Chapter 14 - EARLY ADOLESCENCE

The poignance of early adolescence is crystallized in these fragments from an article in the New York Times. The girls, feeling with some justification more socially poised than their male classmates but not aware how unsophisticated and vulnerable they really are, look to older males for companionship (though not without a degree of apprehension over being taken for older than they are); and they often find older males, sometimes significantly older, looking for them. Their male age-mates, largely unwilling to risk inviting a relationship with a girl and being rejected, hold back, refuse to dance, tease anyone who breaks gender ranks. In their own eyes they're being "cool," but from the girl's point of view, they "act retarded.' Both genders are quick to label anything or anyone that frustrates them as "boring."

Resetting the Thermostat

The mechanisms that set off the physical changes of puberty are not entirely understood. It may be more accurate to say that the brain inhibits puberty all during childhood than that the brain triggers puberty at a particular point as a totally new development. In infancy, a low-level set point is established for the body's sex hormones. The thermostat is set on cool. Shortly before pubertal changes make their appearance, the hormonal feedback systems change the thermostat from, say, sixty degrees to eighty degrees. Now a much higher level of sex hormones is allowed to function in the body before the hypothalamus at the center of the brain tells the pituitary gland to cool the endocrine system down enough to keep the sex hormone level from going any higher.

The pituitary gland, on command from the hypothalamus, also releases growth hormones, although the release may be delayed by factors such as stress, nutritional deficiency, illness, excessive athletic training, or diet-induced thinness. The rapidity of adolescent growth is astonishing. For boys the peak velocity averages about 4.1 inches of height per year. Not all parts of the body grow at the same time. The hands, head, and feet are the first to accelerate, followed by the arms and legs, and finally the torso and shoulders. As Tanner put it, "a boy stops growing out of his trousers (at least in length) a year before he stops growing out of his jackets"

At the peak of the growth surge, the larynx having grown prominently, a boy's voice begins to deepen gradually. For a while, the voice breaks unexpectedly between its higher childhood range and its lower adolescent range until the level of the mature voice is established late in adolescence. Since girls as a group begin their growth spurts a couple of years before boys, they are on average taller than boys from age eleven to thirteen. From age fourteen on, males have gained a height advantage that they never lose. They also develop a marked superiority in strength and muscular development. Body fat increases for both genders at puberty, but the gains are greater for girls. In late adolescence boys have average muscle to fat ratio of three to one, while girls' comparable ratio is five to four. This ratio alone accounts for much of the difference in adolescents' physical performance. At the end of adolescence, boys are stronger; they have "larger hearts and lungs relative to their size, a 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, such as lactic acid," higher blood hemoglobin, and more red blood cells.

What Is Puberty?

Symmetry would be nicely served if all five of the male developmental periods in this book could be firmly age-related. The nature of adolescence, however, necessitates a relaxation of age-relatedness in the last two periods. I've designated the fourth stage (early adolescence) as ages thirteen to fifteen, and the final stage (late adolescence) as ages sixteen to eighteen, but where a boy stands in his adolescent maturation matters more than his age. The arrival of puberty, which starts the engine of adolescence, occurs over a surprising range of time. Some boys' testes begin to enlarge as early as age nine, some as late as age thirteen. Very fine pubic hair makes a first appearance over the same range of age, changing in color (darker) and texture (coarser) a year or so after first appearance. The penis exhibits a growth spurt as early as age ten, as late as age fourteen.

Facial hair appears only after genital development is well underway, about two years after the first appearance of pubic hair-first at the corners of the upper lip, then across the upper lip, still later across the upper cheeks and in the midline below the lips, and lastly along the sides of the face and lower border of the chin. Underarm hair begins to grow about the same time as facial hair, and body hair increases in density on legs, arms, and chests.

Puberty brings changes in skin quality. The skin becomes rougher, especially around the upper arms and thighs, concurrent with the enlargement of sweat glands. These skin changes often give rise to enhanced oiliness, and to acne and other skin eruptions that can plague the self-confidence of the male adolescent as painfully as that of the female adolescent.

Pubertal changes occur in the male breast, stimulated by the body’s production of estrogens. Both estrogen and androgens (male hormones) are manufactured by glands in both sexes, but in different amounts on average. In the male teenager, the area around the nipple, the areola, increases in circumference; the nipples also become more prominent. Some boys develop gynecomastia, a breast enlargement that includes the growth of subcutaneous breast tissue. The tissue on one side of the chest may grow larger than on the other. The condition usually goes away with continued growth of the torso, but it can be observed in males of all ages, particularly among overweight males. The condition is widespread enough to provoke advertisements in many publications for surgical treatment of gynecomastia—essentially the same kind of breast reduction that some heavily breasted females elect.

While a boy's body is changing on the outside, it is also changing on the inside. As the penis grows in length and thickness, the internal sexual organs enlarge. The seminal vesicles that carry sperm from the testicles to the opening of the penis develop, and the prostate and bilbo-urethral glands begin to generate seminal fluid.

A year or so after the acceleration of growth of the penis, the first ejaculation of seminal fluid occurs. It might take the form of a spontaneous nocturnal emission, but probably more often it is the result of masturbation provoked by spontaneous erection and other genital sensations, or by the conversations of cohorts describing their own introductions to masturbation. Boys are not apt to report their very first ejaculations as much as girls report their first menstrual periods to each other, but most boys remember the occurrence. Given the extent to which the adolescent and adult male seek orgasmic pleasure through masturbation or interpersonal sexual contact, and the extent to which their sexuality is reinforced by an active fantasy life, one is tempted to say that the day of first ejaculation is the third keystone day in a male's life after his day of birth and his first day of school.

A shift in sleep and alertness patterns also occurs near this time. Some educators have been lobbying for a later beginning to the school day for adolescents. If allowed to regulate their own sleep schedules, most teenagers stay up to about 1:00 a.m. and sleep until 10:00 a.m. or later. Studies of their alertness patterns show that they are least alert between 8:00 a.m. and 9:00 a.m., when classes begin in most schools, and most alert after 3:00 p.m., when the school day concludes. It seems likely that this shift in sleep and alertness patterns, combined with the demands of the classroom, would affect their moods significantly.

A number of researchers believe that adolescents are not inherently moodier than younger children, notwithstanding widely held opinions to the contrary. Stressful circumstances—such as academic problems, family conflict, or strained friendships—appear to play more substantial roles in the development of mood disturbances and depression in adolescence than do hormones. To the extent that a connection has been established between hormonal changes and behavior, the effects seem to be strongest early in puberty when the system is being “turned on." The culprit is not the absolute increases in hormonal levels but the rapid fluctuations. Once the levels stabilize, later in puberty, problematic effects decrease. Through it all, boys show fewer adverse psychological effects from going through puberty than do girls.

What Is Adolescence?

Lawrence Steinberg has identified as many ways of defining adolescence as Howard Gardner has found varieties of intelligence. Biologically, he writes, adolescence begins with the onset of puberty and ends when a person feels ready for sexual reproduction. Emotionally, adolescence marks the beginning of self-conscious detachment from parents and ends with the attainment of a separate sense of identity. Cognitively, adolescence begins with the emergence of more advanced reasoning abilities, and ends with their consolidation in the ability to entertain hypotheses, weigh contingent possibilities, see situations from the perspectives of others, and draw inferences from available evidence. Interpersonally, to continue Steinberg's catalog, adolescence deepens a shift in interest from family relations to peer relations, culminating in a capacity for deeper intimacy with peers and commitment to a loved one. Socially, adolescence begins with training for adult work and citizen roles, and ends with full attainment of adult status and privileges. Educationally, adolescence begins with entry into junior high school and ends with a completion of formal schooling. Legally, adolescence begins with the attainment of juvenile status and ends with the attainment of majority status. Culturally, adolescence begins in some societies with training for a ceremonial rite of passage and ends with admission to adulthood upon completion of the rite.

There is pertinent information in each of these definitions, but none is sufficient by itself to define adolescence. Biologically, for example, a boy is capable of performing his role in reproduction long before we are ready to say that he has completed his adolescent tasks. Again, a boy may have quite fully shifted his frame of reference from family relations to peer intimacy as a teenager, but we might still judge him to have left other tasks of adolescence incomplete. As we know, many boys reach the age of legal majority without fulfilling all of the tasks of adolescence.

Perhaps we could define adolescence as an interrelated and overlapping set of processes. They don’t begin at exactly the same age for every boy, and they certainly don’t end at the same age. One can say of many boys in the midstream. of adolescence: 'He's fifteen years old-going on sixteen most days, on twenty some days, on ten other days.' Since there is so much individual variation in the onset and resolution of the several processes that constitute adolescence, neat formulas tied to age can't be offered for parental guidance and reassurance. What can be done is to describe the signs of each process; then each boy has to be read by his parents, teachers, and other caregivers to see where he stands day by day, month by month, year by year.

If a thirteen-year-old boy falls ill and misses school for two or three months, he is not doomed to stay behind his class for the remainder of his academic career. When they set their minds to it, boys can catch up with breathtaking speed. Their minds are prone to bursts of activity just as their bodies grow in spurts separated by periods of leveling off. On the question of overall maturation, however, the principle of quick catch-up doesn't apply. The later a boy enters puberty, the longer his adolescent maturation usually takes. This may appear to be a rather cruel caprice of nature, compounded by cultural attitudes. Early maturing boys steal the show. Their increased strength and sexuality are rewarded with approbation. Some of them become the star athletes. Everyone treats them as more grown-up.

Meanwhile, the parents of the late maturer may be worrying as much as the late maturer himself. There is often more stress attendant upon delay of male maturation than upon maturation itself. Every step is more trying for the late maturer because he knows that many of his peers have gotten there before him. The social roles available to the late maturer-the clown or the cut-up, for example-may themselves hinder more than assist maturation. In fact, studies show that late maturers are seen both by other adolescents and by adults as overly anxious and as seeking attention through immature behavior. From a cross-gender perspective, then, the late maturing male is subject to the kind of unease and self-doubt that often marks the early maturing female, who may not feel ready for the social and sexual attention early puberty has brought her.

In the New York Times, an anonymous mother described the teenage social order in a suburb of Minneapolis as a three-tier system. She didn't say so, but I infer that the system is pyramidal: far fewer kids at the top than at the bottom. Tier one consists of the trend setters. They are "the kids who stand out, are a little noisier, more noticed, have a group of kids following them. They're probably a little more risk-taking. They set the pace." Below them on tier two are the aspiring "wannabes. ' "Everyone else" is on tier three. Most of these cliques in early adolescence are limited to members of the same sex, just as they were in elementary school. Ways of speaking, dressing, and behaving are developed by a trendsetting clique to distinguish themselves from lesser-status peers and from adults. It takes a considerable amount of energy and drive—and financial investment—to be a trendsetter. But teenagers have the financial resources to support their social order. They spend $122 billion a year, including 10 percent of all supermarket sales.

Later in adolescence, same-sex cliques will partially give way to mixed-sex cliques in which boys and girls can interact without having to have intimate relations. By late adolescence, most boys and girls feel comfortable establishing relations as couples. They no longer need the mixed-sex clique, which may then dissolve.

It is important, especially with respect to issues of character development, not to fall into the trap of imagining the early adolescent boy as pulling away from the domination of his stuffy hierarchical family in order to enjoy the simple pleasures of democratic life with peer groups. Adolescent cliques often exhibit hierarchical strategies of inclusion and exclusion that are more ruthless and mean-spirited than anything an adolescent boy has experienced before.

Conflict between adolescent males is often expressed physically, and for that reason studies of adolescent aggression have frequently focused on the behavior of boys. But girls use rumor-mongering, exclusion, withdrawal of friendship, and other forms of “relational aggression" to equally painful—if not quite so dramatic—effect. One study refers tellingly to blows to the heart rather than blows to the body.

As boys move from same-sex cliques early in adolescence to mixed-sex cliques, they learn more of the techniques of relational aggression by seeing and imitating them, or suffering them. Being on the receiving end of both physical and relational aggression leads in one direction to submissive, depressive behavior, and in another direction to hostile, bitter behavior. Boys, as well as girls, can follow either path; indeed, girls today may be more prone to respond with hostility, even physical aggression, than they were, say, twenty years ago. Parents and teachers should take account of the fact that relational aggression often leaves the victim with a simmering anger that can break out with slight provocation, and that may be a roadblock to future relationships. The key to dealing with both kinds of aggression is to teach the adolescent negotiating skills so that he can assert his interests effectively without resorting to physical aggression or barely suppressed anger.

A boy is well served by parents and teachers who discuss the advantages and disadvantages of joining cliques: pointing out the temptations to trendsetters to be arrogant and condescending; raising the question of whether the energy and anxiety devoted to becoming a trendsetter is worth it to a wannabe; pointing out alternative paths of opportunity and enjoyment to boys who are members of “everyone else."

Fathers and Sons

In nonindustrial societies, boys in the first surge of puberty are often subjected to an intense rite of passage. The purpose of the rite is to wrest a boy from the social context of women and children where he has been living, and to initiate him into the life and company of manhood. The more anxious the society is about getting boys to make the leap, the more rigorous the preparation and ceremonies. Elders teach boys the ways of men. Feats of strength and endurance may be required. Fasting may be imposed. The boys penis may-be cut or marked to signal his change of status. Upon the conclusion of the ceremonies, the male, who was just a boy only a few weeks earlier, is regarded as a man-ready to work as an adult once he sleeps off his exhaustion, ready to marry within a few years.

Industrial societies need a much longer period to educate a boy for the various occupations of manhood. Rigorous rites of passage don't make much sense when adolescence is expected to last close to a decade for most boys, even longer for those who elect careers requiring extensive postgraduate education. The few remnants we have from such rites-notably religious "confirmations" or bar mitzvahs-have become pleasant celebrations of adolescence; no one pretends that the male recipients have really become adults, or that their social status has changed in any significant way. To a degree these early adolescent ceremonies symbolize separation from parents toward deeper association with peers rather than cohortship with adults. What happens in industrial societies is that a male adolescent goes through an extended period in which he is regarded partly as an adult, partly as a youth, and maybe still partly as a child. It can be quite confusing to him to sort out. In mid-adolescence he is given adult status as a driver. He can at the same stage acquire a paying job in which the expectations are the same for him as for adults: He is expected to arrive for work on time, perform his prescribed responsibilities satisfactorily, and, if he earns enough, pay taxes. But at school he is still confronted with a framework that hasn’t changed all that much since grade school. While he may be old enough to be drafted into military service, at home he may be treated as a child or as a teenager.

Kathleen Norris, in a wise and humorous essay on "Infallibility," caught the irony of the situation:

The mother of a fifteen-year-old boy who had recently obtained a learner's permit for driving accompanied him while he drove to a shopping mail, but as it had begun to rain heavily while they were indoors, she suggested that she drive home. Her son had never driven in the rain, which gave her pause. He insisted that he needed the experience. She acquiesced, but reluctantly, and as he drove out of the parking lot, she began to offer a steady stream of advice. The boy snapped at her to cut it out. She snapped back, “I don't know what you know, and what you don't know-I'm only trying to help!" “Mom," he said, “just assume that I know everything."

The onset of puberty provokes a revision of a boy's relation to his parents—to his mother, as we've just seen, but particularly to his father. The very nature of sexual maturation promotes a boy's deeper identification with his father. There is an opportunity for a father to get closer to his son, yet there are provocations that can lead fathers and sons to be more estranged than ever. It is important to keep in mind that as their sons are approaching or traversing adolescence, many fathers are experiencing what is called "midlife crisis," an awareness of their mortality and limitations, a questioning of their life goals.

The relationships between fathers and adolescent sons have been studied frequently without yielding a consistent profile, partly because the samples studied aren't the same, partly because there are many aspects to the relationship and some of them appear to be at cross-purposes. Here is a catalog of some of the findings:

Mothers and Sons

From the very beginning of puberty, there is some lessening of emotional closeness and attachment to both parents by boys, although boys still describe themselves as enjoying more self-disclosure (but selectively as to subject) and affection with mothers than with fathers. The frequency of arguments between mothers and sons increases. This pulling away may contribute to the "gnawing loneliness" Harry Stack Sullivan attributes to boys at the onset of puberty. But the separation probably saddens mothers more than fathers because mothers have usually enjoyed the closer preadolescent bonds. Sixth-grade boys describe themselves as feeling closer to their mothers than to their fathers, but by ninth grade boys see their fathers as being as dose to them as their mothers.

There are, to be sure, variations in adolescent development attributable to ethnic diversity. Chinese-American parents, for example, describe themselves as more demanding of obedience and respect from their sons than Caucasian-American parents. In Hispanic and Asian Pacific Island families, strong paternal authority is paired with unusually high maternal warmth; this combination causes most of their children to be compliant to family values and deeply loyal to immediate and extended family members.

Spouses do not operate in vacuums as parents. When there is serious conflict between them, they may try to undermine each other's parental roles. Or they may develop uncoordinated but subtly competing relationships to their adolescent son, as we shall see in more detail in the next chapter. When Mark gets into trouble as a computer hacker at school, he and his dad, Harvey, will conspire to keep his mother, Nina, in the dark for a couple of weeks-"She's too emotional about such things"-until they have thought through a strategy for dealing with the crisis.

Mothers' attitudes toward the fathering role of their spouses reflects their experiences with their own fathers. If mothers see their own fathers as having been nurturing, their husbands are more likely to be strongly involved in the children's lives. When fathers restrict themselves-or are restricted-to roles as disciplinarians, playmates, and economic providers, their participation in family life is seen more as "mother's helper" rather than as co-responsible parent. The man who sees his role principally as the breadwinner, as opposed to being an emotionally supportive caregiver, is almost certain to have a rather distant relationship with his son.

The big picture is that despite what the typical mother of an adolescent boy has lost in closeness with him as he matures physically and socially, she continues to be regarded as the superior caregiver. One piece of research that disputes conventional wisdom shows just how influential the mother remains in most families. The conventional wisdom is that sons undoubtedly learn their aggressive behaviors from their fathers, while daughters learn such behaviors from their mothers. It is true that men rank higher than women in degrees of assertiveness, argumentativeness, and verbal aggressiveness. The surprise is that mothers serve as the main model for these traits in both daughters and sons. They model assertiveness and verbal aggressiveness for all their children-perhaps simply because they spend more time with their children. Despite the rich opportunity the adolescence of a son offers the father to forge a deeper and closer relationship, the evidence suggests that many fathers do not take advantage of the opportunity.

Safe Passage versus High Risk

Joy Dryfoos formulated the notion of "safe passage" to represent what we all wish for adolescent boys: that they will not be too severely affected by the risk factors lodged in all of the opportunities they will encounter passing from childhood to adulthood. A 1995 national survey of fourteen-year-olds indicated the extent of new experience already accumulated.

Sexual Activity. Forty-one percent of fourteen-year-old boys acknowledged being sexually active, that is already introduced to sexual intercourse. Among the 41 percent, two-thirds said they used condoms to prevent pregnancy and transmission of disease. By twelfth grade, two-thirds of boys will be sexually active. African-American males have their first sexual intercourse earlier on average (41 percent before age thirteen) than white adolescent males, but by age fourteen white males have caught up.

Drugs. Thirty-two percent of fourteen-year-old boys have smoked a cigarette within the past month. Many smoked their first cigarette before age thirteen. (I a.m. treating cigarettes here as an addictive substance with serious demonstrated health implications.) Approximately 25 percent of boys said that they had smoked marijuana at least once in the past month. As the popularity of smoking has increased, and notwithstanding demonstrations of adverse effects, peer disapproval of smoking marijuana has dropped dramatically. Five percent claim that they have used heavy drugs such as cocaine.

Alcohol. Twenty-eight percent of boys have already done some heavy drinking by age fourteen. Broken down ethnically and racially, the data indicate that Hispanic mates are the heaviest drinkers, whites come next, and African-Americans trail behind. Six percent say they have drunk alcohol and 9 percent have smoked marijuana on school premises.

Academic Problems. Twenty-six percent of boys in the l995 survey were already a year behind in school; 5 percent were two years behind. Boys are much more likely than girls to be kept back. Not a few researchers of adolescence believe that the transition into ninth grade is a "make or break" time for teenagers. If intimidated by the challenge, they may take up with peers who are experimenting with high-risk activities.

Violence. Almost half of adolescent males acknowledge they've been in a fight during the previous year. Approximately 16 percent have fought on school grounds. Thirty-one percent of adolescent males report carrying weapons of one kind or another; 12 percent say they have carried a gun within the past month. There is certainly accuracy in the claim of boys that schools-to say nothing of streets and popular hangouts-are dangerous places, even if there isn't justification for their claim that the most reasonable response to the danger is to carry a weapon.

Crime. From 1988 to 1993 the number of juvenile arrests almost doubled to about 2 million—five times as many males as females and twice as many whites as African-Americans, although, because of the ratio in the population, the rate is higher for African-Americans. One in five arrested teenagers is held in secure detention. In one decade, from the mid 1980s to the mid 1990s, the homicide rate among teens from fourteen to seventeen years old almost tripled. The increasing availability of handguns is undoubtedly a factor. Professor James Fox of Northeastern University, a specialist on youth crime, writes:

The problem of kids with guns cannot be overstated. The fourteen-year-old armed with a gun is far more menacing than a forty-four year old with a gun. While the negative socializing forces of drugs, youth gangs and the media have become more threatening, the positive socializing forces of family, school, religion, and neighborhood have grown relatively weak and ineffective.

Risk Clusters. Many adolescent boys are trustworthily low-risk for experimenting with dangerous behaviors. Search Institute analyzed several large-scale studies to see how risk factors attract each other in predictable clusters. Unfortunately, these statistics are not broken down by gender, but we can safely assume that boys outnumber girls in all categories except eating disorders. In a national sample of ninth graders (the upper end of early adolescence), about 22 percent reported no history of substance abuse, excessive drinking, unsafe sexual activity, depression or suicide attempts, antisocial behavior or crime, unsafe driving, or eating disorders. An additional 29 percent acknowledged only one type of risk-taking. Eighteen percent acknowledged two types, 31 percent three or more. In one Michigan survey, about 40 percent of the ninth graders who acknowledged school problems also reported excessive alcohol use; this compared to 17 percent acknowledgment of school problems among those who did not report excessive drinking. About 60 percent of the adolescents with school problems testified to having had unprotected sex, compared to 30 percent of those who did not acknowledge academic failures.

Ten percent of fourteen-year-olds (again, a higher percentage of boys) could be characterized as living at very high risk. Eighty percent of this segment drank, 40 percent used illegal drugs, 90 percent were sexually active without using protection, and more than half had been arrested at least once during the year preceding the survey. Approximately 40 percent reported episodes of depression. Though only a few had dropped out of school, about 40 percent were two or more classes behind their age-mates.

Not surprisingly, the earlier any type of risk-taking begins, the greater the chance that it will increase in severity and duster with other risky behaviors. The boy who begins to consume alcohol at age ten, for example, may start sexual intercourse at age twelve. If a boy has been aggressive in preschool, the likelihood of his exhibiting worrisome aggressiveness in later childhood and adolescence is substantial.

About 40 percent of American children appear to be on an "achievement track." They live in safe neighborhoods with supportive families, attending schools that are relatively responsive to their needs. Yet every family is vulnerable to parents' unemployment, separation or divorce, and the like. There is no way to construct an impenetrable safety net around adolescent boys. Each family with boys, therefore, has to consider how to prepare them for inevitable temptations and crises.

The risk factors confronting male adolescents in the United States are found in other societies as well. But there are differences in how societies deal with these factors. The United States, for example, is distinctive in the access to firearms it grants to youth and even younger children. Although levels of adolescent sexual activity do not differ much between the United States and the societies of Western Europe, much lower rates of contraception prevail in the United States, reflecting both lack of access to contraceptives and ambivalent attitudes on the part of adolescents, their parents, and the society.

Professor Michael Rutter, a child psychiatrist in London, has studied the differences in social policy toward adolescents in the industrialized societies. It would be "unthinkable" he noted, for a teenage schoolgirl in the Netherlands to bear a child because all social institutions-family, schools, churches, media, and government-are united in the objective to provide adolescent birth control information and services to insure that adolescents' sexual activity is safe, pregnancy rare, and abortion available for the small number of unintended pregnancies. Social institutions in the United States lack this unified approach. In the absence of such consensus, each individual floats on his own. Adolescents are often blamed for their lapses and risk-taking more than they are helped to take responsibility for them, pick up the pieces, and go on with their lives.

Eighteen percent of fourteen-year-old boys say they have had suicidal thoughts. Seven percent say they have attempted to commit suicide. The percentages are lower than for girls the same age, but boys are more effective in completing the act, killing themselves four to six times more often than girls.

William Pollack's writing on depression among young males has been especially cogent in my view. After suggesting that our culture gives many signals to boys not to exhibit sadness, and that some of the methods of diagnosis of depression were originally designed to ascertain depression in adult women and are inappropriate for young males, he argues for a broad definition of depression in boys:

If we dwell merely on the most extreme-and obvious-instances of full-blown, or 'clinical,' depression, we risk failing to help boys cope with emotional states that, though less intense on the surface, are actually very painful for them, emotional states that without appropriate intervention may very well evolve into a major depression or provoke suicidal feelings. There's also a risk that by ignoring certain related behaviors, most notably irritable conduct and the abuse of substances, we may also fail to recognize the onset of serious depression.

Pollack gives some useful suggestions for distinguishing sadness from depression (without downplaying either one). "For instance, a boy who occasionally shuts himself into his room when he's feeling down is probably just momentarily feeling sad. By contrast, a boy who frequently comes home from school, goes into his room, shuts the door, and refuses to talk to anyone is obviously exhibiting behaviors that fall squarely within the continuum of depression. Likewise, a boy who has had a bad day and doesn't feel like coming to the dinner table is clearly quite different from one who consistently refuses to eat or dine with his family." Pollack also notes that depression may be expressed as anger or irritation rather than through the clearer signals of sadness, withdrawal, or apparent hopelessness; parents and other caregivers therefore need to be alert to signs of anger or irritation to see whether they ascertain depression behind or beneath the surface. "Being sad is the same as being mad for me," said one boy quoted by Pollack.

Depression manifests itself differently in boys and girls, according to a study by Per Gjerde, and Jack and Jeanne Block. Fourteen-year-old girls who developed symptoms of depression were found to be anxious, low in self-esteem, very concerned about their bodies, and, mostly, quite intelligent. Boys who exhibited high levels of symptoms of depression, also at age fourteen, showed lack of concern for interpersonal relationships, displayed hostile and antisocial attitudes, and were below average in intellectual prowess.

Pollack gives some specific pointers for handling signs of sadness or depression in a boy:

A parent or other caregiver who notes unusual signs of sadness or symptoms that might be related to depression would be wise to consult a professional, both for the boy himself and to foster the adult's capacity to cope sensitively and effectively with the situation.

Attention Deficit Hyperactivity Disorder

Somewhere between 30 and 70 percent of children, by one estimate, who were diagnosed as having attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD) as children still have the disorder when they reach adolescence and adulthood, I suspect the wide range of the estimate is related both to the variations in diagnostic criteria and to the occasional misdiagnosis of normal-range temperamental variation as ADHD among children, especially boys.

Treating adolescent ADD/ADHD may be more complex than treating childhood ADD/ADHD. Adolescents may deny having the disorder, may fake taking prescribed medication, may give their medication to friends who don't have the disorder but want a chemical boost to study for an examination. Medication needs regular evaluation, including off-periods when the effect of the medication can be compared to behavior during a period of abstinence. Since metabolism is changing during adolescence, teenagers may need higher dosages. ADD/ADHD may reduce an adolescent's prudent appraisal of risk-taking, so teenagers with ADD/ADHD need special training in how they cope with driving or handling machinery. Most adolescents with ADD/ADHD benefit from a continuing relationship with a counselor whom they come to trust.

How to Get Boys to Talk

When I was in pediatric training, only a few of my class were interested in child psychiatry. A wise older psychiatrist at the Judge Baker Guidance Center across the street from Children’s Hospital in Boston, Donald Russell, offered an elective on psychiatric diagnosis. He put us immediately to work on the evaluation of boys who were referred by the Massachusetts division of youth services. Most of these kids had committed pretty serious crimes.

Not a few of these kids were, as the term is used, "hardened.' That's to say that they were familiar with therapists and jaded with people who professed interest in helping them. Getting them to talk was no small task.

Dr. Russell had a technique that he repeated often on the subject. The best way to get a teenager to talk is to take him for a ride in a car. That way, you’re not looking face-to-face, there's time to pass as you proceed to a destination, and there's always something to comment on along the way.

It became clear that boys, particularly boys in trouble, want to tell their stories to a sympathetic listener. Avoiding a posture of making judgments about them, their behavior, their backgrounds, their experiences with the juvenile justice system-and especially avoiding characterizing them as "bad kids"-was important. Being oneself, without airs, expressing interest and concern, also went a long way. But perhaps most importantly, one had honestly to play one's role, not to pretend that one wasn't a doctor in an institution assigned to evaluate them.

Any conversation of any weight with a teenager should take place in a private setting. Therapists also learn the importance of timing. One doesn’t jump in on the most sensitive material; if the child is embarrassed or ashamed, it's much better to approach the subject indirectly. If possible, wait until he introduces it.

One of the time-honored techniques of interviewing on sensitive issues is to use the word "sometimes": “Sometimes kids . . ." That takes the emphasis away from the particular situation, allows a boy to maintain some distance, and enables one to avoid embarrassing him.

An activity may help a boy to relax and confide his problems. Shooting baskets or playing catch can make a neutral, enjoyable setting for a talk.

Lastly, it's important that we not fill up all the time with words. Silence is helpful, because it lets a boy take the lead and bring up what's on his mind.

Notes
Chapter Fourteen: Early Adolescence

C. Quintana, “Riding the Rails," in “Being 13", Special Photography Issue, New York Times Magazine (May 17, 1998), 66.

L. Steinberg, Adolescence, 4th ed. (New York: McGraw-Hill, 1996), 23-60.

growth patterns Tanner, "Sequence, Tempo, and Individual Variation," in Kagan and Coles, Twelve to Sixteen, 5.

L. Steinberg, “The Impact of Puberty on Family Relations: Effects of Pubertal Status and Pubertal Timing," Developmental Psychology 23 (1987), 451-460; and "Reciprocal Relation Between Parent-Child Distance and Pubertal Maturation," Developmental Psychology 24 (1988), 122-128.

Peterson and Taylor, "The Biological Approach to Adolescence," in Adelson, Handbook of Adolescent Psychology, 129.286-290pubertyB. Goldstein, Introduction to Human Sexuality (Belmont, Cal.: Star, 1976).

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From “The Men They Will Become"
Eli H. Newberger, M.D.

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From “The Men They Will Become" Eli H. Newberger, M.D.

Web design by flyte new media email Web Master

From “The Men They Will Become"
Eli H. Newberger, M.D.

Web design by flyte new media
email Web Master