Portal de Periódicos da CAPES

Puberty in Context: Toward a More Nuanced Understanding of Early Maturation

2013; Elsevier BV; Volume: 53; Issue: 6 Linguagem: Inglês

10.1016/j.jadohealth.2013.09.019

1879-1972

Misaki N. Natsuaki,

Pregnancy-related medical research

See Related Article p. 692In India, a daughter had just experienced menarche and was terrified and confused. Her mother told her, "You are normal. You are menstruating. You are a woman now." Then she added: "When you are menstruating, don't cook food because you will pollute it" [[1]George R. The taboo of menstruation. New York Times, December 28, 2012Google Scholar].The statement this mother gave her daughter is absolutely correct. From a physiological perspective, menarche, a signature event of puberty, is inherently a basic biological phenomenon that happens to all females across all species. However, this universal biological event, which we all agree is "normal," can exert a varied impact on the psychological well-being of children. The nature of this impact depends on the context in which puberty occurs; it depends on its timing, place, and the meaning that we attach to it. As reflected in the mother's subsequent comment on menstruation and cooking, sometimes we attach a negative valence to this "normal" physical change, which can adversely affect adolescent adjustment.The study by White et al. [[2]White RMB, Deardoff J, Liu Y, Gonzales NA. Contextual amplification or attenuation of the impact of pubertal timing on Mexican-origin boys' mental health symptoms. J Adolesc Health 2013;53:692–98.Google Scholar] in this issue of the Journal of Adolescent Health is a prime example of how the mental health effects of pubertal timing are contextually dependent. White and colleagues' findings indicated that, compared with their later-maturing counterparts, early-maturing adolescent Mexican-origin boys developed higher levels of externalizing and internalizing symptoms over a 3-year span if they lived in neighborhoods with a low ethnic concentration. Further examination revealed that the observed pubertal effect was mainly driven by physical changes regulated by adrenal maturation (e.g., skin changes, pubic hair). Changes regulated by gonadal maturation (e.g., growth spurts, deepening of the voice, growth of facial hair) did not account for the observed pubertal effect.The White et al. study makes a substantial contribution to puberty literature for several reasons. First and foremost, it highlights how nuanced and contextually dependent the psychological effect of pubertal timing is on psychopathology. One may notice how theoretically intriguing this point is, keeping in mind that puberty is a ubiquitous, neutral event that is mainly (though not entirely) initiated and regulated by our biological system. This finding has its origins in the contextual amplification hypothesis [[3]Ge X. Natsuaki M.N. In search of explanations for early pubertal timing effects of developmental psychopathology.Curr Dir Psychol Sci. 2009; 18: 327-331Crossref Scopus (166) Google Scholar]. This hypothesis purports that biological development does not occur in a vacuum and that context can either exacerbate or ameliorate early pubertal timing effects by providing norms, expectations, opportunities, and implicit reward and punishment. Hence, for example, the literature on girls' puberty indicates that adaptation is particularly challenging for early-maturing girls facing the curious eyes of boys who now look at them as the target of romance and potential sexual involvement [[4]Natsuaki M.N. Biehl M.C. Ge X. Trajectories of depressed mood from early adolescence to young adulthood: The effects of pubertal timing and adolescent dating.J Res Adolesc. 2009; 19: 47-74Crossref Scopus (121) Google Scholar]. In this regard, the effect of puberty on (mal)adjustment is an example of how inseparable context is from biology.Second, the results from the White et al. study carry additional weight: the timing of adrenal and gonadal maturations function differently in the development of boys' psychopathology. Puberty is not a single, discrete event; it is a process that involves a series of changes in different parts of the body (e.g., for boys, it includes increased height, changes in voice, and growth of facial hair, pubic hair, and testes). The development of each facet follows its own growth trajectory but also develops with other facets in an intertwined, orchestrated manner. To further complicate the developmental process, each facet of pubertal development has its own unique meaning in the social context. Because some physical changes associated with puberty are more overt and others are semiprivate, they likely elicit different social reactions and connote special psychosocial valance [5Rudolph KD. Puberty as a developmental context of risk for psychopathology. In: Lewis M, Rudolph KD, eds. Handbook of Developmental Psychopathology. 3rd ed. New York: Plenum; in press.Google Scholar, 6Graber J.A. Nichols T.R. Brooks-Gunn J. Putting pubertal timing in developmental context: Implications for prevention.Develop Psychobiol. 2010; 52: 254-262PubMed Google Scholar]. A clear example of this involves menarche in girls. In many societies, menarche is a social event that symbolizes a transition from girlhood to womanhood and demarcates the time for redefining girls' roles by preparing them for their upcoming adult roles as wives and mothers [7Alsaker F.D. TIming of puberty and reactions to pubertal changes.in: Rutter M. Psychosocial disturbances in young people. Cambridge University Press, Cambridge, UK1995: 37-82Google Scholar, 8Weisfeld G. Puberty rites as clues to the nature of human adolescence.Cross-Cult Res. 1997; 31: 27-54Crossref Scopus (17) Google Scholar]. Although it is an important marker of pubertal maturation, the growth of pubic hair is not treated in the same way as menarche is in our society. In studying girls' puberty, researchers have sought to disentangle the facets of pubertal maturation and uncover the meaning and impact of each [[9]Graber J.A. Petersen A.C. Brooks-Gunn J. Pubertal processes: Methods, measures, and models. Transitions through adolescence: Interpersonal domains and context. Lawrence Erlbaum Associates, Inc, Hillsdale, NJ:1996Google Scholar]. However, the work on boys lags behind the work on girls. The nuanced approach taken by White et al. sheds new light on the facets of male puberty.Perhaps one of the most important contributions of the White et al. study is that it has opened the door for an important next question: how does context moderate the effect of pubertal timing? Existing evidence for the contextual amplification hypothesis primarily relies on the statistical interaction between puberty and context. Although the mathematical meaning of interaction effects is unambiguous, the theoretical meaning of the interaction is much murkier. What are the mechanisms underlying the effects of the neighborhood that magnify or attenuate the adverse effects of early adrenal maturation? Are early maturers more sensitive to contextual factors than late maturers [[10]Natsuaki M.N. Klimes-Dougan B. Ge X. et al.Early pubertal maturation and internalizing problems in adolescence: Sex differences in the role of cortisol reactivity to interpersonal stress.J Clin Child Adolesc Psychol. 2009; 38: 513-524Crossref PubMed Scopus (99) Google Scholar]? Or, do the cultural norms or the availability of social support in neighborhoods with a high ethnic concentration alleviate the feeling of "misfit" among early maturing boys? Are socioeconomic disadvantage and ethnic concentration in neighborhoods simply a macro proxy of other contextual properties, such as peer, family, school, and individual characteristics? Various contextual factors—including stressful life experiences [[11]Ge X. Conger R.D. Elder G.H. Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms.Dev Psychol. 2001; 37: 404-417Crossref PubMed Scopus (512) Google Scholar], family adversities [12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 13Natsuaki M.N. Leve L.D. Mendle J. Going through the rites of passage: Timing and transition of menarche, childhood sexual abuse, and anxiety symptoms in girls.J Youth Adolesc. 2011; 40: 1357-1370Crossref PubMed Scopus (22) Google Scholar], harsh parenting [12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 14Ge X. Brody G.H. Conger R.D. et al.Contextual amplification of pubertal transition effects on deviant peer affiliation and externalizing behavior among African American children.Dev Psychol. 2002; 38: 42-54Crossref PubMed Scopus (216) Google Scholar], peer relationships and structures [4Natsuaki M.N. Biehl M.C. Ge X. Trajectories of depressed mood from early adolescence to young adulthood: The effects of pubertal timing and adolescent dating.J Res Adolesc. 2009; 19: 47-74Crossref Scopus (121) Google Scholar, 12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 14Ge X. Brody G.H. Conger R.D. et al.Contextual amplification of pubertal transition effects on deviant peer affiliation and externalizing behavior among African American children.Dev Psychol. 2002; 38: 42-54Crossref PubMed Scopus (216) Google Scholar, 15Blumenthal H. Leen-Feldner E.W. Trainor C.D. et al.Interactive roles of pubertal timing and peer relations in predicting social anxiety symptoms among youth.J Adolescent Health. 2009; 44: 401-403Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 16Conley C.S. Rudolph K.D. The emerging sex difference in adolescent depression: Interacting contributions of puberty and peer stress.Develop Psychopathol. 2009; 21: 593-620Crossref PubMed Scopus (154) Google Scholar, 17Teunissen H.A. Adelman C.B. Prinstein M.J. et al.The interaction between pubertal timing and peer popularity for boys and girls: An integration of biological and interpersonal perspectives on adolescent depression.J Abnorm Child Psych. 2011; 39: 413-423Crossref Scopus (27) Google Scholar, 18Sontag-Padilla L.M. Graber J.A. Clemans K.H. The role of peer stress and pubertal timing on symptoms of psychopathology during early adolescence.J Youth Adolescence. 2011; 40: 1371-1382Crossref PubMed Scopus (33) Google Scholar], and school [[19]Caspi A. Moffitt T.E. When do individual differences matter? A paradoxical theory of personality coherence.Psychol Inq. 1993; 4: 247-271Crossref Scopus (305) Google Scholar] and neighborhood conditions [[20]Obeidallah D. Brennan R.T. Brooks-Gunn J. Earls F. Links between pubertal timing and neighborhood contexts: Implications for girls' violent behavior.J Am Acad Child Psychol. 2004; 43: 1460-1468Abstract Full Text Full Text PDF Scopus (97) Google Scholar]—are all intertwined, and it is easy to muddle the effects of multiple factors when interpreting the results. As White et al. noted, the use of an ethnically homogenous yet contextually diverse sample provides one way to disentangle the confounding nature of contextual factors. Additionally, it is important to determine what is so unique about experiencing skin changes and pubic hair growth earlier than other boys, especially for those who live in low-ethnic-concentration neighborhoods. Do we attach a special meaning and value to boys' adrenal maturation that we do not attach to their gonadal maturation? All of these theoretical questions still await direct answers.An illustrative metaphor Rosnow and Rosenthal [[21]Rosnow R.L. Rosenthal R. Statistical procedures and the justification of knowledge in psychological science.Am Psychol. 1989; 44: 1276-1284Crossref Scopus (669) Google Scholar] provided nearly 2 decades ago still rings true: a man searched for his lost key under a street lamp, despite the fact that he could have lost it a great distance away. He did not go into the darkness to look for the key because it was easier for him to search under the light. Along with accumulating evidence supporting the contextual amplification hypothesis, the White et al. study has served as the lamp. In the next step, the time is right for us to move beyond statistical interactions and to search for the key that unravels the mechanisms underlying the contextual amplification hypothesis. See Related Article p. 692 See Related Article p. 692 See Related Article p. 692 In India, a daughter had just experienced menarche and was terrified and confused. Her mother told her, "You are normal. You are menstruating. You are a woman now." Then she added: "When you are menstruating, don't cook food because you will pollute it" [[1]George R. The taboo of menstruation. New York Times, December 28, 2012Google Scholar]. The statement this mother gave her daughter is absolutely correct. From a physiological perspective, menarche, a signature event of puberty, is inherently a basic biological phenomenon that happens to all females across all species. However, this universal biological event, which we all agree is "normal," can exert a varied impact on the psychological well-being of children. The nature of this impact depends on the context in which puberty occurs; it depends on its timing, place, and the meaning that we attach to it. As reflected in the mother's subsequent comment on menstruation and cooking, sometimes we attach a negative valence to this "normal" physical change, which can adversely affect adolescent adjustment. The study by White et al. [[2]White RMB, Deardoff J, Liu Y, Gonzales NA. Contextual amplification or attenuation of the impact of pubertal timing on Mexican-origin boys' mental health symptoms. J Adolesc Health 2013;53:692–98.Google Scholar] in this issue of the Journal of Adolescent Health is a prime example of how the mental health effects of pubertal timing are contextually dependent. White and colleagues' findings indicated that, compared with their later-maturing counterparts, early-maturing adolescent Mexican-origin boys developed higher levels of externalizing and internalizing symptoms over a 3-year span if they lived in neighborhoods with a low ethnic concentration. Further examination revealed that the observed pubertal effect was mainly driven by physical changes regulated by adrenal maturation (e.g., skin changes, pubic hair). Changes regulated by gonadal maturation (e.g., growth spurts, deepening of the voice, growth of facial hair) did not account for the observed pubertal effect. The White et al. study makes a substantial contribution to puberty literature for several reasons. First and foremost, it highlights how nuanced and contextually dependent the psychological effect of pubertal timing is on psychopathology. One may notice how theoretically intriguing this point is, keeping in mind that puberty is a ubiquitous, neutral event that is mainly (though not entirely) initiated and regulated by our biological system. This finding has its origins in the contextual amplification hypothesis [[3]Ge X. Natsuaki M.N. In search of explanations for early pubertal timing effects of developmental psychopathology.Curr Dir Psychol Sci. 2009; 18: 327-331Crossref Scopus (166) Google Scholar]. This hypothesis purports that biological development does not occur in a vacuum and that context can either exacerbate or ameliorate early pubertal timing effects by providing norms, expectations, opportunities, and implicit reward and punishment. Hence, for example, the literature on girls' puberty indicates that adaptation is particularly challenging for early-maturing girls facing the curious eyes of boys who now look at them as the target of romance and potential sexual involvement [[4]Natsuaki M.N. Biehl M.C. Ge X. Trajectories of depressed mood from early adolescence to young adulthood: The effects of pubertal timing and adolescent dating.J Res Adolesc. 2009; 19: 47-74Crossref Scopus (121) Google Scholar]. In this regard, the effect of puberty on (mal)adjustment is an example of how inseparable context is from biology. Second, the results from the White et al. study carry additional weight: the timing of adrenal and gonadal maturations function differently in the development of boys' psychopathology. Puberty is not a single, discrete event; it is a process that involves a series of changes in different parts of the body (e.g., for boys, it includes increased height, changes in voice, and growth of facial hair, pubic hair, and testes). The development of each facet follows its own growth trajectory but also develops with other facets in an intertwined, orchestrated manner. To further complicate the developmental process, each facet of pubertal development has its own unique meaning in the social context. Because some physical changes associated with puberty are more overt and others are semiprivate, they likely elicit different social reactions and connote special psychosocial valance [5Rudolph KD. Puberty as a developmental context of risk for psychopathology. In: Lewis M, Rudolph KD, eds. Handbook of Developmental Psychopathology. 3rd ed. New York: Plenum; in press.Google Scholar, 6Graber J.A. Nichols T.R. Brooks-Gunn J. Putting pubertal timing in developmental context: Implications for prevention.Develop Psychobiol. 2010; 52: 254-262PubMed Google Scholar]. A clear example of this involves menarche in girls. In many societies, menarche is a social event that symbolizes a transition from girlhood to womanhood and demarcates the time for redefining girls' roles by preparing them for their upcoming adult roles as wives and mothers [7Alsaker F.D. TIming of puberty and reactions to pubertal changes.in: Rutter M. Psychosocial disturbances in young people. Cambridge University Press, Cambridge, UK1995: 37-82Google Scholar, 8Weisfeld G. Puberty rites as clues to the nature of human adolescence.Cross-Cult Res. 1997; 31: 27-54Crossref Scopus (17) Google Scholar]. Although it is an important marker of pubertal maturation, the growth of pubic hair is not treated in the same way as menarche is in our society. In studying girls' puberty, researchers have sought to disentangle the facets of pubertal maturation and uncover the meaning and impact of each [[9]Graber J.A. Petersen A.C. Brooks-Gunn J. Pubertal processes: Methods, measures, and models. Transitions through adolescence: Interpersonal domains and context. Lawrence Erlbaum Associates, Inc, Hillsdale, NJ:1996Google Scholar]. However, the work on boys lags behind the work on girls. The nuanced approach taken by White et al. sheds new light on the facets of male puberty. Perhaps one of the most important contributions of the White et al. study is that it has opened the door for an important next question: how does context moderate the effect of pubertal timing? Existing evidence for the contextual amplification hypothesis primarily relies on the statistical interaction between puberty and context. Although the mathematical meaning of interaction effects is unambiguous, the theoretical meaning of the interaction is much murkier. What are the mechanisms underlying the effects of the neighborhood that magnify or attenuate the adverse effects of early adrenal maturation? Are early maturers more sensitive to contextual factors than late maturers [[10]Natsuaki M.N. Klimes-Dougan B. Ge X. et al.Early pubertal maturation and internalizing problems in adolescence: Sex differences in the role of cortisol reactivity to interpersonal stress.J Clin Child Adolesc Psychol. 2009; 38: 513-524Crossref PubMed Scopus (99) Google Scholar]? Or, do the cultural norms or the availability of social support in neighborhoods with a high ethnic concentration alleviate the feeling of "misfit" among early maturing boys? Are socioeconomic disadvantage and ethnic concentration in neighborhoods simply a macro proxy of other contextual properties, such as peer, family, school, and individual characteristics? Various contextual factors—including stressful life experiences [[11]Ge X. Conger R.D. Elder G.H. Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms.Dev Psychol. 2001; 37: 404-417Crossref PubMed Scopus (512) Google Scholar], family adversities [12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 13Natsuaki M.N. Leve L.D. Mendle J. Going through the rites of passage: Timing and transition of menarche, childhood sexual abuse, and anxiety symptoms in girls.J Youth Adolesc. 2011; 40: 1357-1370Crossref PubMed Scopus (22) Google Scholar], harsh parenting [12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 14Ge X. Brody G.H. Conger R.D. et al.Contextual amplification of pubertal transition effects on deviant peer affiliation and externalizing behavior among African American children.Dev Psychol. 2002; 38: 42-54Crossref PubMed Scopus (216) Google Scholar], peer relationships and structures [4Natsuaki M.N. Biehl M.C. Ge X. Trajectories of depressed mood from early adolescence to young adulthood: The effects of pubertal timing and adolescent dating.J Res Adolesc. 2009; 19: 47-74Crossref Scopus (121) Google Scholar, 12Ge X. Conger R.D. Elder G.H. Coming of age too early: Pubertal influences on girls' vulnerability to psychological distress.Child Dev. 1996; 67: 3386-3400Crossref PubMed Google Scholar, 14Ge X. Brody G.H. Conger R.D. et al.Contextual amplification of pubertal transition effects on deviant peer affiliation and externalizing behavior among African American children.Dev Psychol. 2002; 38: 42-54Crossref PubMed Scopus (216) Google Scholar, 15Blumenthal H. Leen-Feldner E.W. Trainor C.D. et al.Interactive roles of pubertal timing and peer relations in predicting social anxiety symptoms among youth.J Adolescent Health. 2009; 44: 401-403Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar, 16Conley C.S. Rudolph K.D. The emerging sex difference in adolescent depression: Interacting contributions of puberty and peer stress.Develop Psychopathol. 2009; 21: 593-620Crossref PubMed Scopus (154) Google Scholar, 17Teunissen H.A. Adelman C.B. Prinstein M.J. et al.The interaction between pubertal timing and peer popularity for boys and girls: An integration of biological and interpersonal perspectives on adolescent depression.J Abnorm Child Psych. 2011; 39: 413-423Crossref Scopus (27) Google Scholar, 18Sontag-Padilla L.M. Graber J.A. Clemans K.H. The role of peer stress and pubertal timing on symptoms of psychopathology during early adolescence.J Youth Adolescence. 2011; 40: 1371-1382Crossref PubMed Scopus (33) Google Scholar], and school [[19]Caspi A. Moffitt T.E. When do individual differences matter? A paradoxical theory of personality coherence.Psychol Inq. 1993; 4: 247-271Crossref Scopus (305) Google Scholar] and neighborhood conditions [[20]Obeidallah D. Brennan R.T. Brooks-Gunn J. Earls F. Links between pubertal timing and neighborhood contexts: Implications for girls' violent behavior.J Am Acad Child Psychol. 2004; 43: 1460-1468Abstract Full Text Full Text PDF Scopus (97) Google Scholar]—are all intertwined, and it is easy to muddle the effects of multiple factors when interpreting the results. As White et al. noted, the use of an ethnically homogenous yet contextually diverse sample provides one way to disentangle the confounding nature of contextual factors. Additionally, it is important to determine what is so unique about experiencing skin changes and pubic hair growth earlier than other boys, especially for those who live in low-ethnic-concentration neighborhoods. Do we attach a special meaning and value to boys' adrenal maturation that we do not attach to their gonadal maturation? All of these theoretical questions still await direct answers. An illustrative metaphor Rosnow and Rosenthal [[21]Rosnow R.L. Rosenthal R. Statistical procedures and the justification of knowledge in psychological science.Am Psychol. 1989; 44: 1276-1284Crossref Scopus (669) Google Scholar] provided nearly 2 decades ago still rings true: a man searched for his lost key under a street lamp, despite the fact that he could have lost it a great distance away. He did not go into the darkness to look for the key because it was easier for him to search under the light. Along with accumulating evidence supporting the contextual amplification hypothesis, the White et al. study has served as the lamp. In the next step, the time is right for us to move beyond statistical interactions and to search for the key that unravels the mechanisms underlying the contextual amplification hypothesis.