Puberty marks the sexual transition from childhood to adolescence. The sex hormones estrogen and progesterone in girls and testosterone in boys, which were produced in small amounts during childhood, go into a mass-production phase during puberty. These hormones initiate the physical changes associated with puberty, which are the source of anxiety and adjustment. The age at which puberty begins varies considerably from one child to the next, and children who have early or late changes may be concerned, and sometimes teased, about the differences in their bodies as compared with those of their schoolmates. Children may be too embarrassed to discuss these concerns with their parents.

The sex hormones affect the body and the brain. Sex hormones enter the brain and bind to receptors on nerve cells there, altering the activity of the brain. Changes in brain activity are related to changes in personality and mood. Just as hormones cause some women to experience emotional changes before their menstrual period begins, and abuse of steroid hormones related to testosterone causes some athletes to become irritable or aggressive, adolescents also undergo changes in behavior related to hormones. In fact, some seizures start in adolescence, possibly related to these hormonal changes.

For some children, seizures begin or stop around the time of puberty. This relationship between epilepsy and puberty may be a coincidence, but it is probably a result of hormonal changes affecting the brain. Hormones such as estrogen may increase the likelihood of seizures, and many women report that seizures most often occur around the time of their menstrual period. There is evidence that seizures occur more frequently just before menstruation or at the time of ovulation in some women.

Other brain changes that may be less directly related to hormones also occur during puberty. Early in adolescence, children gain greater fine motor control and begin to show more mature responses to complex problems. Their ability to think about abstract problems and moral issues is greater. Shortly after puberty, children are much better able to understand the consequences of certain behaviors in a theoretical sense; that is, they can understand the outcome of some behaviors without experiencing the outcome itself. For example, girls can understand that they may become pregnant as a consequence of sexual activity. This ability to consider the consequences of behavior has important implications for health matters such as epilepsy. At this point in their development, children are better able to participate in their own care.

The increased production and release of sex hormones into the bloodstream during puberty is not always a gradual, smooth process. The hormones may be released in large amounts over short periods. The changes in hormone levels can be associated with relatively rapid changes in personality, mood, irritability, and physical features, such as a new crop of pimples. The child is not "bad" or "misbehaving," but simply experiencing natural changes as part of development.

Metabolic changes as well as the rapid changes in growth that accompany puberty may be unpredictable and can alter the level of seizure medicine in the blood. If seizure control worsens in an teen, the possibility of a decrease in the these levels should be considered, although missed medication is a more common cause.

Puberty also brings about changes in psychosocial development. The early adolescent is active in three arenas:

• the peer group (friends and schoolmates)
• family
• school

The peer group is often the focus of the young adolescent's life. The bonds are usually strongest among members of the same sex, with an emphasis on conformity and joint activities.

The young teen seeks independence from the family. Earlier relationships with parents and, less often, with brothers and sisters are disrupted. As the physical changes of puberty begin, the child often seeks greater privacy, especially with regard to the parent of the opposite sex. The teen's testing of parental limits is a conflict between the desire for parental guidance and the desire for autonomy.

School life can also be affected by puberty. Intellectual and behavioral maturation will have an impact on school performance. Adolescents who mature sooner than their peers may enjoy improved academic performance and those with relatively delayed maturation may perform more poorly. Also, adolescents who are very bright may rebel against their parents or react to stressors in their life with lower grades at school.

The maturity of children evolves during adolescence but the changes are often erratic. Behaviors that demonstrate a remarkable degree of maturity may be followed closely by immature actions and reactions. Parents must be available to discuss questions and problems. They must support the teen's independence while watching out for his or her safety and well-being. If the teen is avoiding some important issues, it is reasonable for the parent to raise them, but if the teen is uncomfortable with the discussion, it is best not to push. It is often helpful to enlist the aid of an adult outside the immediate family, such as a doctor or someone else who is trusted and liked by the adolescent.

Topic Editor: James W. Wheless, M.D.
Last Reviewed: 10/5/06