AT A GLANCE
Adolescence: physical changes
and neurological development
Olivia Best and Sasha Ban
ABSTRACT
This article provides a brief overview of adolescence. It highlights the key
physical changes related to puberty and identifies the latest understanding
of neurological development in young people. It is also recognised, within
the article, that this period of rapid change can have an impact on social and
emotional wellbeing. There are conditions that typically have an onset during
adolescence, examples of this are offered. The term ‘adolescence’ is used
to describe the stage of development and growth and ‘young people’ is used
throughout to refer to the individuals.
Key words: Young people ■ Adolescence ■ Brain development
■ Risk-taking behaviours ■ Puberty ■ Chronic illness
H
ealth professionals will care for young people in
a variety of settings, across all fields of nursing
and specialties. Understanding key elements of
adolescent development will enhance practice
and improve outcomes for young people
(Colver and Longwell, 2013) . Often young people’s needs are
overlooked, sometimes with fatal consequences (Pettit, 2014).
Practitioners should have an awareness of young people’s growth
and development to be able to recognise and assess their physical,
social, and emotional needs. This article provides an overview
of adolescence and the implications for healthcare practice.
Adolescence is often characterised by biological growth
and hormone changes, this period is commonly referred to as
puberty (Sawyer et al, 2018). Sawyer et al (2018) claimed that this
stage of development typically spans from 10-24 years old and is
complete once there is epiphyseal fusion of long bones (Murray
and Clayton, 2013).Adolescence is a period of immense change.
These changes are physical, social and emotional, all of which
have the possibility to present challenges and obstacles within
a young person’s life (Choudhury et al, 2008). Recent studies
have also highlighted the importance of neurological changes in
young people (Blakemore, 2018).To understand the complexity
Olivia Best, third year student, BSc (Nursing), University of
Northumbria at Newcastle
Sasha Ban, Senior lecturer, Nursing, Midwifery and Health
Department, University of Northumbria at Newcastle,
sasha.ban@northumbria.ac.uk
Accepted for publication: September 2020
272
of adolescence, the sections below provide a brief overview
of puberty, neurological, social, and emotional development.
Puberty, physical growth, and development
Puberty has been described as one of the most profound biological
transitions in a person’s life (Susman and Rogol, 2014). Among
the many endocrine and paracrine activities, one catalyst for these
changes is gonadotrophin hormone (GnRH) release (Murray
and Clayton, 2013). GnRH is produced by the hypothalamus
and controls the release of luteinizing hormone (LH) and follicle
stimulating hormone (FSH), which are secreted by the pituitary
gland. The release of GnRH is the most important control
mechanism regulating sexual maturation and fertility (Child
Growth Foundation, 2003).There are certain disorders that are
prevalent in young people, although there is no definitive cause,
rapid growth and development are indicated (Table 1).
Puberty is characterised by physical changes, such as
females starting their menstrual cycle and breast development,
the descent and enlargement of testes in males, and growth
in stature in both (Porta and Last, 2018). In addition, other
significant changes include development of secondary sexual
characteristics, such as hair growth, voice change and acne.
These physical changes have been well documented, as seen in
Marshall and Tanner’s (1969; 1970) model of assessing puberty
(Figure 1). The initial study was conducted over 20 years by
Marshall and Tanner and, although dated, evidence suggested
that these stages remain relevant and should be incorporated
into growth charts (Cole et al, 2012). These are now added to
the Childhood and Puberty Close Monitoring Chart (Royal
College of Paediatrics and Child Health, 2013).
Neurological development
For many decades, the changes in young people’s behaviour
during adolescence were assigned to the flux of hormonal
activity. However, recent evidence suggests that there are also
changes in the brain during this period. For example, the pre-
frontal cortex of the brain is remodeled during adolescence
(Blakemore, 2018).This is the part of the brain that is involved
in decision-making and is responsible for a young person’s ability
to plan and consider the consequences of their actions, as well
© 2021 MA Healthcare Ltd
as controlling impulses (Choudhury et al, 2008). Understanding
neurological development during adolescence may help to
understand a young person’s thought processes and behaviour.
In England, on average more than 17 children and young
people suffer a serious or fatal injury as a result of a road traffic
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 AT A GLANCE

Michał Komorniczak (Poland)

1 Pre-adolescent 1P
 re-adolescent no
pubic hair

2 Breast budding 2S
 parse, pigmented,
long, straight pubic
hair, mainly along
labia and at base
of penis

3C
 ontinued 3D
 arker, coarse,
enlargement curlier pubic hair

4A
 reola and 4A
 dult pubic hair,
papilla form but decreased
secondary distribution
mound

5M
 ature female 5A
 dult pubic hair in
breast quantity and type,
with spread to
medial thighs

Figure 1. Tanner’s model of sexual maturity (Marshall and Tanner, 1969; 1970)

accident every day (Public Health England, 2018), in part due

Table 1. Examples of conditions with onset in adolescence
to risk-taking behaviours. Such behaviours are commonly
described as defiance, pushing the boundaries and/or identity Condition Cause Prevalence and onset
development, often involving illicit activities (Leslie, 2008; Idiopathic No definitive cause; rapid bone growth, Most common in children aged
Blakemore, 2018). Evidence suggests that risk-taking behaviour is scoliosis genetics, hormones and environmental 10–15 years (NHS England,
a natural and necessary neurological process (Dumontheil, 2016), factors 2020)
being described as ‘essential for the development of optimal Higher prevalence in females
social and psychological competence’ (Ben-Ari, 2004). Risk (Konieczny et al, 2013)
taking is often associated with negative behaviour; however, in Depression No definitive cause, increased About 7.6% of children aged
the context of neurological development, risk taking is anything brain development and activity, 12 years and older have
that pushes the young person out of their comfort zone. This overproduction of cortisol, no positive had moderate to severe
hormonal feedback mechanism depression (Haefner, 2016)
could be a spectrum of activity, including starting a new school,
Risk factors include genetic More common in females
making friends or trying different activities.The brain needs to
predisposing factors, trauma, chronic (National Institute for Health
exercise its neurological pathways to strengthen them. illness, alcohol or substance misuse, and Care Excellence, 2020a)
Risk taking allows the brain to develop lasting neural adverse childhood events
pathways to the pre-frontal cortex.The amygdala and the
© 2021 MA Healthcare Ltd

Crohn’s It is thought to be an auto-immune About 20–30% of cases

hippocampus control the emotional regulatory centres that form disease condition caused by environmental present before the age
part of the limbic region of the brain (Colver and Longwell, triggering events in genetically of 20 years (Oliveira and
2013). This rapid fluctuation in emotions and mood, often susceptible people (National Institute Monteiro, 2017)
seen in adolescence, is attributed to this age group having less for Health and Care Excellence,
2020b)
capacity to regulate heightened emotional reactivity (Heller

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AT A GLANCE
and Casey, 2016). Heller and Casey’s work demonstrates the
development of this area of the brain and the changes that occur
during adolescence. The emphasis shifts during adolescence
from a spontaneous emotional response to a more calculated,
logical response.
Andersen (2016) describes the period of adolescence as a time
of ‘synaptic exuberance’, and concludes that information from
the maturational stages that precede or occur during adolescence
is likely to hold the key to optimising development to produce
a young person and adult who is resilient and well adapted to
their environment. Current research using functional magnetic
resonance imaging adds to the evidence that the capacity for
social interaction develops, in a large part, from the changes
that our brains go through during adolescence (Pandey et al,
2017). Ethological studies have found similar themes, however
more often their emphasis has been on the early attachments in
humans and the lasting impact of these (Bowlby, 1997.
According to Watanabe (2017), ‘the adolescent brain is
undergoing an important and dramatic transition that leaves it
vulnerable to a number of environmental influences that can
push it into a negative trajectory’. Furthermore, according to
other studies (Romeo, 2013), the young person’s brain may
not recover from acute and chronic stress as effectively as that
of an adult may.This has significance when considering young
people as patients—and a diagnosis at this stage in a young
person’s life needs a collaborative approach (Pettit, 2014). The
neurological development in adolescence and increased brain
activity is considered to be a contributing factor to the increased
prevalence of mental illness in this age group (Table 1).
Social and emotional factors
Evidence suggests that young people are social and inter-
dependent beings (Grant et al, 2008), and that social acceptance
is a pivotal aspect in their lives and decision-making (Goddings,
2015). Steinberg (2016) highlighted this in the Stoplight task,
which is a simple driving computer game in which players
control the movement of a vehicle along a straight track. The
research demonstrated that young people were three times more
likely to take risks when they played the game with friends than
when they were alone. Peers become a larger part of young
people’s lives, for example a young person with chronic illness
will gain support from their peers and share experiences, hopes
and fears freely (Teenage Cancer Trust, 2020).
Steinberg (2001) suggested that adolescence is associated with
individuals beginning to examine and explore psychological
characteristics of the self, questioning who they really are and
discovering how they fit into the society in which they live.
This internal, emotional turmoil was said to exhibit symptoms
such as mood swings and rebelliousness, not unlike those
caused by pubertal and neurological changes. Zwozdiak-Myers
(2007) stated: ‘… each of us has experienced not one, but
two childhoods, the first as a biological state of growth and
development and the second as a social construction.’
As a child matures, the influences in their lives widen. Llorca-
Mestre et al’s research (2017) suggested that emotional and
cognitive variables of parenting styles and peer attachment were
equally significant as predictors of emotional instability in the
274
children studied. The needs of a young person for family and
friends, and attachment to others, is significant (Lee et al, 2018).
Life is made up of many factors contributing to a person’s story
and their subsequent growth and development, and for young
people these may include their peers, families and education.
For some young people, however, contributing aspects may
include a medical condition and/or illness.
An example of this is highlighted by Pini et al (2012) who,
within their systematic review, identified issues surrounding
young people who had been diagnosed with cancer. They
identified that healthcare practitioners need to be able to assess
the impact of the young person’s illness on their normality,
identity and independence. Pini et al recognised that young
people with a chronic condition have fears such as absence
from school, losing or missing friends, alongside having to
accept the changes happening to their body due to puberty, as
well as those due to their condition.The paper concluded that
collaboration with healthcare providers, education professionals,
parents and young people themselves is essential to minimise
the impact of illness on their development.
Conclusion
This article has provided an overview of the evidence relating to
adolescence. Understanding and an awareness of the needs of this
age group will support clinical practice and help practitioners
provide care that is evidence based. It should help practitioners
to understand the physical and neurological changes that a
young person is undergoing, ensuring that a young patient is
supported not only to manage their health needs, but also with
their social and emotional development. BJN
Declaration of interest: none
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AT A GLANCE
LEARNING POINTS
■ Assessment of a young person’s growth and development is paramount in
early identification of certain conditions, including endocrine and musculo-
skeletal disorders
■ Chronic illness, acute trauma and other adverse childhood events can have
long-lasting impacts on young people
■ Risk taking is normal in young people, and carers must create positive
risk‑taking opportunities to facilitate healthy development
CPD reflective questions
■ How can you make your service young-person friendly?
■ What factors do you need to consider when planning care for a young
person with a chronic illness?
■ What differences may you find when caring for a young person with
a learning disability or sensory impairment?
■ How would you ensure that peer relationships are maintained while
a young person was in hospital?
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