Caes, Line

Gauntlett-Gilbert, Jeremy

Jones, Abbie

Jordan, Abbie

English

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        Citation for published version:Jones, A, Caes, L, Gauntlett-Gilbert, J & Jordan, A 2023, 'Defining adolescence: A call for consistency in thechronic pain literature', Pediatric Pain Letter.Publication date:2023Document VersionPeer reviewed versionLink to publicationUniversity of BathAlternative formatsIf you require this document in an alternative format, please contact:openaccess@bath.ac.ukGeneral rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Download date: 19. Jun. 20231  Defining adolescence: A call for consistency in the chronic pain literature Adolescence is the distinct developmental period of transition from childhood to adulthood, involving changes in physical, psychological and biological functioning (Berenbaum et al., 2015; Nahman-Averbuch et al., 2023; Tanti et al., 2011; Tilton-Weaver & Marshall, 2017). Whilst adolescence itself is a well-recognised term, there is a lack of consensus regarding the temporal boundaries of adolescence, leading to confusion across the developmental literature.  When considering a definition of adolescence, a common approach is to align with puberty, such that adolescence spans from the start of puberty to physical maturation. Adopting this position, the World Health Organization (WHO) defines adolescence as spanning ages 10 to 19 years (World Health Organization, 2014). However, this purely physical definition overlooks the significant psychological and social development quintessential to this adolescent period (Lesko, 2012). Indeed, literature has shown adolescence to be a time of increased risk taking, autonomy development, focus on identity formation and increased importance of peer relationships compared with other developmental timepoints (e.g. Lam et al., 2014; Schwartz and Petrova, 2018; Smith et al., 2015; Soenens et al., 2017). Neuropsychological research over the last 20 years has shown that such psychosocial development occurs alongside neurological maturation, which continues into the mid-20s (Foulkes & Blakemore, 2018).  Adding complexity, these developmental processes appear to be elongating over time. Universally, adolescence is assumed to end when adulthood begins, often identified by life events such as moving out of the familial home and assuming financial responsibility for oneself. Over time, such normative signs of entering adulthood are occurring later. For 2  example, across the Western World, the average ages associated with entering full time employment, moving out from the parental home, getting married, and having children have increased over time (Eurostat, 2022; Office for National Statistics, 2019; Population Reference Bureau, 2019). Despite greater variation, such trends towards signs of adulthood appearing later in life are seen globally (e.g., Raymo et al., 2015). Considering these trends alongside increased life expectancy (GBD 2017 Mortality Collaborators, 2018) suggests that developmental trajectories across the lifespan have elongated. In the normative developmental literature, such changes have led to calls for the creation of a new life stage referred to as emerging adulthood (Arnett et al., 2014). This new life stage of emerging adulthood encapsulates those individuals who are legally adults, but who are yet to achieve adult developmental milestones. However, although the idea of emerging adulthood has been adopted by some, it has also been met with criticism and debate regarding its evidence base and conceptual usefulness (Côté, 2014). It is also important to note here that there is a distinction between developmental concepts such as childhood, adolescence, and adulthood, and legal or societal concepts of child and adult. For example, a 22-year-old may be legally and societally considered an adult, and yet may not be developmentally an adult. The challenges of clearly defining the age boundaries of adolescence means a plethora of terms and age ranges exist to describe and define this developmental period. In an attempt to overcome this, Sawyer and colleagues (2018) present a valuable overview of the variable terms which are often used interchangeably across the literature (see Table 1). Sawyer et al., (2018) also propose an extended definition of adolescence, spanning an age range of 10 to 24 years old. We agree with this extended definition of adolescence and that its adoption would help to create consistency across the literature.  3  Whilst it is important to consider the developmental context of adolescence in the normative literature, it has arguably greater importance in the pediatric pain literature. There is a growing body of literature providing evidence that adolescent developmental trajectories are altered in the context of chronic pain. For example, adolescents who experience chronic pain may struggle with their peer relationships and identity development (Jones et al., 2021; Jordan et al., 2018). Alternatively, some adolescents with chronic pain report enhanced autonomy as a result of having to manage the many challenges associated with living with chronic pain (Jones et al., 2022). Such evidence points to the extended age definition of adolescence as the most appropriate term to use within the pain literature, over alternatives such as emerging adulthood, as the developmental tasks are fundamentally adolescent in nature and occur on an elongated timescale. These altered developmental trajectories require pain researchers to ensure greater clarity and transparency regarding conceptual definitions and language around adolescence. Consequently, we strongly encourage members of the pain community to be mindful of their language choices, and to consider the developmental stages and influences on their participants.  Currently in the pediatric pain literature, terminology used to refer to adolescents is loosely defined and used inconsistently, creating confusion and lack of clarity. By way of illustration, the examples in Table 1 show that the same group of 10- to 17-year-olds could be described in multiple ways including as children, youth, young people, or adolescents, dependent on the term adopted by the authors.    4  Table 1. Variations in ages and terminology used in the pediatric pain literature  Language Used Ages of participants Children 2 to 12 years old (Pas et al., 2018) 10 to 17 years old (Meldrum et al., 2009) Youth 13 to 17 years old  (Forgeron and McGrath, 2008) 8 to 18 years old  (Soltani et al., 2018) Young People  10 to 24 years old  (Jones et al., 2021) 8 to 16 years old  (Huguet et al., 2009) Adolescent 12 to 17 years old (Donovan et al., 2013) 10 to 24 years old (Heathcote et al., 2020) Emerging Adulthood 18 to 30 years old (Twiddy et al., 2017) 18 to 25 years old (Bonvanie et al., 2016)  Without clarity and developmentally appropriate language it is impossible to fully contextualise, understand, compare, and draw robust conclusions from research findings. Additionally, further clarity would also provide substantial methodological benefits, for example facilitating sub-group analysis in meta-analytic research. We believe that the extended definition of adolescence proposed by Sawyer et al., (2018) provides the most appropriate and inclusive definition for use within a pediatric pain context. However, we acknowledge that there are challenges raised by this extended definition of adolescence and that inconsistencies in terminology occur due to no single definition being perfect. For example, the 10 – 24 years of age definition of adolescence runs the risk of suggesting that a 12-year-old and a 22-year-old are developmentally equal. Such a problem can be overcome 5  by researchers disaggregating adolescence into early-, mid-, and late-adolescence where needed. A more difficult challenge of the extended definition of adolescence is the inclusion of some individuals who are pre-pubescent, and some who are developmentally established adults. However, no age-bound definition of adolescence would be able to include all, but solely only those who are developmentally adolescents.  Additionally, this extended definition of adolescence could be argued to suggest a reduction in the span of childhood if adolescence is considered to begin earlier.  Such issues highlight the complexity of defining adolescence and the need to make a decision concerning whether to have an overly inclusive definition of adolescence (such as the proposed extended age range), an overly exclusive definition, or one that will include some individuals yet exclude others. We feel that the best of these imperfect options is to adopt an overly inclusive definition of adolescence as doing so ensures that all aspects of adolescent development are included, adopting a view of adolescence as a broad transition from childhood to adulthood.  We feel that whilst it is important to acknowledge these imperfections, they do not outweigh the benefits gained by ensuring greater clarity and consistency across the literature. Such consistency would allow for easier review and knowledge synthesis of the literature regarding chronic pain and adolescence. Additionally, consistent use of this extended age definition of adolescence would help to ensure that all aspects of chronic pain and adolescent development are explored.   Conclusions Going forward, we propose two strategies. Firstly, in the context of chronic pain and associated altered developmental trajectories, we argue that researchers use the extended 6  age range of adolescence (10 – 24 years of age). Depending on the research question under investigation, this large age range may be disaggregated into early (10 – 14 years), mid (15 – 19 years), and late (20 – 24 years) to reflect more developmentally distinct periods of adolescence. Researchers may decide that only one or two of these subdivisions of adolescence are appropriate for a study, and in those instances, we urge researchers to clearly state which they are using and why. When the entire adolescent age range is used, we recommend that researchers include descriptive statistics outlining the distribution of their sample across the three adolescent subdivisions. Secondly, although we feel the literature would benefit from consistent use of the extended definition of adolescence, we acknowledge that researchers may disagree and consider alternative terminology more appropriate. For example, terminology choices may be determined by patient and public involvement or how their participants self-define, as seen in the autistic literature (Kenny et al., 2016). Regardless of such disagreements, we emphasise the importance of researchers carefully considering terminology and the developmental context of their participants. We urge researchers to be transparent around their rationale for their language choices, and how it aligns with the research question and the participants’ developmental stage. Connected to this, we urge reviewers and editors not to impose their own language preferences, and if language choices are well-defined and well-justified, we recommend authors are allowed to use the terminology they feel most appropriate. This approach would ensure authors consider and justify their language choices and create greater clarity across the literature as terminology would represent the preferences of the authors and their rationale for their use.    7  References Arnett, J. J., Žukauskienė, R., & Sugimura, K. (2014). The new life stage of emerging adulthood at ages 18–29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7 Berenbaum, S. A., Beltz, A. M., & Corley, R. (2015). The Importance of Puberty for Adolescent Development: Conceptualization and Measurement. In J. B. Benson (Ed.), Advances in Child Development and Behavior (pp. 53–92). Elsevier. https://doi.org/10.1016/bs.acdb.2014.11.002 Bonvanie, I. J., Oldehinkel, A. J., Rosmalen, J. G. M., & Janssens, K. A. M. (2016). Sleep problems and pain: A longitudinal cohort study in emerging adults. Pain, 157(4), 957–963. https://doi.org/10.1097/j.pain.0000000000000466 Côté, J. E. (2014). The Dangerous Myth of Emerging Adulthood: An Evidence-Based Critique of a Flawed Developmental Theory. Applied Developmental Science, 18(4), 177–188. https://doi.org/10.1080/10888691.2014.954451 Donovan, E., Mehringer, S., & Zeltzer, L. K. (2013). A Qualitative analysis of adolescent, caregiver, and clinician perceptions of the impact of migraines on adolescents’ social functioning. Pain Management Nursing, 14(4), e135–e141. https://doi.org/10.1016/j.pmn.2011.09.002 Eurostat. (2022). Marriage indicators. https://ec.europa.eu/eurostat/databrowser/view/demo_nind/default/table?lang=en Forgeron, P., & McGrath, P. (2008). Self-identified needs of youth with chronic pain. Journal of Pain Management, 1(2), 163–172. 8  Foulkes, L., & Blakemore, S. J. (2018). Studying individual differences in human adolescent brain development. Nature Neuroscience, 21, 315–323. https://doi.org/10.1038/s41593-018-0078-4 GBD 2017 Mortality Collaborators. (2018). Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 392(10159), 1684–1735. https://doi.org/10.1016/S0140-6736(18)31891-9 Heathcote, L. C., Timmers, I., Kronman, C. A., Mahmud, F., Hernandez, J. M., Bentley, J., Youssef, A. M., Pine, D. S., Borsook, D., & Simons, L. E. (2020). Brain signatures of threat-safety discrimination in adolescent chronic pain. Pain, 161(3), 630–640. https://doi.org/10.1097/j.pain.0000000000001753 Huguet, A., Eccleston, C., Miró, J., & Gauntlett-Gilbert, J. (2009). Young people making sense of pain: Cognitive appraisal, function, and pain in 8-16 year old children. European Journal of Pain, 13(7), 751–759. https://doi.org/10.1016/j.ejpain.2008.07.011 Jones, A., Caes, L., Eccleston, C., Noel, M., Gauntlett-Gilbert, J., & Jordan, A. (2022). The sands of time: Adolescents’ temporal perceptions of peer relationships and autonomy in the context of living with chronic pain. Paediatric and Neonatal Pain, May 2021, 1–15. https://doi.org/10.1002/pne2.12071 Jones, A., Caes, L., McMurtry, C. M., Eccleston, C., & Jordan, A. (2021). Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review. Journal of Pediatric Psychology, 46(2), 219–230. https://doi.org/10.1093/jpepsy/jsaa101 Jordan, A., Noel, M., Caes, L., Connell, H., & Gauntlett-Gilbert, J. (2018). A developmental arrest? Interruption and identity in adolescent chronic pain. Pain Reports, 3(7), e678. https://doi.org/10.1097/PR9.0000000000000678 9  Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism: The International Journal of Research and Practice, 20(4), 442–462. https://doi.org/10.1177/1362361315588200 Lam, C. B., Mchale, S. M., & Crouter, A. C. (2014). Time with peers from middle childhood to late adolescence: Developmental course and adjustment correlates. Child Development, 85(4), 1677–1693. https://doi.org/10.1111/cdev.12235 Lesko, N. (2012). Act Your Age!: A Cultural Construction of Adolescence (2nd ed.). Routledge. https://doi.org/10.4324/9780203121580 Meldrum, M. L., Tsao, J. C. I., & Zeltzer, L. K. (2009). ‘I Can’t Be What I Want to Be’: Children’s Narratives of Chronic Pain Experiences and Treatment Outcomes. Pain Medicine, 10(6), 1018–1034. https://doi.org/10.1111/j.1526-4637.2009.00650.x Nahman-Averbuch, H., Li, R., Boerner, K. E., Lewis, C., Garwood, S., Palermo, T. M., & Jordan, A. (2023). Alterations in pain during adolescence and puberty. Trends in Neurosciences, 46(4), 307–317. https://doi.org/10.1016/j.tins.2023.01.006 Office for National Statistics. (2019). Milestones: Journeying into adulthood. https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/milestonesjourneyingintoadulthood/2019-02-18 Pas, R., Ickmans, K., Oosterwijck, S. V., Van Der Cruyssen, K., Foubert, A., Leysen, L., Nijs, J., & Meeus, M. (2018). Hyperexcitability of the Central Nervous System in Children with Chronic Pain: A Systematic Review. Pain Medicine, 19, 2504–2514. https://doi.org/10.1093/pm/pnx320 Population Reference Bureau. (2019). Median Age at First Marriage (Men). https://www.prb.org/usdata/indicator/marriage-age-men/snapshot 10  Raymo, J. M., Park, H., Xie, Y., & Yeung, W. J. (2015). Marriage and Family in East Asia: Continuity and Change. Annual Review of Sociology, 41, 471–492. https://doi.org/10.1146/annurev-soc-073014-112428 Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. The Lancet Child and Adolescent Health, 2(3), 223–228. https://doi.org/10.1016/S2352-4642(18)30022-1 Schwartz, S. J., & Petrova, M. (2018). Fostering healthy identity development in adolescence. Nature Human Behaviour, 2, 110–111. https://doi.org/10.1038/s41562-017-0283-2 Smith, A. R., Steinberg, L., Strang, N., & Chein, J. (2015). Age differences in the impact of peers on adolescents’ and adults’ neural response to reward. Developmental Cognitive Neuroscience. https://doi.org/10.1016/j.dcn.2014.08.010 Soenens, B., Vansteenkiste, M., Petegem, S. V., Beyers, W., & Ryan, R. (2017). How To Solve The Conundrum Of Adolescent Autonomy? On the importance of distinguishing between independence and volitional functioning. In B. Soenens, M. Vansteenkiste, & S. Van Petegem (Eds.), Autonomy in Adolescent Development: Towards Conceptual Clarity (pp. 1–33). Taylor & Francis Group. Soltani, S., Neville, A., Hurtubise, K., Hildenbrand, A., & Noel, M. (2018). Finding Silver Linings: A Preliminary Examination of Benefit Finding in Youth With Chronic Pain. Journal of Pediatric Psychology, 43(3), 285–293. https://doi.org/10.1093/jpepsy/jsx126 Tanti, C., Stukas, A. A., Halloran, M. J., & Foddy, M. (2011). Social identity change: Shifts in social identity during adolescence. Journal of Adolescence, 34(3), 555–567. https://doi.org/10.1016/j.adolescence.2010.05.012 11  Tilton-Weaver, L., & Marshall, S. K. (2017). Governance Transfer: A dynamic perspective on adolescent behavioral autonomy and parent regulation. In B. Soenens, M. Vansteenkiste, & S. Van Petegem (Eds.), Autonomy in Adolescent Development: Towards Conceptual Clarity. (pp. 74–93). Taylor & Francis Group. Twiddy, H., Hanna, J., & Haynes, L. (2017). Growing pains: Understanding the needs of emerging adults with chronic pain. British Journal of Pain, 11(3), 108–118. https://doi.org/10.1177/2049463717709641 World Health Organization. (2014). Health for the world’s adolescents: A second chance in the second decade. https://doi.org/10.1016/j.jadohealth.2014.10.260  

Defining adolescence: A call for consistency in the chronic pain literature

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Defining adolescence: A call for consistency in the chronic pain literature

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