoplasma gondiiによるトキソプラズマ脳症 cerebral toxoplasosis (トキソプラズマ脳炎 toxoplasmic encephalitis)
- ■Toxoplasma gondii
- 原虫 胞子原虫類
- (感染予防学 080521のプリント、CASES p,92、HIM p.1305-)
- ・疫学：西洋では30-80%の成人がトキソプラズマの感染の既往がある・・・うぇ(CASES)。日本では10%前後(Wikipedia)。
- ・生活環
- ・終宿主：ネコ：ネコの小腸上皮細胞で有性・無性生殖 糞便にオーシストの排泄
- ・中間宿主：ヒト.ブタを含むほ乳類と鳥類：無性生殖で増殖、シストの形成
- 急性期の増殖盛んな急増虫体tachyzoiteとシスト内の緩増虫体bradyzoite
- ・病原、病因 phathogenesis
- ・緩増虫体(bradyzoite)、接合子嚢(oocyst)
- ・感染経路
- 1. オーシストの経口摂取
- 2. 中間宿主の生肉中のシストの経口摂取
- 3. 初感染妊婦からの経胎盤感染。既感染なら胎盤感染しないらしい(HIM.1306)
- (4)移植臓器、輸血。確率は低い(at low rate)(HIM.1306)
- ・病態
- 1. 先天性トキソプラズマ症 congenital toxoplasmosis
- ①網脈絡膜炎、 ②水頭症、 ③脳内石灰化、 ④精神・運動障害
- 2. 後天性トキソプラズマ症 acquired toxoplasmosis
- (1) 健常者
- ・多くは不顕性感染。発熱、リンパ節腫脹、皮疹(rash)
- ・(少数例)筋肉痛、暈疼痛、腹痛、斑状丘疹状皮疹(maculopapular rash)、脳脊髄炎、混乱(HIM.1308)
- ・(まれ)肺炎、心筋炎、脳症、心膜炎、多発筋炎
- ・網膜、脈絡叢に瘢痕や、脳に小さい炎症性の病変を残すことあり(CASES)。
- ・急性感染の症状は数週間で消失 筋肉や中枢神経系に緩増虫体が残存
- (2)HIV感染者、臓器移植例、がん化学療法例
- シスト内緩増虫体→急増虫体→播種性の多臓器感染
- AIDSでは、トキソプラズマ性脳炎が指標疾患 AIDS-defineing illness(CASES)
- ・治療
- (日本)アセチルスピラマイシン、ファンシダール(感染予防学 080521)
- ■トキソプラズマ脳炎 toxoplasmic encephalitis、トキソプラズマ脳症 cerebral toxoplasosis
- ・症状
- 発熱、頭痛、混乱ｍ、痙攣、認知の障害、局所神経徴候(不全片麻痺、歯垢、脳神経損傷、視野欠損、感覚喪失)(CASES)
- ・画像検査
- (CT,MRI)多発性、両側性、ring-enhancing lesion、特に灰白質-白質境界、大脳基底核、脳幹、小脳が冒されやすい(CASES)
- ・鑑別診断(臨床症状・画像診断の所見で)
- リンパ腫、結核、転移性脳腫瘍(CASES)
- ・病歴と画像所見からの鑑別診断
- リンパ腫、結核、転移性腫瘍
- ？
- このCTがcerebral toxoplasmosisに特徴的かは不明
- □最後に残る疑問
- AIDSでWBC(leukocyte)の数はどうなるんだろう？？？AIDSの初診患者ではWBCが低い人が多いらしいし()、HIVはCD4+ T cellとmacrophageに感染して殺すから、これによってB cellは減るだろうし、CD8+ T cellも若干減少するだろうからWBCは減るんじゃないか？！好中球はAIDSとは関係ない？好中球は他の感染症に反応性に増加している？ちなみに、好酸球は寄生虫(原虫)の感染のために増える傾向にあるらしい(HIMのどこか)。
- スルファジアジン
- sulfadiazine
- ピリメタミン
- pyrimethamine
- 葉酸拮抗剤である。
- サルファ剤と併用され、抗トキソプラズマ薬、抗ニューモシチス・カリニ薬として相乗的に働く。
- ST合剤
- SMX-TMP
- スルファメトキサゾール・トリメトプリム合剤 sulfamethoxazole and trimethoprim mixture
- □AIDSの定義(http://en.wikipedia.org/wiki/CDC_Classification_System_for_HIV_Infection_in_Adults_and_Adolescents)
- A CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).
- or he/she has one of the following defining illnesses:
-
- 01. Candidiasis of bronchi, trachea, or lungs
- 02. Candidiasis esophageal
- 03. Cervical cancer (invasive)
- 04. Coccidioidomycosis, disseminated or extrapulmonary
- 05. Cryptococcosis, extrapulmonary
- 06. Cryptosporidiosis, chronic intestinal for longer than 1 month
- 07. Cytomegalovirus disease (other than liver, spleen or lymph nodes)
- 08. Encephalopathy (HIV-related)
- 09. Herpes simplex: chronic ulcer(s) (for more than 1 month); or bronchitis, pneumonitis, or esophagitis
- 10. Histoplasmosis, disseminated or extrapulmonary
- 11. Isosporiasis, chronic intestinal (for more than 1 month)
- 12. Kaposi's sarcoma
- 13. Lymphoma Burkitt's, immunoblastic or primary brain
- 14. Mycobacterium avium complex
- 15. Mycobacterium, other species, disseminated or extrapulmonary
- 16. Pneumocystis carinii pneumonia
- 17. Pneumonia (recurrent)
- 18. Progressive multifocal leukoencephalopathy
- 19. Salmonella septicemia (recurrent)
- 20. Toxoplasmosis of the brain
- 21. Tuberculosis
- 22. Wasting syndrome due to HIV
- People who are not infected with HIV may also develop these conditions; this does not mean they have AIDS. However, when an individual presents laboratory evidence against HIV infection, a diagnosis of AIDS is ruled out unless the patient has not:
-
- undergone high-dose corticoid therapy or other immunosuppressive/cytotoxic therapy in the three months before the onset of the indicator disease
- OR been diagnosed with Hodgkin's disease, non-Hodgkin's lymphoma, lymphocytic leukemia, multiple myeloma, or any cancer of lymphoreticular or histiocytic tissue, or angioimmunoblastic lymphoadenopathy
- OR a genetic immunodeficiency syndrome atypical of HIV infection, such as one involving hypogamma globulinemia
- AND
- the individual has had Pneumocystis carinii pneumonia
- OR one of the above defining illnesses AND a CD4+ T-cell count below 200 cells/μl (or a CD4+ T-cell percentage of total lymphocytes of less than 14%).
- □AIDSのステージング
- Revised World Health Organization (WHO) Clinical Staging of HIV/AIDS For Adults and Adolescents (2005)
- http://en.wikipedia.org/wiki/WHO_Disease_Staging_System_for_HIV_Infection_and_Disease_in_Adults_and_Adolescents
- ■参考文献
- HIM = Harrison's Principles of Internal Medicine 17th Edition
- CASES = 100 Cases in Clinical Medicine Second edition
- IMD = 内科診断学第2版