From The Men
They Will Become"
Eli H. Newberger, M.D.
Chapter 14 - EARLY
is a hard age, very hard. A lot of people say you have it easy,
you're a kid, but there's a lot of pressure being thirteen-to be
respected by people in your school, to be liked, always feeling
like you have to be good. There's pressure to do drugs, too, so
you try not to succumb to that. But you don't want to be made fun
of, so you have to look cool You gotta wear the right shoes, the
right clothes-if you have Jordans, then it's all right. From, like,
twelve to seventeen, there are a lot of transitions going on, a
lot of moving around. It's not like you know what's going to happen
tomorrow. Life gets different when you get older-there's more work.
And when you go to college it's hard because you're alone for the
first time. But when you get out of college you start to establish
yourself and who you think you are and what you're about. That's
a good time.'
New York City, 1998
is an all-right age, but I'd much rather be fourteen
or fifteen. I hate the people in our grade-they're
all so boring! People usually think we're older,
and we hang out with fifteen-year-olds. Theyre
just so much fun. But thirteen is better than twelve; I hated
being twelve, it's too young. At least thirteen has "teen"
on the end.'
-Andrea Minissale, Ringwood, N.J., 1998
in our grade is so immature. Not really the girls, but all of
the guys are. All of them are really short, and they act retarded.
At dances they won't dance, they think they're too cool to do
that. But it is annoying how everyone thinks we're so much older...
I wish we looked our age.'
-Deirdre Minissale (Andrea's twin sister), 1998
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
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
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 bodys 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 gynecomastiaessentially
the same kind of breast reduction that some heavily breasted
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 circumstancessuch as academic problems, family
conflict, or strained friendshipsappear 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?
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 dont begin at exactly the same age for every boy, and
they certainly dont 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 driveand financial investmentto 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 painfulif not quite so dramaticeffect.
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.
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 hasnt 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:
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 parentsto
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:
of the father as playmate for his children when he is around
is borne out by research. Adolescents help their fathers less
around the house than they help their mothers. Watching television
together is the most common father-son activity.
do not talk to their adolescent sons about emotional problems
and relationships; they talk about academic performance,
future education, occupational plans, etc., and sports. Boysgirls,
toosee their fathers as more enabling, less constraining
than their mothers, but that may be because the mother is
often chief administrator of home life.
Fathers are, on
the whole, more likely to try to exert control over adolescent
boys, and mothers to relinquish control. As still another
study put it, fathers have greater needs for dominance, are
less likely to be permissive than mothers. Sons in one study
said their fathers knew them better than they knew their sisters,
but they also felt their relationships with their fathers
were less affectionate than their mothers' relationships with
their sisters. Popular conceptions have adolescent boys in
rebellion from their parents over broad issues such as religion
and politics, but several studies indicate the major conflicts
are over house rules such as curfews and how messy a boy's
For fathers, there's
an increase of negative feelings toward their sons as they
mature sexually. Teenagers do not report negative emotion
toward their fathers in relation to sexual maturation. The
fathers' level of moral maturity and emotional warmth during
early adolescence is more predictive of their sons' behavior
during adolescence than it was during childhood. Looking back
from later adulthood, adults who enjoy happy marriages and
plentiful friendships overwhelmingly report having had warm
and loving fathers. A high level of supportive fatherly involvement
in an adolescent boy's life is positively correlated with
good school adjustment.
When boys regard
themselves as understood sympathetically by their fathers,
they rate time spent with the fathers as pleasurable; conversely,
when they feel misunderstood, they see time spent with fathers
as forced or unwanted and conflictual. If fathers are controlling
and rigid toward adolescent sons, their sons have less masculine
self-images and more passive personalities. Positive gender
identity and social development are encouraged when a father
allows his son to be reasonably self-assertive.
fathers disappeared from their lives in early childhood have
lower self-esteem than adolescents whose fathers were present
As teenagers renegotiate
their roles to gain more autonomy, power becomes an important
issue. Younger adolescent males regard their fathers as being
more powerful than older adolescent males regard them. But
as adolescent boys mature physically, their fathers often
counter by being more assertive toward them, and the boys
tend to back off rather than challenge their fathers too openly.
The largest study
of sexual orientation among the offspring of gay fathers
showed that only 9 percent were gay or bisexuala little,
but not dramatically, larger segment than one would expect
in a random sample of adult males. The sons' sexual orientation
was unrelated to frequency of contact with their fathers
or the quality of the relationship. Another study established
that gay fathers are no more likely than heterosexual fathers
to offend sexually against their own or other children. The
findings suggest that the parental contribution to sexual
orientation must be small.
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
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.
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
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.
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.
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.
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.
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.
1988 to 1993 the number of juvenile arrests almost doubled to
about 2 millionfive 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:
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.
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
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
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
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:
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.
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:
Create a private
place to talk with him, so he won't feel ashamed if he loses
Be available to
talk with full attention, but don't press him to open up until
he is comfortable. Invite but don't force.
Be careful not
to shame him when you respond to his disclosure of sadness
or depression. Don't tease, or joke, or paper over his feelings
with assertions that everything will be fine. Acknowledge
that you see his discomfort and are lovingly concerned. Avoid
The signs a parent
might be alert to include: intense or prolonged social withdrawal
from family and friends; prolonged depletion or fatigue; increase
in impulsive outbursts of anger or aggressiveness; denial
of pain; sleeping and eating disorders; increasingly rigid
acting out; failure to exhibit appropriate emotion; harsh
self-criticism; falling below usual academic level; increased
risk-taking; evidence of exposure to alcohol and drugs; change
in sexual behavior; and, obviously, unusual mention of suicide,
death, or dying.
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.
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.
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
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 Childrens 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,
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 doesnt
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
"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
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
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