ISSN 1363-8394

Journal of Adolescent Health
and Welfare

Volume
10 - No 1 - Spring 1997

Incorporating
the Newsletter of the International Regional Chapter of the Society for
Adolescent Medicine

Letter from the editor -

Dear Colleagues,

Happy New Year 1997.
The beginning of our second decade. Last year was VERY
busy with the Reunions and the young parents work reaching the fifteen year
follow up; the Blues Brothers tenth Anniversary Party; the Journal coming of
age with registration with the British Library; and of course ... the
conference ....

The conference exceeded all our expectations. I
could not have dreamed of it succeeding as well as it did! Over 460 people
attending with quite a number being turned away ..the
biggest conference ever to be held at the Royal College of Physicians.
Proceedings will be available soon - please send in your orders.

Our scientific meeting this year will be our usual
evening meeting at the Royal Society of Medicine in October 97 but we are
planning a two day conference at Royal College of Physicians in October 1998 -
Early application is advised to avoid disappointment!  Teaching and academic activities will be
very much to the fore in 1997 with a return, by popular demand, of our seminars
at Youth Support House. Details of the first five appear in this edition and
since places are limited you are advised to fax bookings as soon as possible.

Please remember that we very much encourage
colleagues to send in manuscripts for publication. We welcome descriptions of
qualitative research, which often get short shrift elsewhere, and personal
accounts of interventions or experiences with young people.

Once more, best wishes and thanks for
all your support throughout the years and sincere good wishes for a prosperous
1997.

Diana
Birch

Director
Youth Support

Contents

Letter from the
Editor

2

“The Adolescent
parent - a fifteen year longitudinal study of school age mothers and  their children” Diana Birch

17

Twelfth Forum
Meeting - Self Harming Behaviour and eating disorder.

3

The Child that
Rocks the Cradle’

19

International
Chapter News

4

News in collage

26

IRC SAM 1997 -
‘Poverty and Neglect - deprived youth in varied societies’

5

Youth Support
Professional Training - Seminar Programme 1997

27

Youth Support
Appeal

6

Proceedings
conference 1996

27

‘Pearl of
the Orient-Adolescent Care in HongKong

7

Adolescent
Health - conference 1998

28

Adolescents
Perception of their own Health Problems as surveyed in 1959 and 1994  - Inge Bo

12

Youth Support are pleased to invite you to attend
our

Twelfth Forum Meeting

At - The Royal
Society of Medicine

1 Wimpole Street,
London WC1

Thursday 23rd
October 1996 - 6-9pm

Self Harming
Behaviours and Eating Disorder

Name
...................................................................   Designation ...........................................

Address
...............................................................   Tel no ....................................................

..............................................................    Fax no
....................................................

Please
reserve ............ places at the Forum meeting for myself
and colleagues (attach list of names please).  Please ring category below and enclose
appropriate payment.

Non member -
£15 per person.

Forum
member  free
(plus free guest).
Students free.
Young People free.

OR -      I wish to apply
for forum membership and enclose £20 in payment.

Please
send to :-     Youth Support
Conference Administration

13 Crescent Road, London, BR3 2NF.
FAX 0181 659 3309

- International Chapter News -

News of the International
Regional Chapter (IRC) of SAM

(Society for Adolescent Medicine)

Co Chairs -
Diana Birch Gustavo Girard
Treasurer Aric Schichor

London      Buenos Aires              Connecticut

England     Argentina                 USA

Looking forward
to SAM 1997 - It is just around the corner - an earlier date than usual this
year. As discussed in the last newsletter we will be holding our IRC institute. This will take place 9am to 5pm
on Wednesday March 5th.
See the SAM programme booklet for details of venue. At the time of going to
press the format was as overleaf - but please note that ,
as is usual for our International sessions, we would be delighted to include
other speakers. Please FAX as soon as possible to let me know if you have
something you would like to present.

We are VERY
fortunate this year to have secured a two way dialogue between USA based SAM
members and the International members with the inclusion in the Institute
programme of a welcome from Gail Slap who will be dropping in to greet members
- and also our opening speaker will be Bob Blum - who is always excellent at
setting the tone of the meeting - so let’s have a 100% turnout and
prepare to be inspired! We also have an important contribution from PAHO and a
truly world-wide spectrum of presentations. As they say in the British
Parliament - this is a three line whip
- (a term for an important session arising from the notice to attend being
underlined three times) - it means that excuses have to be written in blood -
yours! Or there may be a short trip to the Tower of London ...

Again, I would
also like to suggest that we all bring examples of our work in our countries -
leaflets or display material which could be displayed in our meeting room and
give members a better feel of the work we are separately involved in back in
our own countries.

The other
events are our usual International dinner
which as usual will be in a restaurant outside the hotel - keep your eye on the
notice board at SAM for details and book with Edie at the registration desk.
The dinner will be on Friday night March
7th.

The Chapter business meeting will be a
lunch this year as opposed to a breakfast - Don’t ask me why! The lunch
is scheduled for 12.30-2pm
on Friday 7th. Please
note that this is NOT an alternative to the evening dinner - the lunch is a
business meeting over a working lunch - the evening dinner is a social occasion
- and usually a very good one!

The other item
which you will  note on the
timetable to have an ‘International’ flavour to it is a workshop on Teenage pregnancy which SAM
have asked me to hold on Saturday 8th
March at 1.45pm. If any colleagues have material which they would like to
include please let me know - I do hope many IRC members will attend that
session which should provide lively discussion.

Society for
Adolescent Medicine

San
Francisco March 5-9 1997

‘Institute’ to be held by the
International Regional Chapter (IRC)

9am to 5pm on Wednesday March 5th 1997

‘Poverty
and Neglect - Deprived Youth in varied societies’

Description -  Deprivation comes in all shapes and
sizes - Those of us working in so called ‘developed’ countries
can sometimes be oblivious of the degree of deprivation experienced by our
Youth. Class differences still exist in terms of perinatal
mortality, birth weights and growth in schoolchildren. Adolescents from
differing subcultures within the same city may experience enormous variations
in their socio-economic circumstances .

Presentations
will highlight the presence of deprivation in all aspects of youth culture -
from street children to poverty in inner city Europe and north America and
including the ‘poverty traps’ such as early childbearing and the
‘danger areas’ of child and youth labour and ‘survival
sex’.

Objectives -   To
heighten awareness of the areas of deprivation and youth poverty, to exchange
information on a wide experience of cross cultural issues and to discuss
possible interventions available to the adolescent health practitioner.

Format - This institute is
suitable for all conference participants whatever their level of experience.
The institute will involve didactic component - in terms of the main
presentations and interactive periods of discussion where the participants may
be divided into groups addressing a subtheme and
reporting back to the group as a whole..

Programme -
“Global trends in Adolescent Health -
From where have we come - where are we going?”  Robert
Blum ,Minnesota.:    “A culture of
poverty?” - Inner city deprivation and teen pregnancy.  Diana Birch ,England.:   “PAHO - Lines of Action to
face the challenge of Adolescents in special circumstances”  Matilda Maddaleno, Chile:   “Poverty and early
childbearing - A Lisbon ghetto” Helena
Fonseca, Portugal. :
“Deprivation among immigrant Youth” - Manny Chigier  Israel  :  “Deprivation in Latin America - how are youth
affected? ” Gustavo Girard - Argentina.:  “Living on the Streets - Health
aspects of life for street youth in Brazil”
Irene Adams - Belo Horizonte, Brazil:  “Nutritional issues affecting
Youth” Semi Snadjerman, Israel
:  “Attitudes and Practices of
Physicians in Israel regarding adolescent Medicine” -  Daniel Hardoff
- Haifa. :
“Marginalized Youth in British Columbia”  including aboriginal and street youth.
Roger Tonkin, Vancouver, Canada.

“Pearl of the Orient”

Hong
Kong is known
by most as a thriving, vibrant business centre, high rise office buildings, a plethora of banks, shopping malls, designer clothes
outlets and expensive living. The other side of this ‘Pearl of the
Orient’ is overcrowded slum areas, drug abuse, crime, teenage
prostitution and the general anxiety, insecurity of a culture ‘caught
between’. In a few short months Hong Kong will cease to cling to the vestige of the British
culture and will revert to Chinese rule. Many have left fearing communist
changes, but the transition has been promised to be gentle and most now seem
hopeful for the future. For the more deprived youth of Hong Kong, such political anxiety passes over
their heads.

Within this
tapestry of cultures, two organisations are doing excellent work to support and
nurture young people. The Hong Kong
council for social services , and the Queen Elizabeth Hospital in Kowloon which has a flourishing adolescent unit
led by Dr Winnie Tse.
Hopefully we will hear more of the unit in the future and we hope that Dr Tse and colleagues may be able to attend our conference in
1998. The Council for social services visited Youth Support House in 1994 and I
paid a return visit there and to the Hospital in September 1996. The following
cases were the basis for some of our discussions - we welcome further comment
from readers.

Case 1

Prepared by
Wong Yin Yu and Wu Yuk Shan  (Chinese YMCA)

Client A is a
fourteen year old girl.  She has had
sex for the past year with many different boy friends.  She claims that she is not a casual girl
because she only makes love with her boy friend at the time.  She only makes love with the ones she
really likes.  But, she falls in
love very easily and quickly, even on the first date.

She had an
abortion once.  Her mother (a
fortune-teller) told her that she would only have one child in her life.  After being told this information, she
was even more casual with sex.  She
did not ask her sex partner to use a condom and changed sex partners
frequently.  She was also very
materialistic.  If a boy could
provide her with more things she would stay with him longer.  Otherwise, she would change
partner.  She is now living with her
boy friend and has sex regularly.
She depends on her boy friend to support her.

As a social
worker, I have discussed with her her attitude
towards sex.  I have taught her sex
education, including details concerning the prevention of pregnancy and
sexually transmitted diseases.
Actually, she has a good relationship with me.  She agreed with my opinion, but she did
not practice safer sex.  She needs
me to share her feelings, but she does not accept my advice.  I do not know what I can do next with
this case.

Discussion -   This girl is following a pattern of serial monogamy
- where she sees herself as not promiscuous because she is only able to
perceive the one relationship at a time. When in this
relationship she is totally committed and ‘in love’ perceiving the
relationship as her solution to life’s problems and completely in denial
that she has ever been ‘in love’ with anyone else. Just as
frequently teenage girls see each act of sex as a ‘one off’ and do
not see that they are having sex regularly or frequently - so each sexual
encounter can be seen as unique and leaving a girl unable to appreciate the
‘continuum’ of her behaviour. A poorly developed sense of future
time perspective plus denial of responsibility for and consequences of her
behaviour conspire to maintain a potentially harmful lifestyle.

The denial is
reinforced by ‘magical protection’ - inherent in the young
person’s feelings of invincibility and ‘it could never happen to
me’ - but also in this case specifically enhanced by the mother’s
fortune telling and prophecy of her daughter having only one child. Hence the
girl does not see a need for protection either from unwanted pregnancy or from
sexually transmitted disease.

By falling
headlong into each new relationship the girl is also demonstrating that she has
low self worth and sees her only value in a sexual relationship. by approaching
relationships in this way she is also setting herself up to inevitably make
relationships with a poor prognosis for stability, little depth and constancy -
nevertheless she becomes dependant on her men friends and looks to them for
material support - a pattern which will ensure disappointment and recurrent let
down. Work needs to be done to help her to become more self reliant and self
confident, to build on her self worth and help her to see other sources of self
value rather than merely sexual attraction and sexual conquest.

Picture from newspaper - hong kong

Case 2

Client’s
Basic Information

The client was
a boy of 17 who was studying form 4 at a secondary school.  He was living with his father, mother
and one younger brother who was mentally retarded.

Nature of
the Problem  The client had received counselling
services from the school social worker for four years because of his problem
related to dating girls.  Since
primary 6 the client has been dating different girls.  He has dated 10 girls up to now and
revealed that he has had sex with one or two girlfriends.  He admitted that the
‘ongoing’ dating behaviour was due to his fear of loneliness.  The client actually wished to maintain a
stable relationship with one girl but he did not know how to do this.  As a result, each relationship lasted
only a short time.  He described his
relationships with girls as only out of  habit and not out of love.

Recently, he
had a ‘one night stand’ with his former girlfriend.  However, he disclosed that his feelings
were hurt after the relationship.
He was further confused with love, sex and affection after this
experience.

Service Rendered  Through the interviews with the client, effort
was made to discuss the differences between love, sex and affection.  Workers also helped the client to share
and ventilate such feelings as frustration, loneliness and guilt.  The Client gradually understood more
about his own needs.  Emphasis was
put on logical thinking about relationships with the opposite sex so that the
client might become more rational when he encountered emotional disturbances.

Worker’s
Assessment

The
Client’s personality is rather emotional.  Moreover, his emotion easily fluctuates
by the disturbances created by the unstable love affairs.

However, the
client has lost interest in study and other hobbies.  He also can not obtain warmth and
affection from his family members and peers.  Therefore the client had the tendency to
compensate for these frustrations by trying to maintain relationships with the
opposite sex.

Discussion   This boy is unable to distinguish friendship
and warmth in a relationship - with a sexual relationship. In general he is
shying away from and seems afraid of closeness and true ‘intimacy’ - which is in effect an
emotional matter. He is limiting himself to physical relationships as a defence
against emotional involvement.

This
‘splitting’ of emotional / physical was challenged when he briefly
went back to his first girlfriend - and this could explain his being confused
and uncomfortable in that situation.

It is likely
that his difficulty with closeness and expression of emotion relates to his
family of origin where possibly feelings regarding his handicapped brother were
suppressed and not shared within the family circle.

Case 3

prepared
by Tsang Wai Hung

Client A was
referred by his mother.  As
described by his mother, the client had behaved strangely in recent years.  He often washed his hands for over an
hour daily.  He always thought that
the things in his home were ‘dirty’ and thus he had to wear gloves
when touching things.  Recently, he
even used toothpaste to clean his hands rather than using soap.  His mother claimed that his washing
behaviour had affected his daily functioning such as late for school, and so
she was extremely worried about her son’s behaviour.

Client A
described that he had some sex related problem such as masturbation.  He had once watched a third-class film
in his home.  So, his mother was
worried that his washing behaviour was connected with his sex related problem.

Discussion  - It is important to look at this boy’s problems in perspective
and not to over react to what might be a normal situation. Although this could
be the beginning of an obsessional compulsive
disorder it might not be and treating it as an ‘illness’ can
compound this young man’s problems as her will then see himself as
‘not normal’ - a hint of this is seen in the fact that it is the
mother who has made the referral and not the boy. Is he worried himself? How
did mother know? It would seem unusual for mother and son to discuss
masturbation and maybe the mother is rather overdominant
and ‘suffocating’ - certainly this could be explored further. Young
people can become anxiety and guilt ridden when experimenting with masturbation
and it is often difficult for boys to know ‘how much is normal’.
Anxiety leading to cleansing rituals and obsessive behaviour can be part of a
transient teenage condition which would be expected to resolve with attention
to accurate sex education information and reassurance of normality.

Case 4

Prepared by Ng Wai Ngan

Client A is
growing up in a single parent family.
He is now 14 years old and lives with his mother.  In the past six months, he has said he
has had frequent masturbation.  He
even wanted to masturbate during lessons.
This disturbed his daily life.
Besides, the targets of his masturbation were his mother and his aunt
whom he liked.  He did not think
there was any problem.  He said he
was only masturbating and he did not do any action to abuse or threaten his
mother.

Questions:
1. What is the reason behind his
behaviour?   2. Do we need to
stop his behaviour?  3. If he
continues, would he really sexually abuse his mother?

Discussion  - It is often difficult to gauge the degree of ‘normality’
in a given situation. Is this boy going through a normal process of development
part of which involves masturbation - or is he in fact obsessed with
masturbatory practices which are worrying him and interfering with his everyday
life? He reports wanting to masturbate during lessons - but is not actually
putting such fantasies into practice. Looking at the situation from a positive
perspective - one could say that it might not be surprising that a boy raised
in a female household living with mother might fantasise about her sexually.
Perhaps this is a relatively innocent and transient masturbatory fantasy in a
boy exploring his developing sexuality.

However this
might also have a much more sinister interpretation - and this became more
evident when a female worker interviewing the boy described feeling threatened
and uncomfortable in his presence. One could be seeing a boy rebelling against
the female dominated household without a positive male role figure - who is
exerting his ‘maleness’ in a threatening and dominating manner by
making his mother and aunt the focus of his masturbatory fantasies. It is
likely that he could enter relationships with other women also from this
attitude of control and dominance and hence might well become involved in
violent or sadistic sex. He is likely to be abusive to other women who would
then ‘represent’ his mother - but it is unlikely he would abuse his
mother in reality.

Adolescents’
Perception of their own Health Problems

as
surveyed in 1959 and in 1994.

Inge
Bo

Stavanger College, Department of Cultural Studies and
Social Sciences, POB 2557 N-4004 Stavanger, Norway

Presented
4th European Forum on Adolescent Health Lisbon July 1996.

This paper is
based on a more extensive study, the goal of which has been to compare what a
1959 cohort of high school students experienced as their problem world with the
experience of a corresponding sample of 1994 students.

Instrument - The mapping was accomplished with a Norwegian
version of The Mooney Problem Check Lit (MPCL) This
contains 330 statements relating to all kinds of problems a youth might have.
These items are grouped in domains like health, psycho-social relations,
courtship sex, family life, school, religion morals - 11 altogether. The check
list is constructed so that the problem areas run horizontally in 6 blocks of 5
items across three parallel pages (30 statements within each area). The
statements alternate from the trivial (Feel I do not get enough physical
exercise, I need to learn how to save money) to the more dramatic (Do not feel
sound and healthy, feel I cannot stand my problems any longer).

Sample - The original 1959 sample consisted of 310 junior
and high school students, whereas the 1994 sample contains 296 students. Both
groups have an age range of 14-17 years with an average of 16 years
(st.dev.1.00 and 1.05 respectively).
To secure similarity between the samples, both were drawn from the same
schools and/or equal socio-economic catchment areas
(in case the original school did not exist any longer). Since the survey was
meant to be comparative, the samples should be as equal as possible also in
terms of other characteristics, for example in relation to academic
achievement. Here we were confronted with another problem. In the fifties
schooling beyond the elementary stage was elective. At that time only half of
the teenage Oslo population attended junior or high school. Today almost 100% attend
junior stage compulsory basic school corresponding to the former lower high
school stage in 1959 (age 14-16) whereas about 75% between the age of l7 and l9
in Oslo attend high school.

It is
documented that those former students belonged to the school achievers as
opposed to those who ended their schooling at the age of 14-15 years. To meet
this challenge the 94-sample was divided into two groups of about equal size
based on their academic competence. In the continuation these groups are
referred to as 94/A and 94/B, containing the achievers
and the non-achievers respectively.

None in any of
the cohorts left the interview situation. Five students withdrew before the
start, and ten were absent on the day the forms were filled. Reasons included
visits to the dentist remedial tuition, illness Only 2
forms were rejected.

Procedure - Identical sets of the MPCL were given to students
in the two cohorts. The inventory is self administered with directions on the
cover. Students are asked to read each item and tick ones which are of concern.
They are also invited to weight the ones that concern them
most. Students were informed that anonymity was guaranteed and that only the
investigator and his coding team had access to completed sheets.

The first data
collection by Ingrid Jacobsen(Bo) was completed in
October 1959 and replication was done at the same time of the year 35 years
later by the author In both surveys students filled the forms during one class
period finishing within 45 minutes. Original protocols from
the 59-survey have been followed and coded with 94 data.

Analytical methods - Data was analysed in a SPSS system file. Three
measurements have been used:- 1. frequencies
of ticked single items 2.counts of ticked problems within certain clusters and
areas 3.loaded strain scores within certain clusters and areas

As
mentioned statements lie along a continuum from minor to major concerns. In order to determine the degree of
strain inherent in each item, seven experts in the field of education,
psychology, therapy and counselling - all at professor level - were asked to
weight the problems according to felt seriousness. This was done independently
along a rating scale consisting of steps from 1 to 5, in which 5 represents the
most serious. For instance the item do
not have a suitable place for my homework was ascribed score 1, whereas Afraid of being alone was scored 5 by
all raters. Inter rater
reliability was in the eighties i.e.trustworthy.

To identify
clusters of problems, variables within each sphere have undergone factor
analysis to construct indices or dimensions. Statistical instruments have been
frequencies, correlations and analysis of variance (ANOVA).

Differences
between 1959 and 1994 in terms of mean strain score

N         Girls         Boys        Sum

--------------------------------------------------------

Sample

1959          310       8.17           7.17     7.64

1994A         134       12.59
9.53     11.38

2994B         162       12.96         10.02     11.42

1994
Total    296       12.77
9.82     11.48

--------------------------------------------------------

Sum       606       10.58
8.38     11.49

Results

Differences
between 1959 and 1994 groups - total of strain scores for the health area -  The column to
the right displays that across all 30 statements in the field of health the 94
groups have larger means than the 59 group. The two mid columns show that
94-girls experience most problems, whereas the 59-boys experience least. The
variance between the groups is strongly significant (p-0.1%) Further analyses
of relationship between the three sample groups, gender and age show that the
highest strain scores are found among the oldest girls (17 years) in the 94/A group with a mean of l7. This is more than twice the
boys’ score in this group. When the socio-economic level is considered
the oldest B-girls in the lowest social group have the absolute highest score
-17.4. Least problem experience is found among the 59-boys particularly among
the 14-15 year olds.

Differences
between the groups - dimension.There is no
significant difference between the groups when it comes to the index of Problems with bodily defect. For all the
others the difference between 59 and the 94-groups is in favour of the
59-students who feel better off healthwise. The
differences are significantly below the 5% level and below the 7% level for Appearance.

Tired/generally in bad shape Within all the three sample groups the girls
report more concern than the boys. In the groups-gender-age-interaction the 94
sample exceeds the 59 counterparts in all cells. This tendency relates in
particular to the 94 girls among whom the eldest, school achieving girls have the highest scores. All the boys groups
- irrespective of cohort - have lower scores than the girls. The lowest score
is found among 14-15 year old 59 boys in the low social group.

Problems with appearance Also here the girls exceed the boys
within all sub groups. In the group-gender-age scheme we find the greatest
concerns among the youngest B girls (average score 4.3 as opposed to 2.1 for
the total 94 group). Also the oldest female achievers get a fairly high mean
score(3.4) If we add the SES factor into the model it is among the girls in the
low SES group, particularly the youngest in this group, we identify the highest
strain. Otherwise compared with the average score for the total sample, all the
boys come out well below the average. The oldest 59-boys score definitely
lowest. On the whole, the l7 years boys in the various groups irrespective of
cohort care least about appearance.

Become easily ill- Again girls report more strain than male counterparts.The ANOVA print out shows 94 girls marked
highest number of problems This relates particularly
to the non-achieving girls (2.7 versus a mean of 1.8 for total group).
Considering gender and age, we find that the oldest 94 girls among achievers
and the oldest non-achieving girls in the low SES category exceed all other
groups. Boys in both the two cohorts come out barely below the total average.
Nevertheless, 94 boys report more concern than their counterparts in the 59
sample. In accordance with the tendency reported above, the l7 year old boys
appear to have least worry on this index.

Problems with food and weight We find those with the greatest anxiety
among 94 non achievers. The genders have the same means -2.0
v 1.4 for the total sample. On combining gender and age, 16yr old girls
in this group stand out with a highest strain score (2.8) Difference between 59
and 94 achievers is very small.

Problems
causing increasing concern over 35 yrs (rank order):

1    Bad eating habits

2    Feeling unhealthy

3    Suffer from allergies

4    Easily tired

5    Easily ill

It appears in
particular that the 59 students are much less anxious about their general
health than their 94 counterparts. Almost half the 94 female achievers were
anxious about lack of sleep!

DISCUSSION

A short summary.
The purpose of the
project has been to compare a 1959 and a 1994 cohort of high school students in
terms of their perception of health problems. The data collection has been
based on a problem check list containing 30 statements graduating in
seriousness from relatively minor difficulties to major concerns. These have
been weighed separately by 7 experts in relation to mental hygiene perspective.
The study was first conducted in Oslo in 1959. The protocols were stored over
the years. This situation offered a unique opportunity to replicate the study.
This was done in the same schools catchment areas 35
years later. About 600 students have been involved with 50/50 in each of the
two cohorts. Since the 59 group is believed to belong to the more school
competent part of the teenage Oslo population, the 94 sample was split into
dichotomous groupings - A and B - on the ground of academic performance, the A
group being most comparative to the 59 sample. SPSS programmes on frequency
counts and ANOVAs have been used as main statistical procedures. Comparisons
have been conducted between all the three sample groups - 59, 94A and 94B

The results show
overwhelmingly that today’s Oslo high school youth experience much more
concern about their health and physical development than the corresponding 59
generation. Main tendencies can be summarised in the following points: 1.The 94
sample both genders and subgroups exceed the 59 sample on the total record
across all the 30 items.

2.Broken down to four dimensions and to single
items, the same picture emerges- the 94 students report more health concern.

3.Most of the statistically significant
differences are found between 59 and 94 non achievers, although there exist
very few variables on which the 59 group report larger problems than the 94
achievers. Generally the non-achieving group among the 94s exhibits more
anxiety than the achievers. Exceptions are items relating to general fitness,
lack of sleep, allergies and the feeling of being overweight. Here the brighter
students exceed.

4.Taken as a whole, the girls in all sub-groups
declare larger health concern than the boys, the 94B girls generally exceeding
the other sub-divisions. The 1959 boys report least concern. School
competent 94 girls, deviate from this general pattern by being particularly
sensitive to being in good shape, lack of sleep, allergies and overweight.

5. Age wise the
l7 year olds among the girl achievers appear to be the most sensitive to the
mentioned problems above. In general, the youngest 59 boys report least worry.
Otherwise there is no clear cut pattern in terms of age.

6.In accordance with our expectations
students in both cohorts belonging to the lower socio-economic category report
greatest concern. Highest problem scores are found among various age groups in
the lower class of Bs.For example problems connected
to appearance. However, they are less concerned about being fit.

Reflections - The MPCL instrument is not a test.It
should be looked upon as an inventory developed to help students become aware
of their personal concerns and bring them into the open.The
list has had extensive use in research and counselling. A limitation is that it
only elicits concerns that the student is conscious of and willing to express.
Unconscious anxiety is not revealed. However this is no reason to believe that
study results are unreliable.

Now
to the results. We
have been very negatively oriented in the sense that we have concentrated on students stresses and strains. Time has come to point out
that most youth in the two cohorts report few problems. They appear to be both
healthy and satisfied. For instance, 20% of 59s and 12% of 94s do not tick any
health problems. Medians for the two cohorts are 2 and 3 concerns respectively.
Only 4% of the 59 sample and 10% of 94s checked 7 problems or more.

The present
generation appears much more sensitive and concerned about health and
development than their parent’s generation at the same age particularly
with regard to fitness, nutrition, lassitude, allergies, appearance and weight.
One could argue that a difference between the cohorts concerns frankness.
Perhaps the atmosphere in Norway in the 90s is generally more expressive than
the 50s in that the students today may feel freer to express their emotional
problems. This situation is not peculiar to MPCL but inherent in any
personality or attitude scale It is also a health
statistic that today children are much more allergic than years ago. This fact
is mirrored in the data and strengthens its validity. Public focus on health
initiated by the authorities during recent decades has had a consciousness
raising effect. Likewise and probably more significantly, commercial hysteric
pressure via mass media may have penetrated young minds. Two additional factors
may be at work; better general education emphasising the importance of good
health habits. At the same time daily routines such as being passive in front
of the tube eating junk food, might have changed for the worse explaining
concerns over lack of sleep, insufficient exercise, overweight and feeling
generally unhealthy.

“The Adolescent Parent - A fifteen
year LONGITUDINAL study of school age mothers and their children.”

Diana M.L.Birch

Abstract
- Most behaviour,
including early childbearing is measured as problematic in terms of how it
measures up to the norms and values of a particular society or group. In many
developed nations school age pregnancy is regarded as a ‘deviant’ pattern  arising
from lack of contraceptive availability, poverty and ignorance and resulting in
poor parenting standards, and family disturbance. For a great many young
mothers however pregnancy is desirable and very much the norm of their family
culture.  Continuing this argument,
there are also many cultures where early marriage and pregnancy is very much
desired and one should separate the ‘problems’ raised by cultural
expectations and lack of societal support from the personal and individual
conflicts and stresses which might be caused by early pregnancy.

The findings of
a fifteen year longitudinal study of nearly 200 young families in which the
mother gave birth under the age of 16 years has provided information which
refutes many of the stereotypic views regarding young parents.  It illustrates how the presence of a
supportive family leads to an improved prognosis for young mothers and their
children and gives insights into positive and negative predictive factors. Some
unexpected outcomes and their possible aetiology are discussed.

Consideration
is given to approaches which may enable professionals to confront the
‘cultural trap’ in which many young people are caught - in that
those suffering the worst deprivation in early childhood, those raised in the
‘care’ system and children’s homes are those young parents
most likely to perpetuate the cycle of deprivation for their offspring.

Introduction
-

“The Doll that Grew Up”     Lorna’s bedroom was like that of
any fourteen year old - walls papered with posters and cut outs from teen
magazines and bits of  record covers
- football scarf draped round the light switch and a scatter of old cinema
tickets and memorabilia blue-tacked to the mirror. The floor obscured by
discarded school books and dirty underwear with the odd sweet wrapper, cotton
wool balls and mother’s ‘borrowed’ best shoes. Mixed in among
the tea shirt collection on the bed lay the required row of furry animals and
mascots - teddy, pink pig, Emu puppet, cabbage patch
kid doll which she had pleaded for on her tenth birthday, grotesque stuffed
‘something’ won at the Easter fair .. and
a baby.

She had never
gone out much; was certainly not promiscuous and had no boyfriend then, now or
ever. The baby was conceived on an ill-fated outing with friends when the
little ‘stay at home’ was persuaded to have one taste of the bright
life. Returning from hospital with little David she sat shell shocked in her
room -not knowing whether to play with baby or toys,alternating between them with mother anxiously
hovering. She slept with David beside her in his carry cot and Teddy snuggled
up to her inside the covers.

Fifteen years
later she still has no boyfriend, she hardly ever goes
out except to visit Mum. David is a fine boy, quiet and well mannered and his
mother’s only companion.

*   *   *   *   *

Sonia also got
pregnant at fourteen but was delighted to have her baby. Her one and only
boyfriend stuck by her and they are now married with a delightful family of
four children ranging in age from 14 to 6. Sonia is working and has taken up
professional training. She would like to become a therapist.

*    *    *    *    *

The lives of
young mothers have taken many turns along differing paths in the fifteen years
that we have followed them. For some it has been a success story, for others
the road has been paved with disaster - some are lonely and sad - others have
come through pain and hardship with immense fortitude. Whatever the outcome -
the one message that we need to learn from these stories is not to prejudge
young parents - there are many stereotypes and false impressions and whatever
concept we may have of teenage parenthood we are likely to be wrong.We need to keep an open mind and remember that all
parents young or old, are individuals and deserve unique attention.

*    *    *    *    *

The
study - “Are you my sister, Mummy?”- Early
studies of teenage pregnancy - This first part of the survey provided
an important database regarding pregnant schoolgirls and their circumstances.
It was a vital piece of work since previously available information had dealt
with American groups whose population was not comparable in any demographic or
social sense. We needed information on our own population to examine the
factors, risks and social stresses of the environment pertinent to British
teenagers. (Birch 1987)1
An information base was important in terms of understanding factors
which led to early pregnancy and childbearing - what motivated young people,
what the family’s influence might be and how we might intervene to help
at any stage.

Contact was
made with every school girl who became pregnant in a specific geographical area
- covered by a London Health District. School girls falling pregnant who by
intent or default continued their pregnancies within a time limit were included
- addition to the group began in 1980 and ceased in 1987. The first 126 cases
were analysed for baseline data and formed part of  an MD thesis (Birch 1986) 2;  150 cases were reported in the book
“Are you my sister, Mummy?” ;   174 entered long term study which
is fully described in “The child that rocks the cradle” (Birch
1996)3.

The initial
piece of research involved a number of stages :-

·
base
line information gathering during the pregnancy

·
data
regarding the birth itself

·
six
week follow up

·
six
month follow up

·
one
year follow up

·
two
year follow up

The fifteen year survey.  Further survey points have been at
:-

·
five
years follow up

·
ten
years follow up

·
fifteen
years follow up

Findings and comments -

It is hard to
do justice in a paper to the findings of a fifteen year survey which has
generated volumes of data on this population - both in terms of statistical
facts and, perhaps even more importantly,
in terms of qualitative information. The following is thus a brief
summary of some of the more pertinent features of the study.

A. Fertility and Repeat pregnancy      Those who have been pregnant as
schoolgirls are a highly fertile population. They begin their childbearing
career at an early age and are likely to remain fertile during a large segment
of their life span. Rate of repeat pregnancies continued to be high throughout
the years. Each follow up showed a high number of girls had become pregnant
again since the last interview.

Childbearing
patterns- Three sub-populations were identifyable :-   (Fig
2)

1)Single
pregnancies - girls who
have one pregnancy only. (12%)

2) Constant repeaters - who maintain a
high level of repeat pregnancy throughout (68%)

3)Late repeaters - girls who have one
pregnancy as a schoolgirl then do not have repeat pregnancy until they enter a
second later stage of childbearing (adult childbearing stage) (20%)

This group of
young women  have
a higher fertility rate than other girls of the same age. The risk of pregnancy
is particularly high during the first year after the birth of the first child
when teenage mums are eight times more likely to get pregnant (250 live births
per thousand) than the general teenage (< 20) population (30 per thousand) 4.

Girls who had
been in care tended to have more pregnancies over the years than those who had
not been in care. Girls from more difficult circumstances may have a greater
need to repeat their pregnancies. They form a greater percentage (90%) of the
‘constant repeater’ group.

B. Patterns of Relationships.

Staying Together-Single Partners.    The myth of the promiscuous schoolgirl mother was
exploded when it was noted that at the time of conception, over two thirds of
the couples had been together for more than six months and for over two thirds
of the girls this was their first sexual relationship. Fifteen years later over
a third of the girls (39%) have only ever had one boyfriend. For another 12%
the ‘rescuing’ boy who entered their lives at an early stage during
pregnancy or in the first months of the baby’s life became an
‘early replacement father’ the only other man on the scene. So 51%
of the girls only had one significant relationship.

Multiple Partners.Nearly half the sample(49%)follow
serial monogamy of more than two partners. Girls who ‘bounce’ from
one man to another without breaking down have a high level of flexibility which
allows them to adapt to  differing
domestic arrangements - but a low ability to learn from their experiences -
they thus continue to ‘repeat’ their pattern. The parade of
parenting partners takes a toll - both on children in terms of instability  inconstant boundaries and on the mothers
experiencing recurrent loss and being left ‘holding the baby’ quite
literally over and over again.  A
need to fill a ‘father shaped’ gap in her life coupled with low
self esteem means that she is likely to form a relationship with an inadequate
man or a boy with problems of his own. He is placed under enormous pressure to
cope with a needy ‘instant family’. He too does not enter the arena
in a pristine state - nor does he leave the scene unscathed.

Asexual lives.   Girls without
Boyfriends.  10% of girls did not ever have a real
relationship with a boy after the birth of their first and only child. They
feel let down by society and by the father of their child and do not seek
sexual relationships in
the future. Some never actually had a boyfriend EVER.

The Late Relationship - the
‘Adult’ Relationship.   Many mothers who had been through
painful periods in their lives made a deliberate change of lifestyle and passed
through a threshold in identifying with their new ‘adult’ selves. They had ‘teen’ and later
their ‘adult’ lives.

C. Families

There are many
different family structures. Our society generally has moved away from the idea
of the nuclear family - mother, father and two children as being the only
acceptable pattern. Single parent families are much more the ‘norm’
than when this study commenced in the early eighties. It has also become more
acceptable for couples to live together outside  marriage.

The family of origin of the teenage
mothers. They generally came from large single
parent families with an average of five children. Two thirds of their natural
fathers were absent from the household
and the ‘father figure’ was usually a man who moved in and
out of the ‘family’ fathering more children and then going on his
way. Neither fathers nor stepfathers figured significantly in most girls lives

Just under half
the girls (45%) got on with their mothers but in half the of
these cases -a fifth of the whole- the relationship was described as
‘over close’ and suffocating.
The families fell into the main groups of  -  good relationships with both parents ;
absent or weak father and dominant or poor relationship with mother; both
parents absent or ineffectual. To a large extent this family pattern was
recreated in the next generation.

Baby Fathers - It was noted in the early part of the study that
the boyfriends of schoolgirl mothers tended to be of similar background and
characteristics - dropping out of school, not often in employment,  having similar
family histories of school age pregnancies with regard to their mothers and
sisters and had similar needs to become parents.

Despite all the
negative connotations and difficulties a reasonably high number of the natural
fathers of the first born children were still in contact with their offspring
at the age of two years. (45%). Past this stage a number
of ‘baby-fathers’ dropped out of the children’s lives with
the result that by the time the children were in their teens themselves only
20% of fathers were still in touch with their children. This figure was
significantly different for the partners of young mothers who had been in care
- they were ten times less likely to maintain contact with their children (2%).

Grandmothers often have a very hard time coping with their
children and grandchildren. It is also extremely difficult for a child brought
up by grandparents who may be too old to do some of the ‘parental’
task or have fun.  Children are also
immensely bereaved when grandparents who have been their prime carers
eventually die. Children who had been brought up by grandparents were markedly
deprived in comparison to those brought up by their parents.

D. The Children.

Child Care-Placement of Children.  The majority of children were brought up by their
natural mothers and lived with them throughout the time of the survey 80% of
the children were with their natural mothers at 5 years and this dropped very
slightly to 78% at 10 years and 75% at 15 years. Splitting the groups into
subgroups of girls who have been in care and those who had not, once more the
care group had a worse prognosis with only 62% continuing to care for their
children at 15 years as opposed to 82% of the non care group.

Children’s Views and Lifestyles The children of school age mothers are
like other children of the same age. As teenagers they have similar likes and
dislikes and indulge in all the usual teenage activities. In the main they came
across as a confident and healthy group.

School -Forty percent of the boys reported being bullied at
school -often this was part of a two way process of disruptive behaviour since
70% had behavioural problems relating to violence in school, fighting and
disregarding teachers. A quarter had been involved in something illegal.

The rates for
girls were lower.  20% had
behavioural problems at school and were disruptive in class. 35% were bullied
at school 6% had been involved minor crime

Relationships with Parents - 80% of boys and 95% of girls said they
get on with their parents.  Half the
boys and 70% of girls said they could talk to Mum about most things and 50% of
boys and  two thirds of girls said
they would confide in their mothers if they had problems.

Pregnant
schoolgirls often lack a father figure in their lives. Their sons seem greatly
affected by lack of a father within the household. It is the boys who appear to
be reaching out to a paternal figure, miss their fathers and get involved in
early sexual liaisons possibly in an attempt to identify with the father
figure. This axis of father/teenage son has previously been ignored in the
study of causes of early pregnancies. A significant factor in pregnancy
prevention is the psychological and emotional status of the boy.

Sex Education.
50% of boys and 75% of
girls had knowledge of sex education, 10% of boys and 50% of girls learned this
from their mothers-a significant improvement on the previous generation.

Sexual Activity.
Boys were more sexually
active than the girls some started as early as 11. Most used condoms but 15%
boys had unprotected sex.

Conclusions.

The influence
of the care system is pernicious and young mothers who have been in care do
worse than those who have not over a number of different dimensions. They have
more children, they have more relationships, their relationships are less
stable and more of their children end up in care themselves ...But is this an
influence of the care system alone - does being a young Mum who has been in
care differ from being an older Mum who happens to have been in care? If you
are a family on low income, you are more likely to have a daughter who is
pregnant young. If you are in an area of social deprivation you are more likely
to have a schoolgirl who is pregnant. Schoolgirl pregnancy is very much a
‘culture of poverty’ (“School-girl Pregnancy - a Culture of
Poverty”)5 and traps deprived girls
in a cycle of derivation.

“The
repercussions of teenage childbearing are long lasting: young parents acquire
less education than
contemporaries ; they are more often limited to less prestigious
jobs and the women, to more dead end ones. ..” (Card and Wise 78)6.    “adolescent
mothers consistently experienced great difficulty in realising  their life plans when compared to their
classmates who did not become pregnant pre-maritally
in their early teens..” (Furstenberg 76)7.
If you are in care you are more likely to get pregnant early -in our sample 22%
of the pregnant girls had been in care at a time when less than 2% of the child
population of the area was in care. The important message is that if families
are supported and the effect of social deprivation and poverty is minimised,
then not only will the rate of ‘premature’ early mother-hood
diminish - but those mothers who do start their families early will be able to
raise their families happily and well.

There is a
group of girls who wish to become pregnant at an early age, are ready for it,
are mature emotionally and physically and if it were not for the stigmatising
of our society and the lack of support they would have every chance of success.
Others are immature, they neither desire motherhood nor feel able to cope with  the birth
of their children, they may pass the child over to the care of others.  Between these two extremes we have a
whole spectrum of girls who though not actively and consciously seeking  pregnancy,  nevertheless are happy to be mothers and
make some emotional or existential gain by virtue of their
‘mothering’ status.
Most important in this context is the gain in self esteem and a sense of
‘purpose’ in life. Even on the other side of the Atlantic, where the
general view is perhaps more pessimistic than ours, there are encouraging
comments - “Some adolescent parents do overcome the handicaps imposed by
adolescent childbearing; they complete their educations, get jobs, avoid
welfare dependency” (Furstenberg and Crawford
1978)8

Most studies
from the USA show
that children of teenage mothers do badly in comparison to
their  peers. (East and Felice 90)9
“The children of teenage mothers are distinctly worse off throughout childhood  than
the offspring of older childbearers.”(Furstenberg, Brooks-Gunn
and Chase-Lansdale 89)10. In Britain the same factors operate
to an extent but are highly dependant on the social status of the young mothers
rather than her age per se.

Children can
bear a heavy burden when they are expected to fulfil the role of ‘little parent’to their child mothers. These children fill a
need in their
parents, provide love, fulfilment and self worth. Perhaps in some
ways this is a valid role? These children are valued, wanted and loved in
return. What more could a child want? The male first born children seem to fare
worse.  Daughters take the role of
sisters and at least have a mother as a role model and confidante - something
the young mothers wish they had themselves. Sons have no role model, do not know quite how to relate to their mothers who
they often end up ‘fathering’. Single mothers can lack the
knowledge and resources to appreciate and provide for their developing sons
needs.   These very first born
sons are more prone to early sexual acting  out and their  numbers swell the ranks of the less
supportive and less stable teenage fathers for the next generation.

Families
certainly play an important role. Girls tend to recreate their family of
origin. Those with good supportive families fare better.  Those with  no families do worse. There are
casualties and surprise successes in all life styles. Being a young parent is
not the end of your life and dreams -it need not be a life of toil and hardship
-sadly for some unfortunate families it can be-but given adequate support young
parents can do remarkably well.
Perhaps it is time to stop condemning young families and instead try to
help them. To look for the positive attributes of young parents and work on
them rather than spell doom and gloom with negative statistics. Young mothers
have the potential to succeed in all walks of life - if we give them the chance
to do so.

References
-

1. Birch DML “Are you my sister,
Mummy?” Youth Support Pub ISBN 1 870717 00 7  1987

2. Birch D.M.L."Schoolgirl
pregnancy in Camberwell; A population study of inner city schoolgirl
pregnancies, motherhood and two year follow up".
MD thesis University of London 1986.

3.
Birch DML
“The Child that Rocks the Cradle” Youth Support Pub
1996

4. Live Births per thousand women -Fertility
Rates-OPCS FM196/1 96.

5. Birch D.M.L."Schoolgirl
Pregnancy -a culture of poverty" Proceedings of International Medical
women's federation Conf Sorrento 1987a

6. Card J.J.; Wise L.L. “Teenage Mothers and
Teenage Fathers: The Impact of Early Childbearing On
the Parents’Personal&Professional
Lives” Family Plan Persp Vol10 No4 Aug 1978

7. Furstenberg F.F.
“The Social Consequences of Teenage Parenthood”  Family Planning Perspectives
Vol.8 No4 148-164 August 1976.

8. Furstenberg F.F. ; Crawford A.G. “Family Support : Helping Teenage
Mothers to Cope” Family Planning Perspectives Vol.10 No6 Dec.1978

9. East P.L.; Felice M.E. “Outcomes and
Parent-Child Relationships of Former Adolescent Mothers and their 12-year-old
Children” Developmental and Behavioural Paediatrics Vol.11 No4 175-183
Aug 1990.

10. Furstenberg F.F.;Brooks-Gunn J.;
Chase-Lansdale L.“Teenage Pregnancy and Childbearing” American Psycho-logist Vol44 No2 313-320 Feb 1989.

* NEWS * NEWS * NEWS * NEWS * NEWS * NEWS *

Candid
Camera shots of

The
Blues Brothers Party

Youth Support’s tenth Anniversary
Bash!

NEWS
in Collage

Youth Support Shop Robbed!

Is Nothing Sacred!

Youth Support -
Professional Training

Seminar Programme
1997

This
year we are presenting a series of five seminars at Youth Support House. They
will run from 10am to 5pm with a short lunch break. Lunch will be
provided.  Content
partly didactic and partly interactive. Please bring examples and own
material for discussion. Experience of participants varied - seminar will be
pitched at level appropriate for those present on the day.

1.
Psychological Issues in teenage sexuality and pregnancy.

Wednesday
29th January 1997.

2.
Child protection and the long term consequences of abuse.

Wednesday
19th February 1997.

3.
Emotional development and the development of ‘personality’.

Wednesday
12th March.

4.
Therapeutic principles - group and individual work.

Wednesday
23rd April.

5.
Self Harming behaviours / substance abuse / eating disorder.

Wednesday
14th May.

Fee for seminars - £15 each or £50 for
entire course.

Please send personal details and appropriate fee to Lisa Bioletti at Youth
Support House.

13 CrescentRoad London BR3 2NF.  Fax 0181 659 3309.

Youth Support Conference ‘96

Youth - Our Resource for the Future

you enjoyed the conference

-  now
buy the proceedings -

available
spring ‘97 advance orders £5

AND - book the next one!

join us again in 1998

see over for details!!

Youth  Support

Forum
on Adolescent Health and Welfare

Second Conference on Adolescent Health

Youth Support will be hosting a two day conference
on Adolescent Health in 1998

Dates -22nd /
23rd October 1998

Venue - Royal
College of Physicians

St Andrews Place,
Regent’s Park, London

Featuring - keynote addresses by speakers of
International renown; Dual lecture halls with parallel plenary sessions; Poster
presentations; Workshop sessions ; Discussion groups.

Topics
include:-                              Teenage
pregnancy and sexuality.

Self harming
behaviours and substance abuse.

Eating disorders.

Emotional problems
and therapy.

Youth and violence.

Education and
behavioural problems.

Social and environmental
factors.

Abuse of
adolescents and long term consequences.

Please
write in now to :-

Youth
Support Conference Administration

Youth
Support House,

13
Crescent Road London BR3 2NF

or         FAX
0181 659 3309     for
further details or to make advance
bookings.

Early reservation adviseable since numbers are limited and the last
conference was oversubscribed.
Papers, posters
and abstracts welcome.

The Journal of
Adolescent Health and Welfare

is published by:-   Youth Support,   13, Crescent Road,   London BR3 2NF

Tel No 0181 650
6296                   Charity No 296080                  Fax No 0181 659 3309