Risk and Protective Factors in Adolescence

Adolescence is a transitional period where individuals experience physical, psychological, and social changes and developments as one progresses from childhood into adulthood. Due to the many changes, for some the adolescent phase can be challenging particularly with the presence of risk factors or lack of protective factors. Risk and protective factors affect adolescents’ mental, emotional, and behavioral development, as well as influence the probability of substance use disorder in this population. In this paper, various risk and protective factors, that impact adolescents’ development, will be identified. The relationship between risk/protective factors and the likelihood of adolescents developing disorders, as determined by research, will be analyzed. Moreover, approaches to reduce risk factors and enhance protective factors will be proposed. Assessing for risk and protective factors and comprehending how these factors affect development will allow the therapist to formulate appropriate treatment plan and interventions which will produce therapeutic outcomes and potentially prevent the onset of mental, emotional, behavioral, and substance use disorders.

Risk and protective factors

Risk and protective factors are critical in all aspects of adolescents’ lives which can either predispose them to negative outcomes or increase their resilience against adversities they may face. Studies have identified many factors that help distinguish people more likely to abuse drugs from those less vulnerable to drug abuse. Not all adolescents that experience risk factors will automatically develop Substance Use Disorder (SUD). A risk factor for one person may not be for another. While risk and protective factors can affect all populations, these factors can have a different effect depending on a person’s age, gender, ethnicity, culture, and environment (Robertson, David, & Rao, 2003 pp. 6-7). Sources of risk and protective factors can be individual, peer group, family domain, school, and community domain including both the neighborhood and the larger society (DiClemente, Santelli, & Crosby, 2009 p. 52; Idaho State Department of Education, n.d.; United States, 2001).

Risk factors are any factors that affect adolescents negatively and increase the likelihood of behaviours that usually result with negative consequences. Risk factors increase adolescents’ likelihood of developing mental, emotional, and behavioral disorders as well as SUD. Stressful circumstances such as poverty, familial conflict, parental mental illness, are considered risk factors for a variety of adverse outcomes such as substance use, interpersonal and self-directed violence, emotional distress, and/or school failure (Resnik, 2000 p. 157). Early aggressive behavior, lack of parental supervision, academic problems, undiagnosed mental health problems, peer substance use, drug availability, poverty, peer rejection, and child abuse or neglect are risk factors associated with increased likelihood of SUD in youth. The potential impact of specific risk and protective factors changes with age. For example, risk factors within the family have greater impact on a younger child, while association with drug-abusing peers may be a more significant risk factor for an adolescent. Risk factors that occur during early childhood further increase the risk of youth SUD. Risk factors of prolonged duration continuing from childhood through adolescence, are also associated with increased likelihood of youth SUD. Moreover, risk factors frequently associated with SUD are common across multiple disorders (Robertson, David, & Rao, 2003 p. 6; Youth.gov, n.a.)

According to research cited by Idaho State Department of Education (n.d.), individual/peer domain risk factors are rebelliousness, friends who engage in the problem behavior, favorable attitudes toward problem behavior, and early initiation of the problem behavior. Family domain risk factors are family history of high-risk behavior, family management problems, family conflict, and parental attitudes and involvement in the problem behavior. School domain risk factors are early and persistent antisocial behavior, academic failure beginning in late elementary school, and low commitment to school. Community domain risk factors are availability of drugs; availability of firearms; community laws and norms favorable toward drug use, firearms, and crime; transitions and mobility; low neighborhood attachment and community disorganization; and extreme economic and social deprivation

Protective factors are factors that promote resilience in adolescents and reduce the chances of negative outcomes. At-risk individuals who are also exposed to protective factors might refrain from using substances. The presence of multiple protective factors can lessen the impact of a few risk factors. Strong protection, such as parental support and involvement, could reduce the influence of strong risks, such as having peers who abuse substances (Robertson, David, & Rao, 2003 p. 6). DiClemente, Santelli, & Crosby, (2009 p. 52) note that protective factors may operate in different ways at different stages of development. For example, parental oversight and monitoring in infancy is highly protective, but in adolescence a comparable behavior may impede healthy development.

Idaho State Department of Education (n.d.) state that individual domain protective factors are resilient temperament and positive social orientation. In family domain, protective factors are bonding, and healthy beliefs and clear family standards for behavior. In school domain, protective factors are opportunities for involvement, rewards/recognition for prosocial performance/involvement, and healthy beliefs and clear standards for behavior. In community domain, protective factors are opportunities for prosocial involvement, rewards/recognition for prosocial involvement, and healthy beliefs and clear community standards for behavior.

The relationship between risk/protective factors and disorders identified by research

Extensive research has identified adolescence with increased prevalence in both externalizing and internalizing psychopathology, and the co-occurrence of these emotional and behavioral problems is common during adolescence. Both externalizing and internalizing problems during adolescence carry the risk for health and mental health problems in adulthood (Monahan, et al., 2014 p. 1). Longitudinal studies have identified risk and protective factors predictive of adolescent drug use, delinquency, violence, and school dropout. The strong relationship between exposure to an increasing number of risk factors and the increasing likelihood of a variety of problem behaviors is striking (Arthur, et al., 2002 p. 576). Studies have found, the more risk factors an adolescent has, the greater the likelihood of problem behavior. Conversely, youth with more protective factors and a resilient personality are better able to cope with risk factors and life challenges; they are less likely to be involved in problem behaviors and more likely to do well in school and in life (Alaska Division of Behavioral Health, 2011).

O’Connell, (2009 p. 15) states that signs of potential mental, emotional, and behavioral dis­orders are often apparent at a very young age, parents often reporting concerns before age 5. According to research, 14 to 20 percent of young people experience a mental, emotional, and behavioral disorder at a given point in time. Half of all lifetime cases of diagnosable mental illness are reported to have begun by age 14 and three-fourths by age 24. Multiple studies indicate that almost 40 percent of young people have had at least one psychiatric disorder by age 16. Through greater understanding of when and how fast specific areas of children’s brains develop, researchers are learning more about the early stages of a wide range of mental illnesses that appear later in life (National Institute of Mental Health, 2009).

National Survey on Drug Use and Health (NSDUH) declares that in 2014, 21.5 million Americans (aged 12 and older) had a substance use disorder, 17 million of them battled an alcohol use disorder, over 7 million of them had a drug use disorder, and 2.6 million of them struggled with both alcohol use disorder and drug use disorders. 2.8 million adolescents (11.4 percent) had a major depressive episode in the past year. 33.0 percent of youths aged 12 to 17 in 2014 who had a past year major depressive episode were more likely than those without a past year MDE to have used any illicit drugs in the past year (15.2 percent). An estimated 340,000 adolescents in 2014 (1.4 percent) had a substance use disorder and a major depressive episode in the past year (Center for Behavioral Health Statistics and Quality, 2015 p. 2).

According to O’Connell, (2009 p. 16), youth with emotional and behavioral problems are at greatly increased risk of psychiatric and substance abuse problems. The earlier youth start drinking, the more likely they develop serious alcohol dependency as adults. Likewise, early aggressive behavior significantly increases the risk of conduct disorder, drug use, and other externalizing behaviors. Yet, environmental and individual-level protective factors and preventive interventions can reduce these risks.

Lander, Howsare, & Byrne, (2013 p. 2) state that more than 8 million youth, age 18 and younger, live with at least one adult who has a substance use disorder, a rate of more than one in 10 children. Most of these children are said to be younger than age 5. Studies also show patterns that significantly influence child development and the likelihood that a child will struggle with emotional, behavioral, or substance use problems. The negative impacts of parental substance use disorder on the family include disruption of attachment, rituals, roles, routines, communication, social life, and finances. Furthermore, families with parental substance use disorder are characterized by an environment of secrecy, loss, conflict, violence or abuse, emotional chaos, role reversal, and fear.

Approaches to reduce risk factors and to enhance protective factors.

O’Connell, (2009 p. 15) states that disorders (such as depression, conduct disorder, and substance abuse) among children and adolescents create an enormous burden for them, their families, and the nation. According to The National Institute on Alcohol Abuse and Alcoholism (2006), each year, nearly 5,000 youth under the age of 21 die due to underage drinking; this includes about 1,900 deaths from motor vehicle crashes, 1,600 from homicides, 300 from suicide, as well as hundreds from other injuries such as falls, burns, and drownings.

Most identified risk factors do not appear to have a strong biological basis. Instead, it is theorized, they result from social learning or the combination of social learning and biological processes. This means that youths are far more likely to model their behavior to their parents’ behavior, or learn from their environment, than simply to have inherited it from them (United States, 2001). DiClemente, Santelli, & Crosby, (2009 p. 52) underline that not only does resilience appear to vary depending on life circumstances, research has shown that it can be enhanced by acquiring a set of skills. However, it is noted that failure to address the emotional needs of resilient young people increases the risk of derailing their resilience in adulthood.

Constantine, Benard, & Diaz, (1999, p. 3) claim that understanding the risk factors that often lead to problems can provide critical information in prevention and early intervention program planning (especially in getting services to populations in greatest need). Nevertheless, risk-focused prevention is problematic because it leads to the identification, labeling, and stigmatizing of youth, their families, and their communities. Longitudinal research on high-risk populations, referred to as resilience research, has found that at least 50% and usually closer to 70% of individuals in this category defy the odds and achieve competence, confidence, and caring in adulthood. Therefore, focusing on protective factors can help youths develop resiliency to face adversities and resist risky behaviors.

When working with adolescent clients, Lander, Howsare, & Byrne (2013) emphasize the importance of assessing the individual in the context of his/her family environment because the environment has a significant impact on the individual and vice versa. Youth develop in the context of their families, schools, and communities. Interventions designed to support healthy emotional and behavioral development and prevent disorder take place largely in the contexts of these support systems. The goal for such interventions as prenatal care, home visiting, parenting skills training, programs designed to mitigate specific family-based strain (e.g., bereavement, dealing with a mentally ill parent), and some public policies is to improve family functioning and to create nurturing environments (O’Connell, 2009 p. 154).

Robertson, David, & Rao (2003, p. 6) assert that early intervention with risk factors often has a greater impact than later intervention by changing a child’s life path away from problems and toward positive behaviors. Research-based prevention programs can intervene early in a child’s development to strengthen protective factors and reduce risks long before problem behaviors develop.

According to Jones, et al., (2014), both medication and nonmedication services have been found to be effective for treatment of adolescents with serious emotional or behavioral difficulties. Helping young children and their parents manage difficulties early in life may prevent the development of disorders. Once mental illness develops, it becomes a regular part of your child’s behavior and more difficult to treat. Treatment for a mental health problem can include residential treatment, psychotherapy, support groups, family therapy, group therapy, 12-step groups, and when necessary, medication. Sadly, due to experiences of shame, guilt, confusion, or fear, many teens do not get the kind of treatment they require (National Institute of Mental Health, 2009)

Psychosocial or behavioral therapy aim to help a person identify and change troubling emotions, thoughts, and behavior. Therapies that teach parents and children coping strategies can also be effective. Evidence-based therapies, such as Cognitive Behavioral Therapy (CBT), have been shown in research to reduce symptoms of depression, anxiety, and other disorders. CBT can be used with children and it has been widely studied and is an effective treatment for many conditions, such as depression, obsessive-compulsive disorder, and social anxiety. A person in CBT learns to change distorted thinking patterns and unhealthy behavior. Children can receive CBT with or without their parents, as well as in a group setting. CBT can be adapted to fit the needs of each child. Psychosocial therapies often take time, effort, and patience. However, sometimes children learn new skills that may have positive long-term benefits. (National Institute of Mental Health, 2009). Therapies, including psychotherapy, education or behavioral parent training, and behavioral classroom management can be used for Attention Deficit Hyperactivity Disorder (ADHD). These therapies would be beneficial for other conditions that commonly co-occur with ADHD, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse (National Institute of Mental Health, 2016).

Conclusion

Adolescents face many challenges during this period where they transition from childhood to adulthood. There are many risk and protective factors that affect adolescents’ mental, emotional, and behavioral development. Moreover, these risk and protective factors influence adolescents’ attitudes and behaviors towards substance use and misuse. This paper identified various risk and protective factors, that impact adolescents’ development. It analyzed the relationship between risk/protective factors and the likelihood of adolescents developing disorders which has been confirmed by various studies. Furthermore, it proposed approaches to reduce risk factors and enhance protective factors which would help decrease the likelihood of adolescents developing problem behaviors.

Reference

Arthur, M. W., Hawkins, J. D., Pollard J. A., Catalano R. F., Baglioni Jr., A. J. (2002). Measuring Risk and Protective Factors for Substance Use, Delinquency, and Other Adolescent Problem Behaviors. Evaluation Review, Vol. 26 No. 6, 575-601 DOI: 10.1177/019384102237850. Retrieved from https://www.pridesurveys.com/supportfiles/CTC_reliability.pdf

Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/ data/

Constantine, N., Benard, B., & Diaz, M. (1999). Measuring Protective Factors and Resilience Traits in Youth: The Healthy Kids Resilience Assessment. In seventh annual meeting of the Society for Prevention Research, New Orleans, LA (pp. 3-15). Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.524.3690&rep=rep1&type=pdf

DiClemente, R. J., Santelli, J. S., & Crosby, R. A. (Eds.). (2009). Adolescent Health: Understanding and Preventing Risk Behaviors. Retrieved from https://ebookcentral.proquest.com

Jones, L. I., Pastor, P. N., Simon, A. E., & Reuben, C. A. (2014). Use of Selected Nonmedication Mental Health Services by Adolescent Boys and Girls with Serious Emotional or Behavioral Difficulties: United States, 2010–2012. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db163.pdf

Lander, L., Howsare, J., & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Social Work in Public Health, 28(0), 194–205. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/pdf/nihms-496858.pdf

Monahan, K. C., Oesterle, S., Rhew, I., & Hawkins, J. D. (2014). The Relation Between Risk and Protective Factors for Problem Behaviors and Depressive Symptoms, Antisocial Behavior, and Alcohol Use in Adolescence. Journal of Community Psychology, 42(5), 621–638. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791062/pdf/nihms718124.pdf

National Institute of Mental Health. (2009). Treatment of Children with Mental Illness. NIH Publication No. 09-4702. Retrieved from https://www.nimh.nih.gov/health/publications/treatment-of-children-with-mental-illness-fact-sheet/index.shtml

National Institute of Mental Health (2016). Attention Deficit Hyperactivity Disorder. Retrieved from http://www.nimh.nih.gov/health/topics/eating-disorders/index.shtml.

O’Connell, M. E. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Retrieved from https://ebookcentral.proquest.com

Resnik, M. D. (2000). Protective Factors, Resiliency, and Healthy Youth Development. Adolescent Medicine: State of the Art Reviews. Vol. 11, No. 1. 157-165. Retrieved from https://scholar.google.com/scholar?q=Resnick,+M.+D.+(2000).+Protective+Factors,+Resiliency,+and+Healthy+Youth+Development.&hl=en&as_sdt=0&as_vis=1&oi=scholart

Alaska Division of Behavioral Health. (2011). Risk and Protective Factors for Adolescent Substance Use (and other Problem Behavior). Retrieved from http://dhss.alaska.gov/dbh/Documents/Prevention/publications/Risk_Protective_Factors_Jan_2011%20.pdf

Idaho State Department of Education. (n.d.). Risk and Protective Factors and Developmental Assets. Retrieved from https://www.sde.idaho.gov/student-engagement/sdfs/files/program-guides/Risk-Protective-Factors-Developmental-Assets.pdf

Robertson, E. B., David, S. L., & Rao, S. A. (2003). Preventing Drug Use among Children and Adolescents. A Research-Based Guide for Parents, Educators, and Community Leaders. Second Edition. National Institute on Drug Abuse. Retrieved from https://files.eric.ed.gov/fulltext/ED521530.pdf

The National Institute on Alcohol Abuse and Alcoholism (2006). Alcohol Alert. Underage Drinking. Why Do Adolescents Drink, What Are the Risks, and How Can Underage Drinking Be Prevented? Retrieved from https://pubs.niaaa.nih.gov/publications/AA67/AA67.htm

United States. (2001). Youth violence: A report of the Surgeon General. Rockville, Md.: Office of the Surgeon General. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK44293/#_A12636_

Youth.gov (n.a.). Risk & Protective Factors. Substance Abuse Prevention. Retrieved from https://youth.gov/youth-topics/substance-abuse/risk-and-protective-factors-substance-use-abuse-and-dependence