Parenting a dynamic perspective 2nd edition pdf

207

Parenting

Adolescents

CHAPTER 9

Adolescent Development in the Context of the Home

Physical and Hormonal Changes Neurological and Cognitive Changes Social Changes

Problems for Adolescents and Their Parents

Automobile Accidents Sexual Initiation, Contraception Use,

and Pregnancy Electronic Media Problems Eating Problems School Dropouts

Substance Use and Abuse Mental Health Problems Youth Violence and Delinquency

How Parents Help Teens Navigate Adolescence

Staying Connected via Positive, Warm Relationships

Open Communication Monitoring/Knowledge Appropriate Limits Other Ways Parents Influence

Their Teenagers Limits of Parental Influence on Teens

Chapter Preview: True or False?

• Adolescence is a time of explosive brain growth.

• Parent-child conflict peaks during adolescence.

• Twenty-five percent of adolescents think about suicide.

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The adolescent years have been described in colorful ways. G. Stanley Hall,one of the fathers of American psychology and a pioneer of research intoadolescence, called it a time of “heightened storm and stress” (1904, Vol. 1, p. xiii). It is also known as the “tumultuous” and “awkward years.” As youth grow into the adolescent years (generally defined as from ages 13 to 19), the interpersonal equilibrium established with parents is often disrupted. It is a developmental stage that can be characterized by mood changes and risky behavior.

Many parents approach the adolescent years with trepidation, inspired by perhaps their autobiographic memories and stereotypes and misinformation. Common stereotypes describe teens as being difficult, oppositional, and moody, due to “raging hormones.” For all those reasons, parents are wary of the adolescent years. To be sure, adolescence is a time of change but not necessarily resulting in rebellious youth. Although some parents erroneously regard adolescence as when their child-rearing duties are over, the evidence indicates that in certain ways this time period is especially important for parent-child relationships. Parents need to be responsive to the many types of changes that are going on with the adolescent, including physical, cognitive, self-concept, and social.

Adolescent Development in the Context of the Home

The core task for the adolescent is identity formation, whereby the individual nego- tiates the transition between the safety of childhood and the complex, indetermi- nant world of adulthood (Baumrind, 1991; Steinberg & Silk, 2002). During late adolescence and early adulthood, individuals embark on their life paths, whether they are engaged in such activities as pursuing educational opportunities, begin- ning full-time employment, establishing a family, or perhaps joining the military (see Illustration 9.1). That identity formation process occurs among a sea of changes: physical and hormonal, neurological and cognitive, and social.

Physical and Hormonal Changes

In several ways, parental relations with their adolescents are linked to develop- mental changes. The most obvious indicator of development is the physical changes associated with puberty. Puberty has long been regarded as the hallmark of adoles- cence. In actuality, the surge in sex hormones that precipitates puberty occurs in middle-childhood years (see Box 9.1). Physical changes include emergence of pubic hair, changes in body shape and fat distribution, and breast development and the onset of menstruation in females. The median age of onset of menarche in girls in the United States is now at 12.4 years (ages ranging from 9 to 14 years) (Chumlea et al., 2003). However, breast development can begin as early as age 7 in girls and even earlier for African American girls (Kaplowitz, Slora, Wasserman, Pedlow, & Herman-Giddens, 2001). Physical changes in males include emergence of body,

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facial, and pubic hair; growth of muscle; and change in voice, body shape, and tes- ticular size and function. Boys go through puberty about 6 months to 1 year later than girls (Lee, Guo, & Kulin, 2001).

Many factors influence the onset of puberty, including genes, culture, socio- economic status, diet, exercise, and stress. A provocative prediction based on evolu- tionary theory was proposed by Jay Belsky, Larry Steinberg, and Patricia Draper in 1991. They hypothesized that the home environment, and particularly parenting behavior, would influence the onset of puberty. Families characterized by stress and harsh parenting should have daughters who attained puberty earlier, in contrast to warm and emotionally supportive family environments. In the most thorough test of that prediction, Belsky and his colleagues (2007) found evidence that parenting practices predicted girls’ but not boys’ pubertal development. Both mothers’ and fathers’ harsh controlling practices were associated with earlier onset of menses.

The timing of physical maturation has many more repercussions on teenagers than simply their bodies. It influences boys’ and girls’ psychological well-being (i.e., self-esteem) and onset of emotional problems (i.e., depression). For example, ado- lescents who think they look older than their peers can experience emotional dis- tress (Resnick et al., 1997). However, gender plays a determining role. Boys who mature early and thereby grow taller and heavier are at a distinct advantage for playing many sports. Consequently, early-maturing boys receive a positive psycho- logical impact from their physical changes. In contrast, early maturing girls, who

Chapter 9 • Parenting: Adolescents 209

Illustration 9.1 A teenage boy plays his guitar.

Source: Photograph by J. P. Bell.

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generally are heavier than late maturing girls, are at risk for experiencing emotional problems. For example, early menarche is associated with depression, although this finding suggests there may be hormonal as well as social influences on the disorder (Ge, Lorenz, Conger, Elder, & Simons, 1994).

Neurological and Cognitive Changes

Adolescents are going through a second type of fundamental change as well: neurological and cognitive development. With the advent of the noninvasive Magnetic Resonance Imaging (MRI) and functional Magnetic Resonance Imaging (fMRI) techniques, detailed images of the adolescent brain and brain functioning are now available. As one neurologist described it: “Brain structure goes through explosive [italics added] changes during the teen years” (Giedd, 2004, p. 83). The adolescent brain experiences several types of changes. The most consistent findings across studies are that in two locations on the cortex (prefrontal cortex and parietal lobe) there is a linear increase in white matter (containing myelinated axon cells) responsible for neural communication. In addition, there is a decrease in gray matter (consisting of the cell bodies of neurons and dendrites). These brain changes

210 PART II • PARENTING AND DEVELOPMENT

Adolescent Raging Hormones?

Parents are quick to attribute adolescent mood swings to raging hormones. But what is the evidence? Surprisingly, the evidence that hormones are responsible for dramatic mood swings is weak. Instead, research reviews indicate that biol- ogy does indeed contribute to emotional volatility and negative moods, but the relation is complex. Hormone levels interact with other variables including peers, parents, and situational factors, rather than simply and directly influencing behavior (Brooks-Gunn, Graber, & Paikoff, 1994; Buchanan, Eccles, & Becker, 1994). Recent work has supported this view. For example, Pennsylvania State University researchers tested whether testosterone levels in children and adoles- cents from 6 to 18 years old was linked to two types of behavior: taking risks (e.g., doing something dangerous for the thrill, damaging property, skipping school, or getting drunk) and depression (Booth, Johnson, Granger, Crouter, & McHale, 2003). They used quick and noninvasive saliva tests for testosterone. They found little evidence for direct effects of testosterone on behavior. Instead, the investigators determined that the quality of parent-child relationships mod- erated negative effects of testosterone. That is, in families with good parent- child relationships, children high in testosterone did not engage in risk-taking behavior or experience depression. However, in families with poorer quality parent-child relationships, there was evidence of testosterone-related adjust- ment problems. This study provides supporting evidence for a bioecological model of development because the social context (i.e., quality of relationship with parents) moderates how hormones are expressed.

BOX 9.1

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are significant: Part of the prefrontal cortex continues to develop during adoles- cence and beyond (Blakemore & Choudhury, 2006; Casey, Getz, & Galvan, 2008).

These neurological changes are thought to underlie increases in what is called executive function—the capacity to control and coordinate our thoughts and behavior. The prefrontal cortex is also associated with controlling impulses, weigh- ing potential consequences of decisions, prioritizing, and strategizing. That part of the brain is also involved in self-awareness and perspective taking, the latter ability underlying the capacity for empathy. There is also evidence for development in the brain’s emotion processing and cognitive appraisal, systems related to engaging in risky or reckless behavior—an all-too-common feature of adolescent behavior that parents fear.

Adolescent cognitive abilities become more sophisticated resulting in thinking that is more abstract, multidimensional, and relativistic. They view rules, whether set by parents or others in authority positions, as social conventions: subjective and arbitrary. Thus, parental requests to do chores or clean up messy rooms—a common source of conflict with adolescents—are regarded as unnecessary. In turn, parents often get upset when teenagers challenge their rules, requests, or values.

Despite the improving cognitive sophistication, teen reasoning abilities are not necessarily adultlike. Teen thinking can be characterized by “adolescent egocen- trism,” which results in a heightened sense of self-consciousness and what has been called “personal fable”—the belief that ones experiences are unique to them (e.g., Frankenberger, 2000). Indeed, faulty reasoning processes that are likely tied into brain development may be the reason teens engage in so much risky behavior (Rankin, Lane, Gibbons, & Gerrard, 2004). These cognitive attributes feed into the beliefs that problems other teens have (e.g., pregnancy, car wrecks) cannot happen to them.

Cognitive changes also contribute to changes in identity. Adolescence brings an increased desire for independence and responsibility—as well as a newfound access to money. Consequently teens seek jobs. Somewhere between 35% and 80% of high school students work at some point during their high school years (Rubenstein, Sternbach, & Pollack, 1999). Typically, they find part-time jobs as sales clerks, cashiers, waiters, janitors, or child care providers. Employment provides a variety of benefits, including spending money or money for the family, interpersonal and occupation-specific skills, arenas to develop discipline and responsibility, and opportunities to enhance self-confidence. But hazards also exist in terms of the time it takes away from school and extracurricular activities, stress, and even job-related injuries (Resnick et al., 1997). It is estimated that annually 200,000 adolescents (14 to 17 years of age) experience job-related injuries (Rubenstein et al., 1999).

Another manifestation of the adolescent desire for independence from parents is expressed in hair length, clothing, tattoos or body piercings, or substance abuse. Some teens may be experimenting with autonomy and discovering themselves, while some of their peers engage in behaviors in an intentional way to challenge parental control. From the parents’ perspective, these behavioral expressions, what- ever the source, are often perceived as rejections of parental values, way of life, and authority (Steinberg, 2001).

Chapter 9 • Parenting: Adolescents 211

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Social Changes

In addition to physical and neurological/cognitive changes, a third area of rapid development is in social relationships. Given adolescents are seeking autonomy from their parents and forming identities, they gravitate toward peers. By the time adolescence arrives, teens are spending about 40% of their nonschooltime hours engaged in homework, chores, or paid work and the rest of the time watching TV, being on the Internet, socializing or engaging in sports, or structured activities. All told, adolescents may spend almost half of their waking time doing what they want to do; much of that elective time is spent with peers (Larson, 2000).

Along with an increasing orientation toward peers comes a change in the emotional distance with parents. This distance is commonly thought to give rise to increases in conflicts with parents. Indeed, adolescent-parent conflict is common over such mun- dane issues as refusing to pick up rooms, resisting chores, fighting with siblings, and failing to complete homework (Smetana, Daddis, & Chuang, 2003). However, contrary to stereotypes, conflicts with parents are not the highest during adolescence. A sys- tematic review of the literature found the rate of conflict actually decreases signifi- cantly from pre- or early adolescence (10 to 12 years) to middle adolescence (13 to 16 years), although the intensity increases slightly (Laursen, Coy, & Collins, 1998).

Adolescence is marked by the increasing time spent with and importance of peers. Recreational, athletic, academic, and social activities are spent with youth of the same age. Peers hold an immediate and powerful attraction. Friends become emotional confidants, provide advice, and serve as models of behavior and attitude (Wentzel & Caldwell, 1997). On the other hand, peers can be negative influences: It is friends who introduce tobacco, alcohol and drugs, sex, and violence.

One controversial view that recognizes the important role that peers can have on adolescents is the Group Socialization Theory. According to the theory (men- tioned in Chapters 2 and 4), it is peers who are the most important environmental influence on development, not parents. The theory stemmed from a mother’s obser- vation of her adolescent daughters. One daughter had a relatively smooth adoles- cence, but her younger daughter experienced considerable turmoil and rebelliousness. The fact that her younger teen was adopted prompted the mother to think about development from a behavioral genetics perspective. The mother was Judith Rich Harris, a former Harvard psychology graduate student who never completed her training but became a writer of developmental textbooks. In an effort to provide a theoretical answer to what made her daughters behave so differently, she integrated research from behavioral genetics, anthropology, sociology, as well as social and evo- lutionary psychology. Her solution was this theory (Harris, 1995, 1998).

At the heart of Harris’s theory is a strong environmental perspective—but not from parents. Although parents may be important determinants of behavior inside homes, Harris believes that once a child is out of the confines of the home, it is peers who become the dominant developmental influence (Harris, 1998). According to Harris, parents, with the exception of providing genes, have little or no effect on the psychological characteristics that children will have as adults, including personality, emotional regulation, behavior, or cognitions. Recall from Chapter 2 that human behavioral genetics research indicates heritability from

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parent to child accounts for 30% to 60% of the variance in personality characteris- tics; the rest of the environmental influence comes either from a shared (common to all the children in the home) or unshared (unique to that child) home environ- ment. Harris argued that the shared and unshared environment has little impor- tance in the face of peers: that is, peers trump parents. She believes the influence of peers has been underestimated, along with other nonfamilial agents, such as the movies and television.

Harris does not refute the studies that find that parent-adolescent behavior is correlated; she just reinterprets them. Studies that link harsh parenting to delin- quent adolescent behavior can be interpreted as revealing a genetic predisposition toward aggressive behavior. Further, the associations between parent and child are revealing child effects, rather than parent effects. So, Harris believes parents react to their adolescents’ aggression and acting out with harsh punishment (“tough love”), rather than the other way around (Harris, 1998).

As might be expected, Harris’s theory elicited strong reactions. Steven Pinker, a well-known Harvard University psychologist, gushed that “it will come to be seen as a turning point in the history of psychology” (Pinker, 1998, p. xiii). However, many developmental psychologists (and parents) rejected her theory on various grounds (see Box 9.2). The jury is still out, but most psychologists believe that parents continue to influence their adolescents’ behavior and development in many ways. However, part of Harris’s theory is undoubtedly accurate: One function that some peer groups have is to lead youth off of positive developmental trajectories.

Chapter 9 • Parenting: Adolescents 213

Evaluating the Group Socialization Theory

Harris’ controversial book (1998) attracted a lot of attention from the popular media and researchers. Not surprisingly, many developmental psychologists found her theory to be highly inaccurate by discounting the crucial roles that parents play in promoting positive development. Some researchers also pointed out the potentially dangerous implications of her comments: If parents do not matter in how their children turn out, then it follows that it does not matter how parents rear their children. To date, there has not been much empirical support for her theory (cf., Loehlin, 1997), but many critiques (e.g., Collins et al., 2000; Gottlieb, 2003; Maccoby, 2000; Vandell, 2000). Among the critiques:

• Her research review was incomplete or too simplified. • Pertinent research on siblings, teachers, and friendships is ignored. • Behavioral genetics research is limited by its assumptions and computations. • Gene-by-environment interactions were not examined. • Parental influence over peer group exposure was not considered; parents

affect the choice of and access to peers. • Parents influence the behaviors, attitudes, and decisions of their children

in particular domains that peers do not. • Harris focused only on adolescent outcomes and failed to take a longer

life-span developmental perspective.

BOX 9.2

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As we have seen, adolescence is a time of many changes, including physical, cog- nitive, and social. Some of the behaviors that adolescents engage in that are risky and problematic—and that Harris thought were so revealing of peer influence— will be considered next.

Problems for Adolescents and Their Parents

What are some of the potential pitfalls of adolescence that parents fear? Some problems may be short-lived, such as experimenting with cigarettes or marijuana. However, sometimes those behaviors become habit forming or lead to serious problems or consequences. For example, the adolescent years are characterized by a high death rate. The teen death rate (for 15- to 19-year-olds) is 66 per 100,000. About three fourths of the deaths come from car accidents, homicides, and suicides, with car fatalities accounting for three times as many deaths as the other two causes (Annie E. Casey Foundation, 2007). Table 9.1 lists 12 common problems that ado- lescents experience and their prevalence. These problems include drug and sub- stance abuse, exposure to violence, pregnancy, and dropping out of high school; some of these troubles will be described in more detail below. The list is not exhaus- tive. For example, teens are also susceptible to other problems including gang involvement, gambling, and materialism.

Automobile Accidents

One of the developmental milestones in adolescence is becoming eligible to obtain a driver’s license, in most states at age 16. Automobile driving promotes autonomy, independence, and responsibility. However, it is also dangerous: Car accidents involving teenagers are the most common cause of death for individuals between the ages of 16 and 19. In 2005, a total of 4,544 teens between the ages of 16 to 19 died from motor vehicle crashes. Another 400,000 teens sustained nonfatal injuries (Centers for Disease Control, 2008a). Investigations into teen car accidents determined that two risk factors were driving with two or more friends and driving at night. Why do adolescents get into accidents? In a nutshell, teens do not have dri- ving experience, they underestimate hazardous driving situations, fail to recognize dangerous conditions, and may not wear seatbelts. They also tailgate, drive too fast, and are distracted by talking on a cell phone or even typing text messages. Another cause of automobile accidents is alcohol. Drinking is implicated as a cause in 24% of fatal car crashes involving adolescent males (Centers for Disease Control, 2008a). Thus, adolescents engage in a variety of risky driving practices.

Sexual Initiation, Contraception Use, and Pregnancy

Premarital sexual intercourse among older adolescents is widespread. By the age of 20 years, 80% of U.S. youth will have had sexual intercourse (Guttmacher Institute, 2006). Sexual activity is also common among younger teens. In a sample of over 20,700 youth, about 30% of the 15-year-old boys and girls reported having

214 PART II • PARENTING AND DEVELOPMENT

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sex (Davis & Friel, 2001). Early sexual debut is associated with various problems for the teenager. Initiation at early ages is associated with multiple partners and unpro- tected intercourse. In turn, sex without contraceptives can result in two types of serious problems: sexually transmitted infections (STIs) and pregnancies (see Illustration 9.2).

Chapter 9 • Parenting: Adolescents 215

Prevalence Other Statistics

Automobile accidents1 400,000 injuries per year 4,544 teen deaths in 2005

Births to teenagers2 401 per 100,000 415,000 babies born to 15- to 19-year-old mothers; Hispanics had the highest rate

Dating violence4 9.9% of high school students experienced within past 12 months

11% of boys and 8.8% of girls reported being the target of violence

Drinking alcohol4 44.7% of high school students drank within 30 days of survey

26% of students engaged in binge drinking in past 30 days

Drug use4 38% of high school students have tried marijuana

7.8% of high school students have tried a hallucinogen (e.g., LSD, PCP, mescaline)

High school dropouts2 7% of 16- to 19-year-olds Hispanic rate was highest at 82 per 100,000

Idle teens (neither school nor work)2

In a physical fight4

Mental health problems3

Physical inactivity3

Sexual activity, no condom use3

Smoking cigarettes4

8% of 16- to 19 year-olds

35.5% in past year

21.8% of teens aged 12 to 17 years received mental health attention

64.2% of high school students do not get enough exercise

22% of 12th graders

20% of high school students had smoked within past 30 days

Hispanics have highest rate at 12%

44% of males and 27% of females

5,502 teens per 100,000 have a sexually transmitted disease

Highest rates were among White male seniors

Table 9.1 Prevalence of Risky or Problem Behaviors in Adolescents in the United States

Sources: 1. Centers for Disease Control, 2008a. 2. Annie E. Casey Foundation, 2008. 3. U.S. Department of Health, 2008a. 4. Centers for Disease Control, 2008b.

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The incidence of two youth problems—the likelihood of early sexual activity and weapon- related violence in teenagers—is closely linked to age and socioeconomic status (Blum et al., 2000). The two graphs in Illustration 9.3 show these rela- tions. As can be seen in the top graph, 20% of 7th and 8th graders from a low socioeconomic status (SES) sample reported engaging in sexual inter- course, in contrast to 8% of their middle-SES peers. During the high school years that SES dif- ference was still apparent, more than 50% of low SES reported being sexually active. In contrast, about 40% of the youth from middle-class back- grounds reported engaging in sex. However, other youth behaviors assessed, including cigarette smoking, alcohol use, and suicidal thoughts, did not show this pattern.

Electronic Media Problems

Adolescents seek excitement, arousal, and intense stimulation (Dahl, 2004). Consequently, electronic media holds considerable appeal. Adolescents, on average, watch about 3 hours of television a day and spend an additional hour on computer, not including homework (Wright et al., 2001). In addition, boys in particular enjoy playing video games. In a study of electronic game use, it was found that 36% of adoles- cents (80% of boys but only 20% of girls) played video games (Cummings & Vandewater, 2007).

Although television viewing and the electronic media in general can have posi- tive effects on youth, too much “screen time” is a problem. For instance, although gaming may enhance hand-eye coordination, a common concern from parents is that time spent in front of the screens means time cannot be spent in active activi- ties. Video gamers spent 30% less time reading and 34% less time doing homework than nongamers and less time interacting with parents or friends (Cummings & Vandewater, 2007). Watching a lot (e.g., 5 hours) of television each day is also asso- ciated with problems, including early sexual initiation (Collins et al., 2004) and obesity (Koplan, Liverman, & Kraak, 2005), the next problem to be considered.

Eating Problems

There are two common types of adolescent eating problems: eating too much and eating too little. Eating too much, in conjunction with a lack of activity, results in obesity. Child and adolescent obesity is becoming an increasingly widespread problem in the United States and worldwide. In the United States, the number of adolescents who are overweight has tripled (Krishnamoorthy, Hart, & Jelalian,

216 PART II • PARENTING AND DEVELOPMENT

Illustration 9.2 Teenage pregnancy and parenthood is one of the potential pitfalls of adolescence.

Source: © 2009 Jupiterimages Corporation.

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2006). According to a national study with more than 8,000 children and adoles- cents, 34% of children aged 12 to 19 years (35% males and 33% females) are over- weight or at risk of becoming overweight, as defined by a body mass index (BMI) at or above the 85th percentile (Ogden, Carroll, & Flegal, 2008). Obese individuals are above the 95th percentile of the BMI. What to find out your own BMI? See Box 9.3 for how to calculate your own BMI and what that means.

Overeating is a habit that starts early. Eating high calorie and super-sized foods in front of TV screens has become the norm. As many as 24% of children aged 2 through 5 years are overweight (Ogden et al., 2008). By the middle-childhood, the rate is one in three children. In a low-income inner-city sample, the rate is even higher. Among 3- to 7-year-old children, 29% were found to be overweight across a 2-year period, and an additional 19% were at risk of overweight (Robbins et al., 2007).

Obesity in children is associated with a variety of health problems as well as life adjustments. Some of the health problems include juvenile (Type 2) diabetes, liver failure, heart disease, and a variety of other health problems, including death. Based

Chapter 9 • Parenting: Adolescents 217

60 50

30 40

20 10

0 Smoke Alcohol Suicidal

Thoughts

7–8th Grade

Weapon- Related Violence

Sexual Intercourse

Low SES Middle SES

60 50

30 40

20 10

0 Smoke Alcohol Suicidal

Thoughts

9–12th Grade

Weapon- Related Violence

Sexual Intercourse

Low SES Middle SES

Illustration 9.3 Percentage of Adolescents Who Engage in Behaviors as a Function of Age and Socioeconomic Status

Source: Blum et al., 2000.

Smoke = > 1 cigarette past 30 days

Alcohol = Drank any alcohol in past 12 months

Suicidal Thoughts = Any such thoughts or attempts

Weapon-Related Violence = Any weapon-related violence

Sexual Intercourse = Ever had sexual intercourse

Low SES = Family income < $40,000

Middle SES = Family income > $41,000

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on the projections from current rates of adolescent obesity, it is estimated that by 2020, 30% to 44% of 35-year-olds will be obese (Bibbins-Domingo, Coxson, Pletcher, Lightwood, & Goldman, 2007).

Another type of eating problem is the desire to be thin. In our culture, the female ideal of no fat is glamorized in teen magazines, on television, and in the movies. Teenage girls with this disorder typically engage in one of two types of eating patterns: (1) severely limiting food intake such that it is not enough to sustain one’s weight (anorexia nervosa) and (2) binge eating followed by efforts to minimize the effects of overeating by vomiting, exercise, or fasting (bulimia nervosa). These eating disorders are thought to be prevalent in 5% of the U.S. female teen population (Golden, 2003).

Eating disorders, often comorbid with other mental health problems, put the adoles- cent female at risk for a variety of health and psychological problems. In the process of starving their bodies, teenage girls can delay their normal pubertal development, nega- tively affect their self concept and esteem, and even cause irreversible organ damage.

218 PART II • PARENTING AND DEVELOPMENT

Your BMI Index—and What It Means

To calculate your own body mass index (BMI; for individuals 20 years old and older), divide your weight (in pounds) by your height (in inches, squared). Then multiply by a conversion factor of 703. Alternatively, calculators can be found on the Web (e.g., http://www.nhlbisupport.com/bmi). To simplify classification into categories, the Centers for Disease Control and Prevention now uses the same index values for both men and women:

To calculate the BMI of children and adolescents, the calculations also take into account age and gender (e.g., http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx). The BMI can then be used to determine the category of the individual, as listed below:

BOX 9.3

Category BMI

Obese > 30

Overweight 25.0–29.9

Normal 18.5–24.9

Underweight < 18.5

Category BMI Percentile

Obese > 29.9 > 95th

Overweight 24.9–29.9 85th to 95th

Normal 18.5–24.9 5th to <85th

Underweight < 18.5 < 5th

Holden, George W.. Parenting : A Dynamic Perspective, SAGE Publications, 2009. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/umuc/detail.action?docID=1995144. Created from umuc on 2019-06-17 19:07:04.