Role of Micro-and Mesosystems in Shaping an Adolescent

Address for correspondence Veena G Kamath Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal. Tel No; +919845304647 E-mail: veenak@manipal.edu 1Chandrasekaran, Varalakshmi, Department of Community Medicine, Melaka Manipal Medical College, 2Kamath, Veena G., Department of Community Medicine, Kasturba Medical College, 3Ashok, Lena.,Prasanna School of Public Health, 4Kamath Asha, Department of Biostatistics, 5Hegde Asha P, Department of Paediatrics, Melaka Manipal Medical College. All from Manipal Academy of Higher Education, Manipal, India, 6Devaramane, Virupaksha, Psychiatrist, AV Baliga Hospital, Udupi, India. Abstract


Introduction
A dolescence is a period distinguished by several physiological and psychological changes,often depicted as stress and storm .To gain insight into this complex transition, an ecological approach was suggested by Bronfenbrenner in 1994 1 .Across the globe, the immediate family environment as well as cultural norms have continued to change over the years.Bronfenbenner 1 described that every adolescent is uniquely shaped by the infl uences in his immediate and external sphere of infl uence.The 'Microsystem' involves immediate interactions with family, peers, neighbourhood, the school and religious communities.They are often inter-linked with the 'Mesosystem' depicting interactions between the family and school systems.The exo-and macrosystems describe infl uences that are external to the immediate environment in which the adolescent grows and matures.The World Health Organisation recognises that behavioural problems contribute signifi cantly to the global disease burden 2 .The transition from adolescence to adulthood is also marked by increasing manifestation of emotional and behavioural disorders 3 with fi rst episodes making their appearance in early adolescence and about 50%-70% extending into adulthood 4 .Across cultures, externalizing deviancy or internalizing problems 5 amongst adolescents have been well researched to range between 16.5%-40.8% 5,6and are on the rise globally 7,8,9 warranting a closer look.This review attempts to delve into the role of the micro-and mesosystems' infl uence on shaping adolescent behaviours.
Studies included in the review dealt with theoretical insights into parenting practices as well as developmental changes and challenges in a child.Peer reviewed primary research papers in English language, conducted using cross-sectional, longitudinal or intervention designs were selected.Studies were not included if they focused on therapeutic measures or focused on co-morbidities among adolescents that infl uenced behavioural outcomes.Four literature databases including Pubmed, Embase, PsychINFO and Cochrane Library were searched for literature through December 2016.The key search terms included using parenting style and dimensions, adolescent development, perceptions, and behavioural outcomes.

Family cohesion
The family is the primary medium where social and cultural norms are instilled in the growing child.Research shows that adolescents who spend quality timeand have more meaningful relationships with their family members tend not to pursue deviance 4,10 .As adolescents grow, family relationships also undergo changes becoming less hierarchical 11 .Consequently, it becomes increasingly important for the family to support the lows and buffer the highs of adolescence.Family cohesion is described at two levels: enmeshment and disengagement.Extremely high levels of cohesion leads to enmeshment, while disengagement is described as too little cohesion, and both are linked with problem behaviors 12,13 .Enmeshed adolescents have been documented to exhibit internalising behaviours while those in disengaged homes showed delinquent behaviors 14 .Age appropriate autonomy along with adequate parental monitoring are emerging as important facets that shape adolescent adaptiveness.A question arises on the bearing the developing adolescent has on parenting.Problem behaviours may have a deleterious effect on the parent-adolescent relationship.Early adolescence is marked by the beginning of 'identity' of self and the need for increasing autonomy.This could drive a wedge between parent-adolescent connectedness, and navigating this phase becomes critical in predicting long-term consequences 14 .

Parenting styles and dimensions:
Parents as primary caregivers of their offspring exert possibly the greatest impact on the psychological development of a child.They may adopt various styles of parenting, some stemming from their own experiences as children 15 .Baumrind D 16 identifi ed authoritative, authoritarian and permissive styles while Maccoby and Marting 17 included a fourth style known as 'neglectful.'Alternately, the dimensional approach 10 to parenting assesses different attitudes as well as the nature of the parenting practices.Parenting dimensions have been described in the context of parents expressing 'warmth' or 'control' over their wards.
Authoritative parenting is widely recognised to allow developmental advantages in comparison with those parented in authoritarian, permissive or neglecting households.High levels of parental involvement with effective disciplining and demonstrating higher levels of warmth 10 are found to be signifi cantly associated with reduction in mental and behavioural problems among adolescents 10,[18][19] .Consistent monitoring and supervision are also pertinent aspects of authoritative parenting.Better psychological adjustment was noted among adolescents who were allowed to participate in decision making with their parents across ethnicities 4 .While it is true that adolescents are monitoredto a lesser extent than in childhood, it is important that they feel acknowledged and have the family as a strong buffer 20 .Nevertheless, with increasing age, adolescents acknowledged experiencing higher levels of loneliness, insomnia, anxiety and a sense of hopelessness in various study settings 19,21,22 .
Authoritarian parenting involves highly controlling behaviour and less warmth.Gaps in communication, parental stress, dysfunctional home environments and use of corporal punishment were found to be associated with problem behaviors 21,22 .A breakdown in communication with either parent was associated with anxiety 24 while unsupportive parenting and use of harsh discipline may precipitate disregard for family norms 25 .Intrusive control by parents with excessive rule setting exerted a negative infl uence on adolescent psychological expression and were positively correlated with problem behaviors 26 .
Permissive form of parenting includes very warm, passive parents who remain undemanding and indulge their children with freedom.Poor parental monitoring, premature adolescent autonomy, and alternating levels of harsh and lax disciplining known as'seesaw' disciplining have been associated with problem behaviors 27,28 .Unavailable and unsupportive parents may drive adolescents to obtain guidance from possibly deviant alternates.

The sibling eff ect:
Sibling relationships provide means of expressing affection and enjoying companionship but can also be marked by confl icts.The occurrence of behavioural problems declined with supportive relationships with siblings while confl ict and hostility contributed to maladaptive behaviors 29 .Although arguments have existed for and against the heritability in relation to sibling deviance, the role of the family environment has been found to be decisive 30 .Parent-adolescent and adolescent-sibling networks appear to exert signifi cant infl uence on the psychological adaptation of adolescents.A combination of poor quality parent-adolescent relationship along with siblings who engaged in deviance led to risky behaviors 31 and infl uenced suicidal ideation 32 .When the parents and siblings no longer acted as a buffer against the stresses of adolescence, poor behaviours surfaced in the adolescent.

Peers and the developing adolescent:
Peer groups are important networks wherein the growing adolescent learns the much needed skills for adult life.More recently research suggests that peer infl uences may shape the development and expression of deviance.Parenting and the family environment mediate the risk factors in relation to self-regulation as well as peer selection 33 .Developmental trajectories have been documented to explain the infl uence of ineffi cient parenting, poor childhood behaviours, peer rejection and further into adolescent externalising and internalising behaviors 34 .Inability to regulate impulsive behaviour combined with poor parenting techniques and experiences of rejection may lead to ineffective peer bonding in early childhood 35 .Children then tend toward peers who similarly are rejected which may snowball into less than desirable academic performance and conduct disorders.Deviant peer affi liations formed the bridge between poor parenting practices and adolescent externalising behaviours.

School environment:
The school environment can wield a lot of infl uence on the academic as well as social development of adolescents.Researchers emphasize the need for positive school and class-room atmosphere to enhance emotional well-being among adolescents 36 .Parental discord, poor parenting techniques and home environment, particularly among children from economically poor families have been consistently found to co-occur with poor school performance, poor emotional regulation and further onto externalising behaviours.Apart from the proximal infl uence of the family and home environment, teachers play an important role as a surrogate support system for the adolescent 36 .Adolescents who demonstrate behavioural problems also engage in lifestyles which are inappropriate such as drug addiction or binge drinking which feeds the vicious cycle of poor self-esteem, low social image, poor school performance, bullying and other externalising behaviors 37 .Bully-victims who can play the roles of both bullies and victims were found at greatest risk for suicidal ideation and attempts while also experiencing depression.Research on the more recent phenomenon of school shooting incidents were perpetrated by bully victims who had experienced peer rejection from early years 38 .In combination with lax parental supervision and an unstable familial environment, this can lead to unfavourable outcomes for the adolescent as well to the community.

The demographics of problem behaviour:
While a large part of literature is dedicated to parenting and the bearing it has on adolescent psychological development, factors such as the family environment including income status and structure of the family have been seen to infl uence adolescent emotional and behavioural outcomes.Residing in rural areas predicted better mental and behavioural outcomes in comparison with urban adolescents 39 .Reduced connectedness between the parent-adolescent dyad with inadequate family support, low parental education, chronic exposure to poverty and a potentially hazardous home environments increased the adolescent's risks for mental and behavioural disorders [40][41] .Economic stress often fi gures in relation with unsafe neighbourhoods and higher rates of crime which may lead to poor academic performance or early school drop outs 40 .Poverty can infl uence the emergence of both externalising and internalising behaviours.High crime neighbourhoods offer accessibility to drugs and alcohol.In the presence of these factors, mediation by unsupportive or violent parenting may predict externalising and anti-social conduct.
Sudden as well as chronic economic strain have been found to be associated with greater confl ict between parents and their adolescent children as well as harsher parenting 40 .There is good evidence that living in an intact family is linked with lower risk for problem behaviour onset 41 .The family structure itself has diversifi ed in recent decades.The greatest shifts from the joint family to nuclear have been observed in the Eastern context, particularly in the South Asian region 42 where traditional family systems are giving way to nuclear structures.Although the structure itself is devolving, this can be described as 'changing' as against 'breaking down.'The unique aspect is that the smaller nuclear units draw their functional and emotional support from the larger family system 42,43 .The increasing need for economic autonomy has been one of the primary reasons for this shift.This phenomenon has been seen in recent decades and its impact on adolescent behavioural outcomes has not been suffi ciently delved into.Further, the emergence of single parent families poses signifi cant questions on the bearing it has on the children involved.While literature in the western contexts exist, very few emphasize the individual role of the primary parent 43 and their parenting practices or on the infl uence that the extended family exerts in the emergence of these behaviours.
Drastic shifts in the family structure, such as divorce, may place the children involved at risk for mental and behavioural problems.In some instances, however, benefi ts may be observed in that reduction in familial violence or inter-parental confl ict infl uences the adolescents in a positive manner 44 .In families headed by single parents, the psychological balance of the child and consequently the developing youth is infl uenced by the manner in which the tutelary parent manages the home environment.As the number of non-resident parents grows, adolescent behaviour studied in the context of unbroken intact families may be less representative of processes that affect problem behaviour in this sub-section of youth.
Family structures are also changing in terms of parental gender.Households with same-sex parents raising children have also emerged over the past few decades.The psychological impact on adolescents raised by same-sex parents have been an increasing area of interest in recent years.However, research fi ndings cannot be generalised globally as evidence is not exhaustive.In fact, data from more restrictive societies is lacking.While available evidence has indicated that adolescents in gay households are as well-adjusted as their peers living in heterosexual households, differences of opinion exist 45,46 .Studies indicate that children may experience stigmatising behaviour from peers and the possibility of having gay or lesbian relationships for themselves was considered as an option to a higher degree than adolescents raised in heterosexual homesteads.Authors have, however, emphasised the need of cautiously generalising these fi ndings 47 .Regardless of the type of family, parenting techniques and family cohesion within these families have been found to be signifi cant contributors to the development of the adolescents raised in these families.
In the absence of biological parents, grandparents, the extended family, or foster parents may adopt the role of primary caregivers and the process involved in these contexts are outside the scope of this review.

Concepts in resolution
The present review sought to gain insight into the infl uence of relationships within and outside the family context on shaping adolescent behaviours.Each adolescent's psychological makeup is framed by multiple risk and protective factors.In almost every relationship, positive infl uences promote positive outcomes in adolescents while negative ones pose risks for maladjustment and antisocial behaviours.Childhood familial interactions and behaviours may lay the foundation for future behaviours.Compelling evidence points towards intra-familial processes such as bonding and support systems as well as confl ict resolution techniques that mark each relationship within the family, be they inter-parental, parent-adolescent or adolescent-sibling relationships.Parent-adolescent confl ict resolution methods may be a much needed skill that helps in learning negotiation skills in adult life.The use of corporal punishment in confl ict resolution as a determinant to mental health has also been extensively documented.With age and growing independence from parents, peers become important agencies of support or purveyors of unsociable behaviour.In addition, several references exist to emphasize the role of schools and neighbourhoods.Targeting interventions through the school system in fostering a positive atmosphere among teachers and student peers, along with early identifi cation and redressal of peer victimisation can improve social and psychological maladjustment among at risk adolescents.The changing family structure and composition poses previously unknown infl uences on the developing adolescent.Further research is warranted as the changing social structures may challenge established fi ndings on adolescent behaviours from intact families headed by heterosexual parents.This again begs further probing within the cultural context as some societies are more accepting than others.The impact of migration on adolescent psychology and behavioural aspects also needs further research as families carry certain traditional values with them which may be challenged in the newer environment.Notwithstanding the infl uence of myriad factors including intra-familial relationships and peer affi liations, this review concludes that a fi rm parenting base with adequate and appropriate parentadolescent relationship has a signifi cant bearing on behavioural outcomes in adolescents.The family continues to remain the bedrock for intervention in enhancing behavioural skills among adolescents.