Chapter 8
Aligned 2016 CACREP StandardsStandard 2.F.3.b. Theories of learning
Standard 2.F.3.c. Theories of normal and abnormal personality development
Standard 2.F.3.e. Biological, neurological, and physiological factors that affect human development, functioning, and behavior
Standard 2.F.3.f. Systemic and environmental factors that affect human development, functioning, and behavior
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In this chapter, we examine neurophysiological and social development that extends from childhood into adolescence. Some of the developmental issues explored in this chapter, such as the development of sex characteristics and gender and sexual identity, have their beginnings in early childhood but become more prominent during adolescence. In this chapter, we review the second major stage of synaptic pruning and cortisol trajectories during childhood and adolescence. We also explore the different speed of neural growth in the limbic versus prefrontal cortex, the development of the dopaminergic system, and improved mentalization and metacognitive capacities during adolescence. When writing this chapter we adhered to our definition of adolescence in the preface as encompassing the period from 12 to 18 years of age, recognizing that the range for pubertal onset is from 9 to 16 years (Galván, 2017).
In writing this chapter, we were informed by the following texts: Developmental Cognitive Neuroscience: An Introduction (4th ed.) by Johnson and de Haan (2015) and The Neuroscience of Adolescence by Galván (2017). We recommend these texts as additional resources if you would like more information about adolescence.
As we learned in Chapter 4, the prefrontal cortex is the last major brain region to fully myelinate during childhood (Galván, 2017). This trend of extended prefrontal cortex development continues into adolescence and even emerging adulthood. As the cerebrum becomes fully myelinated, and more gray matter transforms into white matter, the speed of neurotransmission increases. The cerebrum also becomes more efficient as synapses are pruned during the second major phase of synaptic pruning, which occurs during mid to late adolescence (Spear, 2013).
Biological sex plays a role during adolescent brain maturation. Adolescents whose biological sex is female reach peak cerebral volume at 10.5 years compared to 14.5 years for males (Galván, 2017). This difference, alongside other neurophysiological developments such as pubertal onset (which is also earlier for females), may explain why females are higher academic achievers than males on average during adolescence (Galván, 2017).
The limbic system and striatum develop at a faster speed than the prefrontal cortex during adolescence (Casey, Jones, & Hare, 2008; Tyborowska, Volman, Smeekens, Toni, & Roelofs, 2016). Compared to adults, adolescents experience greater extremes of emotion associated with amygdala activity (Tyborowska et al., 2016), such as euphoria and depression in response to life events such as interactions with peers (Weinstein & Mermelstein, 2007). The adolescent brain also seems to be more responsive to novel changes in the environment, as new neurons are produced at a rate 4 to 5 times greater than adult neurogenesis (He & Crews, 2007). The striatum is associated with motivation and conditioning learning related to rewards, and its faster development than that of the prefrontal cortex explains why adolescents seek out novel and high-sensation (i.e., thrill) experiences in certain social contexts, even if they are potentially threatening (Baker, Bisby, & Richardson, 2016). This pull toward novel and risky experiences can be understood when one examines the development of the striatum structure of the nucleus accumbens relative to the prefrontal cortex (and especially the orbitofrontal area; Galván et al., 2006). The nucleus accumbens has a major role in the dopaminergic system, with production increasing two- to sevenfold during adolescence (Galván et al., 2006). This results in stronger motivational drives, especially toward reward seeking and risk taking (Galván, 2017; Galván et al., 2006). This development of the dopaminergic system is believed to be an underlying mechanism for why substance use increases markedly during adolescence (Galván, 2017). Most drug addictions begin during adolescence (Arain et al., 2013).
The faster speed of subcortical (i.e., limbic system) than cortical (i.e., prefrontal cortex) development helps us understand why adolescents experience deep and intense emotions without the circuitry yet to fully process and regulate their emotions. It also helps us understand why adolescence is marked by risk taking and experimentation. Adolescents are more likely than adults to place greater weight on the potential benefits of an action than the potential negative consequences (Arain et al., 2013). Most risk taking is healthy, as it enables adolescents to form new relationships and be exposed to new experiences (Spear, 2013). But risk taking can also result in dangerous consequences for health at times, such as driving without a seatbelt, engaging in unprotected sex, and so forth.
The faster pace of neural development for the limbic region versus the prefrontal cortex has been called the imbalance model of adolescent brain development (Casey, Jones, et al., 2008). As depicted in Figure 8.1, the prefrontal cortex continues to develop until a person is in their 20s (Arain et al., 2013; Casey, Getz, & Galvan, 2008). As the adolescent matures during puberty, stronger connections are forged between subcortical structures such as the amygdala and cortical structures such as regions of the prefrontal cortex, resulting in improved abilities to regulate emotions and control impulses (Guyer, Silk, & Nelson, 2016; Tyborowska et al., 2016).
The hyperemotionality of adolescence has also been associated with an increased risk of psychopathology and developing mental health conditions, in particular anxiety, bipolar disorder, depression, and substance use disorders (Guyer et al., 2016). The age of onset for many mental health conditions is during adolescence (Guyer et al., 2016). It is believed that the second major period of synaptic pruning, alongside development and activation of the striatum and amygdala, may contribute to this vulnerability to developing mental health conditions (Baker et al., 2016).
FIGURE 8.1 The Imbalance Model of Adolescent Brain Development
Note. Adapted from articles by Casey, Getz, et al. (2008), Casey and Jones (2010), and Casey (2015).
When working with adolescents, counselors should understand why it can be a challenge for adolescents to prioritize long-term over short-term benefits and moderate their impulses toward sensation seeking and risk taking. In counseling sessions, we have found it useful to validate and support adolescents’ intent to make independent decisions while also introducing questions that help them consider what they want to achieve in the long term. In the case study of Luciana (see Case Vignette 8.1), we show how to engage an adolescent in longer term planning in a manner that is nonjudgmental and supportive. Michelle uses first-person narrative to describe the counseling process.
This case study illustrates a few key counseling skills. First, validating the adolescent’s thoughts and feelings is an important first step. If Michelle had not demonstrated understanding and validation before attempting to problem-solve or give advice, Luciana may have felt invalidated and could have developed a strong negative reaction toward Michelle. Second, clarifying the adolescent’s ultimate long-term objective when making decisions can help to provide direction during their innate attempts at problem-solving. Third, the counselor should wait for the adolescent to request advice or direction before providing it. Adolescents need less direction and guidance than children, and thus counselors should attempt to facilitate adolescent autonomy and empowerment to the extent possible.
Nelson, Jarcho, and Guyer (2016) contended that neurophysiological changes during adolescence occur in the context of burgeoning social relationships and affiliations. During adolescence, youth transition in their social behavior from engaging in peer-focused play behavior with their parents or guardians as their base to fully joining with their peer group (Nelson et al., 2016). The peer group social environment provides opportunities for novel and sensation-seeking experiences (e.g., first sexual experiences). Several changes occur in the brain during adolescence that assist young people to form deeper emotional bonds with peers.
Facial recognition continues to develop during early adolescence (Galván, 2017). Recognizing and understanding facial expressions has a prominent role in appraising the emotional states of others. The fusiform face area (FFA) of the fusiform gyrus has been strongly associated with facial recognition (Galván, 2017). FFA activation is crucial to social relationships. Young adolescents (11–14 years old) have similar FFA activation to adults when presented with images of faces (Scherf, Luna, Avidan, & Behrmann, 2011). This activation is almost absent in younger children (5–8 years old). FFA activation is impaired in children with autism (Nomi & Uddin, 2015), who also have difficulties sustaining eye contact and eye gaze (Pelphrey, Shultz, Hudac, & Vander Wyk, 2011). This causes impairments in recognizing and understanding the emotions of others (Galván, 2017).
Improvements in perspective-taking abilities help adolescents to form deep empathic bonds with their peers. The ability of an adolescent to form an empathic understanding of a peer’s thoughts and feelings is known as mentalization or theory of mind (Guyer et al., 2016). Perspective taking assists adolescents in anticipating and understanding the goals and behaviors of others and responding accordingly. Fully joining with peers requires this ability to forge a deeply emotional and empathic connection. For example, an adolescent might intentionally seek to reach out to a member of their peer group whom they realize is upset from being excluded socially. Mentalization capacities are facilitated by brain development during adolescence. The ability to understand another’s perspective is associated with maturation of the prefrontal cortex, in particular the dorsolateral and medial regions (van den Bos, van Dijk, Westenberg, Rombouts, & Crone, 2011). In addition, enhanced connectivity between the amygdala and prefrontal cortex grants adolescents the ability to gain emotional insight into their own experiences as well as the experiences of others.
In addition to facilitating mentalization, prefrontal brain development enables adolescents to appraise their own thoughts, known as thinking about thinking or metacognition (Guyer et al., 2016). This ability assists with self-referential and self-reflective thinking, which is a precursor to enhanced self-awareness. Adolescents with metacognitive capacities can appraise whether their thinking and behavioral response is accurate and fair in a given situation (Gross & Jazaieri, 2014; McRae et al., 2012). Such self-reflection grants adolescents the ability to benefit from insight-oriented counseling approaches such as cognitive behavior therapy, among others. Learning to manage enhanced emotions and moods is an important task of adolescent development (Gross & Jazaieri, 2014).
Self-reflective abilities also support identity development, which is a crucial task during adolescence (Meeus, 2011). The reciprocal interaction between person and environment is crucial to identity development. As adolescents develop prefrontal functions and amygdala-prefrontal circuitry associated with higher order cognitive capacities such as mentalization and metacognition, they forge deeper relationships with their peers. These peer relationships then exert a substantial influence on the adolescents’ development of identity, values, and behavior (Cheung, Chudek, & Heine, 2011).
Alongside development of the limbic system (especially the amygdala), developments in the anterior cingulate cortex during adolescence have been associated with heightened sensitivity to social ostracism and rejection (Collins, Welsh, & Furman, 2009). Rejection sensitivity has been associated with increased activation of the amygdala during adolescence, along with other subcortical structures, including the anterior cingulate cortex, insula, and striatum (Sebastian, Viding, Williams, & Blakemore, 2010; Silk et al., 2013). Longitudinal studies have found that heightened rejection sensitivity during adolescence is associated with the severity of depression symptoms (Masten et al., 2011) and is thus an important target of intervention.
Puberty is a transitional stage that results in a young person developing adult physical characteristics and becoming capable of sexual reproduction (Colvin & Abdullatif, 2013). The onset of puberty is on average 10 to 11 years of age for children with female biological sex characteristics and 11 to 12 years of age for children with male biological sex characteristics (Shumer, Nokoff, & Spack, 2016). Galván (2017) estimated that the range for pubertal onset is from 9 to 16 years. Some children develop secondary sex characteristics early, such as in third or fourth grade of elementary school. Other adolescents develop secondary sex characteristics later, such as in middle school or even high school. Pubertal onset varies by ethnic background, with African American and Latinx youth starting puberty slightly earlier than Euro-American youth (Colvin & Abdullatif, 2013). Tyborowska and colleagues (2016) found that an adolescent’s pubescent stage had a strong relationship with their stage of brain development. In their study, prefrontal development was associated with the stage of gonadal hormone (i.e., testosterone) secretion rather than with age in years.
During puberty, adolescents develop secondary sex characteristics, which results in the growth and maturation of their genitals, breasts, muscles and skeleton, and facial and body hair (Galván, 2017). Pubertal development is initiated by activation of the hypothalamic-pituitarygonadal axis. During adolescent maturation, the hypothalamus projects gonadotropin-releasing hormone to the pituitary gland, which in turn secretes luteinizing hormone and follicle-stimulating hormone. Luteinizing hormone facilitates the production of sex hormones (i.e., ovaries and testes) in the gonads. Estrogen is developed in the ovaries. There are three estrogens: estrone, estradiol, and estriol.
Luteinizing hormone also facilitates the development of androgens, such as testosterone in the testes. Estrogen and testosterone are sex hormones. Both females and males develop and secrete androgens and estrogens, with children of female biological sex typically secreting larger amounts of estrogens and children of male biological sex typically secreting larger amounts of androgens (Galván, 2017). Follicle-stimulating hormone supports the development of ovarian follicles that will contain egg cells known as oocytes. Follicle-stimulating hormone also facilitates the enlargement of the testicles.
At approximately 6 to 8 years of age, the early pubertal period is initiated when the adrenal glands produce and secrete adrenal androgens such as dehydroepiandrosterone (Galván, 2017). These androgens assist with the development of pubic hair, body odor, and skin oil that can result in acne. This secretion of adrenal androgens is known as adrenarche.
Estrogen and progesterone production during adolescence results in thelarche, or secondary breast development (Galván, 2017). Estrogen facilitates the development of adipose breast tissue that begins with breast budding. Progesterone initiates development of the mammary glands. Breast development is typically completed within 4 to 5 years. Estrogen production and the development of ovarian follicles contribute to the onset of menarche, or the first occurrence of menstruation. Menstruation and menses typically begin approximately 2 years after the start of breast budding.
Testosterone production supports the enlargement of the phallus and testes; thinning of the scrotal skin; enlargement of the larynx and a deeper vocal tone; and musculoskeletal changes such as an increase in muscle mass, a widening of the shoulders, and increases in height. The development of facial hair in children with male biological sex characteristics begins later than genital development.
Metabolism seems to be related to pubertal onset, with energy and fuel stores essential to the production and excretion of gonadotropin-releasing hormone (Sanchez-Garrido & Tena-Sempere, 2013). Obesity has been associated with earlier onset of puberty, as has the adipose (i.e., fatty tissue) hormone leptin (Sanchez-Garrido & Tena-Sempere, 2013). Leptin is associated with hunger inhibition and satiation. Leptin levels climb just prior to the onset of puberty (Galván, 2017). Children with decreased leptin production and secretion do not begin puberty until synthetic leptin has been introduced (Sanchez-Garrido & Tena-Sempere, 2013). Presumably because of depleted energy stores, anorexia nervosa has also been associated with delays in pubertal onset (Katz & Vollenhoven, 2000).
The increased production and secretion of gonadal hormones during adolescence has a marked impact on emotions and moods (Guyer et al., 2016). During the female reproductive cycle, the secretion of gonadal hormones varies substantially. Estrogen levels begin to rise before ovulation, then decrease after ovulation and fall significantly just before menstruation (Sacher, Okon-Singer, & Villringer, 2013). Progesterone secretion rises after ovulation and also falls rapidly just before menstruation (Sacher et al., 2013). These changes in the excretion of estrogen and progesterone during ovulation and menstruation have been linked to changes in acetylcholine, dopamine, norepinephrine, oxytocin, and serotonin activity (Sacher et al., 2013). Falling estradiol (a type of estrogen) and progesterone levels are linked to depressive symptomatology, whereas higher estradiol and progesterone levels enhance serotonin secretion and have antidepressant-like effects in both females and males (Benmansour, Weaver, Barton, Adeniji, & Frazer, 2012; Lanzenberger et al., 2011). Low estradiol and progesterone have been associated with increased suicide attempts in women (Baca-Garcia et al., 2010). Testosterone does not appear to influence serotonergic functioning (Montoya, Terburg, Bos, & van Honk, 2012).
Estrogen, progesterone, and testosterone appear to have different impacts on amygdala coupling with prefrontal regions (van Wingen, Ossewaarde, Bäckström, Hermans, & Fernández, 2011). All three gonadal hormones appear to stimulate activation of the amygdala, which is associated with emotional and fear-based responses. However, estrogen and progesterone increase amygdala projections to the medial prefrontal cortex, whereas testosterone reduces amygdala projections to the orbitofrontal cortex (van Wingen et al., 2011). Activation of the medial prefrontal cortex is associated with higher order rational processing of emotions and can result in internalizing problems (Balzer, Duke, Hawke, & Steinbeck, 2015), such as rumination about negative emotions (van Wingen et al., 2011). Reduced activation of the orbitofrontal cortex predisposes a person to becoming behaviorally inhibited and engaging in more impulsive and aggressive behaviors (van Wingen et al., 2011). In summary, the differing effects of these gonadal hormones (estrogen and estradiol, progesterone, testosterone) might partially explain differences in the prevalence of internalizing (anxiety, depression) and externalizing (aggression, impulse control issues, substance use) problems by biological sex (Soares & Zitek, 2008).
Differences in cortisol secretion during adolescence, known as cortisol trajectories, may also help to explain the increased incidence of anxiety and depression during early adolescence. A longitudinal study by Shirtcliff and colleagues (2012) followed children from third through ninth grade. The authors found that cortisol production initially decreases between ages 9 and 11 and then increases again during early adolescence. By 15 years of age, adolescents have lower morning cortisol than at 9 years of age but higher evening cortisol. Note that cortisol is higher among children whose biological sex is female and declines less during the day compared to children whose biological sex is male (Shirtcliff et al., 2012). Shirtcliff and colleagues proposed that this increase in daily circulating cortisol during early adolescence may explain increases in anxiety and depression, especially in females.
Chronic stress impacts the speed of sexual maturation. Adolescents who experience chronic stress during childhood have increased basal (i.e., baseline) cortisol production, which accelerates adrenarche (Belsky, Ruttle, Boyce, Armstrong, & Essex, 2015). Noll and colleagues (2017) found that sexual abuse was associated with accelerated breast development (8 months earlier than controls) and pubic hair development (12 months earlier than controls) in adolescents with female biological sex. These findings were observed after confounding variables, such as ethnicity and obesity, were controlled for. Accelerated sexual maturation has been associated with physical and mental health problems (Belsky et al., 2015). Negriff, Saxbe, and Trickett (2015) found in a longitudinal study that early pubertal change predicted delinquency in males and substance use in females.
Counselors working with adolescents who are experiencing hormone fluctuations can use this information to normalize experiences with emotions and mood changes and support the adolescents’ management of such symptoms. Adolescents might be confused about these changes or privately worry that they are developing at a different rate than their peers. Understanding the basics of gonadal hormones and secondary sex characteristics can help adolescents quell these anxieties. See Reflection Question 8.1.
Adolescence is a period marked by exploration of one’s own identity (Cheung et al., 2011). Although identity development has important beginnings in childhood, adolescence tends to be the time when identity becomes a more crucial focal point of a child’s developmental experience. During this time, many adolescents seek to separate from their parents and families of origin to forge their own independent identities and accordingly begin to look to peer groups for social affiliation. We now explore the development of gender, sexual, and ethnic identity.
Children are “born into a gendered world” (Shumer et al., 2016, p. 82) in which dress, games, and styles of play are influenced by assigned gender and gender labels. A child’s ability to distinguish faces by gender begins early, at approximately 6 months of age (Quinn, Yahr, Kuhn, Slater, & Pascalis, 2002). By 2 years of age, children begin to ascribe gender labels to themselves and others (Shumer et al., 2016; Stennes, Burch, Sen, & Bauer, 2005). Children may identify as having a gender that is not in alignment with their biological sex, with gender-nonconforming behaviors developing as early as 3 years of age (Shumer et al., 2016).
By and large, young children tend to prefer clothing, toys, and objects that correspond to their identified gender (Fast & Olson, 2018). This is also true of socially transitioned children who identify as transgender. Olson, Key, and Eaton (2015) examined gender recognition in 5- to 11-year-old children who identified as transgender and cisgender. The researchers found that transgender children had a strong implicit preference for their expressed gender, similar to cisgender children.
Gender identity development is complex and involves genetic, hormonal, and environmental factors (Shumer et al., 2016). No single gene has been identified as causative for transgender identity development, though twin studies suggest some degree of genetic influence. Heylens and colleagues (2012) found that gender dysphoria, defined as a person’s dissatisfaction with their biological sex, was concordant in approximately 40% of monozygotic (i.e., identical) twin pairs. Although one might imagine that prenatal hormone release might be related to gender identity, studies on the influence of sex hormone release during pregnancy on gender identity development have not yielded any significant relationship as yet (Shumer et al., 2016).
Romantic attraction also begins to develop during the childhood period. Although the age by which children start to develop romantic interests can vary, feeling romantic attraction is fairly common by middle school age. More than half of middle schoolers report having a current romantic crush (Bowker, Spencer, Thomas, & Gyoerkoe, 2012). During childhood, children become aware of their sexual/affective orientation and may begin to identify as lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, intersex, and/or asexual (LGBTQQIA). Calzo, Antonucci, Mays, and Cochran (2011) examined the retrospective recall of sexual identity development during childhood among more than 1,000 gay, lesbian, and bisexual adults. Of those in the study, 22% reported coming out before adolescence. Research has found several indications of genetic influences on sexual identity development, such as a higher concordance of gay or lesbian children of gay or lesbian parents and higher concordance rates among monozygotic (i.e., identical) versus dizygotic (i.e., fraternal) twins (Shumer et al., 2016). In a large study of nearly 500,000 people, Ganna et al. (2019) found that genetics explained between 8% and 25% of same-sex sexual behavior. Sanders et al. (2015) conducted another large study of more than 400 pairs of gay brothers and found that the Xq28 region of the genetic sequence seemed to play a role in sexual orientation development for males. Subsequent studies have also observed other chromosomal correlates with gay and lesbian sexual orientation, such as the SLITRK6 gene on chromosome 13 and the thyroid-stimulating hormone receptor (TSHR) on chromosome 14 (Sanders et al., 2017). SLITRK6 on chromosome 13 and TSHR on chromosome 14 are particularly intriguing, because they are associated with hypothalamic function. Sanders and colleagues (2017) argued that the thyroid functions differently in people who identify as gay and lesbian.
Children who identify as LGBTQQIA experience far greater incidences of stigma, bullying, and harassment (Reisner et al., 2015). Consequently, mental health problems such as anxiety, depression, self-injurious behavior, and suicidal ideation and suicide attempts are 2 to 3 times more common in children who identify as transgender compared to children who identify as cisgender (Reisner et al., 2015). By adulthood, 41% of transgender adults will have attempted suicide, a staggering number (Shumer et al., 2016).
Peer group socialization diminishes somewhat after romantic relationships begin to form (Collins et al., 2009). Romantic relationships are common during later adolescence. The majority (70%) of 17-year-olds report that they have been in a romantic relationship in the past year (Collins et al., 2009). As adolescents reach reproductive capability, they begin to experience sexual interest. By age 14, nearly 90% of males and 20% of females have masturbated (Fortenberry, 2013). The average age of first sexual intercourse is 17 years for both males and females (National Center for Health Statistics, 2017).
Oxytocin has an important role in the development of sexual relationships. During puberty, gonadal hormones assist with the proliferation of oxytocin receptors in the amygdala and nucleus accumbens in the limbic system (Albert, Chein, & Steinberg, 2013; Spear, 2009). Enhanced oxytocin activity in the limbic system is associated with improved emotional bonding, which is important to romantic relationships that are formed during adolescence. Oxytocin is secreted before, during, and after sexual activity and promotes partner bonding and affiliation (Gonzaga, Turner, Keltner, Campos, & Altemus, 2006). Oxytocin levels are higher among new lovers than single people and remain high for at least the first 6 months of a sexual relationship (Schneiderman, Zagoory-Sharon, Leckman, & Feldman, 2012). Females have greater oxytocin release during sexual activity than males, with the intensity of the orgasm related to oxytocin release (Carmichael, Warburton, Dixen, & Davidson, 1994; Gonzaga et al., 2006). Adolescents may feel closely bonded with their sexual partners, especially females, even if the relationship is still in an early stage of development. This superficially close bond can give rise to topics that are frequently discussed in counseling sessions, such as intense relationships, fair expectations of partners, and fears of rejection (see Reflection Question 8.2). Hurlemann and Scheele (2016) proposed that the disrupted oxytocin signaling that occurs following the loss of affection bonds (e.g., the breakup of a sexual relationship) can elevate the risk of stress-related adjustment problems.
Ethnic and racial identity develops throughout childhood (Pahl & Way, 2006). The general phases of ethnic and racial identity development have been differentiated by early, middle, and late childhood (Umaña-Taylor et al., 2014). Early childhood is marked by differentiation of self and other alongside ethnic labeling and knowledge (Umaña-Taylor et al., 2014). Early adolescence has been associated with an awareness of bias and social hierarchy and in-group/out-group dynamics (Umaña-Taylor et al., 2014). Late childhood (i.e., adolescence) has been connected with self-identification with ethnic practices and values, exploration of self-identity and collective self-verification, understanding of one’s common fate or destiny with others in one’s ethnic group, and internalization or self-denial of cultural identity (Umaña-Taylor et al., 2014). Perceived and actual discrimination by peers may moderate the speed of ethnic identity development (Pahl & Way, 2006).
We encourage counselors to ask their adolescent clients about how they identify regarding their ethnic and racial background and heritage. Counselors should also support youth in experiences of discrimination and oppression and advocate when needed. Cabral and Smith (2011) found that the counselor does not need to have the same ethnic or racial background as their client to have effective conversations about ethnic and racial identity. In our experience, regardless of background, the counselor’s inquiry about ethnic and racial identity can send an important message to children and adolescents that their ethnic and racial identity is important. We propose the guidelines below when facilitating conversations about identity.
During counseling sessions, it is important for the counselor to demonstrate an affirming attitude toward diverse identities and allow adolescents space to process their thoughts and feelings about their identity without judgment. We recommend that counselors provide space for adolescents to independently explore their identity without significant direction from them unless requested. Adolescents may need assistance recruiting support from their family when they are ready to disclose their gender and/or sexual identity, and counselors can be a resource for helping children to practice phrasing their disclosure to their parents or guardians.
Counselors have an especially important role in establishing a supportive environment for adolescents who identify as gender minorities or sexual minorities. Counselors at times will need to advocate for an LGBTQQIA-supportive and -affirming atmosphere in the communities in which they reside. Counselors may also need to advocate for adolescents and adolescents who experience discrimination and oppression because of their ethnic and racial background.
Adolescence is a transitional stage marked by tremendous neurophysiological growth and development. The hormonal changes and rapid development of the limbic system and striatum that occur during adolescence enhance the emotional experiences and sensation-seeking impulses of teenagers before they have the ability to control them cognitively. As youth approach older adolescence, stronger connections are forged between the prefrontal cortex and the subcortical limbic regions, which assists them in better managing these emotions and moods. Adolescents also become more aware of themselves and others in their environment and form close relational bonds with peers. Counselors working with adolescents should support their emerging independence and problem-solving abilities, help to scaffold executive functioning (such as long-term planning), provide support during explorations of identity development, and normalize the moods and physiological changes that occur during adolescence.