Adolescence is usually a wonderful time, perhaps better for current generations than for any earlier cohort. Nonetheless, serious troubles plague about 20 percent of youths. For instance, one specific survey of over ten thousand 13- to 17-year-olds in the United States using the categories of the DSM-IV found that 23 percent had a psychological disorder in the past month (Kessler et al., 2012). Another review cited a statistic that “one in five adolescents have a mental illness that will persist into adulthood” (F. Lee et al., 2014, p. 547).

Comprehensive surveys have not yet been reported from DSM-5, but changing definitions of disorders within DSM-5 are likely to find more problems rather than fewer. Most disorders are comorbid, with several problems occurring at once. Distinguishing between pathology and normal moodiness, between behavior that is seriously troubled versus merely unsettling, is complex, especially in adolescence.

It is typical for an adolescent to be momentarily less happy and more angry than a younger child, but that is not usually a problem because teen emotions often change quickly (Neumann et al., 2011). For a few, however, negative emotions cloud every moment, becoming intense, chronic, even deadly.

The general emotional trend from childhood to early adolescence is toward less confidence and more depression, and then, gradually, self-esteem increases. A dip in self-esteem at puberty is found for children of every ethnicity and gender (Fredricks & Eccles, 2002; Greene & Way, 2005; Kutob et al., 2010; Zeiders et al., 2013). Often self-esteem rises after middle school (especially for African American girls and European American boys), but reports vary, and every study finds notable individual differences.

The same seems true for adolescents worldwide. A report from China also finds a dip in self-esteem in seventh grade (when many Chinese children experience puberty) and then a gradual rise. Sociocultural conditions always have an impact, evident in other data from China that find that the self-esteem of Chinese teenagers has decreased in recent years. The authors ascribe this to reduced family connections: Currently, many Chinese youth have no siblings or cousins, divorce rates are rising, and more parents work and live far from their children (Liu & Xin, 2014).

Adolescent self-esteem tends to be higher in boys than girls, in older adolescents than younger ones, in African Americans than European Americans, who themselves are higher than Asian Americans (Bachman et al., 2011). These same trends, in reverse, apply to most disorders, with girls at puberty having high rates of psychological stress (Kessler et al., 2012).

The above are only averages: Every study finds notable variability among individuals as well as evident continuity within each person. Thus, most young Asian American girls are at risk, but few actually are severely depressed. No matter what the age or sex of a depressed person, it may be less severe with age, but it rarely disappears (Huang, 2010).

Context matters. When compared to the high rates of depression among European American girls, the Latina rise in self-esteem is particularly notable (Zeiders et al., 2013). One explanation is familism—the cultural belief that family members should care for one another. Latinas become increasingly helpful at home, which makes their parents appreciative and them proud, unlike other U.S. teenage girls.

CLINICAL DEPRESSION Some adolescents sink into clinical depression, a deep sadness and hopelessness that disrupts all normal, regular activities. The causes, including genes and early care, predate adolescence. Then the onset of puberty—with its myriad physical and emotional ups and downs—pushes some vulnerable children, especially girls, into despair.

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The rate of clinical depression more than doubles from childhood to adolescence and continues to increase in adulthood. One study found that the rate of clinical depression in a sample of 13- to 18-year-olds at 7.5 percent (Avenevoli et al., 2015). Every study finds that girls have much higher rates than boys, usually about twice as high.

Hormones are probably part of the reason for gender differences, but girls also experience social pressures from their families, peers, and cultures that boys do not. Women’s roles have changed markedly in the past decades, so a 12-year-old girl who is trying to figure out her sexual and vocational identity is confronted with many contradictory options (Naninck et al., 2011). A combination of biological and psychosocial stresses causes some to slide into depression.

Differential susceptibility is apparent. One study found that the short allele of the serotonin transporter promoter gene (5-HTTLPR) increased the rate of depression among girls everywhere but increased depression among boys only if they lived in low-SES communities (Uddin et al., 2010).

It is not surprising that vulnerability to depression is partly genetic, or that girls have higher rates than boys, but why does living in a middle- or upper-class neighborhood protect boys more than girls? Perhaps cultural factors depress females everywhere, but boys may be protected unless jobs, positive male role models, a protective police force, and encouragement within their community are scarce.

A cognitive explanation for gender differences in depression focuses on rumination—talking about, brooding, and mentally replaying past experiences. Girls ruminate much more than boys, and rumination often leads to depression (Michl et al., 2013).

Indeed, some research finds that close mother–daughter relationships increase the rate of depression if the pair ruminate about the mother’s problems (Waller & Rose, 2010). On the other hand, when rumination occurs with a close friend after a stressful event, the friend’s support relieves some shame (Rose et al., 2014). This shows differential susceptibility again, in this case not genetic but social.

A distinction can be made between internalizing and externalizing psychopathology, depending on whether the problem is expressed inward (such as depression and eating disorders) or outward (such as defiance, destroying things). Girls tend to internalize and boys externalize, but those observable differences mask similarities. In adolescence, depressed adolescents may act in externalizing ways.

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SUICIDE Serious, distressing thoughts about killing oneself (called suicidal ideation) are most common at about age 15. The 2013 Youth Risk Behavior Survey revealed that more than one-third (35 percent) of U.S. high school girls felt so hopeless that they stopped doing some of their usual activities for two weeks or more in the previous year (an indication of depression), and more than one-fifth (22.4 percent) seriously thought about suicide (MMWR, June 13, 2014).

Rates for boys were lower, but they also suffered. The corresponding rates for boys were 20 percent feeling hopeless and 11.6 percent thinking about suicide (MMWR, June 13, 2014).

Suicidal ideation can lead to parasuicide, also called attempted suicide or failed suicide. Parasuicide includes any deliberate self-harm that could have been lethal. Parasuicide is the best word to use because “failed” suicide implies that to die is to succeed (!); suicide “attempt” is likewise misleading because, especially in adolescence, the difference between attempt and actual suicide may be luck and prompt treatment, not intent.

As you see in Figure 10.4, parasuicide can be divided according to instances that require medical attention (surgery, pumped stomachs, etc.) and those that do not, but any parasuicide is a warning. If there is a next time, the person may die. Thus, parasuicide must be taken very seriously.

One form of psychotherapy that seems to reduce the risk of completed suicide springs from cognitive theory, the hope that a person’s thinking can help them deal with problems. This type of treatment for suicidal adolescents is called dialectical behavior therapy, designed to help the adolescent accept their moods but not act on them (Miller et al., 2007). That strategy makes sense and seems to forestall impulsive suicide (Berk et al., 2014).

Internationally, rates of teenage parasuicide range between 6 and 20 percent. Among U.S. high school students in 2013, 10.6 percent of the girls and 5.4 percent of the boys tried to kill themselves in the previous year (MMWR, June 13, 2014; see Figure 10.4).

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Because they are not logical and analytical, adolescents are particularly affected when they hear about someone’s suicide, either through the media or from peers (Niedzwiedz et al., 2014). That makes them susceptible to cluster suicides, which are several suicides within a group over a brief span of time. For that reason, media portrayal of a tragic suicide may inadvertently trigger more deaths.

While suicidal ideation during adolescence is common, completed suicides are not. The U.S. annual rate of completed suicide for people aged 15 to 19 (in school or not) is less than 8 per 100,000, or 0.008 percent, which is only half the rate for adults aged 20 and older (Parks et al., 2014). In every large nation except China, girls are more likely to attempt suicide but boys are more likely to complete it. In the United States, males kill themselves four times more often than females, a sex difference more notable from age 15 to 30 than 30 to 65.

The reason may be method: Males typically jump from high places or shoot themselves (immediately lethal), whereas females often swallow pills or cut their wrists, which allows time for conversation, intervention, and second thoughts. Boys also have more access to guns, especially in the United States. Given adolescent volatility, second thoughts are protective.

The suicide rate for European American youth is three times higher than for African, Hispanic, or Asian Americans. Suicide is the only major cause of death that increases with SES.

These are important statistics to keep in mind whenever someone claims that adolescent suicide is “epidemic.” It is not. Nor is education and income always protective. For suicide it seems to make things worse.

Like low self-esteem and suicidal ideation, sudden fury is common in adolescence. As already mentioned, a moody adolescent could be both depressed and delinquent because externalizing and internalizing behavior are connected during these years (Loeber & Burke, 2011). This may explain suicide in jail: Teenagers jailed for assault (externalizing) are higher suicide risks (internalizing) than adult prisoners.

Some externalizing acts are obvious—slamming doors, cursing adults, telling friends exactly how badly other teenagers (or siblings or teachers) have behaved. Some teenagers—particularly boys—“act out” by breaking laws. They steal, damage property, or injure others.

RAGE AND RESISTANCE Developmentalists disagree as to whether teenage anger is necessary for normal development. Anna Freud (Sigmund’s daughter, herself a prominent psychoanalyst) thought defiance was normal. She wrote that adolescent resistance to parental authority was “welcome . . . beneficial . . . inevitable.” She explained:

We all know individual children who, as late as the ages of fourteen, fifteen or sixteen, show no such outer evidence of inner unrest. They remain, as they have been during the latency period, “good” children, wrapped up in their family relationships, considerate sons of their mothers, submissive to their fathers, in accord with the atmosphere, ideas and ideals of their childhood background. Convenient as this may be, it signifies a delay of their normal development and is, as such, a sign to be taken seriously.

[A. Freud, 1958/2000, p. 37]

The idea that adolescents are rebellious is evident in cultural images and icons, from James Dean in Rebel without a Cause to popular bands such as the Arctic Monkeys idolizing black leather, spikes, and death. In many communities, it is illegal for adolescents to buy cigarettes, drive cars, have intercourse, or even be on the streets at night—activities that adults do routinely. The assumption is that adolescents are naturally out of control, and the laws must keep them in check.

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That assumption has been challenged by data on contemporary adolescents, who are often not tossed by the “storm and stress” that was assumed to be inevitable.

For example, most contemporary psychologists, teachers, and parents are quite happy with well-behaved, considerate teenagers, considering them quite normal and expecting them to become happy adults. That seems more often the case than for rageful, hurtful adolescents (Hollenstein & Lougheed, 2013).

The 30-year Dunedin, New Zealand study first mentioned in Chapter 1 found that adults who had never been arrested usually earned degrees, “held high-status jobs, and expressed optimism about their own futures” (Moffitt, 2003, p. 61). In addition to this study, research from many nations finds that many adolescents are quite respectful of their parents and teachers and that defiance can be unhealthy rather than necessary.

Some psychologists suggest that adolescent rebellion is a social construction, an idea created and endorsed by many Western adults but not expected or usual in Asian nations (Russell et al., 2010). Some adolescent rebellion may be a reaction against parental restrictions. Perhaps if adults react to their fears about adolescent lawlessness with strict prohibitions, that itself may increase adolescent defiance (Van Petegem et al., 2015).

BREAKING THE LAW Both the prevalence (how widespread) and the incidence (how frequent) of criminal actions are higher during adolescence than earlier or later. Arrest statistics in every nation reflect this fact, with 30 percent of African American males and 22 percent of European American males being arrested at least once before age 18 (Brame et al., 2014).

How many more young people have broken the law but were not caught, or caught but not arrested? Confidential self-reports suggest that most adolescents (male and female) break the law at least once before age 20. Few are caught.

The actual percentage is unknown, as some adolescents refuse to answer and some might brag—falsely—about skipping school, drinking underage, shoplifting, hurting another person, vandalizing. Others might deny—again falsely—ever having done such a thing. Researchers in the Netherlands found that one-third of those interrogated by the police later denied ever having police contact (van Batenburg-Eddes et al., 2012).

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Research on confessions to a crime is noteworthy in this regard. In the United States, about 20 percent of confessions are false; that is, people confess to a crime they did not commit. False confessions are more likely in adolescence, partly because of brain immaturity and partly because young people want to please adults—-including the police (Feld, 2013; Steinberg, 2009). A disproportionate number of prisoners sentenced to death have been convicted of crimes committed and punishments set before their 20th birthday.

Many scientists who study teenage crime suggest that we need to distinguish two kinds of lawbreakers (Monahan et al., 2013), as first proposed by Terri Moffitt (2001, 2003). Most juvenile delinquents are adolescence-limited offenders, whose criminal activity stops by age 21. They break the law with their friends, facilitated by antisocial peers. More boys than girls are in this group, but some gangs include both sexes (the gender gap in lawbreaking is narrower in late adolescence than earlier or later).

The other delinquents are life-course-persistent offenders, who break the law before and after adolescence as well as during it. Their lawbreaking is more often done alone. The cause of their behavior may be neurological impairment, inborn or caused by early abuse. Childhood symptoms include not only defiance but also slow language and academic development.

During adolescence, the criminal records of both types may be similar. However, if adolescence-limited delinquents can be protected from various snares (such as quitting school, entering prison, drug addiction, early parenthood), they outgrow their criminal behavior. This is confirmed by other research: Few delinquent youths who are not imprisoned continue to be criminals in early adulthood (Monahan et al., 2009). On the other hand, longitudinal research on adolescents randomly assigned to judges who are likely to send them to prison are less likely to complete high school (Aizer & Doyle, 2015).

CAUSES OF DELINQUENCY One way to reduce adolescent crime is to notice early behavior problems and then stop delinquency before the police become involved. Parents and schools need to develop strong and protective relationships with children, teaching them emotional regulation and prosocial behavior, as explained in earlier chapters. In adolescence, three pathways to dire consequences can be seen:

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Each of these pathways demands a different response. The rebelliousness of the first can be channeled or limited until maturation reduces impulsive anger. Those on the second pathway require stronger human relationships and moral education. Those on the third trajectory are the most serious; bullying aggression should be stopped in early childhood. In all cases, intervention is more effective at the early warning signs than at the first arrest (Loeber & Burke, 2011).

Adolescent crime in the United States and in many other nations has decreased in the past 20 years. Only half as many juveniles under age 18 are arrested for murder than was true in 1990. For almost every crime, boys are arrested and convicted at least twice as often as girls are.

No explanation for declining rates or gender differences is accepted by all scholars. Regarding gender, it is true that boys are more overtly aggressive and rebellious at every age, but this may be nurture, not nature (Loeber et al., 2013). Some studies find that female aggression is typically limited to family and friends, and therefore it is less likely to lead to arrest.

Regarding the decrease in adolescent crime, many possibilities have been suggested: fewer high-school dropouts (more education means less crime); wiser judges (who have community service as an option); better policing (arrests for misdemeanors are up, which may warn parents); smaller families (parents are more attentive to each of two children than each of twelve); better contraception and legal abortion (wanted children are less likely to become criminals); stricter drug laws (binge drinking and crack use increase crime); more immigrants (who are more law-abiding); less lead in the blood (early lead poisoning reduces brain functioning); and more.

Nonetheless, it remains true that adolescents break the law more than adults do: The arrest rate for 15- to 17-year-olds is twice that for those over 18. This disproportion holds for almost every crime (fraud, forgery, and embezzlement are exceptions) (FBI, 2013). Jail increases the risk that temporary rebellion will become a lifetime pattern, but delinquency should not be accepted. As with depression, angry adolescents cannot be ignored: They harm themselves as well as others.