Quick viewing(Text Mode)

Transitioning from a Young Girl to a Young Woman – Body and Mind Changes During Teen Years

Transitioning from a Young Girl to a Young Woman – Body and Mind Changes During Teen Years

Transitioning from a young to a young – body and mind changes during teen years

Natella Rakhmanina, MD, PhD Professor of The George Washington University, Children’s National Health System Senior Technical Advisor Elizabeth Glaser Pediatric AIDS Foundation Disclosure • No conflicts to disclose Outline • Stages of • Growth and development • Sexual maturation in • Changes in body systems • Physical health related issues • Mental health related issues • Approaches to health care for adolescents Adolescent

Adolescents –10-19 years - 15-24 years Young people -10-24 years

Period of major changes: • physical • cognitive • physiological • psychological • sexual • financial • emotional • social • behavioral • cultural Common descriptions

• Time of physical growth and personality development • Series of predictable events • Confusing and ambiguous period for all Stages in adolescence

• • Peer network • Privacy • • Independence • Control over life • Peers as confidents • Bundles of energy • role models • Developing adult identity

• Separation • Decision making • Continue developing adult identity Puberty ● Gonadarche - activation of the by the pituitary follicle-stimulating (FSH) and luteinizing hormone (LH)

● Adrenarche - increase in production of dehydroepiandrosterone (DHEA) and androstenedione by the adrenal cortex Hormonal changes in females

• FSH stimulates the growth of ovarian follicles • FSH and LH stimulate production of by the • Estradiol stimulates development and growth of the skeleton • FSH, LH and estradiol lead to and menstrual cycles Puberty

• In addition to hormones, androgenic hormones induce growth of maturation of the apocrine sweat glands and development of • Other hormones involved along the hypothalamic- pituitary axis include growth hormone-insulinlike growth factor, thyroid axes, oxytocin and vasopressin • Chronic health issues such as HIV, and others can delay puberty Severe growth and puberty delay with HIV

Weight= 17.2 kg (37.9 lbs) Sexual maturation stages

Females – precede hair development and menstrual period Males – testicular enlargement precede hair development and penile growth Sexual maturation stages Factors affecting puberty • Genetics >environment matter • Modest acceleration of puberty in recent years • Increased BMI possibly the cause through peripheral aromatization of adrenal androgens in adipose tissue • Environmental exposures with estrogenic and/or anti-androgenic effects • Social/ stress • Presence of an adult non- biologically-related male in the

Pediatric Research in Office Settings (PROS) study, 1970 Sexual maturation related symptoms

• Male genital system: urethral discharge, scrotal masses, inguinal adenopathy, inguinal hernia, STDs, uncircumcised hygiene • genital system – vulvar itching, vaginal discharge, , menstrual dysfunction, STDs, contraception, hygiene • Breast– tenderness, erythema, dimpling, asymmetric masses or size, discharge, axillary adenopathy, in males Growth velocity

Gaining up to 25% of adult height and 50% of adult weight Muscle growth in and fat deposition in girls Growth spurt

• Limbs accelerate before the trunk, with the distal portions of the limbs accelerating before the proximal portions • Growth spurt is primarily truncal • Peak female growth velocity - 0.5 years prior to • The growth spurt typically lasts for about two years in both • Modest seasonal variations in growth with greater growth occurring in the spring Timing of hormonal changes and growth

Patton GC, Viner R. The Lancet 2007 369, 1130-1139 Body mass

Males Females Body systems

• - acne, facial and axillary hair development • Eyes – frequent onset of myopia • Dentition - eruption of the third set of molar teeth • Heart - accentuated heart sounds, functional murmurs becoming more apparent • Hematology – anemia and iron deficiency common among females • Musculoskeletal – scoliosis, joint issues, Osgood- Schlatter disease (inflammation of the tibial tubercle apophysis), sport and accidental injuries, damage to epiphyseal growth plates health

• Bone growth occurs in length, followed by width, then mineral content, and then bone density • ~50% of total body calcium is accumulated during puberty in females and 50-65% in males • By the end of puberty males have ~50% more total body calcium compared to females • Increase in bone density is greater in African- American than in Caucasian females • Risk for during adulthood may be related to the bone calcium deposition in puberty Drug metabolism

Kearns GL, N Engl J Med 2003. Frequent onset in adolescence

• Polycystic ovarian syndrome • Adulthood asthma • Epilepsy • Type 1 diabetes • Autoimmune diseases (lupus, rheumatoid arthritis, thyroiditis) • Earlier onset of puberty has been associated with shorter height and increased BMI Puberty and long-term health outcomes

50th-74th percentiles BMI in adolescence associated with increased cardiovascular and all-cause mortality during 40 years follow-up

Twig G. N Engl J Med 2016. Overweight and during adolescence strongly associated with increased cardiovascular mortality in adulthood Infectious diseases in adolescence Mortality in adolescence

WHO/UNAIDS 2016 Physical and psychological maturation

Patton GC, Viner R. The Lancet 2007. We do not know about puberty…..

• Triggers of puberty • Relationship between puberty and central nervous system development • Relationship between puberty with the health issues of adulthood • Triggers of diseases with onset during adolescence • Role of puberty in the formation of identity • Impact of growing mismatch between biological and social We know even less about the mind…… Frequent onset in adolescence

• Increased vulnerability to behavioral problems • Dysregulation of emotional behaviors • Eating disorders (anorexia, bulimia) • Altered sleep patterns • Increase in prevalence in changes in mood • Addictive behaviors • • Anxiety Cognitive changes in adolescence

• Thinking long-term • Setting goals • Developing the ability to think abstractly • Concerns with philosophy, politics, social issues • Comparing oneself to one's peers • Peer influence and acceptance is very important • Romantic relationships becoming very important • Seeking independence from Brain changes in adolescents

• Teenagers are naturally risk takers - it is evolutionarily advantageous • Brain evolution during adolescence forces teenagers to become more social/akin to their peers and learn through their own experiences • Teenage brain undergoes a massive reconstruction of the neural connections

Dobbs D, National Geographic, 2011 Brain changes during puberty

• Changes in brain morphology mirror physiologic puberty • Observed earlier in girls

• Changes in cortical complexity • Global and regional decreases in cortical and increases in

Blanton et al. 2001; Toga et al. 2006; Giedd et al. 2004 Brain changes during puberty

• Pubertal status (Tanner Stage hair and breast) is significantly associated with limbic structures (left amygdala and right hippocampus) volumes

Blanton RE, et al., 2012: 217:105-112 Puberty and brain anatomy in girls • Possible alignment of biological clock with gonadal pubertal changes instead of daily circadian rhythms • Sensitivity to by left amygdala affects retrieval of emotional memories and mood • Decrease in right hippocampus leads to increase in autobiographical narratives and the changes in the ability to regulate emotions • Since depression involves dysfunction in the amygdala and hippocampus, changes in morphology of in puberty may contribute to increases frequency of depression Blanton RE, et al., Neuroscience 2012: 217:105-112 Additional complicating factors • Gender based violence ‐ Decreased response effectiveness in risky situations ‐ Reduced behavioral and brain responses to trust violations • Chronic illness ‐ Lower self-esteem worsening during adolescence ‐ More prominent in girls from resource-limited settings • Exposure to HIV ‐ Increased behavioral health risks (mental health, sexual and drug behaviors) associated with older rage ‐ Among ALHIV living with birth and having detectable VL is associated with behavioral health risks

Lenow et al. Psychiatry Res. 2014; Pinquart M. Care Health Dev. 2013; Mellins CA et al. AIDS Patient Care and STDs. 2011 Approach to health care services

• Comprehensive multidisciplinary health care including general medical care and specialized care in high-risk areas (e.g. mental health, sexual and and ) • of adolescent girls on health and health care rights and services • Encouragement of health care seeking behaviors, including independent health care • Education and support to parents, caregivers and communities on adolescent girls and young women and their needs

Top View