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Introduction

Adolescents face a daunting array of developmental challenges. Beginning as early as age 9, young people experience significant physical changes as they go through puberty. Adolescents also experience emotional changes as they seek greater independence from their parents, search for acceptance by peers, and begin to navigate new adult-like roles in society. For most teenagers, these changes are accompanied by the negotiation of new and conflicting demands and pressures, the exploration of novel ideas and risky behaviors, engagement in more complex intellectual tasks, and the formation of distinct identities. At the same time, adolescence is also a time of tremendous opportunity, when parents and their teenage children can forge new, meaningful relationships and when young people can begin to serve as a resource in their communities. Throughout their development, adolescents are shaped by experiences with other individuals and in a variety of contexts and settings, including families, schools, peers, neighborhoods, community-based organizations, health care organizations, the child welfare and juvenile justice systems, the media, and others.

Our challenge as a society is to ensure that all adolescents have a promising future; find a valued place in a constructive group; learn how to form close, durable human relationships; earn a sense of worth as a person; achieve a reliable basis for making informed choices; express constructive curiosity and exploratory behavior; find ways of being useful to others; believe in a promising future with real opportunities; cultivate the inquiring and problem-solving habits of mind necessary for lifelong learning and



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Risks and Opportunities: Synthesis of Studies on Adolescence 1 Introduction Adolescents face a daunting array of developmental challenges. Beginning as early as age 9, young people experience significant physical changes as they go through puberty. Adolescents also experience emotional changes as they seek greater independence from their parents, search for acceptance by peers, and begin to navigate new adult-like roles in society. For most teenagers, these changes are accompanied by the negotiation of new and conflicting demands and pressures, the exploration of novel ideas and risky behaviors, engagement in more complex intellectual tasks, and the formation of distinct identities. At the same time, adolescence is also a time of tremendous opportunity, when parents and their teenage children can forge new, meaningful relationships and when young people can begin to serve as a resource in their communities. Throughout their development, adolescents are shaped by experiences with other individuals and in a variety of contexts and settings, including families, schools, peers, neighborhoods, community-based organizations, health care organizations, the child welfare and juvenile justice systems, the media, and others. Our challenge as a society is to ensure that all adolescents have a promising future; find a valued place in a constructive group; learn how to form close, durable human relationships; earn a sense of worth as a person; achieve a reliable basis for making informed choices; express constructive curiosity and exploratory behavior; find ways of being useful to others; believe in a promising future with real opportunities; cultivate the inquiring and problem-solving habits of mind necessary for lifelong learning and

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Risks and Opportunities: Synthesis of Studies on Adolescence adaptability; learn to respect democratic values and the elements of responsible citizenship; and build a healthy lifestyle. These requirements can be met only by a conjunction of the people, settings, and institutions that collectively and powerfully shape adolescent development, for better or worse. WEALTH OF RESEARCH Over the past two decades, researchers have made substantial progress in describing the complexity of adolescence and in determining the common features of adolescent development. As a result, we now know how diverse and heterogeneous this age group is and how important hormonal, social, and environmental factors are in shaping their development. We also know how meaningful peers are to the formation of adolescent identity. Through this rich body of research, we have come to understand that adolescence need not be a time of turmoil and strife between teenagers and their parents, though it often is. Moreover, we now know that peer influence is not necessarily negative; rather, it can often be very positive. Finally, we now realize the significance of the settings in which adolescents grow up and how important they are to ensuring their successful transition from childhood to adulthood. The institutions within these settings—schools, health care organizations, community-based programs, and the child welfare and juvenile justice systems—need to be scrutinized carefully, as do policies designed to ensure that all adolescents grow to become healthy, happy, and productive adults. SCOPE OF REPORT This report constitutes one of the first activities of the Forum on Adolescence, a cross-cutting activity of the Institute of Medicine and the National Research Council of the National Academies. Established under the auspices of the Board on Children, Youth, and Families, the forum's overaching mission is to synthesize, analyze, and evaluate scientific research on critical national issues that relate to youth and their families, as well as to disseminate research and its policy and programmatic implications. The goals of the forum are to: (1) review and establish the science base on adolescent health and development and make efforts to foster this development; (2) identify new directions and support for research in this area, approaching research as a resource to be developed cumulatively over time;

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Risks and Opportunities: Synthesis of Studies on Adolescence (3) showcase new research, programs, and policies that have demonstrated promise in improving the health and well-being of adolescents; (4) convene and foster collaborations among individuals who represent diverse viewpoints and backgrounds, with a view to enhancing the quality of leadership in this area; and (5) disseminate research on adolescence and its policy implications to a wide array of audiences, from the scientific community to the lay public. The forum's mission suggested that an excellent starting point was the work already done on these topics by the National Research Council and the Institute of Medicine: nearly 60 reports published by the National Academy Press touch on adolescent issued and on issues relevant to their health and development. Taking advantage of this body of individual research syntheses, this report attempts to characterize the institution's work to date that bears on adolescence. To ensure that the data presented are reasonably up to date, this volume emphasizes reports published after 1990. Also, the reports covered address only adolescents in the United States, although the forum believes efforts are needed to understand the essential characteristics and needs of adolescents worldwide, as well as to understand which characteristics are culture specific. Each chapter concludes with a list of the reports reviewed in it. A complete list of all reports considered appears in the Appendix. This synthesis draws from a wide range of types of reports produced by the National Academies, including committee reports that include conclusions and recommendations developed over several years, workshop reports that summarize meetings on specific topics, and other documents that reflect work carried out by experts on the topic of adolescence. Our goal in developing this synthesis on adolescence was not to produce a comprehensive or representative review of all recent research on adolescence, nor to offer conclusions or recommendations, but rather to provide a starting point for the forum's work on this important period in human development. A number of themes emerged from our overview of the National Academies' work: Adolescence is a time of both tremendous opportunity and risk. The social context in which adolescents are developing has changed markedly during the past decade. Families in U.S. society have also experienced dramatic changes. Adolescent development does benefit from the support of a variety of social institutions.

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Risks and Opportunities: Synthesis of Studies on Adolescence Specific strategies can be employed to promote the health and well-being of adolescents. Adolescents are increasingly joining the U.S. workforce. Dramatic sociodemographic changes are anticipated in the 21st century, including a great increase in the number of adolescents, as well as increasing cultural diversity within this age group. In the pages that follow, we amplify these themes with findings gleaned from the reports examined. In only a few areas are data from outside sources incorporated into this report. These include data reported by the Bureau of the Census regarding the demographic profile of adolescents living in the United States and data reported by the U.S. Department of Health and Human Services regarding recent trends in adolescents' health and well-being. These data are included to provide a portrait of the U.S. adolescent population at the current time. It is important to note that this report is limited in several ways. First, it does not provide, nor was it the intention to provide, a review of the science base of adolescent health and development—or to establish such a base. It provides an extensive review of certain issues, such as infection with sexually transmitted diseases and use of tobacco, alcohol, and illicit drugs, but not of others, such as motor vehicle accidents associated with alcohol use, unintended injuries, violence, and suicide. Second, while the previously published reports focus on many of the problems and risks associated with adolescence, they do not focus equal attention on the opportunities that exist during adolescence, nor on the successes experienced by the majority of adolescents on a day-to-day basis. This exaggerated focus on the problems experienced by adolescents is due largely to the nature and types of the requests that have been directed to the National Academies by Congress, federal agencies, and private foundations. Thus, this report provides an extensive review of what can go wrong during the adolescent years and what is known about youth who are at high risk for experiencing problems and poor developmental outcomes; it does not provide this same attention to issues of resilience and what is known about adolescents who are succeeding in school, at work, and at play. Moreover, while existing reports have examined the range of factors associated with increased risks, few of them have focused on the types of interventions that have been found to be most effective at preventing or intervening when problems do occur. This report therefore runs the risk of stereotyping youth as problem-prone and problem-ridden, and potentially serves to re-

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Risks and Opportunities: Synthesis of Studies on Adolescence inforce the image that youth are a scary, troubled lot. As discussed in the concluding section, this problem-focused approach is endemic to American society, driven largely by existing program funds, which are categorical in nature and may be influenced by policies that are often inconsistent and contradictory. Third, the connections among adolescent behaviors and the context in which they occur is missing. Thus, although adolescent problem behaviors tend to cluster, this report is structured in such a way as to treat the various problems as if they were separate from one another. While this report provides an extensive review of the various social contexts and settings that potentially influence adolescent development—such as family, community, schools, the media—there is little attention to the links between these contexts. There is also little attention to the psychological worlds of adolescents and the ways that teenagers construct and interpret the developmental changes they are experiencing, and, therefore, how the influence of social settings is mediated by psychological and cognitive processes. In writing this report, the forum has learned a good deal about what questions have been asked about adolescents and what research has contributed to the answers. The forum has also learned what questions have not been asked and so where new efforts may be most needed. Furthermore, very recent data show evidence of an exciting and promising reversal of some trends. For example, studies suggest that an increasing number of adolescents are using condoms during sexual intercourse, and federal statistics suggest decreasing rates of unintended pregnancies among teenagers. We discuss some of these recent trends in the concluding section.