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Psychiatric Times. Vol. 24 No. 13
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The Case for Adolescence

November 1, 2007
Dr Helper is a psychiatrist in private practice in Newton, Mass. She has written previously about managed care, the diagnostic assessment of children, the therapeutic space, and the developmental aspects of tree houses.

There are many practical problems in administering a nationwide competency test. What if the teen feels ill on the day of the test? How often should the test be administered? While the format of the test excerpt in the book is simple, what if the teen has a learning disability that makes standardized testing difficult? Should there be an age cutoff for the test? If adults cannot pass the test, should their rights be curtailed? Who would be responsible for administering the test, and would this make for tighter government control of families?

No doubt, competent teens should be encouraged to use their skills and to learn from life's challenges. However, if the excerpt in the book is representative, Epstein's competency test will fail to unambiguously separate teens who can "skip ahead" to adult life from those who need further maturation. The test looks at the capacity to function at the most superficial level and, thus, cannot provide the certainty that teens have accomplished appropriate developmental tasks for their age.

The flip side

Alternative viewpoints on adolescence abound. Marsha Levy-Warren, associate director of the Institute for Child, Adolescent, and Family Studies and author of The Adolescent Journey (Jason Aronson, 2000), has been treating adolescent patients for the past 30 years. In her opinion, teens who are ready for adult decision making may be those who have been thrust into a position of taking on the responsibilities of adult life. These children may have had early parental loss or chronically ill parents. Levy-Warren's work with these children has led her to conclude that these youngsters accept their fate but feel fearful and cheated out of adult care. She believes that teens who are allowed sufficient time to integrate their experience in the world, who consider situations from various vantage points, who have access to abstract thinking, and who have psychological differentiation will prove to be more capable adults.

Epstein pronounces the restrictions placed on teenagers' rights and privileges as a direct cause of delinquent behavior. Levy-Warren proposes instead that teens who act out and are delinquent are immature and that their behavior may be a way of expressing anger from assuming adult roles too soon. In Levy-Warren's view, gangs usually include teens who are looking for a leader—essentially a parent surrogate—to make decisions for them.

In Huck's Raft: A History of American Childhood (Belknap Press, 2004), Steven Mintz, a leading authority on the history of families and children, cited studies by the Guttmacher Institute that relate the rise in older-teen pregnancies—a marker of acting-out behavior—to poverty, lack of economic opportunity, low self-esteem, and the longing for a long-term relationship with the child. Contrary to Epstein's assertion, the studies found no evidence that restrictive laws concerning sex and marriage contribute to teen pregnancy.

On abortion

Epstein spotlights the work of Jennifer Soper, a former University of Alabama law student, who wrote a paper in 1999 on abortion statutes across the nation. In addressing the difficulty faced by pregnant teens who live in states where they cannot legally decide about their own medical care, including abortion, Soper brings up a complex set of issues that are closely related to Epstein's concerns.

She points out that if pregnant teens are forced to gain parental or court consent to have an abortion, their own input into this life-changing decision might not be taken into account. Judges, she reports, have different ways to assess a teen's ability to decide about her own abortion: one girl was asked about her knowledge of electricity, while another was asked to describe hemorrhage and its consequences.

Soper looks at the various definitions of "age of legal majority," physical maturity and its relationship to intellectual maturity, competency versus emotional maturity, and experience as a contributor to wisdom. She differentiates between capacity, which is the ability to understand the nature and effects of one's acts, and competency, which she defines as the ability to understand problems and make decisions.

By Soper's standard, Epstein's test is truly a capacity test, which is less valuable in assessing whether a teen is capable of handling adult responsibilities. Soper and Epstein are on the same path: How does one discover who is capable of making major medical decisions without resorting to an arbitrary age cutoff?

The Case Against Adolescence struggles to change the artificial way in which society lumps teens. Not all teens of the same age are at the same stage of development. Epstein has not found a solution to the challenge of identifying when a teen is ready for the responsibilities of adult life. There are many ways for competent teens to enjoy their lives without full adult rights. How about reading, creative writing, music, sports, or joining groups of teens with similar passions? Supporting our children in developing their skills is my solution to the regression and acting-out behavior that Epstein believes to be a dire problem in our culture.

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