Adolescent development – in the context of human capital development

Prof Ruth Nduati MBCHB, MMED, MPH

Adolescent development – in the context of human capital

developmentProfessor of Paediatrics and Child health University of Nairobi

Consultant Paediatrician at Kenyatta National Hospital

Chair Kiriri Women’s University of Science and Technology

Past Chairperson KEMRI

Definitions

HUMAN CAPITAL

Stock of habits, knowledge, social and personality attributes (including creativity) embodied in the ability to perform labour so as to produce economic value for the individuals, their employers, or their community

Includes assets like education, training, intelligence, skills, health, and other things employers value such as loyalty and punctuality.

Countries & Companies can invest in human capital, for example, through education and training, enabling improved levels of quality and production.

Human intelligence (IQ) is the intellectual capability of humans, which is marked by complex cognitive feats and high levels of motivation and self-awareness. (Wikipedia)

Intellect is the ability to learn and reason, as well as the capacity for knowledge and understanding. It is intelligence and using your mind creatively.

A one (1) point increase in a nation's average IQ is associated with a persistent 0.11% annual increase in GDP per capita.

The human brain’s’ ultimate structure and capacity is shaped in early life before the age of 3 years

• Dimensions of brain growth and development

Cognition

Social

Emotional

• Failure to optimize development early in life has long term consequences with respect to;

Education

Job potential

Adult mental health

Teen pregnancy /motherhood is harmful to the young woman but also their lack of capacity contributes to these deficits in early childhood. Teen pregnancy robs Kenya of its Human Capital potential

Brain growth – starts from foetal life and goes on until attaining adulthood.

There is a shift – red least mature to blue – more mature

First 1000 days – conception to 3 years

Part of the Brain Period of accelerated growth

Coating of nerves with myelin that improves communication between nerves

Begins in pregnancy and goes on until 2 years

Neuro-transmitters that mediate reward, affect and mood

From pregnancy brisk pace until 3 years

Hippocampus – mediates recognition & spatial memory

From pregnancy to 18 months

Pre-frontal cortex – complex activities such as attention, and multitasking

First 6 months of life

Threats to early brain development –[Development of the human capital](i) Malnutrition - Chronic malnutrition that goes uncorrected beyond 3 years of life has long-term impact on cognition while ongoing malnutrition in childhood interferes with learning (ii) Neglect – has severe life adverse effects

Malnutrition

• Failure to establish effective breastfeeding sets the stage for malnutrition.

• Chronic malnutrition that goes uncorrected beyond 3 years of life has long-term impact on cognition –child’s intelligence

Impact of Malnutrition is not limited to early childhood

Indian study among malnourished children aged 5-7 years and 8-10 years

• Malnourished children showed poor performance on tests of higher cognitive functions that are essential for learning Bhoomika et al. 2008 –

Double whammy / tragedy of teen pregnancy – need to go back to school interferes with breastfeeding & interruption of studies increases likelihood of living in poverty

Randomized trials of high protein and energy drink versus low protein energy drink up to 7 years of age demonstrates the erosion of human capital by malnutrition

Age Effect of combined protein and energy drink

4-5 years Higher cognitive scores

11-18 years Higher scores – maths, reading, general knowledge, vocabulary and reading achievement

22-29 years Women had higher IQ and reading scores

26-42 years Men had 46% higher wages

Bright intelligent children are less likely to drop out of school and be at risk of malnutrition

Institutionalization of Children Interferes With Brain Development

Babies of adolescents are more likely to be in the care of others and therefore miss optimal opportunity of stimulation by their own mother

Babies of teenagers are exposed to other factors that interfere with optimal early brain development

• Toxic stress and inflammation• Mothers illness during pregnancy – high blood pressure, diabetes

• Intimate partner violence / violence and rejection by family

• Lack of Social support and secure attachment• Responsive parenting – avoid child neglect

• Avoidance of institutionalization – foster care, children’s homes

• Sub-optimal nutrition• Inadequate or complete lack of Breastfeeding

Breastfeeding provides a Child the earliest Stimulation

• Study in Jamaica among poor malnourished children – stunted

• Children provided nutrition supplements

• One group a health worker visited the home once a week to demonstrate how to play with the child

• At 18 ears of age – higher IQ, language and reading ability among those with increased stimulation.

• Similar nutrition status

Malnourished children on

supplements

One hour play per

week

At 18 years Higher IQ, Language and

reading ability

Usual care

Poorer performance

Teen mother often lacks the cognitive maturity to invest time to play and stimulate her baby

Brain development is central to adolescent development

Makes

Hormones –

Influence

physical growth

Sexual

maturation

Brain

ThinksReasonsEmotionsCommunicationDecision makingValuesRelationships

14

TEEN BRAIN

Greater capacity to learn and createIncreased risk of damage from drugs and alcohol Increased risk of developing addiction

Increased risk of mental illnessIncreased desire for risk takingParts of the brain that control emotions are not yet mature.

Physical development and sexual maturation- Activation of hypothalamus-pitutary-gonad (ovaries/testes) axis in late childhood

Stage Girls Boys

Early

adolescence

10-13 years

Growth in height

(3inch/year,

17.5lbs/year)

Early secondary sexual

characteristics

Growth of the genitalia

First ejaculation (1 year after

scrotum starts growing)

At the end of this stage both boys and girls are capable procreating and become mums and dads.

Mid

adolescence

(14-16 years)

Further growth of

breasts,

Menarche

Further increase in size of genitalia

Growth in height (4in/yr, 20 lb/yr)

Voice breaks

Malnutrition deays

adolescent

development

Late

adolescence

> 17 years

Mature physical development

During adolescence a teenager doubles his weight and

increases in height by 15-20%

Emotional DevelopmentEarly

Adolescent

(10-13years)

Wide mood swings, Intense

feelings, Low impulse control

Source of conflict with parents and school

authorities

Mid adolescent

(14-16 years)

Sense of invulnerability,

Risk taking behaviour peaks

Risk taking is typical of adolescents or all over the world and is characterized by;

Drug use – cigarette smoking is often the entry point into other substance abuse, such as alcohol… Violence – formation of gangs Unprotected and/or casual sex – teen pregnancy, HIV and STI epidemic

Late adolescent

(> 17 years)

Sense of responsibility for

ones health, Increasing sense

of vulnerability, Able to think of

others and suppress ones

needs, Less risk taking 16

Cognitive DevelopmentEarly (10-13years) Concrete thinking

Little ability to anticipate long term

consequences of their action

Literal interpretation of ideas

Mid (14-16 years) Able to conceptualize abstract

ideas such as love, justice, truth

and spirituality

Questions parents values

Things are black and white

Source of disagreement with parents and

other authorities

Late (> 17 years) Formal operational thought

Ability to understand and set limits

Understands others thoughts and

feelings.

25% of the adult population never reach this level of thinking.

Formal operational thinking where a decision making tree can be made and iss essential to understanding the consequences of various actions. Formal operational thinking is achieved in late adolescence.

17

Teen Brain

18

Relation to PeersEarly Adolescence

10-13years

Increased importance and intensity of same sex

relationships (boys hang out with boys and Girls with

girls)

The opinion of your friends is very important.

Show me your friends

and I will be able to

tell who you are

Mid-Adolescence

14-16 years

Peak of peer conformity – (feeling that your friends

know more than your parents)

Increased opposite sex relations

‘Serial faithful relations’

Late adolescence

> 17 years

Peers decrease in importance

Begin to develop mutually supportive, mature,

intimate relationships

Relation to Family

Early Adolescence

10-13years

Growing separation (Estrangement) from the family

Need for privacy – I don’t want my mother to walk into my

room without knocking

Children who don’t have the privilege of their own room have the

same feelings – maybe be a push factor to early marriage

Mid-Adolescence

14-16 years

Peak of parental conflict (feeling that my parents don’t

understand me, they do not value my opinion)

Rejection of parental values

My views are different from my parents

My parents don’t know

Late Adolescents

> 17 years

Dad I need your advice ….

20

WHO - Programming for adolescent health and development (1997)The adolescent health and development report cites “home” as the first

intervention setting and “family” as key players for intervention delivery.

family environment is central to healthy adolescent development and to the prevention and treatment of health problems.

• family: provides support and love; promotes moral development and a sense of responsibility; provides role models and education about culture; sets expectations; negotiates for services and opportunities; filters out or counteracts harmful or inconsistent influences from the social

environment.

Ref: WHO - Programming for adolescent health and development (1997)

5 Roles of parents in nurturing adolescents

• connection – love

• behaviour control – limit

• respect for individuality – respect

• modelling of appropriate behaviour – model

• provision and protection – provide.

1. Connection & adolescent behaviour Well connected adolescents - perceive themselves to be accepted by their primary caregivers

Poorly connected adolescents are those who

1. perceive themselves to be rejected by primary caregivers, or

2. who experience psychologically hurtful behaviours, such as

• behaviours that are cold and unaffectionate,

• or hostile and aggressive,

• or indifferent and neglecting

adolescents who report feeling connected to their parents are less

likely to;

1. consider or attempt suicide,

2. be involved with interpersonal violence,

3. smoke cigarettes,

4. use alcohol or

5. have sexual intercourse at a young age.

2. Behaviour Control-regulation, monitoring, structure, and limit-setting,

• Encompasses parents’ actions aimed at shaping or restricting adolescents’ behaviours.

• Actions include • supervising and monitoring

adolescents’ activities,• establishing behavioural rules and

consequences for misbehaviour,• conveying clear expectations for

behaviour.

Parental monitoring/knowledge is associated with better outcomes.• decreased risk of drug and alcohol

use, • decreased sexual activity, • later age of pregnancy, • decreased depression,• decreased school problems,• decreased victimization and

delinquency, • decreased negative peer influences

3. Respect for individuality - allow the adolescent to develop a healthy sense of self, apart from his or her parents.

adolescents (and younger children) who perceive their parents to be psychologically controlling (i.e. disrespectful of their individuality)

• have higher rates of internalized problems (e.g., depression, eating disorders)

• as well as externalized problems (e.g. risky sexual behaviour, substance use).

Parents can foster adolescents’ sense of worth and individuality by

• respecting what the adolescent has to say,

• seeking his or her opinion on important family matters,

• trusting him or her to complete responsibilities assigned and

• fostering dreams and goals.

4. Modelling appropriate behaviour

Having parents who make healthy choices is linked to

• better skills and attitudes around academic achievement,

• employment,

• health habits,

• relationships,

• communication,

• coping and conflict resolution.

A high correlation has been repeatedly documented between

• substance-abusing parents and adolescent substance use.

• adolescents are increasingly more likely to use alcohol as the number of people in their lives, including their parents, who do increases.

• non-using parents mediated the effect of peer pressure

5. Provision and protection

• Provide from the resources they have and seek out resources when they cannot meet the need from their own resources

• Participating in school activities

• Creating social capital – other caring adults who can support this child

• Headmistresses of Kenya High School and Highlands are outstanding in not sending students who have problems with school fees at home

The trip home to collect school fees is a;1. physical safety2. Psychological threat

28

Strengths:

1. Motivated parents who are eager to learn

2. Adolescents want to be taught by parents and already trust parents

Weaknesses:

1. SRH viewed as culturally-taboo topic

2. Some current SRH education is not evidence-

based

Opportunities:

1. Parent & guardian SRH education to fill knowledge gaps

2. Adolescent-focused healthcare practices (youth centers, increased training for all staff)

Threats:

1. Decline in community parenting mentality

2. Economic & financial incentives to sexual activity

Kisii County

Adolescent SRH

• If one considers the physical growth and sexual maturation as hardware, emotional thinking as the software and the cognitive development as the anti-virus.

• The challenge facing adolescents globally and here in Kenya is that the hardware is fully functional before the software and anti-virus are fully installed.

CONCLUSIONAdolescence is a time of unprecedented promise – and peril.

Asante