David Pruitt M.D. - Your Adolescent: Emotional, Behavioral, and Cognitive Development from Early Adolescence Through the Teen Years

E DITOR-IN -C HIEF

David B. Pruitt, M.D.

Professor of Psychiatry and Pediatrics

Director, Division of Child and Adolescent Psychiatry

University of Maryland School of Medicine

Baltimore, Maryland

A SSOCIATE E DITORS

Claudia Berenson, M.D.

Associate Professor, Psychiatry and Pediatrics

University of New Mexico

Albuquerque, New Mexico

William Bernet, M.D.

Associate Professor, Department of Psychiatry

Vanderbilt University School of Medicine

Director

Vanderbilt Forensic Psychiatry

Nashville, Tennessee

Jerry Heston, M.D.

Associate Professor of Psychiatry

Division of Child and Adolescent Psychiatry

University of Tennessee, Memphis

Medical Director, Behavior Health Unit, Le Bonheur Childrens Medical Center

Memphis, Tennessee

Paramjit T. Joshi, M.D.

Chief, Division of Behavioral Medicine and Chair, Department of Psychiatry and Behavioral Sciences

Professor of Psychiatry & Pediatrics

Childrens National Medical Center

George Washington University School of Medicine

Washington, D.C.

Penelope Krener Knapp, M.D.

Professor, Psychiatry and Pediatrics

University of California, Davis

Davis, California

James C. MacIntyre II, M.D.

Associate Professor of Psychiatry

Albany Medical College

Albany, New York

D EPUTY E DITORS

Paul L. Adams, M.D.

Louisville, Kentucky

Virginia Q. Anthony

Washington, D.C.

C ONTRIBUTING E DITORS

Thomas Anders, M.D.

Davis, California

Alan Axelson, M.D.

Pittsburgh, Pennsylvania

Larry Brown, M.D.

Providence, Rhode Island

Catherine DeAngelis, M.D.

Baltimore, Maryland

David Fassler, M.D.

Burlington, Vermont

Henry Gault, M.D.

Northbrook, Illinois

Gerald Golden, M.D.

Philadelphia, Pennsylvania

David Herzog, M.D.

Boston, Massachusetts

Steven Jaffe, M.D.

Atlanta, Georgia

Allan Josephson, M.D.

Augusta, Georgia

Henrietta Leonard, M.D.

Providence, Rhode Island

Alexander Lucas, M.D.

Rochester, Minnesota

Bruce D. Miller, M.D.

Buffalo, New York

Frederick Palmer, M.D.

Memphis, Tennessee

Rachel Z. Ritvo, M.D.

Rockville, Maryland

John Schowalter, M.D.

New Haven, Connecticut

Robert Schreter, M.D.

Lutherville, Maryland

Larry Silver, M.D.

Washington, D.C.

Michael Silver, M.D.

Wynnewood, Pennsylvania

Deborah Simkin, M.D.

Fort Walton Beach, Florida

E DITORIAL D IRECTOR

Hugh G. Howard

Red Rock Publishing, Inc.

East Chatham, New York

C ONTRIBUTORS

Dale Gelfand

Spencertown, New York

Elizabeth Lawrence

East Chatham, New York

Dawn Micklethwaite Peterson

Maplewood, New Jersey

Elizabeth Tinsley

Chatham, New York

Lyn Yonack

Great Barrington, Massachusetts

Child and adolescent psychiatry begins with a profound respect for your adolescent, his or her endowments, and a deep regard for the task of parenting.

For more than two decades, I have attended seminars, case conferences, grand rounds, scientific meetings, and committee meetings. Both as a parent and in my professional capacity, I am invariably struck that this respect pervades virtually every presentation about individual youngsters by child and adolescent psychiatrists. Discussions, publications, and stories share this appreciation for the adolescent, and the individuals strengths and uniqueness. And so, you will find, does Your Adolescent .

The Academy was founded in 1953 by eighty-one child and adolescent psychiatrists who saw a need for a forum to focus on the clinical, educational, and research problems unique to children. The early meetings were informative. The struggles for separation from other medical and mental health groups, for new ties, and for a sense of identity were earnest and absorbing. Differences in values and focus from other professions led to the founding of the Academy as an academic association, but over more than four decades of growth, the agenda here at the Academy has developed to include vigorous advocacy for children and adolescents, an outstanding program of professional education, and an increasing focus on prevention and public health.

In the past fifteen years, the Academy has reached out to you as parents and members of extended families. We recognize that you are on the front line, whether your role is as a parent, grandparent, or caregiver. You deal daily with disorders of adolescence and other parenting issues and concerns. Since early identification is one of the most effective forms of prevention, we believe our outreach can help in preventing or limiting the pain, trauma, and failure experienced by children and adolescentsand perhaps reduce the anguish and heartache felt by parents of youngsters in distress.

Our attempts to inform the public are not aimed solely at the parents of the children and adolescents who need professional help. Often, in part because of todays very stressful homework environment, parents need reassurance about the differences between personality and temperament, and education about what constitutes the normal phases of growing up. We can provide guidance about when you should be concerned about your adolescent and, ultimately, whether you should seek treatment.

Over a career, a child and adolescent psychiatrist learns a great deal from and about families, about specific resilience and breaking points, about vulnerabilities and elasticities, and about how teens with the same parents can be so alike and yet so different. This book is an outgrowth of a vigorous parent education effort based on that learning. This volume addresses normal development, normal problems, as well as more serious disorders and concerns with adolescents. It is a way of sharing child and adolescent psychiatrys appreciation of the teenage years, developmental milestones, and adolescent achievement with you, the parents, grandparents, and caregivers, who are caring and concerned, anxious, or just inquisitive.

The Academy is very proud of Your Adolescent as a key part of our ongoing partnership with parents. We commend David B. Pruitt, M.D., Hugh Howard, the editorial board, and the many authors, readers, and critics who have contributed to this offering.

Virginia Q. Anthony, Executive Director

A parent helps her fifteen-year-old son pack for a summer program at a college some 200 miles away. When she pushes aside a pile of underwear to squeeze in some clean socks, the mother notices that in the bottom of the suitcase, along with the shaving equipment he thinks he needs, her son has stowed a family picture and a small stuffed animal. She muses that even though he has a girlfriend, will soon have a drivers license, and can be as exasperating and opinionated as any adult she has ever met, within his grown-up-size body, underneath the deep voice and behind the often-defiant eyes, is a tender, tentative, uncertain child.

Every parent forgets, at moments, that there is a child still lurking within their adolescent. That forgetfulness is particularly likely when you are in the grips of the power struggles that all too often characterize the parent-child relationship during the teenage years. By the time your child has reached adolescence, chances are that you have succeeded in providing him (or her) with a firm sense of roots, a sense of belonging, of love and attachment. You may have afforded him ample opportunity to develop and test his wings, too, to gradually and increasingly experience himself as a separate, independent being.