life cycle case study adults answers

This is “Nutrition through the Life Cycle: From Childhood to the Elderly Years”, chapter 13 from the book An Introduction to Nutrition (v. 1.0). For details on it (including licensing), click here .

This book is licensed under a Creative Commons by-nc-sa 3.0 license. See the license for more details, but that basically means you can share this book as long as you credit the author (but see below), don't make money from it, and do make it available to everyone else under the same terms.

This content was accessible as of December 29, 2012, and it was downloaded then by Andy Schmitz in an effort to preserve the availability of this book.

Normally, the author and publisher would be credited here. However, the publisher has asked for the customary Creative Commons attribution to the original publisher, authors, title, and book URI to be removed. Additionally, per the publisher's request, their name has been removed in some passages. More information is available on this project's attribution page .

For more information on the source of this book, or why it is available for free, please see the project's home page . You can browse or download additional books there. To download a .zip file containing this book to use offline, simply click here .

Chapter 13 Nutrition through the Life Cycle: From Childhood to the Elderly Years

Good nutritional choices reduce the risk of chronic disease during the middle-aged years.

The emergence of the obesity epidemic not only relates to what we eat and drink, but also how much we consume on a daily basis.

© Thinkstock

One hundred years ago, when many families sat down to dinner, they might have eaten boiled potatoes or corn, leafy vegetables such as cabbage or collards, fresh-baked bread, and, if they were fortunate, a small amount of beef or chicken. Young and old alike benefitted from a sound diet that packed a real nutritional punch. Times have changed. Many families today fill their dinner plates with fatty foods, such as french fries cooked in vegetable oil, a hamburger that contains several ounces of ground beef, and a white-bread bun, with a single piece of lettuce and a slice or two of tomato as the only vegetables served with the meal.

Our diet has changed drastically as processed foods, which did not exist a century ago, and animal-based foods now account for a large percentage of our calories. Not only has what we eat changed, but the amount of it that we consume has greatly increased as well, as plates and portion size have grown much larger. All of these choices impact our health, with short- and long-term consequences as we age. Possible effects in the short-term include excess weight gain and constipation. The possible long-term effects, primarily related to obesity, include the risk of cardiovascular disease, Type 2 diabetes, hypertension, stroke, osteoarthritis, sleep apenea, respiratory problems, liver and gallbladder disease, and certain cancers (endometrial, breast, and colon) among middle-aged and elderly adults. Centers for Disease Control and Prevention. “Overweight and Obesity: Health Consequences.” Last updated March 3, 2011. http://www.cdc.gov/obesity/causes/health.html .

It is best to start making healthy choices from a young age and maintain them as you mature. However, a recent report published in the American Journal of Clinical Nutrition , suggests that adopting good nutritional choices later in life, during the forties, fifties, and even the sixties, may still help to reduce the risk of chronic disease as you grow older. Rivlin, R. S. “Keeping the Young-Elderly Healthy: Is It Too Late to Improve Our Health through Nutrition?” Am J Clin Nutr 86, supplement (2007): 1572S–6S. Even if past nutritional and lifestyle choices were not aligned with dietary guidelines, older adults can still do a great deal to reduce their risk of disability and chronic disease. As we age, we tend to lose lean body mass. This loss of muscle and bone can have critical health implications. For example, a decrease in body strength can result in an increased risk for fractures because older adults with weakened muscles are more likely to fall, and to sustain serious injuries when they do. However, improving your diet while increasing physical activity helps to control weight, reduce fat mass, and maintain muscle and bone mass.

There are a number of changes middle-aged adults can implement, even after years of unhealthy choices. Choices include eating more dark, green, leafy vegetables, substituting high-fat proteins with lean meats, poultry, fish, beans, and nuts, and engaging in moderate physical activity for thirty minutes per day, several days per week. The resulting improvements in body composition will go a long way toward providing greater protection against falls and fractures, and helping to ward off cardiovascular disease and hypertension, among other chronic conditions. Rivlin, R. S. “Keeping the Young-Elderly Healthy: Is It Too Late to Improve Our Health through Nutrition?” Am J Clin Nutr 86, supplement (2007): 1572S–6S.

What is one nutritional choice that you can make today to reduce your risk of chronic disease tomorrow?

In Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" , we focused on the effects of dietary choices during pregnancy, infancy, and the toddler years. Our examination of nutrition through the human life cycle continues as we study the remainder of childhood into adulthood and the elderly years. Nutritional choices remain critical throughout a person’s life and influence overall health and wellness. The nutritional choices we make today affect not only our present health, but also our future well-being.

Weight Gain and Body-Composition Changes, Midlife into Older Age

This video focuses on the consequences of changing body composition from the middle-aged years into old age.

13.1 The Human Life Cycle Continues

Learning objectives.

• Identify and define the different stages of the human life cycle.
• Explain how the human body develops from childhood through the elderly years.

As children mature, their friends can exert a strong influence on their nutritional choices.

As discussed in Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" , all people need the same basic nutrients—essential amino acids, carbohydrates, essential fatty acids, and twenty-eight vitamins and minerals—to maintain life and health. However, the amounts of needed nutrients change as we pass from one stage of the human life cycle to the next. Young children require a higher caloric intake relative to body size to facilitate physical and mental development. On the other hand, inactive senior citizens need fewer calories than other adults to maintain their weight and stay healthy. Psychological, emotional, and social issues over the span of a human life can also influence diet and nutrition. For example, peer pressure during adolescence can greatly affect the nutritional choices a teenager makes. Therefore, it is important to weigh a number of considerations when examining how nutrient needs change. In this chapter, we will focus on diet, nutrition, and the human life cycle from the remainder of childhood into the elderly years.

Changes during Childhood

Early childhood encompasses infancy and the toddler years, from birth through age three. The remaining part of childhood is the period from ages four through eight and is the time when children enter school. A number of critical physiological and emotional changes take place during this life stage. For example, a child’s limbs lengthen steadily, while the growth of other body parts begins to slow down. By age ten, the skull and the brain have grown to near-adult size. Beverly McMillan, Human Body: A Visual Guide (Sydney, Australia: Weldon Owen, 2006), 258. Emotional and psychological changes occur as well. Children’s attitudes and opinions about food deepen. They not only begin taking their cues about food preferences from family members, but also from peers and the larger culture. All of these factors should impact the nutritional choices parents make for their children. This time in a child’s life provides an opportunity for parents and other caregivers to reinforce good eating habits and to introduce new foods into the diet, while remaining mindful of a child’s preferences. Parents should also serve as role models for their children, who will often mimic their behavior and eating habits.

Changes during Puberty

The onset of puberty The period of the human life cycle between ages nine to thirteen, nutritionally speaking. is the beginning of adolescence The period of the human life cycle between ages fourteen to eighteen, nutritionally speaking. , and is the bridge between the childhood years and young adulthood. Medically, adolescence is defined as the period between ages eleven and fourteen for girls and between twelve to fifteen for boys. For the purpose of discussing the influence of nutritional choices during the life cycle, this text will follow the 2010 Dietary Guidelines for Americans , which divides the adolescent years into two stages: ages nine to thirteen, or puberty, and ages fourteen to eighteen, or late adolescence. We will discuss puberty first. Some of the important physiological changes that take place during this stage include the development of primary sex characteristics, or the reproductive organs, along with the onset of menstruation in females. This life stage is also characterized by the appearance of secondary sex characteristics, such as the growth of facial and body hair, the development of breasts in girls, and the deepening of the voice in boys. Other physical changes include rapid growth and alterations in body proportions. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 170–71. All of these changes, as well as the accompanying mental and emotional adjustments, should be supported with sound nutrition.

Changes in Late Adolescence

The Dietary Guidelines defines the next phase of the human life cycle, late adolescence, as the period from ages fourteen to eighteen. After puberty, the rate of physical growth slows down. Girls stop growing taller around age sixteen, while boys continue to grow taller until ages eighteen to twenty. One of the psychological and emotional changes that takes place during this life stage includes the desire for independence as adolescents develop individual identities apart from their families. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 171–76. As teenagers make more and more of their dietary decisions, parents or other caregivers and authority figures should guide them toward appropriate, nutritious choices.

Changes in Young Adulthood

The next phase, young adulthood, is the period from ages nineteen to thirty. It is a stable time compared to childhood and adolescence. Physical growth has been completed and all of the organs and body systems are fully developed. Typically, a young adult who is active has reached his or her physical peak and is in prime health. For example, vital capacity, or the maximum amount of air that the lungs can inhale and exhale, is at its peak between the ages of twenty and forty. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 192–93. Proper nutrition and adequate physical activity at this stage not only promote wellness in the present, but also provide a solid foundation for the future.

Changes in Middle Age

Nutritionally speaking, middle age is defined as the period from age thirty-one to fifty. The early period of this stage is very different from the end. For example, during the early years of middle age, many women experience pregnancy, childbirth, and lactation. In the latter part of this life stage, women face perimenopause, which is a transition period that leads up to menopause, or the end of menstruation. A number of physical changes take place in the middle-aged years, including the loss of bone mass in women due to dropping levels of estrogen during menopause. In both men and women, visual acuity declines, and by age forty there can be a decreased ability to see objects at a close distance, a condition known as presbyopia. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 192–93. All of these are signs of aging, as the human body begins to change in subtle and not-so-subtle ways. However, a middle aged person can remain vital, healthy, and near his or her physical peak with proper diet and adequate exercise.

Changes in the Older Adult Years

The senior, or elderly, years are the period from age fifty-one until the end of life. A number of physiological and emotional changes take place during this life stage. For example, many elderly adults face serious health challenges, such as cancer, heart disease, diabetes, or dementia. Both men and women experience a loss of muscle mass and strength and undergo changes in body composition. Fat deposits build up in the abdominal area, which increases the risk for Type 2 diabetes and cardiovascular disease. The skin becomes thinner and may take longer to heal after an injury. Around age seventy, men begin to experience bone loss when estrogen and testosterone levels begin to decline. American Medical Association, Complete Guide to Prevention and Wellness (Hoboken, NJ: John Wiley & Sons, Inc., 2008), 512. Healthy nutritional choices can help to prevent or manage disability and chronic conditions.

In addition, disorders of the nervous system can have profound effects. Dementia A disorder of the nervous system characterized by changes in the normal activity of the brain. is the umbrella term for changes in the normal activity of the brain. Elderly adults who suffer from dementia may experience memory loss, agitation, and delusions. One in eight people over age sixty-four and almost half of all people over eighty-five suffer from the brain disorder Alzheimer’s disease, which is the most common form of dementia. American Medical Association, Complete Guide to Prevention and Wellness (Hoboken, NJ: John Wiley & Sons, Inc., 2008), 421. Neurological disorder and psychological conditions, such as depression, can influence attitudes toward food, along with the ability to prepare or ingest food. They might lead some adults to overindulge to compensate for stress or emotions that are difficult to handle. Other adults might eat less or pay less attention to their diet and nutritional needs. Elderly adults may also need guidance from dietitians and health-care professionals to make the best dietary choices for this stage of life.

Changing Needs and Nutrition

Nutritional needs continue to change at each stage of life. It is important to adjust your diet and physical activity to meet these changing needs and ensure health and wellness throughout your life. Parents must continue to help their school-aged children and adolescents establish healthy eating habits and attitudes toward food. Their primary role is to bring a wide variety of health-promoting foods into the home, so that their children can make good choices. As children become adults, they must be mindful of the choices they make and how those choices affect their health, not only in the present but also in the future.

Key Takeaways

• The human body constantly changes throughout the life cycle, from childhood into adulthood and old age.
• Proper nutrition and physical activity ensure health and wellness at each stage of the human life cycle.

Discussion Starter

• In preparation for this chapter, predict how nutrient needs might change as a healthy young adult matures into old age. Then, after reading the text, discuss if your predictions were correct or incorrect.

13.2 Childhood and Nutrition

• Summarize nutritional requirements and dietary recommendations for school-aged children.
• Discuss the most important nutrition-related concerns during childhood.

Nutritional needs change as children leave the toddler years. From ages four to eight, school-aged children grow consistently, but at a slower rate than infants and toddlers. They also experience the loss of deciduous, or “baby,” teeth and the arrival of permanent teeth, which typically begins at age six or seven. As new teeth come in, many children have some malocclusion, or malposition, of their teeth, which can affect their ability to chew food. Other changes that affect nutrition include the influence of peers on dietary choices and the kinds of foods offered by schools and afterschool programs, which can make up a sizable part of a child’s diet. Food-related problems for young children can include tooth decay, food sensitivities, and malnourishment. Also, excessive weight gain early in life can lead to obesity into adolescence and adulthood.

Childhood (Ages Four to Eight): “Growing Pains”

In school-aged children, muscle mass and strength increase and motor skills show improvement.

At this life stage, a healthy diet facilitates physical and mental development and helps to maintain health and wellness. School-aged children experience steady, consistent growth, with an average growth rate of 2–3 inches (5–7 centimeters) in height and 4.5–6.5 pounds (2–3 kilograms) in weight per year. In addition, the rate of growth for the extremities is faster than for the trunk, which results in more adult-like proportions. Long-bone growth stretches muscles and ligaments, which results in many children experiencing “growing pains,” at nighttime in particular. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 150–51.

Children’s energy needs vary, depending on their growth and level of physical activity. Energy requirements also vary according to gender. Girls ages four to eight require 1,200 to 1,800 calories a day, while boys need 1,200 to 2,000 calories daily, and, depending on their activity level, maybe more. Also, recommended intakes of macronutrients and most micronutrients are higher relative to body size, compared with nutrient needs during adulthood. Therefore, children should be provided nutrient-dense food at meal- and snack-time. However, it is important not to overfeed children, as this can lead to childhood obesity, which is discussed in the next section. Parents and other caregivers can turn to the MyPlate website for guidance: http://www.choosemyplate.gov/ .

Macronutrients

For carbohydrates, the Acceptable Macronutrient Distribution Range (AMDR) is 45–65 percent of daily calories (which is a recommended daily allowance of 135–195 grams for 1,200 daily calories). Carbohydrates high in fiber should make up the bulk of intake. The AMDR for protein is 10–30 percent of daily calories (30–90 grams for 1,200 daily calories). Children have a high need for protein to support muscle growth and development. High levels of essential fatty acids are needed to support growth (although not as high as in infancy and the toddler years). As a result, the AMDR for fat is 25–35 percent of daily calories (33–47 grams for 1,200 daily calories). Children should get 17–25 grams of fiber per day.

Micronutrients

Micronutrient needs should be met with foods first. Parents and caregivers should select a variety of foods from each food group to ensure that nutritional requirements are met. Because children grow rapidly, they require foods that are high in iron, such as lean meats, legumes, fish, poultry, and iron-enriched cereals. Adequate fluoride is crucial to support strong teeth. One of the most important micronutrient requirements during childhood is adequate calcium and vitamin D intake. Both are needed to build dense bones and a strong skeleton. Children who do not consume adequate vitamin D should be given a supplement of 10 micrograms (400 international units) per day. Table 13.1 "Micronutrient Levels during Childhood" shows the micronutrient recommendations for school-aged children. (Note that the recommendations are the same for boys and girls. As we progress through the different stages of the human life cycle, there will be some differences between males and females regarding micronutrient needs.)

Table 13.1 Micronutrient Levels during Childhood

Source: Institute of Medicine. http://www.iom.edu .

Factors Influencing Intake

A number of factors can influence children’s eating habits and attitudes toward food. Family environment, societal trends, taste preferences, and messages in the media all impact the emotions that children develop in relation to their diet. Television commercials can entice children to consume sugary products, fatty fast-foods, excess calories, refined ingredients, and sodium. Therefore, it is critical that parents and caregivers direct children toward healthy choices.

One way to encourage children to eat healthy foods is to make meal- and snack-time fun and interesting. Parents should include children in food planning and preparation, for example selecting items while grocery shopping or helping to prepare part of a meal, such as making a salad. At this time, parents can also educate children about kitchen safety. It might be helpful to cut sandwiches, meats, or pancakes into small or interesting shapes. In addition, parents should offer nutritious desserts, such as fresh fruits, instead of calorie-laden cookies, cakes, salty snacks, and ice cream. Also, studies show that children who eat family meals on a frequent basis consume more nutritious foods. Dakota County, Minnesota. “Research on the Benefits of Family Meals.” © 2006. Last revised April 30, 2012. http://www.co.dakota.mn.us/Departments/PublicHealth/Projects/ResearchFamilyMeals.htm .

Children and Malnutrition

Malnutrition is a problem many children face, in both developing nations and the developed world. Even with the wealth of food in North America, many children grow up malnourished, or even hungry. The US Census Bureau characterizes households into the following groups:

• food secure
• food insecure without hunger
• food insecure with moderate hunger
• food insecure with severe hunger

Millions of children grow up in food-insecure households with inadequate diets due to both the amount of available food and the quality of food. In the United States, about 20 percent of households with children are food insecure to some degree. In half of those, only adults experience food insecurity, while in the other half both adults and children are considered to be food insecure, which means that children did not have access to adequate, nutritious meals at times. Coleman-Jensen, A. et al. “Household Food Security in the United States in 2010.” US Department of Agriculture, Economic Research Report , no. ERR-125 (September 2011).

Growing up in a food-insecure household can lead to a number of problems. Deficiencies in iron, zinc, protein, and vitamin A can result in stunted growth, illness, and limited development. Federal programs, such as the National School Lunch Program, the School Breakfast Program, and Summer Feeding Programs, work to address the risk of hunger and malnutrition in school-aged children. They help to fill the gaps and provide children living in food-insecure households with greater access to nutritious meals. You will learn more about food insecurity and the consequences for children and adults in Chapter 14 "Nutrition and Society: Food Politics and Perspectives" .

The National School Lunch Program

Beginning with preschool, children consume at least one of their meals in a school setting. Many children receive both breakfast and lunch outside of the home. Therefore, it is important for schools to provide meals that are nutritionally sound. In the United States, more than thirty-one million children from low-income families are given meals provided by the National School Lunch Program. This federally-funded program offers low-cost or free lunches to schools, and also snacks to afterschool facilities. School districts that take part receive subsidies from the US Department of Agriculture (USDA) for every meal they serve. School lunches must meet the 2010 Dietary Guidelines for Americans and need to provide one-third of the RDAs for protein, vitamin A, vitamin C, iron, and calcium. However, local authorities make the decisions about what foods to serve and how they are prepared. US Department of Agriculture. “National School Lunch Program Fact Sheet.” 2011. Accessed March 5, 2012. http://www.fns.usda.gov/cnd/lunch/AboutLunch/NSLPFactSheet.pdf . The Healthy School Lunch Campaign works to improve the food served to children in school and to promote children’s short- and long-term health by educating government officials, school officials, food-service workers, and parents. Sponsored by the Physicians Committee for Responsible Medicine, this organization encourages schools to offer more low-fat, cholesterol-free options in school cafeterias and in vending machines. Physicians Committee for Responsible Medicine. “Healthy School Lunches.” Accessed March 5, 2012. http://healthyschoollunches.org/ .

The USDA Introduces New School Lunch Standards

This video focuses on changes to the National School Lunch Program in the United States.

Children and Vegetarianism

Another issue that some parents face with school-aged children is the decision to encourage a child to become a vegetarian or a vegan. Some parents and caregivers decide to raise their children as vegetarians for health, cultural, or other reasons. Preteens and teens may make the choice to pursue vegetarianism on their own, due to concerns about animals or the environment. No matter the reason, parents with vegetarian children must take care to ensure vegetarian children get healthy, nutritious foods that provide all the necessary nutrients.

Types of Vegetarian Diets

There are several types of vegetarians, each with certain restrictions in terms of diet:

• Ovo-vegetarians. Ovo-vegetarians eat eggs, but do not eat any other animal products.
• Lacto-ovo-vegetarians. Lacto-ovo-vegetarians eat eggs and dairy products, but do not eat any meat.
• Lacto-vegetarians. Lacto-vegetarians eat dairy products, but do not eat any other animal products.
• Vegans. Vegans eat food only from plant sources, no animal products at all.

Children who consume some animal products, such as eggs, cheese, or other forms of dairy, can meet their nutritional needs. For a child following a strict vegan diet, planning is needed to ensure adequate intake of protein, iron, calcium, vitamin B 12 , and vitamin D. Legumes and nuts can be eaten in place of meat, soy milk fortified with calcium and vitamins D and B 12 can replace cow’s milk.

Food Allergies and Food Intolerance

As discussed in Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" , the development of food allergies is a concern during the toddler years. This remains an issue for school-aged children. Recent studies show that three million children under age eighteen are allergic to at least one type of food. American Academy of Allergy, Asthma and Immunology. “Allergy Statistics.” Accessed on March 5, 2012. http://www.aaaai.org/about-the-aaaai/newsroom/allergy-statistics.aspx . Some of the most common allergenic foods include peanuts, milk, eggs, soy, wheat, and shellfish. An allergy occurs when a protein in food triggers an immune response, which results in the release of antibodies, histamine, and other defenders that attack foreign bodies. Possible symptoms include itchy skin, hives, abdominal pain, vomiting, diarrhea, and nausea. Symptoms usually develop within minutes to hours after consuming a food allergen. Children can outgrow a food allergy, especially allergies to wheat, milk, eggs, or soy.

Anaphylaxis A life-threatening, extreme immune response to a food allergen. Anaphylaxis can result in difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock, and death. is a life-threatening reaction that results in difficulty breathing, swelling in the mouth and throat, decreased blood pressure, shock, or even death. Milk, eggs, wheat, soybeans, fish, shellfish, peanuts, and tree nuts are the most likely to trigger this type of response. A dose of the drug epinephrine is often administered via a “pen” to treat a person who goes into anaphylactic shock. National Institutes of Health, US Department of Health and Human Services. “Food Allergy Quick Facts.” Accessed March 5, 2012. http://www.niaid.nih.gov/topics/foodallergy/understanding/pages/quickfacts.aspx .

Some children experience a food intolerance, which does not involve an immune response. A food intolerance is marked by unpleasant symptoms that occur after consuming certain foods. Lactose intolerance, though rare in very young children, is one example. Children who suffer from this condition experience an adverse reaction to the lactose in milk products. It is a result of the small intestine’s inability to produce enough of the enzyme lactase, which is produced by the small intestine. Symptoms of lactose intolerance usually affect the GI tract and can include bloating, abdominal pain, gas, nausea, and diarrhea. An intolerance is best managed by making dietary changes and avoiding any foods that trigger the reaction. National Digestive Disease Information Clearinghouse, a service of National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. “Lactose Intolerance.” NIH Publication No. 09–2751 (June 2009). Last updated April 23, 2012. http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/ .

The Threat of Lead Toxicity

There is a danger of lead toxicity, or lead poisoning, among school-aged children. Lead is found in plumbing in old homes, in lead-based paint, and occasionally in the soil. Contaminated food and water can increase exposure and result in hazardous lead levels in the blood. Children under age six are especially vulnerable. They may consume items tainted with lead, such as chipped, lead-based paint. Another common exposure is lead dust in carpets, with the dust flaking off of paint on walls. When children play or roll around on carpets coated with lead, they are in jeopardy. Lead is indestructible, and once it has been ingested it is difficult for the human body to alter or remove it. It can quietly build up in the body for months, or even years, before the onset of symptoms. Lead toxicity can damage the brain and central nervous system, resulting in impaired thinking, reasoning, and perception.

Treatment for lead poisoning includes removing the child from the source of contamination and extracting lead from the body. Extraction may involve chelation therapy, which binds with lead so it can be excreted in urine. Another treatment protocol, EDTA therapy, involves administering a drug called ethylenediaminetetraacetic acid to remove lead from the bloodstream of patients with levels greater than 45 mcg/dL. Mayo Foundation for Medical Education and Research. “Lead poisoning.” ©1998–2012 Accessed March 5, 2012. http://www.mayoclinic.com/health/lead-poisoning/FL00068 . Fortunately, lead toxicity is highly preventable. It involves identifying potential hazards, such as lead paint and pipes, and removing them before children are exposed to them.

• The recommended intakes of macronutrients and micronutrients for children are higher relative to body size compared with nutrient needs during adulthood. Also, children’s daily energy needs vary depending on their level of physical activity and their gender. Girls ages four to eight require 1,200 to 1,800 calories, while boys ages four to eight need 1,200 to 2,000 calories.
• Some food- and nutrition-related problems that can affect school-aged children include malnutrition, food allergies, food intolerances, and lead toxicity.

Which nutritional issues should parents who raise their children as vegans consider? Examine the vegan lifestyle and its impact on childhood development. Visit the following websites for more information on veganism:

http://www.vrg.org/nutshell/kids.htm

http://kidshealth.org/parent/nutrition_center/healthy_eating/vegan.html

http://www.fcs.uga.edu/ext/pubs/html/FDNS-E-18.html

13.3 Puberty and Nutrition

• Summarize nutritional requirements and dietary recommendations for preteens.
• Discuss the most important nutrition-related concerns at the onset of puberty.
• Discuss the growing rates of childhood obesity and the long-term consequences of it.

Puberty is the beginning of adolescence. The onset of puberty brings a number of changes, including the development of primary and secondary sex characteristics, growth spurts, an increase in body fat, and an increase in bone and muscle development. All of these changes must be supported with adequate intake and healthy food choices.

The Onset of Puberty (Ages Nine to Thirteen)

Puberty typically begins slightly earlier in girls than in boys. For girls, puberty often begins around age eleven, while for boys it begins around age twelve.

This period of physical development is divided into two phases. The first phase involves height increases from 20 to 25 percent. Puberty is second to the prenatal period in terms of rapid growth as the long bones stretch to their final, adult size. Girls grow 2–8 inches (5–20 centimeters) taller, while boys grow 4–12 inches (10–30 centimeters) taller. The second phase involves weight gain related to the development of bone, muscle, and fat tissue. Also in the midst of puberty, the sex hormones trigger the development of reproductive organs and secondary sexual characteristics, such as pubic hair. Girls also develop “curves,” while boys become broader and more muscular. Beverly McMillan, Illustrated Atlas of the Human Body (Sydney, Australia: Weldon Owen, 2008), 258.

The energy requirements for preteens differ according to gender, growth, and activity level. For ages nine to thirteen, girls should consume about 1,400 to 2,200 calories per day and boys should consume 1,600 to 2,600 calories per day. Physically active preteens who regularly participate in sports or exercise need to eat a greater number of calories to account for increased energy expenditures.

For carbohydrates, the AMDR is 45 to 65 percent of daily calories (which is a recommended daily allowance of 158–228 grams for 1,400–1,600 daily calories). Carbohydrates that are high in fiber should make up the bulk of intake. The AMDR for protein is 10 to 30 percent of daily calories (35–105 grams for 1,400 daily calories for girls and 40–120 grams for 1,600 daily calories for boys). The AMDR for fat is 25 to 35 percent of daily calories (39–54 grams for 1,400 daily calories for girls and 44–62 grams for 1,600 daily calories for boys), depending on caloric intake and activity level.

Key vitamins needed during puberty include vitamins D, K, and B 12 . Adequate calcium intake is essential for building bone and preventing osteoporosis later in life. Young females need more iron at the onset of menstruation, while young males need additional iron for the development of lean body mass. Almost all of these needs should be met with dietary choices, not supplements (iron is an exception). Table 13.2 "Micronutrient Levels during Puberty" shows the micronutrient recommendations for young adolescents.

Table 13.2 Micronutrient Levels during Puberty

Childhood Obesity

Frequent television, computer, and video game usage leads to a sedentary lifestyle, which, along with poor diet, contributes to childhood obesity.

Children need adequate caloric intake for growth, and it is important not to impose very restrictive diets. However, exceeding caloric requirements on a regular basis can lead to childhood obesity, which has become a major problem in North America. Nearly one of three US children and adolescents are overweight or obese. Let’s Move. “Learn the Facts.” Accessed March 5, 2012. http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity . In Canada, approximately 26 percent of children and adolescents are overweight or obese. Childhood Obesity Foundation. “Statistics.” Accessed March 5, 2012. http://www.childhoodobesityfoundation.ca/statistics .

There are a number of reasons behind this problem, including:

• larger portion sizes
• limited access to nutrient-rich foods
• increased access to fast foods and vending machines
• lack of breastfeeding support
• declining physical education programs in schools
• insufficient physical activity and a sedentary lifestyle
• media messages encouraging the consumption of unhealthy foods

Children who suffer from obesity are more likely to become overweight or obese adults. Obesity has a profound effect on self-esteem, energy, and activity level. Even more importantly, it is a major risk factor for a number of diseases later in life, including cardiovascular disease, Type 2 diabetes, stroke, hypertension, and certain cancers. World Health Organization. “Obesity and Overweight Fact Sheet.” Last revised March 2011. http://www.who.int/mediacentre/factsheets/fs311/en/ .

A percentile for body mass index (BMI) specific to age and sex is used to determine if a child is overweight or obese. This is more appropriate than the BMI categories used for adults because the body composition of children varies as they develop, and differs between boys and girls. If a child gains weight inappropriate to growth, parents and caregivers should limit energy-dense, nutrient-poor snack foods. Also, children ages three and older can follow the National Cholesterol Education Program guidelines of no more than 35 percent of calories from fat (10 percent or less from saturated fat), and no more than 300 milligrams of cholesterol per day. In addition, it is extremely beneficial to increase a child’s physical activity and limit sedentary activities, such as watching television, playing video games, or surfing the Internet.

Programs to address childhood obesity can include behavior modification, exercise counseling, psychological support or therapy, family counseling, and family meal-planning advice. For most, the goal is not weight loss, but rather allowing height to catch up with weight as the child continues to grow. Rapid weight loss is not recommended for preteens or younger children due to the risk of deficiencies and stunted growth.

Voice of America: Adolescent Obesity Raises Risk of Severe Obesity in Adulthood

This video provides information about the link between adolescent obesity and adult obesity.

Avoiding Added Sugars

One major contributing factor to childhood obesity is the consumption of added sugars Sugars and other sweeteners (such as high-fructose corn syrup, honey, maple syrup, and molasses), that are added to food at the table, and are also ingredients in food products. . Added sugars include not only sugar added to food at the table, but also are ingredients in items such as bread, cookies, cakes, pies, jams, and soft drinks. The added sugar in store-bought items may be listed as white sugar, brown sugar, high-fructose corn syrup, honey, malt syrup, maple syrup, molasses, anhydrous dextrose, crystal dextrose, and concentrated fruit juice. (Not included are sugars that occur naturally in foods, such as the lactose in milk or the fructose in fruits.) In addition, sugars are often “hidden” in items added to foods after they’re prepared, such as ketchup, salad dressing, and other condiments. According to the National Center for Health Statistics, young children and adolescents consume an average of 322 calories per day from added sugars, or about 16 percent of daily calories. National Center for Health Statistics. “Consumption of Added Sugar among US Children and Adolescents, 2005–2008.” NCHS Data Brief , no. 87, (March 2012). http://www.cdc.gov/nchs/data/databriefs/db87.pdf . The primary offenders are processed and packaged foods, along with soda and other beverages. These foods are not only high in sugar, they are also light in terms of nutrients and often take the place of healthier options. Intake of added sugar should be limited to 100–150 calories per day to discourage poor eating habits.

Tools for Change

The 2008 Physical Activity Guidelines for Americans call for sixty minutes of moderate to vigorous physical activity daily for preteens and teens. This includes aerobic activity, along with bone- and muscle-strengthening exercises. US Department of Health and Human Services. “2008 Physical Activity Guidelines for Americans.” Accessed March 5, 2012. http://www.health.gov/paguidelines/pdf/paguide.pdf . However, many young people fall far short of this goal. Preteens must be encouraged to lead more active lifestyles to prevent or treat childhood obesity. In the United States, the Let’s Move! campaign inspires kids to start exercising. This program, launched in 2010 by First Lady Michelle Obama, works to solve the problem of rising obesity rates among children, preteens, and teens. It offers information to parents and educators, works to provide healthier food choices in schools and afterschool programs, and helps children become more active. One way the program promotes physical activity is by encouraging preteens and teens to find something they love to do. When kids find an activity they enjoy, whether riding a bike, playing football, joining a soccer team, or participating in a dance crew, they are more likely to get moving and stay healthy. You can learn more about Let’s Move! and efforts to encourage physical activity among adolescents at this website: http://www.letsmove.gov/ .

• During puberty, preteens experience growth spurts, along with the development of primary and secondary sex characteristics.
• The daily energy requirements for preteens differ according to gender, growth, and activity level. Girls ages nine to thirteen should consume 1,400 to 2,200 calories per day, and boys should consume 1,600 to 2,600 calories per day.
• Nutritional concerns for older children include malnutrition and obesity.
• Preteens should be encouraged to develop good habits, including consuming a healthy diet and regularly participating in sports or an exercise program.

What would you recommend to help families prevent obesity among their children? What tips would you provide? What lifestyle changes might help? Use the dietary guidelines at this website to discuss suggestions.

http://www.choosemyplate.gov/ .

13.4 Older Adolescence and Nutrition

• Summarize nutritional requirements and dietary recommendations for teens.
• Discuss the most important nutrition-related concerns during adolescence.
• Discuss the effect of eating disorders on health and wellness.

In this section, we will discuss the nutritional requirements for young people ages fourteen to eighteen. One way that teenagers assert their independence is by choosing what to eat. They have their own money to purchase food and tend to eat more meals away from home. Older adolescents also can be curious and open to new ideas, which includes trying new kinds of food and experimenting with their diet. For example, teens will sometimes skip a main meal and snack instead. That is not necessarily problematic. Their choice of food is more important than the time or place.

However, too many poor choices can make young people nutritionally vulnerable. Teens should be discouraged from eating fast food, which has a high fat and sugar content, or frequenting convenience stores and using vending machines, which typically offer poor nutritional selections. Other challenges that teens may face include obesity and eating disorders. At this life stage, young people still need guidance from parents and other caregivers about nutrition-related matters. It can be helpful to explain to young people how healthy eating habits can support activities they enjoy, such as skateboarding or dancing, or connect to their desires or interests, such as a lean figure, athletic performance, or improved cognition.

Adolescence (Ages Fourteen to Eighteen): Transitioning into Adulthood

As during puberty, growth and development during adolescence differs in males than in females. In teenage girls, fat assumes a larger percentage of body weight, while teenage boys experience greater muscle and bone increases. For both, primary and secondary sex characteristics have fully developed and the rate of growth slows with the end of puberty. Also, the motor functions of an older adolescent are comparable to those of an adult. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 171–173. Again, adequate nutrition and healthy choices support this stage of growth and development.

Adolescents have increased appetites due to increased nutritional requirements. Nutrient needs are greater in adolescence than at any other time in the life cycle, except during pregnancy. The energy requirements for ages fourteen to eighteen are 1,800 to 2,400 calories for girls and 2,000 to 3,200 calories for boys, depending on activity level. The extra energy required for physical development during the teenaged years should be obtained from foods that provide nutrients instead of “empty calories.” Also, teens who participate in sports must make sure to meet their increased energy needs.

Older adolescents are more responsible for their dietary choices than younger children, but parents and caregivers must make sure that teens continue to meet their nutrient needs. For carbohydrates, the AMDR is 45 to 65 percent of daily calories (203–293 grams for 1,800 daily calories). Adolescents require more servings of grain than younger children, and should eat whole grains, such as wheat, oats, barley, and brown rice. The Institute of Medicine recommends higher intakes of protein for growth in the adolescent population. The AMDR for protein is 10 to 30 percent of daily calories (45–135 grams for 1,800 daily calories), and lean proteins, such as meat, poultry, fish, beans, nuts, and seeds are excellent ways to meet those nutritional needs.

The AMDR for fat is 25 to 35 percent of daily calories (50–70 grams for 1,800 daily calories), and the AMDR for fiber is 25–34 grams per day, depending on daily calories and activity level. It is essential for young athletes and other physically active teens to intake enough fluids, because they are at a higher risk for becoming dehydrated.

Micronutrient recommendations for adolescents are mostly the same as for adults, though children this age need more of certain minerals to promote bone growth (e.g., calcium and phosphorus, along with iron and zinc for girls). Again, vitamins and minerals should be obtained from food first, with supplementation for certain micronutrients only (such as iron).

The most important micronutrients for adolescents are calcium, vitamin D, vitamin A, and iron. Adequate calcium and vitamin D are essential for building bone mass. The recommendation for calcium is 1,300 milligrams for both boys and girls. Low-fat milk and cheeses are excellent sources of calcium and help young people avoid saturated fat and cholesterol. It can also be helpful for adolescents to consume products fortified with calcium, such as breakfast cereals and orange juice. Iron supports the growth of muscle and lean body mass. Adolescent girls also need to ensure sufficient iron intake as they start to menstruate. Girls ages twelve to eighteen require 15 milligrams of iron per day. Increased amounts of vitamin C from orange juice and other sources can aid in iron absorption. Also, adequate fruit and vegetable intake allows for meeting vitamin A needs. Table 13.3 "Micronutrient Levels during Older Adolescence" shows the micronutrient recommendations for older adolescents, which differ slightly for males and females, unlike the recommendations for puberty.

Table 13.3 Micronutrient Levels during Older Adolescence

Eating Disorders

Many teens struggle with an eating disorder A behavioral condition that involves extreme attitudes and behaviors toward food and nutrition. These disorders are characterized by overeating or undereating, and include anorexia nervosa, binge-eating disorder, and bulimia nervosa. , which can have a detrimental effect on diet and health. A study published by North Dakota State University estimates that these conditions impact twenty-four million people in the United States and seventy million worldwide. North Dakota State University. “Eating Disorder Statistics.” Accessed March 5, 2012. http://www.ndsu.edu/fileadmin/counseling/Eating_Disorder_Statistics.pdf . These disorders are more prevalent among adolescent girls, but have been increasing among adolescent boys in recent years. Because eating disorders oftenlead to malnourishment, adolescents with an eating disorder are deprived of the crucial nutrients their still-growing bodies need.

Eating disorders involve extreme behavior related to food and exercise. Sometimes referred to as “starving or stuffing,” they encompass a group of conditions marked by undereating or overeating. Some of these conditions include:

• Anorexia Nervosa. Anorexia nervosa is a potentially fatal condition characterized by undereating and excessive weight loss. People with this disorder are preoccupied with dieting, calories, and food intake to an unhealthy degree. Anorexics have a poor body image, which leads to anxiety, avoidance of food, a rigid exercise regimen, fasting, and a denial of hunger. The condition predominantly affects females. Between 0.5 and 1 percent of American women and girls suffer from this eating disorder.
• Binge-Eating Disorder. People who suffer from binge-eating disorder experience regular episodes of eating an extremely large amount of food in a short period of time. Binge eating is a compulsive behavior, and people who suffer from it typically feel it is beyond their control. This behavior often causes feelings of shame and embarrassment, and leads to obesity, high blood pressure, high cholesterol levels, Type 2 diabetes, and other health problems. Both males and females suffer from binge-eating disorder. It affects 1 to 5 percent of the population.
• Bulimia Nervosa. Bulimia nervosa is characterized by alternating cycles of overeating and undereating. People who suffer from it partake in binge eating, followed by compensatory behavior, such as self-induced vomiting, laxative use, and compulsive exercise. As with anorexia, most people with this condition are female. Approximately 1 to 2 percent of American women and girls have this eating disorder. National Eating Disorders Association. “Learn Basic Terms and Information on a Variety of Eating Disorder Topics.” Accessed March 5, 2012. http://www.nationaleatingdisorders.org/information-resources/general -information.php .

Eating disorders stem from stress, low self-esteem, and other psychological and emotional issues. It is important for parents to watch for signs and symptoms of these disorders, including sudden weight loss, lethargy, vomiting after meals, and the use of appetite suppressants. Eating disorders can lead to serious complications or even be fatal if left untreated. Treatment includes cognitive, behavioral, and nutritional therapy.

Eating Disorders: Anorexia

This video provides more information about the eating disorder anorexia nervosa.

• Older adolescents experience numerous physical changes and must increase their energy intake to support these changes and meet nutrient needs.
• Nutrient needs are greater during adolescence than at any other time in the life cycle, except during pregnancy.
• The daily energy requirements for ages fourteen to eighteen are 1,800 to 2,400 calories for girls, and 2,000 to 3,200 calories for boys, depending on activity level.
• Nutritional concerns for older adolescents include eating disorders.

Research the biological, social, and psychological aspects of eating disorders at this website. Then, brainstorm a list of risk factors and warning signs for parents, teachers, and physicians.

http://www.nationaleatingdisorders.org/

13.5 Young Adulthood and Nutrition

• Summarize nutritional requirements and dietary recommendations for young adults.
• Discuss the most important nutrition-related concerns during young adulthood.
• Explain how nutritional and lifestyle choices can affect current and future health.

With the onset of adulthood, good nutrition can help young adults enjoy an active lifestyle. For most people, this is the time when their bodies are in the best condition. The body of an adult does not need to devote its energy and resources to support the rapid growth and development that characterizes youth. However, the choices made during those formative years can have a lasting impact. Eating habits and preferences developed during childhood and adolescence influence health and fitness into adulthood. Some adults have gotten a healthy start and have established a sound diet and regular activity program, which helps them remain in good condition from young adulthood into the later years. Others carry childhood obesity into adulthood, which adversely affects their health. However, it is not too late to change course and develop healthier habits and lifestyle choices. Therefore, adults must monitor their dietary decisions and make sure their caloric intake provides the energy that they require, without going into excess.

Young Adulthood (Ages Nineteen to Thirty): At Your Peak

At this time, growth is completed and people reach their physical peak. Major organs and body systems have fully matured by this stage of the life cycle. For example, the human body reaches maximum cardiac output between ages twenty and thirty. Also, bone and muscle mass are at optimal levels, and physical activity helps to improve muscle strength, endurance, and tone. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 192–193. In order to maintain health and fitness at this age, it is important to continue to practice good nutrition. Healthy eating habits promote metabolic functioning, assist repair and regeneration, and prevent the development of chronic conditions. In addition, the goals of a young adult, such as beginning a career or seeking out romantic relationships, can be supported with good habits.

Young men typically have higher nutrient needs than young women. For ages nineteen to thirty, the energy requirements for women are 1,800 to 2,400 calories, and 2,400 to 3,000 calories for men, depending on activity level. These estimates do not include women who are pregnant or breastfeeding, who require a higher energy intake (see Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" ).

For carbohydrates, the AMDR is 45 to 65 percent of daily calories. All adults, young and old, should eat fewer energy-dense carbohydrates, especially refined, sugar-dense sources, particularly for those who lead a more sedentary lifestyle. The AMDR for protein is 10 to 35 percent of total daily calories, and should include a variety of lean meat and poultry, eggs, beans, peas, nuts, and seeds. The guidelines also recommend that adults eat two 4-ounce servings (or one 8-ounce serving) of seafood per week.

It is also important to replace proteins that are high in trans fats and saturated fat with ones that are lower in solid fats and calories. All adults should limit total fat to 20 to 35 percent of their daily calories and keep saturated fatty acids to less than 10 percent of total calories by replacing them with monounsaturated and polyunsaturated fatty acids. Avoid trans fats by limiting foods that contain synthetic sources, such as partially hydrogenated oils. The AMDR for fiber is 22 to 28 grams per day for women and 28 to 34 grams per day for men. Soluble fiber may help improve cholesterol and blood sugar levels, while insoluble fiber can help prevent constipation.

A healthy diet of nutrient-rich meals incorporates a variety of whole foods. Whole foods are unprocessed or unrefined, or have been created with as little processing as possible. They do not include a lot of added ingredients, such as sugar, sodium, or fat, and are free of preservatives or other chemicals that are often added to food products. Examples of whole foods with no processing include legumes and fresh fruits and vegetables. Examples of whole foods with minimal processing include whole-grain breads and cereals. Dietitians recommend consuming whole foods for a variety of reasons. Whole foods provide nutrients in their natural state, with all of the vitamins and minerals intact. Food processing can remove some nutrients during manufacturing. Also, diets rich in whole foods contain high concentrations of fiber and antioxidants, and can protect against chronic disease.

Micronutrient needs in adults differ slightly according to sex. Young men and women who are very athletic and perspire a great deal also require extra sodium, potassium, and magnesium. Males require more of vitamins C and K, along with thiamine, riboflavin, and niacin. Females require extra iron due to menstruation. Therefore, it can be beneficial for some young adults to follow a daily multivitamin regimen to help meet nutrient needs. But as always, it is important to remember “food first, supplements second.” Table 13.4 "Micronutrient Levels during Adulthood" shows the micronutrient recommendations for adult men and women.

Table 13.4 Micronutrient Levels during Adulthood

Nutritional Concerns in Young Adulthood

There are a number of intake recommendations for young adults. According to the IOM, an adequate intake (AI) of fluids for men is 3.7 liters per day, from both food and liquids. The AI for women is 2.7 liters per day, from food and liquids. Institute of Medicine. “Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate.” Accessed March 5, 2012. http://www.iom.edu/Reports/2004/Dietary-Reference-Intakes-Water-Potassium-Sodium-Chloride-and-Sulfate.aspx .

It is best when fluid intake is from water, instead of sugary beverages, such as soda. Fresh fruits and vegetables, including watermelon and cucumbers, are excellent food sources of fluid.

In addition, young adults should avoid consuming excessive amounts of sodium. The health consequences of high sodium intake include high blood pressure and its complications. Therefore, it is best to limit sodium to less than 2,300 milligrams per day.

Gastrointestinal Integrity

Good nutrition during the young adult years can help to support gastrointestinal integrity and prevent digestive disorders, such as constipation and diarrhea. Dietary fiber helps bind indigestible food together and normalize bowel movements. It also holds more water in the stool to make it softer for those who suffer from constipation. Excellent sources of fiber include oats, barley, rye, wheat, brown rice, celery, carrots, nuts, seeds, dried beans, oranges, and apples. In addition, healthy intestinal microflora can be supported by prebiotics, which stimulate the growth of beneficial bacteria already in the colon and are found in fruits and vegetables, and probiotics, which change or improve the bacterial balance in the gut and are found in yogurt.

Obesity during Adulthood

Obesity remains a major concern into young adulthood. For adults, a BMI above 25 is considered overweight, and a BMI of 30 or higher is obese. By that measurement, about two-thirds of all adults in the United States are overweight or obese, with 35.7 percent considered to be obese. Centers for Disease Control, National Center for Health Statistics. “Prevalence of Obesity in the United States, 2009–2010.” NCHS Data Brief , No. 82, January 2012, accessed on March 5, 2012. http://www.cdc.gov/nchs/data/databriefs/db82.pdf . As during childhood and adolescence, physical inactivity and poor dietary choices are major contributors to obesity in adulthood. Solid fats, alcohol, and added sugars (SoFAAS) make up 35 percent of total calories for most people, leading to high levels of saturated fat and cholesterol and insufficient dietary fiber. Therefore, it is important to limit unrefined carbohydrates and processed foods.

• Young adults typically have reached their physical peak and can support health and wellness with adequate nutrition and exercise.
• For ages nineteen to thirty, the daily energy requirements are 1,800 to 2,400 calories for women and 2,400 to 3,000 calories for men, depending on activity level.
• Nutritional concerns for young adults include adequate energy and fluid intake, sodium intake, and the consumption of fiber.
• Young adults should avoid consuming solid fats, added sugars, and alcohol in excess.
• How does your intake of carbohydrates, proteins, and fats compare to the AMDR? What can you do to make changes and meet the nutritional recommendations?

13.6 Middle Age and Nutrition

• Summarize nutritional requirements and dietary recommendations for middle-aged adults.
• Discuss the most important nutrition-related concerns during middle age.
• Define “preventive nutrition” and give an applied example.

During this stage of the human life cycle, adults begin to experience the first outward signs of aging. Wrinkles begin to appear, joints ache after a highly active day, and body fat accumulates. There is also a loss of muscle tone and elasticity in the connective tissue. Elaine U. Polan, RNC, MS and Daphne R. Taylor, RN, MS, Journey Across the Life Span: Human Development and Health Promotion (Philadelphia: F. A. Davis Company, 2003), 212–213. Throughout the aging process, good nutrition can help middle-aged adults maintain their health and recover from any medical problems or issues they may experience.

Middle Age (Ages Thirty-One to Fifty): Aging Well

Many people in their late thirties and in their forties notice a decline in endurance, the onset of wear-and-tear injuries (such as osteoarthritis), and changes in the digestive system. Wounds and other injuries also take longer to heal. Body composition changes due to fat deposits in the trunk. To maintain health and wellness during the middle-aged years and beyond, it is important to:

• maintain a healthy body weight
• consume nutrient-dense foods
• drink alcohol moderately or not at all
• be a nonsmoker
• engage in moderate physical activity at least 150 minutes per week

The energy requirements for ages thirty-one to fifty are 1,800 to 2,200 calories for women and 2,200 to 3,000 calories for men, depending on activity level. These estimates do not include women who are pregnant or breastfeeding (see Chapter 12 "Nutrition through the Life Cycle: From Pregnancy to the Toddler Years" ). Middle-aged adults must rely on healthy food sources to meet these needs. In many parts of North America, typical dietary patterns do not match the recommended guidelines. For example, five foods—iceberg lettuce, frozen potatoes, fresh potatoes, potato chips, and canned tomatoes—account for over half of all vegetable intake. Adam Drewnowski and Nicole Darmon. “Food Choices and Diet Cost: an Economic Analysis.” The Journal of Nutrition . © 2005 The American Society for Nutritional Sciences. Accessed March 5, 2012. http://jn.nutrition.org/content/135/4/900.full . Following the dietary guidelines in the middle-aged years provides adequate but not excessive energy, macronutrients, vitamins, and minerals.

Caloric Restriction

This video focuses on the possible connection between caloric restriction and longevity.

Macronutrients and Micronutrients

The AMDRs for carbohydrates, protein, fat, fiber, and fluids remain the same from young adulthood into middle age (see Section 13.5 "Young Adulthood and Nutrition" of this chapter). It is important to avoid putting on excess pounds and limiting an intake of SoFAAS to help avoid cardiovascular disease, diabetes, and other chronic conditions.

There are some differences, however, regarding micronutrients. For men, the recommendation for magnesium increases to 420 milligrams daily, while middle-aged women should increase their intake of magnesium to 320 milligrams per day. Other key vitamins needed during the middle-aged years include folate and vitamins B 6 and B 12 to prevent elevation of homocysteine, a byproduct of metabolism that can damage arterial walls and lead to atherosclerosis, a cardiovascular condition. Again, it is important to meet nutrient needs with food first, then supplementation, such as a daily multivitamin, if you can’t meet your needs through food.

Preventive/Defensive Nutrition

Brightly colored tomatoes are another example of foods that are high in antioxidants.

During the middle-aged years, preventive nutrition The use of dietary practices to reduce disease and promote health and well-being. can promote wellness and help organ systems to function optimally throughout aging. Preventive nutrition is defined as dietary practices directed toward reducing disease and promoting health and well-being. Healthy eating in general—such as eating unrefined carbohydrates instead of refined carbohydrates and avoiding trans fats and saturated fats—helps to promote wellness. However, there are also some things that people can do to target specific concerns. One example is consuming foods high in antioxidants, such as strawberries, blueberries, and other colorful fruits and vegetables, to reduce the risk of cancer.

Phytochemicals are compounds in fruits and vegetables that act as defense systems for plants. Different phytochemicals are beneficial in different ways. For example, carotenoids, which are found in carrots, cantaloupes, sweet potatoes, and butternut squash, may protect against cardiovascular disease by helping to prevent the oxidation of cholesterol in the arteries, although research is ongoing. Sari Voutilainen, Tarja Nurmi, Jaakko Mursu, and Tiina H. Rissanen. “Carotenoids and Cardiovascular Health.” Am J Clin Nutr 83 (2006): 1265–71. http://www.ajcn.org/content/83/6/1265.full.pdf . According to the American Cancer Society, some studies suggest that a phytochemical found in watermelons and tomatoes called lycopene may protect against stomach, lung, and prostate cancer, although more research is needed. American Cancer Society. “Lycopene.” Last revised May 13, 2010. http://www.cancer.org/Treatment/TreatmentsandSideEffects/ComplementaryandAlternativeMedicine/DietandNutrition/lycopene .

Omega-3 fatty acids can help to prevent coronary artery disease. These crucial nutrients are found in oily fish, including salmon, mackerel, tuna, herring, cod, and halibut. Other beneficial fats that are vital for healthy functioning include monounsaturated fats, which are found in plant oils, avocados, peanuts, and pecans.

In the middle-aged years, women undergo a specific change that has a major effect on their health. They begin the process of menopause, typically in their late forties or early fifties. The ovaries slowly cease to produce estrogen and progesterone, which results in the end of menstruation. Menopausal symptoms can vary, but often include hot flashes, night sweats, and mood changes. The hormonal changes that occur during menopause can lead to a number of physiological changes as well, including alterations in body composition, such as weight gain in the abdominal area. Bone loss is another common condition related to menopause due to the loss of female reproductive hormones. Bone thinning increases the risk of fractures, which can affect mobility and the ability to complete everyday tasks, such as cooking, bathing, and dressing. Academy of Nutrition and Dietetics. “Eating Right During Menopause.” © 1995–2012. Accessed March 5, 2012. http://www.eatright.org/Public/content.aspx?id=6809 . Recommendations for women experiencing menopause or perimenopause (the stage just prior to the end of the menstruation) include:

• consuming a variety of whole grains, and other nutrient-dense foods
• maintaining a diet high in fiber, low in fat, and low in sodium
• avoiding caffeine, spicy foods, and alcohol to help prevent hot flashes
• eating foods rich in calcium, or taking physician-prescribed calcium supplements and vitamin D
• doing stretching exercises to improve balance and flexibility and reduce the risk of falls and fractures
• Middle-aged adults begin to experience signs of aging and must continue to support their health and wellness with nutrition and exercise.
• The daily energy requirements for ages thirty-one to fifty are 1,800 to 2,200 calories for women and 2,200 to 3,000 calories for men, depending on activity level.
• Nutritional concerns for middle-aged adults relate to menopause and the prevention of chronic disease.

Visit the following websites to learn more about nutrition during the years of perimenopause and menopause. Discuss with classmates what you believe to be the three most important nutritional concerns for women during this phase of life.

http://www.medicinenet.com/script/main/art.asp?articlekey=59895

http://www.webmd.com/menopause/guide/staying-healthy-through-good-nuitrition

13.7 Old Age and Nutrition

• Summarize nutritional requirements and dietary recommendations for elderly adults.
• Discuss the most important nutrition-related concerns during the senior years.
• Discuss the influence of diet on health and wellness in old age.

Beginning at age fifty-one, requirements change once again and relate to the nutritional issues and health challenges that older people face. After age sixty, blood pressure rises and the immune system may have more difficulty battling invaders and infections. The skin becomes more wrinkled and hair has turned gray or white or fallen out, resulting in hair thinning. Older adults may gradually lose an inch or two in height. Also, short-term memory might not be as keen as it once was. Beverly McMillan, Illustrated Atlas of the Human Body (Sydney, Australia: Weldon Owen, 2008), 260.

In addition, many people suffer from serious health conditions, such as cardiovascular disease and cancer. Being either underweight or overweight is also a major concern for the elderly. However, many older adults remain in relatively good health and continue to be active into their golden years. Good nutrition is often the key to maintaining health later in life. In addition, the fitness and nutritional choices made earlier in life set the stage for continued health and happiness.

Older Adulthood (Ages Fifty-One and Older): The Golden Years

An adult’s body changes during old age in many ways, including a decline in hormone production, muscle mass, and strength. Also in the later years, the heart has to work harder because each pump is not as efficient as it used to be. Kidneys are not as effective in excreting metabolic products such as sodium, acid, and potassium, which can alter water balance and increase the risk for over- or underhydration. In addition, immune function decreases and there is lower efficiency in the absorption of vitamins and minerals.

Regular exercise, along with a nutritious diet, can help older adults maintain their health.

Older adults should continue to consume nutrient-dense foods and remain physically active. However, deficiencies are more common after age sixty, primarily due to reduced intake or malabsorption. The loss of mobility among frail, homebound elderly adults also impacts their access to healthy, diverse foods.

Due to reductions in lean body mass and metabolic rate, older adults require less energy than younger adults. The energy requirements for people ages fifty-one and over are 1,600 to 2,200 calories for women and 2,000 to 2,800 calories for men, depending on activity level. The decrease in physical activity that is typical of older adults also influences nutritional requirements.

The AMDRs for carbohydrates, protein, and fat remain the same from middle age into old age (see Section 13.5 "Young Adulthood and Nutrition" of this chapter for specifics). Older adults should substitute more unrefined carbohydrates for refined ones, such as whole grains and brown rice. Fiber is especially important in preventing constipation and diverticulitis, and may also reduce the risk of colon cancer. Protein should be lean, and healthy fats, such as omega-3 fatty acids, are part of any good diet.

An increase in certain micronutrients can help maintain health during this life stage. The recommendations for calcium increase to 1,200 milligrams per day for both men and women to slow bone loss. Also to help protect bones, vitamin D recommendations increase to 10–15 micrograms per day for men and women. Vitamin B 6 recommendations rise to 1.7 milligrams per day for older men and 1.5 milligrams per day for older women to help lower levels of homocysteine and protect against cardiovascular disease. As adults age, the production of stomach acid can decrease and lead to an overgrowth of bacteria in the small intestine. This can affect the absorption of vitamin B 12 and cause a deficiency. As a result, older adults need more B 12 than younger adults, and require an intake of 2.4 micrograms per day, which helps promote healthy brain functioning. For elderly women, higher iron levels are no longer needed postmenopause and recommendations decrease to 8 milligrams per day. People over age fifty should eat foods rich with all of these micronutrients.

Nutritional Concerns for Older Adults

Dietary choices can help improve health during this life stage and address some of the nutritional concerns that many older adults face. In addition, there are specific concerns related to nutrition that affect adults in their later years. They include medical problems, such as disability and disease, which can impact diet and activity level. For example, dental problems can lead to difficulties with chewing and swallowing, which in turn can make it hard to maintain a healthy diet. The use of dentures or the preparation of pureed or chopped foods can help solve this problem. There also is a decreased thirst response in the elderly, and the kidneys have a decreased ability to concentrate urine, both of which can lead to dehydration.

Sensory Issues

At about age sixty, taste buds begin to decrease in size and number. As a result, the taste threshold Minimum concentration at which taste sensitivity to a food or substance can be perceived. is higher in older adults, meaning that more of the same flavor must be present to detect the taste. Many elderly people lose the ability to distinguish between salty, sour, sweet, and bitter flavors. This can make food seem less appealing and decrease the appetite. An intake of foods high in sugar and sodium can increase due to an inability to discern those tastes. The sense of smell also decreases, which impacts attitudes toward food. Sensory issues may also affect the digestion because the taste and smell of food stimulates the secretion of digestive enzymes in the mouth, stomach, and pancreas.

Gastrointestinal Problems

A number of gastrointestinal issues can affect food intake and digestion among the elderly. Saliva production decreases with age, which affects chewing, swallowing, and taste. Digestive secretions decline later in life as well, which can lead to atrophic gastritis (inflammation of the lining of the stomach). This interferes with the absorption of some vitamins and minerals. Reduction of the digestive enzyme lactase results in a decreased tolerance for dairy products. Slower gastrointestinal motility can result in more constipation, gas, and bloating, and can also be tied to low fluid intake, decreased physical activity, and a diet low in fiber, fruits, and vegetables.

Some older adults have difficulty getting adequate nutrition because of the disorder dysphagia, which impairs the ability to swallow. Any damage to the parts of the brain that control swallowing can result in dysphagia, therefore stroke is a common cause. Dysphagia is also associated with advanced dementia because of overall brain function impairment. To assist older adults suffering from dysphagia, it can be helpful to alter food consistency. For example, solid foods can be pureed, ground, or chopped to allow more successful and safe swallow. This decreases the risk of aspiration, which occurs when food flows into the respiratory tract and can result in pneumonia. Typically, speech therapists, physicians, and dietitians work together to determine the appropriate diet for dysphagia patients.

This video provides information about the symptoms and complications of dysphagia.

Obesity in Old Age

Similar to other life stages, obesity is a concern for the elderly. Adults over age sixty are more likely to be obese than young or middle-aged adults. As explained throughout this chapter, excess body weight has severe consequences. Being overweight or obese increases the risk for potentially fatal conditions that can afflict the elderly. They include cardiovascular disease, which is the leading cause of death in the United States, and Type 2 diabetes, which causes about seventy thousand deaths in the United States annually. Centers for Disease Control, National Center for Health Statistics. “Deaths and Mortality.” Last updated January 27, 2012. http://www.cdc.gov/nchs/fastats/deaths.htm . Obesity is also a contributing factor for a number of other conditions, including arthritis.

For older adults who are overweight or obese, dietary changes to promote weight loss should be combined with an exercise program to protect muscle mass. This is because dieting reduces muscle as well as fat, which can exacerbate the loss of muscle mass due to aging. Although weight loss among the elderly can be beneficial, it is best to be cautious and consult with a health-care professional before beginning a weight-loss program.

The Anorexia of Aging

In addition to concerns about obesity among senior citizens, being underweight can be a major problem. A condition known as the anorexia of aging A condition that affects the elderly and is characterized by poor food intake. is characterized by poor food intake, which results in dangerous weight loss. This major health problem among the elderly leads to a higher risk for immune deficiency, frequent falls, muscle loss, and cognitive deficits. Reduced muscle mass and physical activity mean that older adults need fewer calories per day to maintain a normal weight. It is important for health care providers to examine the causes for anorexia of aging among their patients, which can vary from one individual to another. Understanding why some elderly people eat less as they age can help health-care professionals assess the risk factors associated with this condition. Decreased intake may be due to disability or the lack of a motivation to eat. Also, many older adults skip at least one meal each day. As a result, some elderly people are unable to meet even reduced energy needs.

Nutritional interventions should focus primarily on a healthy diet. Remedies can include increasing the frequency of meals and adding healthy, high-calorie foods (such as nuts, potatoes, whole-grain pasta, and avocados) to the diet. Liquid supplements between meals may help to improve caloric intake. Morley, J. E. “Anorexia of Aging: Physiologic and Pathologic.” Am J Clin Nutr 66 (1997): 760–73. http://www.ajcn.org/content/66/4/760.full.pdf . Health care professionals should consider a patient’s habits and preferences when developing a nutritional treatment plan. After a plan is in place, patients should be weighed on a weekly basis until they show improvement.

Vision Problems

Many older people suffer from vision problems and a loss of vision. Age-related macular degeneration is the leading cause of blindness in Americans over age sixty. American Medical Association, Complete Guide to Prevention and Wellness (Hoboken, NJ: John Wiley & Sons, Inc., 2008), 413. This disorder can make food planning and preparation extremely difficult and people who suffer from it often must depend on caregivers for their meals. Self-feeding also may be difficult if an elderly person cannot see his or her food clearly. Friends and family members can help older adults with shopping and cooking. Food-assistance programs for older adults (such as Meals on Wheels) can also be helpful.

Diet may help to prevent macular degeneration. Consuming colorful fruits and vegetables increases the intake of lutein and zeaxanthin. Several studies have shown that these antioxidants provide protection for the eyes. Lutein and zeaxanthin are found in green, leafy vegetables such as spinach, kale, and collard greens, and also corn, peaches, squash, broccoli, Brussels sprouts, orange juice, and honeydew melon. American Medical Association, Complete Guide to Prevention and Wellness (Hoboken, NJ: John Wiley & Sons, Inc., 2008), 415.

Neurological Conditions

Elderly adults who suffer from dementia may experience memory loss, agitation, and delusions. One in eight people over the age sixty-four and almost half of all people over eighty-five suffer from Alzheimer’s, which is the most common form of dementia. These conditions can have serious effects on diet and nutrition as a person increasingly becomes incapable of caring for himself or herself, which includes the ability to buy and prepare food, and to self-feed.

Longevity and Nutrition

The foods you consume in your younger years influence your health as you age. Good nutrition and regular physical activity can help you live longer and healthier. Conversely, poor nutrition and a lack of exercise can shorten your life and lead to medical problems. The right foods provide numerous benefits at every stage of life. They help an infant grow, an adolescent develop mentally and physically, a young adult achieve his or her physical peak, and an older adult cope with aging. Nutritious foods form the foundation of a healthy life at every age.

• As adults age, physical changes impact nutrient needs and can result in deficiencies.
• The daily energy requirements for adults ages fifty-one and over are 1,600 to 2,200 calories for women and 2,000 to 2,800 calories for men, depending on activity level.
• Older adults are more susceptible to medical problems, such as disability and disease, which can impact appetite, the ability to plan and prepare food, chewing and swallowing, self-feeding, and general nutrient intake.
• A nutrient-dense, plant-based diet can help prevent or support the healing of a number of disorders that impact the elderly, including macular degeneration and arthritis.
• Revisit the predictions you made at the beginning of this chapter about how nutrient needs might change as a healthy young adult matures into old age. Which predictions were correct? Which were incorrect? What have you learned?

13.8 End-of-Chapter Exercises

It’s your turn.

• Visit http://www.choosemyplate.gov/ to research suggestions to help kids eat healthier foods. Create a list of tips for parents.
• Visit http://www.webmd.com/diet/food-fitness-planner/default.htm to create a food and fitness plan that fits your current height, weight, and lifestyle.

Create a list of nutritional tips for adults who are caring for their elderly parents after watching the following video:

Nutrition for Senior Citizens

• Visit http://www.health.gov/paguidelines/guidelines/default.aspx to study the 2008 Physical Activity Guidelines for Americans . Then create a chart that suggests physical activities for teens, young adults, and middle-aged adults, and includes the amount of physical activity recommended for each group per week.
• How do the physical changes that a preteen experiences during puberty relate to changing nutrient needs? Hold a small group discussion to talk about puberty and nutrition.
• Research ways to help an older adult who suffers from poor intake to get enough nutrients at the following website: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/preventive-medicine/aging-preventive-health/ . Then create a brochure for patients to explain your findings.

Expand Your Knowledge

• Write a short speech that you would give to a group of school children between ages nine and thirteen. Explain to them how their sugar intake impacts their bodies and overall well-being.
• Consider the changing needs of an older adolescent, along with a teen’s access to food and desire to make dietary choices. Then create a three-day meal plan for a teenage boy or girl.

After watching the video, hold a small group discussion to discuss the influence of environment, economics, culture, and lifestyle on dietary choices.

The Obesity Epidemic

Emerging Adulthood as a Critical Stage in the Life Course

• Open Access
• First Online: 21 November 2017

Cite this chapter

You have full access to this open access chapter

• David Wood MD, MPH 5 ,
• Tara Crapnell OTD, OTR/L 6 ,
• Lynette Lau PhD 6 ,
• Ashley Bennett MD 7 ,
• Debra Lotstein MD, MPH 6 ,
• Maria Ferris MD, PhD, MPH 6 &
• Alice Kuo MD, PhD 6  

148k Accesses

183 Citations

5 Altmetric

• An erratum to this publication is available online at https://doi.org/10.1007/978-3-319-47143-3_27

Emerging adulthood, viewed through the lens of life course health development, has the potential to be a very positive developmental stage with postindustrial societies giving adolescents and emerging adults a greater opportunity for choice and exploration but also greater challenges with greater educational and social role requirements. The loss of supports and structures offered by schools, families, and child- and family-oriented health and social services means that the emerging adult must rely more on his/her own resources in a less structured environment. This increased agency in the context of less structure is occurring as the human brain is still developing higher-level capacities such as executive functioning. The person-context interactions during EA are many and complex, leading to multiple different pathways through emerging adulthood. Those with sufficient economic and adult supports as well as personal resources and maturity will be more likely to choose well and embark on a positive trajectory during EA. Those lacking these resources, or those with physical and mental health or intellectual disabilities, may struggle during this period and experience a negative trajectory in the spheres of education, vocation, relationships, and health status. The life course health science of EA requires more detailed and deeper analysis of the relationship between family, peers, and societal supports and personal internal resources in order to help promote successful developmental trajectories during EA.

You have full access to this open access chapter,  Download chapter PDF

Similar content being viewed by others

Introduction

Codevelopment of Well-Being and Developmental Progress in Central Life Domains During Established Adulthood

Extending the Five Psychological Features of Emerging Adulthood into Established Adulthood

1 introduction to emerging adulthood.

The path that individuals take from dependency in childhood to independence in adulthood is now a longer and more complicated one than at any other point in history (Arnett 2014 ). From the mid- to late twentieth century and extending into the twenty-first century, industrial societies have experienced a surge in the concept of individualism and increased salience of self-realization and personal expression (Arnett 1998 ). Moreover, we have seen a dramatic increase in the number of youth seeking post-high school education, which is required for success as the economy transitions from an industrial to an information-based economy (Rifkin 2011 ). However, stagnation of wages for low-skilled workers and the lack of work opportunities for youth and young adults, combined with the increased costs of education and independent living, have made the pathway to independence and adulthood prolonged, complex, and varied, creating a new stage in the life course that has been labeled emerging adulthood (EA). While not all life course or developmental scientists agree that emerging adulthood constitutes a new developmental stage , there is agreement that social and economic forces have prolonged entry into adulthood and with significant role and developmental challenges beyond the traditional adolescent years (Cote 2014 ).

At the beginning of this stage, 17–18 years of age, emerging adults are generally dependent, living with their parents or caretakers, beginning to engage in romantic relationships, and attending high school. At the end of this stage, mid- to late 20s, most emerging adults live independently, are in long-term relationships, and have clear career paths ahead of them. How they traverse this life stage is dependent upon the personal, family, and social resources they possess as they enter this stage of life, dynamic and reciprocal interaction between the emerging adult and their environment, and the supports they receive during this stage. The result is that there are many pathways that youth and young adults pursue through this stage to achieve stable adulthood. For example, 40% do not pursue post-high school education. While 60% entered college immediately after graduating high school, many drop out or interrupt their college education with periods of work. Some 33% in this stage remain unmarried; however, 67% of them achieve stable domestic partners. Importantly, only a minority of emerging adults are employed in full-time jobs, limiting the economic opportunities they experience (U.S. Census Bureau. American Community Survey 2006 ).

Emerging adulthood is considered to be the volitional years , as it offers the most opportunity for identity exploration in the areas of love, work, and worldviews (Arnett 2000 ). During this time, individuals begin to develop the characteristic qualities necessary for becoming self-sufficient, engage in mature, committed relationships, assume more adult roles and responsibilities, and obtain a level of education and training that sets the foundation for work during the adult years. Characterizing emerging adulthood as a stage in the life course has proven to be beneficial to explain the social, cognitive, and psychological development that occurs during this stage. Research demonstrating continued brain development into the late 20s provides further justification for viewing emerging adulthood as a stage in the life course (Spear 2000 ).

2 Conceptual Framework

The Life Course Health Development (LCHD) model posits that myriad factors (e.g., biological, psychological, cultural) on multiple levels (e.g., micro, meso, macro) interact simultaneously in a transactional fashion to influence an individual’s LCHD during each stage to determine a “health developmental” trajectory (see also Halfon and Forrest 2017 ). The Life Course Health Development (LCHD) model further posits that transitions and pivotal points in an individual’s life have the potential to influence and alter an individual’s developmental pathways. EA is a life stage characterized by changes in person-context cognitive, emotional, physical, and social domains, and the ultimate pathway achieved by the emerging adults during this stage is determined by the ongoing, dynamic, and reciprocal interactions between the individual and their environment. The degree of agency and role exploration that characterizes EA results in the potential for growth in intellectual and emotional functioning (Arnett 2000 ). EA represents a broad and diverse but fundamentally important area of consideration by virtue of the multiple avenues through which an individual’s developmental trajectories and outcomes may be influenced. Important developmental challenges during EA include the continued formation of identity and values, which occur in the midst of frequent changes in personal relationships, living arrangements, vocational and educational pursuits, and social roles (Shanahan 2000 ).

No stage in life, other than perhaps infancy, experiences such dynamic and complex changes on the personal, social, emotional, neuroanatomical, and developmental levels. For the 10 years between 18 and 28, the vast majority of emerging adults change living situation, change their primary relationships, complete education or vocational preparation, get married, have children, and transition from adolescent/dependent roles to adult/independent roles. This occurs during often volatile emotional, neurodevelopmental, and social development. Increasing agency occurs at the same time as decreasing institutional and family supports. The theoretical framework developed by Learner and others to create the positive youth development theory nicely explains how the developmental trajectories that emerge during the period of EA are dependent upon multiple influential, bidirectional, person-context coactions. Individuals during emerging adulthood act as co-developers of their own developmental pathways, adaptively responding to different biological, social, cultural, and physical environmental contexts that they influence and are also influenced by (Learner and Overton 2008). Successfully navigating the developmental challenges inherent in EA will likely, in large part, influence the developmental trajectory of adulthood because these challenges ultimately influence the important adult outcomes of independent living, committed intimate relationships, and vocational and educational achievement. Youth and young adults with chronic disease or disabilities face additional challenges (disease management, disease complications, limitations in opportunities, etc.) in the context of these multiple domains of growth and development, which impact their pathway through this stage.

The continued positive trajectory of the emerging adult’s mental health, identity formation, education achievement, social relationships, and other developmental areas is somewhat dependent on the degree to which there are matches or mismatches between the individual and his/her resources and the environmental challenges and supports . If the transition, such as school to work, provides a reasonable and developmentally appropriate challenge and the emerging adult successfully navigates that challenge, then the developmental trajectory of the emerging adult will be enhanced. In contrast, if the same transition lacks supports or is an inappropriate match for the emerging adult’s abilities (e.g., an inadequate vocational program for an emerging adult with a learning disorder or lack of support for chronic disease management) and the emerging adult experiences failure, then the developmental trajectory may be impaired, resulting in significantly less achievement or developmental progression across the lifespan. A major defining characteristic of the stage of EA is that contexts are changing significantly (family to independence or romantic relationships, school to work or disconnected state, dependent living to independent living arrangements). The changes are so significant that emerging adults need substantial supports to navigate the transition successfully. Emerging adults with disabilities or chronic health conditions require more support to maximize their potential development during EA (Table 1 ).

The above table outlines the seven principles of the Life Course Health Development framework. These principles can be applied to the stage of emerging adulthood in a limited fashion due to the limited research literature focused on this life stage. However, conceptually, using the seven principles to view the stage of emerging adulthood can be instructive and can lead to additional research questions (see end of this article). For example, Principle 5 states that health development expressions are malleable and enable and constrain health development pathways and plasticity. According to Bogin’s reserve capacity hypothesis, prolonged childhood into adolescence and perhaps emerging adulthood leads to greater biologic and social resilience in adulthood, which leads to enhanced fertility and greater longevity (Bogin 2013 ). Principle 4 states that health development is sensitive to life course timing and social structuring of the environment. As we described above, this is particularly true of emerging adulthood, where the interaction between age, personal development, and environment (peers, schools, social institutions, etc.) leads to multiple pathways to identify formation and academic and social achievement during this stage (Benson and Elder 2011 ; Benson et al. 2012 ).

Multiple factors can influence the life course during EA, including factors at the macro-level (historical and societal influences), meso-level (parent-child relationship, family environment, and socioeconomic status), and microlevel (individual cognitive, personality, and emotional development). The timing of these exposures during EA, which we consider a critical or sensitive period in the life course development, can significantly impact adult outcomes. For example, an emerging adult that engages in criminal activity and is convicted of a felony will suffer repercussions that will greatly diminish their chances of achieving success in relationships and work. In the sections that follow, we review the macro-, meso-, and microlevel influences occurring during EA for emerging adults generally. Next we explore the additional challenges faced by those with selected chronic health or developmental conditions including mental illness or substance abuse, diabetes, chronic renal failure, and autism, to serve as case studies of the increased complexity faced by emerging adults with chronic disease. Finally, we finish up with a set of questions and issues that are research priorities for developing an LCHD research agenda on the stage of emerging adulthood.

3 Macro-level Influences on the Trajectory of Emerging Adulthood

Emerging adulthood, like many other developmental stages, is a period in the life course that is culturally constructed and not universal (Arnett 1998 , 2000 ). Thus, the very existence and trajectory of EA are dependent on macro-level societal expectations and influences. For many years, it was theorized that an individual transitioned from adolescence (which begins in puberty and ends in the late teens) into young adulthood. Over history and cross-culturally, the length of time during which an individual spends in adolescence has been determined by the age at which the person enters marriage or a committed relationship (Schlegel and Barry III 1991 , Gilmore 1990 ). In fact, human life history posits that the life stage of adolescence came into existence about 75,000 years ago due to changes in human societies and cultures associated with pair bonding and living in large groups (Bogin 2013 ). So massive culture and reproductive change led to a change in life history with the addition of a new period of development. It is theorized by those promoting emerging adulthood as a new life stage that the same kind of massive cultural and reproductive change is happening once again and new social and cultural demands of adult life necessitate a longer and more complex prologue to adult life.

Although the functional outcome of EA, causing a delayed transition to adulthood, appears relatively novel, this practice of prolonging the transition to adulthood may be dated back to early modern English society from the 1500s to 1700s (Ben-Amos 1994 ). Similar to what generally occurs during EA today, individuals during that era took part in a “life cycle service ” between their late teens and 20s, wherein they would engage in developing important vocational skills (e.g., a trade or craft) and marriage was often postponed until the late 20s for both men and women; adult roles and responsibilities for individuals during that era were provided only gradually, as each individual acquired the desired character qualities deemed appropriate by society (Ben-Amos 1994 ). It was not until industrialization in America began to emerge in the nineteenth century that the concept of individualism developed and strengthened (Rotundo 1994 ). The twentieth century marked the first time that an individual could obtain and gain control over the resources that would allow them to choose the timing of major life events and personal expression was valued in society (Modell 1991 ).

As we move forward into the twenty-first century, individualism in contemporary postindustrial society continues to strengthen, while the age at which individuals marry continues to increase, and individuals increasingly seek to pursue other life course events (Modell 1991 ; Alwin 1988 ; Bellah et al. 2007 ). As a reflection of these trends, recent evidence indicates that contemporary postindustrial society considers marriage status of low importance in the determination of whether or not an individual has reached adulthood; rather, societies in developed countries appear to now consider the acquisition of certain character qualities as the most important indicator of having attained adulthood, the top three character qualities of which include (1) accepting responsibility for oneself, (2) making independent decisions, and (3) assuming financial independence – all of which emphasize an individual’s ability to be self-sufficient (Scheer et al. 1996 ; Greene et al. 1992 ; Arnett 1997 , 1998 ).

4 Meso-level Influences of Life Trajectories During Emerging Adulthood

Earlier life experiences and family environment can impact one’s life trajectory from childhood through EA and into adulthood. Longitudinal studies that span early childhood through EA indicate that there is both continuity and discontinuity of healthy and unhealthy paths and outcomes. (Masten et al. 2006 , 2005 ). In this section, we will be discussing the impact of the parent-child relationship, family environment, and other sociodemographic factors, such as socioeconomic status (SES) and its influence in EA.

4.1 Earlier Parent-Child Relationships

The quality of parent-child relationships during EA is, in large part, a function of the history of early parent-child attachment experiences. Attachment theory suggests that positive bonding with an emotionally available adult during early childhood facilitates the development of the child’s capacity to bond with others and respond to stressful events. A history of positive attachment experiences will ultimately provide a foundation for positive interactions with others and foster secure, lasting relationships in EA which subsequently influence the LCHD (Mikulincer M and Shaver PR 2009 ). whereas insecure attachments can result in mistrust or lack of security and reduced sense of self-efficacy and self-esteem. Simultaneously, social learning theory suggests that styles of family interactions learned in early and middle childhood are carried by emerging adults into adulthood (Whitbeck et al. 1994 ). Familiar patterns of interaction help individuals deal with new situations and have a significant influence on the emerging adult’s capacity to deal with the multiple changes that occur during EA. Alternatively, inadequate parenting, disrupted family bonds, and poverty are environmental risks for childhood-onset conduct, behavioral and emotional problems, and educational underachievement that can persist into adolescence and emerging adulthood (Moffit and Caspi 2001 ).

Adverse events experienced in childhood such as parental divorce or alcoholism or the experience of abuse are major risk factors for the leading causes of illness and death as well as poor quality of life in adults in the USA. Disruptions in the parent relationship (e.g., divorce) can have strong, negative effects on the parent-child relationship (Aquilino 1994 ) causing significant emotional impact throughout the life course. Parental divorce may influence the emerging adults’ ability to form stable romantic relationships and their decision to marry early or may undermine the emerging adult’s financial ability to attend college (Jacquet and Surra 2001 , Cherlin et al. 1998 ).

Importantly, parental acceptance and support for independence have been linked to higher self-esteem, individualism, and feelings of worthiness among emerging adults (Ryan and Lynch 1989 ). Critical to the emerging adult’s achievement of independence are feeling connected, secure, understood, and loved in their families and having the willingness to call on parental resources for help in making choices in educational, relationship, living, and other changes that confront the emerging adult. Persistent connectedness to parents facilitates rather than undermines ongoing identity development in emerging adulthood (Grotevant and Cooper 1986 ; Ryan and Lynch 1989 ).

4.2 Childhood Socioeconomic Status

Socioeconomic status (SES), family supports, and the neighborhood environment all can contribute to the positive or negative life trajectory prior to and during EA (Galobardes et al. 2008 ; Gilman 2012 ; Gilman and Loucks 2012 ). Socioeconomic status has been identified as one of the most important health determinants throughout the life course (Miller et al. 2015 ). Low financial resources and all the other exposures that go along with poverty – poor schools, chaotic families, exposure to violence, and victimization – limit opportunities for growth or acquisition of other resources that enhance quality of life (Wadsworth et al. 2016 ; Kim et al. 2015 ).

In addition to being an important predictor of disease-specific morbidity and mortality in adulthood, early childhood poverty has been associated with lower adult educational attainment (Duncan and Brooks-Gunn 2000 ). Educational achievement has a major influence on the life trajectory, including financial stability and health in EA and onward throughout adulthood. Seventy percent of emerging adults who grow up in poverty delay enrollment in postsecondary education, in comparison to 40% who grow up in household of higher SES. Furthermore, research has indicated that individuals who delay enrollment past the age of 22 are less likely to ever enroll in postsecondary education and less likely to complete a degree (Feliciano and Ashtiani 2012 ). The result is that only 22% of young adults from low-income families earn college degrees, while 48% of young adults from higher-income families earn at least an associate’s degree. Earning a college education results in not only higher lifetime earnings but enhancement of multiple aspects of psychosocial development (Evans and Cassells 2014 ).

However, while SES has been found to be predictive of educational attainment, the impact of poverty can be mitigated by a number of factors such as individual characteristics of self-efficacy and hope . Students from poor families that have high self-efficacy and a similar concept of hope for educational attainment do equally as well in school as their higher SES peers (Osgood et al. 2005 ). Recent research by Dweck and colleagues indicates that students’ mindsets are critically linked to resilience and achievement and that they can be changed through brief interventions, leading to substantial increases in measures of resilience and achievement (Yeager and Dweck 2012 ). These studies suggest that in addition to SES, individual characteristics also have a large influence on outcomes of EA and that these characteristics can be influenced through individual interventions. Individual characteristics and development are discussed in the next section.

5 Microlevel Influences on the Trajectories During Emerging Adulthood

As discussed in previous sections, individualism and the qualities of character have become increasingly important in the transition to EA and ultimately reaching full adulthood in postindustrial, developed societies. Studies have shown that the ability to accept responsibility for one’s self, make independent decisions, and assume financial independence are the top three most important factors in becoming an adult (Arnett 2014 ). In order to achieve individualism and obtain these important qualities of character, one needs to reach some degree of cognitive and psychological maturity, as well as possess some level of resilience. These individual factors are discussed in this section.

5.1 Cognitive Development

One of the identified qualities of character that is important in EA and reaching full adulthood is independent decision-making. While the ability to make independent decisions is a reflection of one’s psychological and moral identity, it also has to do with cognitive maturity and the ability to weigh a variety of considerations before deciding on a choice. Recent neuroscience research indicates that brain development (particularly in the prefrontal cortex) continues well into the third decade of life, ultimately resulting in the integration and coordination of cognitions, emotion and action, and strategic executive control (Luciana et al. 2005 ). The continuous unfolding and acquisition of specific neurodevelopmental capacities during adolescences and EA influence the acquisition of goal directedness and future orientation that have been observed behaviorally during EA (Dahl 2004 ; Nelson et al. 2012 ; Nurmi 1999 ; Steinberg et al. 2006 ). As new capacities emerge, they are available to solve problems, delay gratification, and filter unnecessary input. With maturation of these skills, emerging adults are also more capable of reflecting on the influence of their environment and on their internal state, regulate their emotions, and use problem-solving skills to effectively compromise, which is important for the development of meaningful social interactions and personal relationships as well as in the work environment. These skills also support an emerging adult’s capacity for optimally interacting with the health-care system, managing their health-care needs, and making decisions that will influence their long-term health outcomes.

However, the preceding paragraph assumes that the individual has experienced optimal neurodevelopment up to the point that they enter the stage of EA. Studies have demonstrated that exposure to chronic stress during childhood (e.g., poverty) or experiencing adverse childhood events (e.g., child maltreatment, neglect, parental divorce, parental substance abuse) may cause detrimental impact to the developing brain. For example, repeated exposure to stressful events has been associated with structural differences in specific brain regions (i.e., amygdala, hippocampus, and prefrontal cortex), which are in turn associated with functional differences in learning, memory, and aspects of executive functioning. Furthermore, preliminary studies go on to suggest that there may be sensitive periods of brain development with increased susceptibility to the effects of stress and adverse events. These environmentally induced modulations in neurodevelopment can impact an individual’s cognitive development and their capacity to develop the necessary skills and relationships that will enable them to thrive.

An emerging adult, who has experienced chronic stress or adverse events earlier in childhood and adolescence and is cognitively immature, is more likely, through adverse interaction with their environment, to suffer secondary effects such as school failure, risky/impulsive behaviors, accidental injury, criminal activity, or substance misuse or overuse. These behaviors may in turn interfere with the ongoing development of an optimal pathway to adulthood. Feelings of isolation and rates of substance abuse in individuals often peak during this period as emerging adults are faced with the stresses of having to navigate societal structures that are not adequately informed or equipped to address the needs of an emerging adult population – all while their brains have yet to reach full maturation (Spear 2000 ). An impulsive emerging adult fueled by alcohol and despair is at high risk for suicide. It is thus apparent that multiple factors related to an individual’s cognitive and emotional development may intersect and interact to multiply the likelihood of adverse or positive health outcomes in EA. It is crucial for service providers to recognize the level of cognitive maturation an emerging adult possesses and tailor their interventions and supports based on this.

5.2 Identity Formation

Identity formation is a major developmental activity during EA. Identity development , occurs in a number of dimensions: (1) psychological dimension, or ego identity via a sense of temporal-spatial continuity and its concomitants; (2) the personal dimension, or a behavioral and character repertoire that differentiates the individuals; and (3) the social dimension, or recognized roles within a community. These components come together during the stage of identity formation (adolescence and EA) and stabilization (EA and young adulthood), and once the identity is considered stable, this is when a relatively firm sense of ego identity is developed, behavior and character become stabilized, and community-sanctioned roles are acquired (2002).

Identity formation during adolescence was thought to be a critical milestone in adolescence; however, it has been recognized that in certain societal contexts, identity formation continues beyond adolescence. In the postindustrial society, with the prolongation of educational and vocational attainment, prolongation of identity exploration in the three main areas of love, work, and worldviews into the 20s has become the norm. Identity formation is critical in EA, as it has direct implications on psychological and moral identity and in achieving the three qualities of character deemed as important in the transition to adulthood.

5.3 Resilience in Emerging Adulthood

Resilience is an individual’s capacity to adapt to change in healthy and flexible ways during stressful events (Catalano et al. 2004 ). Resilience can be measured in various ways, including internal adaption (e.g., well-being, happiness, or self-concept) or external adaption (academic achievement, relationship development) to adverse circumstances, such as how well a person navigates and achieves the developmental tasks presented by the external world (e.g., educational achievement, stable work/career, marriage, etc.). Resiliency in adolescence and young adulthood is higher among youth with higher intellectual resources, optimistic future orientation, the presence of caring relationships with positive adult role models, and opportunities to succeed and serve the community. Emerging adulthood is a particularly important stage in the life course to understand resilience because the important changes in functional capacity, educational achievement, and social roles are large and varied and have a significant influence on life course outcomes.

Key individual characteristics that predict resilience during EA are goal-directed motivation and planfulness about the future. In addition, adult support and mentorship are important factors that help promote resilience (Miller GE 2015 ; Masten et al. 2005 ; Arnett 2005 ). Furstenberg, Brooks-Gunn, and others studied young women who became pregnant during adolescence and found that a small proportion with positive adult relationships had dramatic change in trajectory for the better (Furstenberg 2002 ). Masten, studying a cohort of low-income youth (beginning at ages 8–12) over a 20-year period, found that a number of factors predict competence in EA including higher intellectual capacity, higher parenting quality, and higher SES (Masten and Coatsworth 1998 ). When they examined resilience between the 10- and 20-year follow-up, they found that youth doing well in EA was predicted from doing well 10 years earlier. In the context of high adversity, childhood IQ was particularly an important moderator and predictor of resilience. During EA, individuals who were doing well from high-adversity backgrounds had significant personal resources in intelligence and personal competence and a history of receiving high-quality parenting (Masten et al. 2004 ).

6 Trajectories During Emerging Adulthood for Emerging Adults with Chronic Health Condition

Chronic health conditions can significantly impact the developmental trajectory of emerging adults during this life stage. Many types of chronic conditions, including those that impact physical, intellectual, or emotional functioning, may undermine the assumption of adult roles by the emerging adult, undermine success in school, impair the transition to work, and make living independently more of a challenge. Eighteen percent of youth aged 12–17 in the USA are defined as having a special health-care need , meaning they have a chronic physical, medical, emotional, or developmental condition that requires a more intensive use of health-care and related services. Emerging adults with chronic conditions are at risk for a number of problems during transition to adulthood, including experiencing gaps in needed medical and related services and gaps in health insurance (Lotstein et al. 2008 , Reiss et al. 2005 ). Below we review the impact of several specific chronic conditions on the growth trajectory during emerging adulthood.

6.1 Autism Spectrum Disorders (ASDs)

For youth with autism spectrum disorders (ASDs) and their families, the transition from adolescence to emerging adulthood is a time of uncertainty and loss of entitlement to many services that were available while in the public school system under the Individuals with Disabilities Education Act (IDEA). In comparison to childhood, young adults with autism often experience a dearth of appropriate supports and opportunities. Leaving high school is associated with deterioration in ASD symptom presentation, increase in maladaptive behaviors, and worsening family functioning (Taylor and Seltzer 2010 , 2011a , b ). Many persons with ASD are able to work successfully within the community (Garcia-Villamisar et al. 2000 ; Mawhood and Howlin 1999 ); however, the majority experience difficulty securing meaningful employment (Eaves and Ho 2008 ; Howlin et al. 2004 ; Newman et al. 2011 ). A recent study indicated that only 58% have ever worked for pay. In addition, it was found that only one in five individuals ever lived independently (Roux et al. 2015 ). Even among those employed, their jobs tended to be low level and low income (Cimera and Cowan 2009 ; Eaves and Ho 2008 ; Howlin et al. 2004 ). Jobs often ended prematurely because of social or behavioral difficulties or other work-related difficulties (Mawhood and Howlin 1999 ).

Young adults on the autism spectrum are reported to experience difficulties in assuming other important adult roles and responsibilities, including attaining postsecondary education and living independently (Roux et al. 2015 ). A number of studies (Billstedt et al. 2005 ; Gillespie-Lynch et al. 2012 ; Howlin et al. 2004 ) have found that having an IQ of around 70 seemed to be a critical cutoff point for better outcome (e.g., level of independence). A number of comorbid conditions can complicate the trajectory for youth with intellectual disability through adolescence and EA, such as seizure disorder, which substantially increase in prevalence from childhood through adolescence into adulthood. Adults with ASD and related conditions are more vulnerable to anxiety and depression which can require specific treatments (Skokauskas and Gallagher 2010 ; White et al. 2009 ). The majority of young adults with ASD remain dependent on parents for support in living, recreation, and occupational situations. The availability of appropriate resources, services, and supports for the individuals with ASD and their families is key for successful transition into adulthood and better outcomes throughout adult life. The following elements are important for high-quality transition services and associated with improved young adult outcomes: (1) individualized services that reflect the strengths of the individual, (2) positive career development and early work experiences, (3) collaboration and interagency involvement, (4) family supports and expectations, (5) fostering self-determination and independence, (6) social and employment-related skill instruction, and (7) establishment of job-related supports. Therefore, outcomes for emerging adults with ASD could be improved if social and institutional supports available through adolescence continued into adulthood.

6.2 Type 1 Diabetes Mellitus (DM)

The study of emerging adults with type 1 DM has elucidated the potential challenges facing emerging adults with diabetes and other chronic health conditions that have significant self-management burden. Emerging adults with type 1 diabetes face extensive behavioral demands in order to maintain their health, including the necessity for precisely scheduled daily insulin injections, blood glucose monitoring, dietary monitoring, regular physical exercise, and the management of DM-related complications. In early adulthood, frequent changes in roles, living situations, educational routines, jobs, friendships, and romantic relationships are common and can undermine the routines and the resolve needed to maintain metabolic control (Anderson and Wolpert 2004 ).

The developmental tasks of emerging adulthood may be at odds with maintaining the intensive self-care that is required of those with type 1 diabetes and vice versa. For example, the tasks of establishing autonomy and prevailing egocentrism may be associated with the emerging adult not wanting to follow medical advice or advice of his or her family (Masten et al. 1995 ). Heightened concern for peer acceptance or the establishment of intimate relationships is characteristic of this period of development. Emerging adults may be reluctant to admit to their significant others that they have type 1 diabetes or any other chronic condition that puts them at risk for being rejected (Madsen et al. 2002 ). Moreover, the major cognitive developmental milestone during the stage of emerging adulthood is the ability to think abstractly (Erikson 1994 ). Those who have not yet reached this developmental milestone may struggle with taking responsibility to maintain good disease management understanding the consequences of poor disease management. Lastly, increased rates of drinking, illicit drug use, or other high-risk behaviors may disrupt the emerging adults’ lifestyle and negatively impact self-care management of diabetes, resulting in (Madsen et al. 2002 ) lack of control of diabetes and the resulting physical and mental consequences of hypo- or hyperglycemia, which undermine emerging adults’ abilities to perform in school, maintain relationships, or keep employment.

As has been demonstrated in other chronic childhood conditions, the transition from pediatric- to adult-centered medical care for youth with DM is associated with a decline in DM control (Busse et al. 2007 ; Oeffinger et al. 2006 ). Adverse health-related outcomes documented in the young adult population with diabetes include a decline in disease self-care behaviors and an increased risk for diabetes-related complications (Bryden et al. 2001 ; Fredericks et al. 2010 ; Yeung et al. 2008 ). In addition, emerging adults with diabetes are at higher than average risk for psychosocial morbidity including social delays and isolation, impaired social competence, and emotional problems such as depression (Helgeson et al. 2007 ). As in the case in ASD, additional support for an emerging adult with DM during the transition to adult medical care has been shown to help decrease the adverse outcomes seen with usual practice. For example, DM transition programs that include introductions to new adult care providers or intensive care coordination have been found to be protective (Holmes-Walker et al. 2007 ).

6.3 Chronic Kidney Disease

Chronic kidney disease (CKD) is a condition characterized by disease progression, significant cardiovascular morbidity, growth failure, neurocognitive impairment, and impaired quality of life changes (Sarnak 2003 ; Copelovitch et al. 2011 ; Gerson et al. 2006 ; McKenna et al. 2006 ). CKD is divided into five stages based on glomerular filtration rate, with stage 1 being the mildest form and stage 5 the worst form, also called end-stage kidney disease (ESKD ), requiring renal replacement therapy (dialysis or transplant) (Hogg et al. 2003 ). The prevalence of pediatric CKD is unknown as it may be silent in early stages. The prevalence of pediatric ESKD is 15 cases per million population (Saran et al. 2015 ). African-Americans and Latinos are disproportionately affected by CKD in part due to a higher incidence of glomerular conditions (Ferris et al. 2006 ). While the 10-year survival for adolescent-onset ESKD is 80–85% (much higher than adult-onset ESKD patients), this still represents a 30-fold increase in mortality compared to the general US adolescent population. Survival is better for younger adolescents, males, Caucasians, Asians, and transplant recipients ( 2006 ). However, emerging adults with CKD achieve adult milestones (e.g., employment, marriage) less frequently than their healthy peers (Bartosh et al. 2003 ).

The burden of care directly correlates with the stage of CKD . Based on the mean number of unique medications , those with CKD stages 1–4 take 6.2 ± 4 of medications, those with peritoneal dialysis (CKD 5) take 8.5 ± 2 medications, those with kidney transplant (CKD 5) take 9.7 ± 4.2 medications, and those on hemodialysis (CKD 5) take 11.3 ± 2.1 (So et al. 2011 ). The complexity of care also include procedures such as self-catheterization several times per day, fluid and dietary restrictions, blood pressure measurements daily, and injections (erythropoiesis-stimulating agents once to thrice weekly, growth hormone daily, or insulin several times per day). The life course of pediatric-onset CKD-ESKD varies by etiology and age at onset of this condition, but once they reach ESKD, most patients share the same comorbidities (hypertension, anemia, acidosis, metabolic bone disease, and growth delay). Patients with greater level of CKD have a decreased sense of self-worth, perceive a poor future, and feel limited in their physical and psychosocial capacities to have the same potential and opportunity as their healthy peers.

While most children and adolescent patients with ESKD will receive a kidney transplant , they likely will experience dialysis prior to receiving an organ. The most common cause of kidney transplant rejection in adolescents and emerging adults is treatment nonadherence (Andreoni et al. 2013 ). Adherence among adolescents is compromised by poor understanding and poor consequence recognition leading to an inconsistent commitment to the treatment regimens. Once the kidney transplant is lost, patients return to dialysis and likely will not receive another kidney transplant for many years. As in adult patients, cardiovascular disease (CVD) accounts for a majority of deaths in patients with pediatric-onset CKD, but unlike adults, pediatric-onset CKD patients rarely demonstrate symptomatic atherosclerosis (Shroff et al. 2011 ). Lastly, survivors of pediatric-onset CKD are at greater risk for malignancies and posttransplant diabetes mellitus (Koukourgianni et al. 2010 ).

Patients who transfer to adult-focused services without transition preparation and support appear to be at greater risk to lose their kidney transplant (Watson 2000 , 2005 ). The international societies of internal medicine and pediatric nephrology have published position statements and policies to promote health-care transition preparation (Watson 2005 ; Watson et al. 2011 ). Strategies to increase patient autonomy, health-care transition, and self-management are needed to achieve successful outcomes at the time of transfer to adult-focused providers.

6.4 Mental Health and Substance Use

Emerging adulthood is a time of increased experimentation with tobacco, drugs, and alcohol (Schulenberg et al. 2004 ; Schulenberg and Maggs 2002 ), increasing from rates of 12.2% in adolescence to 40.2% in young adulthood for cigarette smoking, from 10.7% to 41.9% for binge drinking, from 11.2% to 20.3% for illicit drug use, and from 2.6% to 14.9% for heavy alcohol use. While cigarette, alcohol, and drug use are normative during adolescence and emerging adulthood, a number of factors predict excessive use rather than experimentation including genetic (e.g., family history of alcohol abuse), biological (e.g., early puberty timing), family (e.g., low parental monitoring), school (e.g., low grade average, school failure), peer (e.g., peer substance use), and youth personality and psychopathology (e.g., depression) factors (Cicchetti 1999 ). However, the pattern of use/abuse of these substances is influenced by the experience during the stage of EA. For example, increasing responsibility, work, and marriage all are associated with decreased use of these substances (Masten et al. 1999 ; Bachman et al. 2014 ). Again, there is great heterogeneity in the trajectories followed by individuals with regard to substance use during this period, all influenced by the multiplicity of factors listed above.

Among young adults, 13.7% experience serious mental illness such as major depressive disorders, schizophrenia, and bipolar disorder (AmericanPsychiatricAssociation 2013 ). The neuropsychological pathology that has onset during EA has many of the predisposing factors related to family adversities, such as social disadvantage, divorce, dysfunctional parenting, multiple family changes/moves, and peer group choices. The expanded independence and self-reliance during EA may be difficult to handle for youth with preexisting emotional or social challenges or poor attachment. The decrease in supports from school or family during EA may be even further destabilizing, leading to increased emotional and interpersonal difficulties. Young people with serious mental health conditions have difficulty with impulse control and self-regulation (Walker and Gowen 2011 ). Their apparent immaturity reflects a delay in social and emotional development and undermines progress toward goals in education, relationships, independence in health, and health-care management.

Three-quarters of lifetime cases of mental, emotional, and behavioral disorders begin by age 24 (Kessler et al. 2005 ). In emerging adults with social, emotional, and behavioral disorders, much higher risk is associated with onset in early adolescence versus onset in late adolescence (Mofitt and Caspi 2001 ). Dysfunctional family environments and participation in deviant peer group increase the likelihood of early-onset delinquency followed by a long trajectory of social, emotional, and behavioral problems. Youth with later onset of social, emotional, and behavioral problems are more commonly from relatively healthy family backgrounds and more likely to desist from delinquency by age 23 (Roisman et al. 2004 ). Similar patterns can be seen for major psychiatric disorders such as depression, with early-onset mood disorders being representative of more severe recurrent forms of mood disorders arising from increased severity and complexity of family and biologic risk factors (Fergusson and Woodward 2002 ) and later-onset disorders reflecting lower levels of risk factors in childhood.

7 Protective and Risk Factors That Impact Emerging Adulthood

The supports, opportunities, and experiences that occur during the stage of EA greatly influence the ultimate outcome of this stage and the ensuing life trajectory into young adulthood. As discussed in this chapter, critical influences during EA include mentoring relationships, socioeconomic supports, and educational and vocational opportunities. Emerging adulthood typically is accompanied by an increase in agency/independence and decrease in social and institutional support (e.g., schools and family), such that most individuals have more choice in day-to-day activities and life decisions. This increase in choice may result in greater success which will likely contribute to well-being. However, increased freedom can result in poor choices (e.g., drug use, criminal activity) that have a negative impact on the developmental trajectory as well (Schulenberg and Maggs 2002 ; Schulenberg et al. 2004 ). For example, many relationships and other aspects of life are so unstable during EA that important and powerful negative experiences can occur such as date rape, school failure, and substance addiction. These experiences can have a lasting, if not lifetime, detrimental impact on the developmental and mental health trajectory of the emerging adult. Similarly, many potential powerful positive influences can occur during this period in life (e.g., marriage, educational achievement, mentoring) that can enhance the developmental and mental health trajectory. Therefore, experiences both distal (early childhood) and proximal (during emerging adulthood) can influence, either positively or negatively, the developmental and mental health trajectory of the emerging adult (Miller et al. 2015).

Practical supports during EA provided by families include financial support for education, transportation, independent living, health insurance, and other necessities. The primary determinant of parental support are the level of parental resources. Emerging adults with wealthier parents and those with fewer siblings receive more financial support for education (Steelman and Powell 1991 ). Divorced parents provide less financial support than parents with intact marriages (Cooney and Uhlenberg 1992 ). Support from families by parents and grandparents during EA is also provided in the form of guidance or advice, information, and emotional support. Parents of emerging adults may also help the emerging adult negotiate the health-care system, formulate and carry out educational and vocational goals, and acquire leases for apartments and even provide advice for intimate relationships. In short, continued social and financial connection to parents with adequate emotional and financial resources can be a very significant factor in the positive life trajectory during emerging adulthood (Aquilino 2005 ). Previous studies have found a high correlation between improved EA outcomes and adolescent hope in the future (Bennett 2014 ). Hope is a form of personal capital that protects youth from social, emotional, and behavioral disorders and correlates with and predicts the rates of many outcomes, including academic achievement, delay of initiation of early sexual activity, and lower likelihood of violent behavior. Hope requires a sense of self-efficacy and knowledge of alternate outcomes. Hope is reflected in adolescent and young adult goals as they reflect and make ongoing assessments of their current and future selves. Individual goals and aspirations relate to the sense of control an individual feels in relation to a particular domain.

Positive youth development (PYD) programs are approaches that provide supports to adolescents and emerging adults to achieve social, emotional, behavioral, and moral competence, foster self-efficacy, a clear and positive identity, and belief in the future; and reinforce pro-social norms (Catalano et al. 2004 ). Positive development approaches involve a paradigm shift from targeting the risk factors to enhancing the assets and protective factors. The emphasis on hope, empowerment, and well-being resonates with youth and mental health professionals. The PYD approach outlined above suggests that effective programs to support EA would include an individualized approach supporting young people to identify and move toward personally meaningful goals. This begins with envisioning a positive future identity (“Who do I want to become?”). Pursuing goals promotes a sense of purpose, and making progress toward those goals contributes to building feelings of efficacy, empowerment, and self-determination, enhancing the individual’s ability to act as the primary causal agent in pursuing personally meaningful goals (Silbereisen and Lerner 2007 ).

A PYD perspective further suggests that youth and emerging adults will benefit from learning specific strategies for increasing and maintaining interpersonal support from positive peers, family, providers, and people in the community (Guerra and Bradshaw 2008 ). Young people can learn specific steps and skills that can help them increase the quality and the extent of their interpersonal networks, as well as the amount of emotional, instrumental, and informational support available to them. Using a PYD perspective suggests that the development of assets is an important recovery-oriented outcome in and of themselves, as well as a mediator of longer-term outcomes related to education, employment, mental health, and general quality of life. Indeed, a review of the available research on community-based programs and interventions for EA reveals a common focus on personal asset building (Lerner 2014 ). Also consistent with the PYD perspective is that many of the programs and interventions include a focus on changing the meso-environment of youth so that it encourages young people to develop or express strengths and assets.

8 Services and Supports

As we better understand the limits of and issues related to EA, it is imperative that we review and revise policy and current social and medical services and supports so they optimally address the current and future needs of individuals during this life stage. Current medical, mental health, and social service delivery models are geared toward either child or adult populations. In other words, individuals generally seek child-serving services between the ages of 0 and 18, and they are subsequently transferred directly to adult-serving services. However, the various biobehavioral and sociocultural factors discussed above make this direct transition from child to adult-centered care ill-suited for optimally addressing the nuances and challenges that individuals may face during EA. For example, an adult-centered medical doctor may regularly treat patients with fixed habits and lifestyles, who may already suffer from a variety of chronic health conditions. However, many such chronic health conditions in adults represent a culmination of experiences from an individual’s earlier years, which may not yet be apparent during EA. It is thus strongly recommended that EA service providers reorient themselves using a prevention-based paradigm and familiarize themselves with the possible antecedents to social, emotional, and medical conditions so that they may make health-care or social service recommendations to minimize risk factors and to maximize strengths and assets to facilitate development along optimal health trajectories. EA presents a unique opportunity for service providers to intervene and influence an individual’s LCHD before significant social, emotional, and medical pathology fully develops, utilizing existing knowledge of the skills and capacities associated with EA to inform services and interventions.

In addition to training service providers to reorient their approach to care and become more sensitive to antecedents of chronic health conditions in adulthood, the multifactorial nature of the LCHD model suggests that it would be important for service providers to consider horizontal (i.e., cross sector) and longitudinal (i.e., across the lifespan) service integration. Specifically, the current model posits that myriad factors (e.g., biological, psychological, cultural) on multiple levels (e.g., micro, meso, macro) interact simultaneously in a transactional fashion to influence an individual’s LCHD and overall health trajectory. However, most current training models which emphasize specialization in their independent fields and opportunities for cross-disciplinary case conceptualization and collaboration with regard to service delivery – particularly with respect to preventive care, which may be of special importance when considering EA as a sensitive period of development – tend to be rare. Such specialization in service delivery may result in service fragmentation. Additionally, adult service providers generally do not work in tandem with child service providers as individuals transition from one care setting to the next, consequently resulting in potential gaps in service delivery and care, which may be exacerbated as individuals work to rebuild rapport with their new service providers. Moreover, health, mental health, social service, and education professionals rarely collaborate to create comprehensive models across the EA stage. Clearly, the current service delivery infrastructure does not adequately support the needs and challenges unique to emerging adult populations. It is thus important to recognize emerging adults as a unique population requiring additional and specialized skills of service providers and the creation of specific pathways for transition which support continuity of care.

The larger sociopolitical and cultural contexts may also facilitate or create challenges which impact service and intervention efforts directed at emerging adults. The majority of individuals in developed nations transitioning through EA, for instance, may be classified as “digital natives ,” individuals who have been brought up in environments where exposure to digital technology may be normative and who are therefore familiar with computers and the Internet. As emerging adults increasingly turn to digital and mobile solutions to support and enhance their daily routines, it behooves service providers to creatively explore ways of engaging emerging adult populations using technology. Use of social networks, such as Instagram, Twitter, and Facebook, to advance primary prevention efforts, increase awareness of public health issues, and provide basic health and psychological education affords service providers the opportunity to outreach to unprecedented numbers and populations. Use of text messaging may also be effective as a way of engaging with digital native emerging adult populations and promoting engagement and adherence by emerging adults or to promote youth development programs. Also, as service providers keep pace with technological advancements, they may even begin to explore novel methods of service delivery and intervention using digital or Internet-based platforms, which may increase “buy-in” and potentially preventive service utilization, among digitally native emerging adult populations. For example, service providers might potentially leverage the data that digitally native emerging adults might collect as part of the “quantified self” movement (e.g., pedometer information, weight, blood pressure, etc.) in an effort to inform their ongoing care efforts.

On the other hand, due to clinical billing practices and regulations , as well as patient privacy concerns and regulations (e.g., Health Insurance Portability and Accountability Act, HIPAA), current service delivery models often tend to operate in a fragmented and siloed fashion, which in turn may limit the ability of service providers to develop a holistic treatment plan to address each individual’s needs. Further complicating this fragmentation is the restricted access to health records once an individual turns 18 years of age, when parents who may have been primarily responsible for managing their child’s health-care needs no longer are able to access their child’s medical records (unless explicit permission is granted by the child, who is now an emerging adult). Depending on each family’s cultural context and the relationship between the emerging adult and his or her parents, this transition may be a cause for significant stress and/or strife between family members as they work to renegotiate previously familiar boundaries. Mothers of children with diabetes, for example, have indicated feeling increased stress as their children transitioned from pediatric to adult care, particularly if they perceived that their children were not managing their health-care condition as well as they had been when it was previously under greater parent control (Allen et al. 2011 ). Such stress might result in familial conflict and dysfunction which could subsequently interfere with the emerging adult’s willingness or ability to adequately access services. One potential solution to overcoming the issue of patient privacy may be to implement public health programs and tools to educate and empower individuals with respect to managing and taking an active role in their own care. However, it is important to underscore the need for larger, overall systems to change in order to support service providers in working together with individuals and their families to ensure continuity and comprehensiveness of services and health-related information during the transition.

Finally, the implementation of health-care policies may have important implications for service and intervention delivery with an emerging adult population. With the introduction of the Patient Protection and Affordable Care Act of 2010 (ACA), for example, individuals may now remain on their parents’ health insurance plans until they turn 26 years of age. While this theoretically affords emerging adults the opportunity to develop the necessary skills for interacting with the health-care system and managing their own care, research indicates that emerging adults frequently perceived themselves as being at lower risk for health problems and the financial burden of health insurance as lacking in value. Consequently, emerging adults may opt for high-deductible catastrophic insurance which generally costs less compared to other health insurance plans, but translates to fewer opportunities for interaction with the health service sector and fewer opportunities for service providers to intervene early during an individual’s LCHD trajectory prior to the onset of chronic adult disease. Importantly, research indicates that despite preventive maintenance health visits being mandatory under the ACA, emerging adults were less likely to request health maintenance visits. Thus, it may be important for public health efforts to determine the underlying factors associated with this diminished utilization of health services by emerging adults and subsequently develop health literacy programs to promote prevention mindedness and service utilization in emerging adults.

9 Recommendations for Research Priorities

The following is a list of issues in life course research that are critical for better understanding the positive supports and challenges that influence the trajectory of development of emerging adults organized along the macro-, meso-, micro-framework.

Macro Issues

What community supports in emerging adulthood enhance health development into adulthood and improve outcomes for an emerging adult with specific health, mental health, and developmental conditions? Is there an “early intervention model” to optimize outcomes for EA? What model should be used for an emerging adult with chronic health, mental health, and developmental conditions?

What are the historical, economic, and cultural influences on the meaning of EA, adaption, and maladaptation to the stage and expectations for normative transitions? How have these changed over time? How are they different for an emerging adult with social, health, mental health, and developmental problems?

How have the delays in marriage/relationship commitment impacted adult life trajectories?

What are the racial and ethnic differences for how these factors interact to support development during EA?

How has the information economy and the increased demands for education impacted the life course for youth in upper, middle, and lower socioeconomic strata? Are there regional variations in these outcomes and how can they be improved?

Meso Issues

Earlier childhood development and family environment are predictors of adult outcomes, but it is unclear how optimizing health development can be achieved with supports during EA.

What is the interaction between health and social system supports, family supports, youth abilities, cognitive and psychological maturity, and EA outcomes for an emerging adult with and without mental or physical disabilities?

How can the different support systems be integrated to provide seamless services to youth and emerging adults with significant physical, mental health, or intellectual disabilities?

Using the model below from the work of Masten et al. ( 2005 ), how do these different resources, supports, and personal characteristics interact to promote optimal development during EA? (Fig. 1 )

Moving toward resilience : a model of positive change in emerging adulthood

What factors promote resilience for youth during EA who lack family supports?

What is the role of extended families in support for EA?

How can studies of conditions and processes that influence development during EA inform educational/vocational/EA support policies?

How can data be gathered across this stage in the lifespan given that emerging adults leave school and have many changes in living arrangements, education, relationships, and work?

Micro Issues

To what degree is cognitive, social, physical, moral, and spiritual development mediated during emerging adulthood? How are these developmental pathways impacted by chronic health, mental health, and developmental conditions?

How can we optimize the person-context match to promote development during EA with and without chronic health, mental health, and developmental conditions?

What is the impact of positive turning points in EA compared to early life stages on life trajectories into adulthood?

During EA, exploration of new experiences is normative. Is more exploration better or worse and for which activities is it better or worse? How is this equation different for an emerging adult with chronic health, mental health, and developmental conditions?

Do emerging adults with particular health conditions, such as diabetes, spina bifida, solid organ transplant, or cancer survivorship, experience sharply downward trajectories during EA, and what supports are effective to prevent these sharply downward trajectories?

How does brain development progress during EA? What is the impact of brain development on the factors that influence the developmental trajectory during EA such as executive control (planfulness, future orientation), motivation, self-efficacy, and hope?

Allen, D., Channon, S., Lowes, L., Atwell, C., & Lane, C. (2011). Behind the scenes: The changing roles of parents in the transition from child to adult diabetes service. Diabetic Medicine, 28 (8), 994–1000.

Article   CAS   PubMed   Google Scholar  

Alwin, D. F. (1988). From obedience to autonomy changes in traits desired in children, 1924–1978. Public Opinion Quarterly, 52 , 33–52.

Article   Google Scholar  

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders . Arlington: American Psychiatric Publishing.

Book   Google Scholar  

Anderson, B. J., & Wolpert, H. A. (2004). A developmental perspective on the challenges of diabetes education and care during the young adult period. Patient Education and Counseling, 53 , 347–352.

Article   PubMed   Google Scholar  

Andreoni, K. A., Forbes, R., Andreoni, R. M., Phillips, G., Stewart, H., & Ferris, M. (2013). Age-related kidney transplant outcomes: Health disparities amplified in adolescence. JAMA Internal Medicine, 173 , 1524–1532.

Aquilino, W. S. (1994). Impact of childhood family disruption on young Adults’ relationships with parents. Journal of Marriage and the Family, 56 , 295–313.

Aquilino, W. S. (2005). Impact of family structure on parental attitudes toward the economic support of adult children over the transition to adulthood. Journal of Family Issues, 26 , 143–167.

Arnett, J. J. (1997). Young People’s conceptions of the transition to adulthood. Youth & Society, 29 , 3–23.

Arnett, J. J. (1998). Learning to stand alone: The contemporary American transition to adulthood in cultural and historical context. Human Development, 41 , 295–315.

Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55 , 469.

Arnett, J. J. (2005). The developmental context of substance use in emerging adulthood. Journal of Drug Issues, 35 , 235–254.

Arnett, J. J. (2014). Emerging adulthood: The winding road from the late teens through the twenties . New York: Oxford University Press.

Bachman, J. G., O’malley, P. M., Schulenberg, J. E., Johnston, L. D., Bryant, A. L., & Merline, A. C. (2014). The decline of substance use in young adulthood: Changes in social activities, roles, and beliefs . New York: Psychology Press.

Bartosh, S. M., Leverson, G., Robillard, D., & Sollinger, H. W. (2003). Long-term outcomes in pediatric renal transplant recipients who survive into adulthood. Transplantation, 76 , 1195–1200.

Bellah, E. R. N., Bellah, R. N., Tipton, S. M., Sullivan, W. M., Madsen, R., Swidler, A., Sullivan, W. M., & Tipton, S. M. (2007). Habits of the heart: Individualism and commitment in American life . Berkeley: University of California Press.

Google Scholar  

Ben-Amos, I. K. (1994). Adolescence and youth in early modern England . New Haven: Yale University Press.

Bennett, A. (2014). Finding hope in hopeless environments. International Journal of Child Health And Human Development, 7 , 313.

Benson, J. E., & Elder, G. H. (2011). Young adult identities and their pathways: A developmental and life course model. Developmental Psychology, 47 , 1646–1657.

Article   PubMed   PubMed Central   Google Scholar  

Benson, J. E., Johnson, M. K., & Elder, G. H. (2012). The implications of adult identity for educational and work attainment in young adulthood. Developmental Psychology, 48 (6), 1752.

Billstedt, E., Gillberg, C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13-to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35 , 351–360.

Bogin, B. (2013). Chapter 2, Childhood, adolescence and longevity: A chapter on human Evolutionary life history. In B. Hewlett (Ed.), Adolescent identify: Evolutionary, cultural and developmental perspectives . New York: Routledge.

Brody, G. H., et al. (2013). Is resilience only skin deep? Rural African Americans’ socioeconomic status–related risk and competence in preadolescence and psychological adjustment and Allostatic load at age 19. Psychological Science . doi: 10.1177/0956797612471954 .

Bryden, K. S., Peveler, R. C., Stein, A., Neil, A., Mayou, R. A., & Dunger, D. B. (2001). Clinical and psychological course of diabetes from adolescence to young adulthood a longitudinal cohort study. Diabetes Care, 24 , 1536–1540.

Busse, F., Hiermann, P., Galler, A., Stumvoll, M., Wiessner, T., Kiess, W., & Kapellen, T. (2007). Evaluation of patients’ opinion and metabolic control after transfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Hormone Research in Pædiatrics, 67 , 132–138.

Article   CAS   Google Scholar  

Catalano, R. F., Berglund, M. L., Ryan, J. A., Lonczak, H. S., & Hawkins, J. D. (2004). Positive youth development in the United States: Research findings on evaluations of positive youth development programs. The Annals of the American Academy of Political and Social Science, 591 , 98–124.

Cherlin, A. J., Chase-Lansdale, P. L., & Mcrae, C. (1998). Effects of parental divorce on mental health throughout the life course. American Sociological Review, 63 (2), 239–249.

Cicchetti, D., et al. (1999). A developmental psychopathology perspective on drug abuse. Drug abuse: Origins & interventions (pp. 97–117). Washington, DC: American Psychological Association, xxiii, 492 pp.

Cimera, R. E., & Cowan, R. J. (2009). The costs of services and employment outcomes achieved by adults with autism in the us. Autism, 13 , 285–302.

Cooney, T. M., & Uhlenberg, P. (1992). Support from parents over the life course: The adult Child's perspective. Social Forces, 71 , 63–84.

Copelovitch, L., Warady, B. A., & Furth, S. L. (2011). Insights from the chronic kidney disease in children (Ckid) study. Clinical Journal of the American Society of Nephrology, 6 , 2047–2053.

Cote, 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.

Dahl, R. E. (2004). Adolescent brain development: A period of vulnerabilities and opportunities. Keynote address. Annals of the New York Academy of Sciences, 1021 , 1–22.

Duncan, G. J., & Brooks-Gunn, J. (2000). Family poverty, welfare reform, and child development. Child Development, 71 , 188–196.

Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism Spectrum disorders. Journal of Autism and Developmental Disorders, 38 , 739–747.

Erikson, E. H. (1994). Identity: Youth and crisis . New York: Ww Norton & Company.

Evans, G. W., & Cassells, R. C. (2014). Childhood poverty, cumulative risk exposure, and mental health in emerging adults. Clinical Psychological Science, 2 (3), 287–296.

Feliciano, C., & Ashtiani, M. (2012). Postsecondary educational pathways of low-income youth: An analysis of add health data . Irvine: Uc/Accord.

Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59 , 225–231.

Ferris, M. E., Gipson, D. S., Kimmel, P. L., & Eggers, P. W. (2006). Trends in treatment and outcomes of survival of adolescents initiating end-stage renal disease care in the United States of America. Pediatric Nephrology, 21 , 1020–1026.

Fredericks, E. M., Dore-Stites, D., Well, A., Magee, J. C., Freed, G. L., Shieck, V., & James Lopez, M. (2010). Assessment of transition readiness skills and adherence in pediatric liver transplant recipients. Pediatric Transplantation, 14 , 944–953.

Furstenberg, F. F. (2002). How it takes thirty years to do a study. In Looking at lives: American longitudinal studies of the twentieth century (pp. 37–57).

Galobardes, B., Lynch, J. W., & Smith, G. D. (2008). Is the Association between childhood socioeconomic circumstances and cause-specific mortality established? Update of a systematic review. Journal of Epidemiology and Community Health, 62 , 387–390.

Garcia-Villamisar, D., Ross, D., & Wehman, P. (2000). Clinical differential analysis of persons with autism in a work setting: A follow-up study. Journal Of Vocational Rehabilitation, 14 , 183–185.

Gerson, A. C., Butler, R., Moxey-Mims, M., Wentz, A., Shinnar, S., Lande, M. B., Mendley, S. R., Warady, B. A., Furth, S. L., & Hooper, S. R. (2006). Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors. Mental Retardation and Developmental Disabilities Research Reviews, 12 (3), 208–215.

Gillespie-Lynch, K., Sepeta, L., Wang, Y., Marshall, S., Gomez, L., Sigman, M., & Hutman, T. (2012). Early childhood predictors of the social competence of adults with autism. Journal of Autism and Developmental Disorders, 42 , 161–174.

Gilman, S. E. (2012). The successes and challenges of life course Epidemiology: A commentary on Gibb, Fergusson and Horwood (2012). Social Science & Medicine, 75 , 2124–2128.

Gilman, S. E., & Loucks, E. B. (2012). Invited commentary: Does the childhood environment influence the Association between every X and every Y in adulthood? American Journal of Epidemiology, 176 , 684–688.

Gilmore, D. D. (1990). Manhood in the making: Cultural concepts of masculinity . New Haven: Yale University Press.

Greene, A., Wheatley, S. M., & Aldava, J. F. (1992). Stages on Life’s way Adolescents’ implicit theories of the life course. Journal of Adolescent Research, 7 , 364–381.

Grotevant, H. D., & Cooper, C. R. (1986). Individuation in family relationships. Human Development, 29 , 82–100.

Guerra, N. G., & Bradshaw, C. P. (2008). Linking the prevention of problem behaviors and positive youth development: Core competencies for positive youth development and risk prevention. New Directions for Child and Adolescent Development, 2008 , 1–17.

Halfon, N., & Forrest, C. B. (2017). The emerging theoretical framework of life course health development. In N. Halfon, C. B. Forrest, R. M. Lerner, & E. Faustman (Eds.), Handbook of life course health-development science . Cham: Springer.

Helgeson, V. S., Snyder, P. R., Escobar, O., Siminerio, L., & Becker, D. (2007). Comparison of adolescents with and without diabetes on indices of psychosocial functioning for three years. Journal of Pediatric Psychology, 32 , 794–806.

Hogg, R. J., Furth, S., Lemley, K. V., Portman, R., Schwartz, G. J., Coresh, J., Balk, E., Lau, J., Levin, A., & Kausz, A. T. (2003). National Kidney Foundation’s kidney disease outcomes quality initiative clinical practice guidelines for chronic kidney disease in children and adolescents: Evaluation, classification, and stratification. Pediatrics, 111 , 1416–1421.

Holmes-Walker, D., Llewellyn, A., & Farrell, K. (2007). A transition care Programme which improves diabetes control and reduces hospital admission rates in young adults with type 1 diabetes aged 15–25 years. Diabetic Medicine, 24 , 764–769.

Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45 , 212–229.

Jacquet, S. E., & Surra, C. A. (2001). Parental divorce and premarital couples: Commitment and other relationship characteristics. Journal of Marriage and Family, 63 , 627–638.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of Dsm-iv disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62 , 593–602.

Kim, P., Neuendorf, C., Bianco, H., & Evans, G. W. (2015). Exposure to childhood poverty and mental health symptomatology in adolescence: A role of coping strategies. Stress and Health, 32 , 494–502.

Koukourgianni, F., Harambat, J., Ranchin, B., Euvrard, S., Bouvier, R., Liutkus, A., & Cochat, P. (2010). Malignancy incidence after renal transplantation in children: A 20-year single-Centre experience. Nephrology Dialysis Transplantation, 25 , 611–616.

Lerner, R. M. (2014). Developmental science, developmental systems, and contemporary theories of human development. In Handbook of child psychology . New York: Wiley and Sons.

Lotstein, D. S., Inkelas, M., Hays, R. D., Halfon, N., & Brook, R. (2008). Access to care for youth with special health care needs in the transition to adulthood. Journal of Adolescent Health, 43 , 23–29.

Luciana, M., Conklin, H. M., Hooper, C. J., & Yarger, R. S. (2005). The development of nonverbal working memory and executive control processes in adolescents. Child Development, 76 , 697–712.

Madsen, S. D., Roisman, G. I., & Collins, W. A. (2002). The intersection of adolescent development and intensive intervention: Age-related psychosocial correlates of treatment regimens in the diabetes control and complication trial. Journal of Pediatric Psychology, 27 , 451–459.

Masten, A. S., & Coatsworth, J. D. (1998). The development of competence in favorable and unfavorable environments: Lessons from research on successful children. American Psychologist, 53 , 205.

Masten, A. S., Coatsworth, J. D., Neemann, J., Gest, S. D., Tellegen, A., & Garmezy, N. (1995). The structure and coherence of competence from childhood through adolescence. Child Development, 66 , 1635–1659.

Masten, A. S., Hubbard, J. J., Gest, S. D., Tellegen, A., Garmezy, N., & Ramirez, M. (1999). Competence in the context of adversity: Pathways to resilience and maladaptation from childhood to late adolescence. Development and Psychopathology, 11 , 143–169.

Masten, A. S., Burt, K. B., Roisman, G. I., Obradovic, J., Long, J. D., & Tellegen, A. (2004). Resources and resilience in the transition to adulthood: Continuity and change. Development and Psychopathology, 16 , 1071–1094.

Masten, A. S., Roisman, G. I., Long, J. D., Burt, K. B., Obradović, J., Riley, J. R., Boelcke-Stennes, K., & Tellegen, A. (2005). Developmental cascades: Linking academic achievement and externalizing and internalizing symptoms over 20 years. Developmental Psychology, 41 , 733.

Masten, A. S., Burt, K. B., & Coatsworth, J. D. (2006). Competence and psychopathology in development. D. Cicchetti, C. Dante, & J. Donald (Eds). Developmental psychopathology: Risk, disorder, and adaptation (Vol. 3, 2nd ed., pp. 696–738). Hoboken: John Wiley & Sons Inc, xvi 944 pp.

Mawhood, L., & Howlin, P. (1999). The outcome of a supported employment scheme for high-functioning adults with autism or Asperger syndrome. Autism, 3 , 229–254.

Mckenna, A. M., Keating, L. E., Vigneux, A., Stevens, S., Williams, A., & Geary, D. F. (2006). Quality of life in children with chronic kidney disease—Patient and caregiver assessments. Nephrology Dialysis Transplantation, 21 , 1899–1905.

Mikulincer, M., & Shaver, P. R. (2009). The attachment and behavioral systems perspective on social support. Journal of Social and Personal Relationships, 26 (1), 7–19.

Miller, G. E., Yu, T., Chen, E., & Brody, G. H. (2015 Aug 18). Self-control forecasts better psychosocial outcomes but faster epigenetic aging in low-Ses youth. Proceedings Of The National Academy Of Sciences., 112 (33), 10325–10330.

Modell, J. (1991). Into One’s own: From youth to adulthood in the United States, 1920–1975 . Berkeley: University of California Press.

Moffitt, T. E., & Caspi, A. (2001). Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females. Devcelopment and Psychopathology, 13 , 355–375.

Nelson, C. A., Thomas, K. M., & De Haan, M. (2012). Neuroscience of cognitive development: The role of experience and the developing brain . Hoboken: John Wiley & Sons.

Newman, L., Wagner, M., Knokey, A.-M., Marder, C., Nagle, K., Shaver, D., & Wei, X. (2011). The post-high school outcomes of young adults with disabilities up to 8 years after high school: A Report from the National Longitudinal Transition Study-2 (Nlts2). Ncser 2011–3005 . Washington, DC: National Center For Special Education Research.

Nurmi, J.-E. (1999). 15 self-definition and mental health during adolescence and young adulthood. In J. Schulenberg, J. L. Maggs, & K. Hurrelmann (Eds.), Health risks and developmental transitions during adolescence (p. 395). New York: Cambridge University Press.

Oeffinger, K. C., Mertens, A. C., Sklar, C. A., Kawashima, T., Hudson, M. M., Meadows, A. T., Friedman, D. L., Marina, N., Hobbie, W., & Kadan-Lottick, N. S. (2006). Chronic health conditions in adult survivors of childhood cancer. New England Journal of Medicine, 355 , 1572–1582.

Osgood, D. W., Ruth, G., Eccles, J. S., Jacobs, J. E. & Barber, B. L. (2005). Six paths to adulthood: Fast starters, parents without careers, educated partners, educated singles, working singles, and slow starters. na.

Reiss, J. G., Gibson, R. W., & Walker, L. R. (2005). Health care transition: Youth, family, and provider perspectives. Pediatrics, 115 , 112–120.

Rifkin, J. (2011). The Thired industrial revolution . New York: St. Martin’s Press.

Roisman, G. I., Aguilar, B., & Egeland, B. (2004). Antisocial behavior in the transition to adulthood: The independent and interactive roles of developmental history and emerging developmental tasks. Development and Psychopathology, 16 , 857–871.

Rotundo, E. A. (1994). American manhood: Transformations in masculinity from the revolution to the modern era . New York: Basic Books.

Roux, A. M., Shattuck, P. T., Rast, J. E., Rava, J. A., & Anderson, K.,. A. (2015). National autism indicators report: Transition into young adulthood . Philadelphia: Life Course Outcomes Research Program/A.J. Drexel Autism Institute/Drexel University.

Ryan, R. M., & Lynch, J. H. (1989). Emotional autonomy versus detachment: Revisiting the vicissitudes of adolescence and young adulthood. Child Development, 60 (2), 340–356.

Saran, R., Li, Y., Robinson, B., Ayanian, J., Balkrishnan, R., Bragg-Gresham, J., Chen, J., Cope, E., Gipson, D., & He, K. (2015). US renal data system 2014 annual data Report: Epidemiology of kidney disease in the United States. American Journal of Kidney Diseases: The Official Journal of the National Kidney Foundation, 65 , A7.

Sarnak, M. J. (2003). Cardiovascular complications in chronic kidney disease. American Journal of Kidney Diseases, 41 , 11–17.

Scheer, S. D., Unger, D. G., & Brown, M. B. (1996). Adolescents becoming adults: Attributes for adulthood. Adolescence, 31 , 127.

CAS   PubMed   Google Scholar  

Schlegel, A., & Barry Iii, H. (1991). Adolescence: An anthropological inquiry . New York: Free Press.

Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol, Supplement No. 14 , 54–70.

Schulenberg, J. E., Sameroff, A. J., & Cicchetti, D. (2004). The transition to adulthood as a critical juncture in the course of psychopathology and mental health. Development and Psychopathology, 16 , 799–806.

PubMed   Google Scholar  

Shanahan, M. J. (2000). Pathways to adulthood in changing societies: Variability and mechanisms in life course perspective. Annual Review of Sociology, 26 , 667–692.

Shroff, R., Weaver, D. J., & Mitsnefes, M. M. (2011). Cardiovascular complications in children with chronic kidney disease. Nature Reviews Nephrology, 7 , 642–649.

Silbereisen, R. K., & Lerner, R. M. (2007). Approaches to positive youth development . Los Angeles/London: Sage.

Skokauskas, N., & Gallagher, L. (2010). Psychosis, affective disorders and anxiety in autistic Spectrum disorder: Prevalence and Nosological considerations. Psychopathology, 43 , 8–16.

So, T.-Y., Bradley Layton, J., Bozik, K., Farrington, E., Gipson, P. E., Gibson, K., Primack, W., Conley Iii, W., Gipson, D. S., & Ferris, M. (2011). Cognitive pharmacy services at a pediatric nephrology and hypertension clinic. Renal Failure, 33 , 19–25.

Spear, L. P. (2000). The adolescent brain and age-related behavioral manifestations. Neuroscience & Biobehavioral Reviews, 24 (4), 417–463.

Steelman, L. C., & Powell, B. (1991). Sponsoring the next generation: Parental willingness to pay for higher education. American Journal of Sociology, 96 (6), 1505–1529.

Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. S. (2006). The study of developmental psychopathology in adolescence: Integrating affective neuroscience with the study of context. In D. Cicchetti & D. Cohen (Eds.), Handbook of developmental psychopathology (Vol. 2, pp. 710–741). New York: Wiley.

Taylor, J. L., & Seltzer, M. M. (2010). Changes in the autism behavioral phenotype during the transition to adulthood. Journal of Autism and Developmental Disorders, 40 , 1431–1446.

Taylor, J. L., & Seltzer, M. M. (2011a). Changes in the mother–child relationship during the transition to adulthood for youth with autism Spectrum disorders. Journal of Autism and Developmental Disorders, 41 , 1397–1410.

Taylor, J. L., & Seltzer, M. M. (2011b). Employment and post-secondary educational activities for young adults with autism Spectrum disorders during the transition to adulthood. Journal of Autism and Developmental Disorders, 41 , 566–574.

Wadsworth, M. E., et al. (2016). Poverty and the development of psychopathology. In: M. E. Wadsworth, G. W. Evans, K. Grant, J. S. Carter, & S. Duffy (Eds.), Development and psychopathology.Volume Four. Risk, resilience, and intervention , Ch 8 (pp. 215–237). Hoboken: John Wiley & Sons.

Walker, J. S., & Gowen, L. K. (2011). Community-based approaches for supporting positive development in youth and young adults with serious mental health conditions . Portland: Research and Training Center for Pathways to Positive Futures, Portland State University.

Watson, A. R. (2000). Non-compliance and transfer from Paediatric to adult transplant unit. Pediatric Nephrology, 14 , 469–472.

Watson, A. R. (2005). Problems and pitfalls of transition from Paediatric to adult renal care. Pediatric Nephrology, 20 , 113–117.

Watson, A. R., Harden, P., Ferris, M., Kerr, P. G., Mahan, J., & Ramzy, M. F. (2011). Transition from pediatric to adult renal services: A consensus statement by the international society of nephrology (Isn) and the international pediatric nephrology Association (Ipna). Pediatric Nephrology, 26 , 1753–1757.

Webster, B. H., Jr., & Bishaw, A. (2006). U.S. Census Bureau, American Community Survey Reports, ACS-02, Income, Earnings, and Poverty Data From the 2005 American Community Survey . Washington, DC: U.S. Government Printing Office.

Whitbeck, L., Hoyt, D. R., & Huck, S. M. (1994). Early family relationships, intergenerational solidarity, and support provided to parents by their adult children. Journal of Gerontology, 49 , S85–S94.

White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism Spectrum disorders. Clinical Psychology Review, 29 , 216–229.

Yeager, D. S., & Dweck, C. S. (2012). Mindsets that promote resilience: When students believe that personal characteristics can be developed. Educational Psychologist, 47 (4), 302–314.

Yeung, E., Kay, J., Roosevelt, G. E., Brandon, M., & Yetman, A. T. (2008). Lapse of care as a predictor for morbidity in adults with congenital heart disease. International Journal of Cardiology, 125 , 62–65.

Download references

Author information

Authors and affiliations.

Department of Pediatrics, ETSU College of Medicine, PO Box 70578, Johnson City, TN, 37614, USA

David Wood MD, MPH

Department of Pediatrics, UCLA, Los Angeles, CA, USA

Tara Crapnell OTD, OTR/L, Lynette Lau PhD, Debra Lotstein MD, MPH, Maria Ferris MD, PhD, MPH & Alice Kuo MD, PhD

Department of Pediatrics, USC, Los Angeles, CA, USA

Ashley Bennett MD

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to David Wood MD, MPH .

Editor information

Editors and affiliations.

Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California, USA

Neal Halfon

Applied Clinical Research Center Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

Christopher B. Forrest

Tufts University, Medford, Massachusetts, USA

Richard M. Lerner

Institute for Risk Analysis and Risk Communication, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA

Elaine M. Faustman

Rights and permissions

This chapter is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this chapter are included in the work's Creative Commons license, unless indicated otherwise in the credit line; if such material is not included in the work's Creative Commons license and the respective action is not permitted by statutory regulation, users will need to obtain permission from the license holder to duplicate, adapt or reproduce the material.

Reprints and permissions

Copyright information

© 2018 The Author(s)

About this chapter

Wood, D. et al. (2018). Emerging Adulthood as a Critical Stage in the Life Course. In: Halfon, N., Forrest, C., Lerner, R., Faustman, E. (eds) Handbook of Life Course Health Development . Springer, Cham. https://doi.org/10.1007/978-3-319-47143-3_7

Download citation

DOI : https://doi.org/10.1007/978-3-319-47143-3_7

Published : 21 November 2017

Publisher Name : Springer, Cham

Print ISBN : 978-3-319-47141-9

Online ISBN : 978-3-319-47143-3

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

• Submit       Member Login

Access provided by

Login to your account

If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password

If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password

Download started.

• Academic & Personal: 24 hour online access
• Corporate R&D Professionals: 24 hour online access
• Add To Online Library Powered By Mendeley
• Add To My Reading List
• Export Citation
• Create Citation Alert

Nutrition Through the Life Cycle

• Patricia Case, MS, RD Patricia Case Affiliations Oregon State University Extension Family and Community Health, 6923 Washburn Way, Klamath Falls, OR 97601 Search for articles by this author

Purchase one-time access:

Sneb member login, article info.

Inclusion of any material in this section does not imply endorsement by the Society for Nutrition Education and Behavior. Evaluative comments contained in the reviews reflect the views of the authors. Review abstracts are either prepared by the reviewer or extracted from the product literature. Prices quoted are those provided by the publishers at the time materials were submitted. They may not be current when the review is published. Reviewers receive a complimentary copy of the resource as part of the review process.

Identification

DOI: https://doi.org/10.1016/j.jneb.2015.08.002

ScienceDirect

Related articles.

• Download Hi-res image
• Download .PPT
• Access for Developing Countries
• Articles & Issues
• Articles In Press
• Current Issue
• List of Issues
• Supplements
• For Authors
• Author Guidelines
• Submit Your Manuscript
• Statistical Methods
• Guidelines for Authors of Educational Material Reviews
• Permission to Reuse
• About Open Access
• Researcher Academy
• For Reviewers
• General Guidelines
• Methods Paper Guidelines
• Qualitative Guidelines
• Quantitative Guidelines
• Questionnaire Methods Guidelines
• Statistical Methods Guidelines
• Systematic Review Guidelines
• Perspective Guidelines
• GEM Reviewing Guidelines
• Journal Info
• About the Journal
• Disclosures
• Abstracting/Indexing
• Impact/Metrics
• Contact Information
• Editorial Staff and Board
• Info for Advertisers
• Member Access Instructions
• New Content Alerts
• Sponsored Supplements
• Statistical Reviewers
• Reviewer Appreciation
• New Resources
• New Resources for Nutrition Educators
• Submit New Resources for Review
• Guidelines for Writing Reviews of New Resources for Nutrition Educators
• Podcast/Webinars
• New Resources Podcasts
• Press Release & Other Podcasts
• Collections
• Society News

The content on this site is intended for healthcare professionals.

• Privacy Policy   
• Terms and Conditions   
• Accessibility   
• Help & Contact

• Case Studies

0    comments

February 25

14 Questions To Build A Dominating Full Life Cycle Use Case

Awad Makkawi

ln our last article we discussed how to create your end user persona template .

Next up is mapping out the f ull life cycle use case for how the user will interact with your product so that you can engage, enlighten and entertain her at every step of the value creation process. 

The concept is adapted from Bill Aulets, Disciplined Entrepreneurship.

Here's what we'll cover:

• 5 advantages to your business model for having a full life cycle use case
• 3 step process for innovation and finding customers desired outcomes
• 4 categories of questions to create a smashing life cycle use case

Table of Contents

• What is the full life cycle use case?
• What the full life cycle use case means for your business model?

But What If You Don't Use It?

How to create your full life cycle use case, full life cycle use case example, 4 categories to uncover your full life cycle use case.

• 1. Awareness
• 2. Interest And Desire
• 3. Acquisition And Activation
• 4. Retention And Referral

When To Build The Full Life Cycle Use Case

• ​Conclusion

What Is The Full Life Cycle Use Case? 

Defining your customer is the first step to answering the question:

"Who are we serving?"

On the other hand, the full life cycle use case answers a different question:

"How will this end user interact with our product?"

It is a detailed description of how your customer will:

• Find out about your product
• Test and evaluate it
• Use and get value out of it
• Tell others about it

The bulk of the your use case document will be the result of your customer discovery efforts where you gather insights about your:

• Customers: what are their goals in relation to your product
• Their problems: the biggest challenges that they face
• The solutions they are seeking: including the features that are most important to them, what solutions they are currently using and why.

Before diving in any further,

What are the benefits for creating this document?

What the full life cycle use case means for your business model

What's in it for you?

The full life cycle use case plays a pivotal role in your business model development because it brings clarity to the strategies you'll develop for your:

• Go-To-Market
• Pricing frameworks
• Value proposition
• Competitive positioning
• Product growth plan

Moreover, mapping out the entire customer journey in relation to your product means that you will identify, and in turn proactively resolve, stumbling blocks for your startup that aren't obvious.

It allows you to design a product aligned with the users perception of value creation.

Have a look at this diagram on value proposition cycles in a study by Laura Anne Phillips et al .

On the flip side:

What happens if you don't build your full life cycle use case?

You end up wasting time and resources making corrections to your model that could have been easily avoided through a few hours of planning and research.

Here's an example:

The first part of the use case is to determine how the user first recognizes that she has a problem that needs to be solved.

Nobody will search for a solution to a problem  that they don't know they have .

By understanding how the user comes to the conclusion that she has a problem worth solving you have the upper hand in triggering the user into action and crafting a value proposition baked around what resonates with her most.

Now that we've covered the why .

Let's get to the how .

How do we construct a use case journey that captures a detailed illustration about how the customer will use the product?

It's a 3 step process that starts by understanding the Job To Be Done by the user i.e. the end result.

Second, is framing every step the user must go through to reach this end result i.e. build a "job map".

Finally, you define the desired user outcome(s) at each step of the job map in order to understand the metrics involved for creating measurable value for the your user at every step of the way.

Let's look at an example to make this easier to digest:

Say your Job To Be Done is: "Find new apartment for rent"

The job map would look like something along the lines of:

Notice that current rent being paid is high - Go online - Select a property platform - Filter search results - Screen results - Star interesting results - Contact realtors - Arrange site visit - Go for site visit - Select new apartment for rent.

With this in mind, you would then put together a list of desired outcome(s) that the user expects for each step in the above job map.

The information you develop here then supports your next steps for creating innovative new solutions.

Of course, you could get even more granular with your job map and add more steps. 

In fact, you could also have multiple maps associated with a single Job To Be Done statement.

The important thing is to paint a picture of how the user will interact with your product from start to finish.

For the purpose of reducing assumptions you have about customer excitement and shift your focus towards pointing out all the obstacles, effort and risks that she might experience.

What are the questions to ask when developing your full life cycle use case?

Earlier we mentioned that you'll validate your job map through customer interactions.

But what questions will reveal what you need to know about how users will interact with your solution?

The questions to ask can be divided into 4 groups:

• Awareness 
• Interest and Desire 
• Acquisition and Activation 

Retention and Referral

Take a look at this adaptation from Dave McClure's AARRR framework .

The following questions help to develop you value proposition and your go-to-market strategy and as a result your customer acquisition cost.

• How will the user discover she has a problem that needs to be solved or and opportunity to do something differently?
• What triggers her to look for a solution?
• Where and how will she search for find your product?
• Her areas of focus when searching for solutions?

Interest And Desire

These questions help with creating your minimum viable business product, your value proposition and competitive positioning.

• What does the user value most i.e. benefits and features?
• How will she analyze and assess the value she will receive from your product?
• Her process to compare the product to existing solutions both direct and indirect?

Acquisition and Activation

The below questions help with refining your business model, pricing framework, value proposition and customer satisfaction.

Ask how will the user:

• Acquire the product? A note here that this is not the same as paying for the product. Are they purchasing a monthly online software subscription? An annual one time payment? A physical product delivered to the door? These are all points of friction that arise once a user has decided to make a purchase.
• Pay for the product? I.e. is it cash? Credit card? Apple Pay?
• Sign up, Install, setup or integrate the solution into her workflow?
• Use and get value out of it?

Here the information received helps develop the customer service program and incentives, your product expansion plan and the business model.

How will you: 

• Engage with the user to keep them coming back and using your solution?
• Provide support for her so that her experience after purchasing your solution is as delightful as when she bought it?
• Create the opportunity for her to tell others?

At what point do you create your full life cycle use case?

This is done after you've completed your market segmentation analysis and built your user persona profile .

It's not a document that you use to begin coding and adding features to your product. 

Consider it a road map that guides you on what to validate with your customers in order to uncover the true route that they will take when purchasing your solution.

In turn, this will bring all the team behind a clear vision of what is being built, why it's being built that way, for whom it's being built and where improvements can be made.

For a dive into how to tackle meeting and interviewing customers in as little as 4 days check out the following article:

Customer Discovery: How To Find Customers And Build Products They Want

The full life cycle use case is an extensive map of how the user will interact with your solution.

From the moment the user realizes she has a problem to be solved, to how she seeks out a solution, compare alternatives, measure value, buy the product, get value out of it and even tell others about it.

The purpose is to draw a clear path of the customer journey and proactively present the friction points that a user might go through preventing them from purchasing your solution.

It allows the design of optimized business models for your startup by revealing go-to-market strategies, product expansion, customer acquisition strategies that are aligned with what your customers already do.

Design your life cycle use case.

Optimize for the desired outcomes your customers want.

You already know you want to please your customers.

May 12, 2020

How To Design A Value Proposition Like Apple and AirBnB

May 7, 2020

We Analyzed 150 UAE Ecommerce Sites For User Behavior & Found This

April 29, 2020

How Coronavirus HAS Hit Your Business Model & What To Do About It

February 28, 2020

How Cafu Captured Its Market To Become A World Leader In 7 Months

Session expired

Please log in again. The login page will open in a new tab. After logging in you can close it and return to this page.

The Family Life Cycle and the ASWB Exam

Agents of change.

• November 28, 2023

Welcome to our latest blog post, where we dive into the Family Life Cycle and its pivotal role in the ASWB (Association of Social Work Boards) exam. This is a topic provides a comprehensive framework for understanding the dynamic and evolving nature of family life.

Whether you’re a student studying for the big test, a practicing Social Worker looking to refresh your knowledge, or simply someone intrigued by the complexities of family dynamics, this post promises to offer valuable insights and practical advice.

We’re not just talking about dry theory here; we’re about to explore real-life applications that can illuminate your professional practice and enrich your understanding of families in all their diverse forms.

Learn more about the ASWB exam and create a personalized ASWB study plan with Agents of Change. We’ve helped thousands of Social Workers pass their ASWB exams and want to help you be next!

1) The Stages of the Family Life Cycle

1. young adults leaving home.

• Independence and Exploration : This stage marks a significant transition as young adults step out of their comfort zone, leaving their parental homes. It’s a time of exploration, independence, and self-discovery.
• Challenges : They might face challenges like financial management, career decisions, and developing new social networks.
• Social Work Perspective : Here, Social Workers can play a vital role in guiding young adults through this transition, offering support in career counseling, mental health, and fostering independence.

2. The Newly Formed Couple

• Partnership and Adjustment : This stage is characterized by the formation of a partnership, whether through marriage or otherwise. It involves learning to live with a partner, adjusting to new roles, and balancing individual and joint goals.
• Challenges : Couples may struggle with communication, financial planning, and managing expectations.
• Social Work Perspective : Social Workers can provide counseling to help couples develop healthy communication skills and address any relationship issues.

3. Families with Young Children

• Growth and Responsibility : The arrival of children brings a profound change. This stage is about nurturing and raising children, which includes imparting values and coping with the demands of parenting.
• Challenges : Parents might face stress related to childcare, balancing work and family life, and dealing with behavioral issues in children.
• Social Work Perspective : In this stage, Social Workers can offer parenting classes, connect families with community resources, and provide support in dealing with child development issues.

4. Families with Adolescents

• Transition and Adaptation : As children enter adolescence, families encounter a new set of challenges. This stage involves guiding adolescents through physical, emotional, and social changes.
• Challenges : Common issues include teenage rebellion, identity crises, and academic pressures.
• Social Work Perspective : Social Workers can assist in navigating these challenges through counseling, facilitating parent-teen communication, and providing resources for educational and emotional support.

5. Launching Children and Moving On

• Redefinition and Rediscovery : This stage occurs when children become adults and leave home. It’s a time for parents to redefine their roles and focus on personal and marital growth.
• Challenges : Empty nest syndrome, rekindling relationships, and finding new purposes can be challenging.
• Social Work Perspective : Social Workers can help individuals and couples navigate this transition, offering support in dealing with emotional adjustments and exploring new life goals.

6. Families in Later Life

• Reflection and Continuity : The final stage involves reflecting on life, dealing with aging, and possibly coping with the loss of a spouse and peers.
• Challenges : Health issues, loneliness, and generational conflicts can arise.
• Social Work Perspective : Here, Social Workers play a crucial role in providing elderly care support, grief counseling, and helping families manage the complexities of aging.

Learn more additional tips and tricks for the ASWB exam and get hundreds of practice questions with Agents of Change!

2) The ASWB Exam Connection

The ASWB (Association of Social Work Boards) exam is a pivotal stepping stone for Social Workers, serving as a gateway to professional licensure.

Why the Family Life Cycle is Central to the ASWB Exam

• Comprehensive Understanding of Client Situations : The exam tests a candidate’s ability to assess and intervene in client situations effectively. Knowledge of the Family Life Cycle provides a framework for understanding clients in the context of their family dynamics at different life stages.
• Application of Theory to Practice : The ASWB exam emphasizes the practical application of theoretical knowledge. Candidates are often presented with scenarios where they must apply their understanding of the Family Life Cycle to propose appropriate interventions.
• Ethical Decision-Making : Ethical dilemmas in Social Work often involve complex family situations. An in-depth understanding of family dynamics across various life stages is crucial for making informed, ethical decisions.

Integrating Family Life Cycle Concepts into Exam Preparation

Understanding the stages.

• Study Each Stage : Deeply understand the characteristics, challenges, and developmental tasks of each stage of the Family Life Cycle.
• Connect Theories and Models : Link relevant theories and models of Social Work to different stages of the Family Life Cycle.

Applying Knowledge to Case Scenarios

• Case Studies and Practice Questions : Regularly practice with case scenarios that incorporate elements of the Family Life Cycle. Agents of Change programs include hundreds of practice questions and full-length exams.
• Critical Thinking Exercises : Engage in exercises that challenge you to apply Family Life Cycle concepts to complex family situations.

Ethical Considerations

• Ethical Frameworks : Familiarize yourself with the ethical considerations that may arise in different stages of the Family Life Cycle.
• Decision-Making Practice : Work through practice questions that involve ethical dilemmas related to family dynamics.

Tips for Exam Success

• Holistic Understanding : Go beyond memorization. Strive to understand how the Family Life Cycle is interwoven into the fabric of Social Work practice.
• Real-Life Application : Whenever possible, relate the concepts to real-life experiences or observations. This deepens understanding and aids in recall.
• Self-Reflection : Reflect on your own experiences and biases about family dynamics, as this can influence how you interpret exam questions and scenarios.

Get 100’s of practice questions, answers, and rationales with Agents of Change.

3) FAQs – The Family Life Cycle and ASWB Exam

Q: Can you explain how the Family Life Cycle is featured in the ASWB exam and its significance for Social Work practice?

A: The Family Life Cycle is included in the ASWB exam to test a candidate’s understanding of family dynamics across different life stages. This concept is crucial as it helps in identifying and addressing the specific needs and challenges faced by families at various points in their life journey.

In the exam, you’ll encounter questions that require you to apply knowledge of the Family Life Cycle in assessing client situations, planning interventions, and making ethical decisions. For instance, you may be presented with a case study involving a family with young children and asked to identify appropriate intervention strategies based on their developmental stage.

Q: What are some challenges students face in grasping the Family Life Cycle for the exam, and do you have tips to overcome these hurdles?

A: One common challenge is the sheer breadth of the concept, which encompasses various life stages, each with its unique characteristics and challenges. To overcome this, we recommend breaking down the cycle into individual stages and studying them in depth. 

Another challenge is applying this knowledge to the diverse and complex scenarios presented in the exam. To tackle this, engage in plenty of practice with case scenarios and discussion groups, where you can apply Family Life Cycle theories to real-world situations. All Agents of Change programs include 2 live study groups per month.

Lastly, students often struggle with the integration of the Family Life Cycle into ethical decision-making. To address this, study ethical frameworks and practice decision-making with scenarios that specifically involve family dynamics across different life stages.

Q: Beyond the ASWB exam, how is an understanding of the Family Life Cycle beneficial for someone entering the field of Social Work?

A: Knowledge of the Family Life Cycle is incredibly beneficial for Social Work practitioners beyond just passing the ASWB exam. It equips you with a comprehensive framework to understand and address the evolving needs of families.

In practice, this means you can offer more tailored and effective interventions. For example, understanding the challenges of families with adolescents can guide you in providing more targeted support for issues like communication, boundary setting, and conflict resolution.

Additionally, this knowledge fosters empathy and cultural competence, as you’ll be more attuned to the unique experiences of families from diverse backgrounds and life stages.

4) Conclusion

By understanding the distinct stages of the Family Life Cycle, Social Workers are better equipped to empathize with, assess, and address the unique challenges and needs of families at various points in their life journey. This knowledge is important for crafting effective interventions and supports that are tailored to the specific dynamics and developmental stages of each family.

Furthermore, mastering the Family Life Cycle for the ASWB exam underscores a commitment to ethical and competent practice. As you prepare for the exam, embrace this learning as an opportunity to deepen your insights and enhance your professional skills. The effort you put into understanding the Family Life Cycle will pay dividends not only in your exam performance but also in your future career as a compassionate and effective Social Worker.

5) Practice Question – The Family Life Cycle

Maria and Jose have been married for 22 years and have two children. Their eldest, Luis, is 20 years old and recently moved out to attend college. Their youngest, Elena, is 18 and planning to move to another city for her job next month. Maria has expressed feelings of sadness and loss to you, their Social Worker, mentioning that she feels her role as a mother is diminishing. Jose has been quiet about the situation but seems to be more focused on his hobbies and spending time with Maria. They both are unsure of what their relationship will look like with an empty nest.

Based on the Family Life Cycle theory, which stage are Maria and Jose currently navigating, and what is a primary task they should focus on during this stage?

A. Family with young children – Fostering children’s independence B. Family with adolescents – Adjusting to teenagers’ need for autonomy C. Launching adult children – Redefining the couple relationship D. Retirement – Adapting to the aging process

Correct Answer: C. Launching adult children – Redefining the couple relationship

Rationale: Maria and Jose are experiencing the ‘Launching adult children’ stage of the Family Life Cycle. This stage is marked by the transition of children moving out of the family home, often for education or work, and the subsequent adjustments that parents need to make. The primary task for parents in this stage is to redefine their relationship as a couple now that their day-to-day parenting roles are less central.

This involves finding new ways to connect with each other and exploring interests that they may have put aside while raising children. Maria’s feelings of sadness and loss and Jose’s shift towards hobbies and spending more time with Maria are indicative of the adjustments they are both making during this transition. The other options refer to different stages of the Family Life Cycle that do not apply to Maria and Jose’s current situation.

————————————————————————————————————————————————

► Learn more about the Agents of Change course here: https://agentsofchangeprep.com

About the Instructor, Meagan Mitchell: Meagan is a Licensed Clinical Social Worker and has been providing individualized and group test prep for the ASWB for over five years. From all of this experience helping others pass their exams, she created the Agents of Change course to help you prepare for and pass the ASWB exam!

Find more from Agents of Change here:

► Facebook Group: https://www.facebook.com/groups/aswbtestprep

► Podcast: https://anchor.fm/agents-of-change-sw

#socialwork #testprep #aswb #socialworker #socialwork #socialworktest #socialworkexam #exam #socialworktestprep #socialworklicense #socialworklicensing #licsw #lmsw #lcsw #aswbexam #aswb #lcswexam #lmswexam #aswbtestprep #aswbtest #lcswtestprep #lcswtest #lmswtestprep #lmswtest #aswbcourse #learningstyles #learningstyle

Disclaimer: This content has been made available for informational and educational purposes only. This content is not intended to be a substitute for professional medical or clinical advice, diagnosis, or treatment

Share this:

Popular posts.

Feedback, Reflection, and Next Steps After ASWB Practice Exams

Mastering Case Note Writing for the ASWB Exam

Leadership in Social Work and the ASWB Exam

Handling Difficult Client Interactions and the ASWB Exam

Legal Considerations for Social Workers and the ASWB Exam

Mastering Crisis Intervention Strategies on the ASWB Exam

Holistic Approaches in Social Work and the ASWB Exam

Integrating Neurodiversity into Social Work Practice and the ASWB Exam

You may also like.

Pass Your Social Work Exam

Try it for free  

Agents of Change will help you prepare to  PASS  your licensing exam and level up your career.

Quick Links

If you have any questions not covered by our FAQs, please get in touch using the email below

Email: [email protected]

Discover more from Agents of Change Social Work Test Prep

Subscribe now to keep reading and get access to the full archive.

Type your email…

Continue reading

Leverage our technology expertise for custom applications and API's as well application rewrites. Driven by emerging technologies in open source, AI, automation, IoT and big data.

Platform solutions, consulting expertise and seasoned advisory for defining and executing AI services. These can be internal operational improvements or external support and services.

Quick turn around of individuals and teams within our core disciplines. Exceptional technical vetting and retention with global location and time zone coverage. Flex utilization for certain roles.

• Strategy & Ideation
• UX/UI Design
• Integration & APIs
• Quality Assurance
• Support and Hosting Services
• Custom SaaS Dev and Cloud Services
• Telehealth Software
• EHR Software
• EMR Software
• Medical Software
• Engagements
• Mobile Apps
• Mobile Testing
• React Native
• Objective-C
• Ruby on Rails
• About Intersog
• Why Intersog
• Leadership Team
• Letter from the CEO
• Team Management
• Software Dev Blogs
• IT Strategy
• Coding Tips
• IT News and Trends
• White Papers
• Strategy & Ideation
• Integration/APIs
• MVP Development
• Backend Development
• Agriculture
• IT Cost Calculator
• Software Development

Agile Software Development Life Cycle: Case Study

Learn more about our agile software development life cycle from our Mitsubishi case study.

Any software development project, either big or small, requires a great deal of planning and steps that divide the entire development process into several smaller tasks that can be assigned to specific people, completed, measured, and evaluated. Agile Software Development Life Cycle (SDLC), is the process for doing exactly that – planning, developing, testing, and deploying information systems. The benefit of agile SDLC is that project managers can omit, split, or mix certain steps depending on the project’s scope while maintaining the efficiency of the development process and the integrity of the development life cycle. 

Today, we are going to examine a software development life cycle case study from one of Intersog’s previous projects to show how agility plays a crucial role in the successful delivery of the final product. Several years back, we worked with Mitsubishi Motors helping one of the world’s leading automotive manufacturers to develop a new supply chain management system. With the large scope of the project, its complex features, and many stakeholders relying on the outcomes of the project, we had to employ an agile approach to ensure a secure software development life cycle.

Business Requirements

Mitsubishi Motors involves many stakeholders and suppliers around the world, which makes its supply chain rather complex and data-heavy. That is why timely improvements are crucial for the proper functioning of this huge system and a corporation as a whole. Over the years of functioning, the old supply chain has been accumulating some noticeable frictions that resulted in the efficiency bottlenecks, and Intersog offered came ups with just the right set of solutions to make sufficient solutions that would help Mitsubishi ensure a coherent line of communication and cooperation with all the involved suppliers.

• Intersog Gains Game-Changer Status on Clutch

Previously, Mitsubishi used an outdated supply chain management system that involved a large number of spreadsheets that required a lot of manual input. Considering a large number of stakeholders, the problem of synchronization has been a pressing one as well – different stakeholders would input the data at different speeds and at different times of day, which created a degree of confusion among suppliers. Though the system has been sufficient for a long time, the time has come to eliminate all the redundancies and streamline data input. 

The legacy system has been partially automated and ran on the IBM AS400 server, which allows for impressive flexibility, but it no longer sufficed for Mitsubishi’s growing needs. The main requirement, thus, was to create a robust online supply chain solution that would encompass the entire logistics process starting with auto parts and steel suppliers and ending with subcontractors and car dealerships around the world. That being said, Mitsubishi did not want to completely change the system, they opted for overhaul, and we came up with the idea of an integrated web application that was meant to function in conjunction with a DB2 base that was already used on the IBM AS400 server. 

IT Architecture and Agile SDLC

Mitsubishi employs a series of guidelines and rules on how to build, modify, and acquire new IT resources, which is why Intersog had to be truly agile to adapt to the client’s long-established IT architecture. Adapting to the requirements of the client, and especially to the strict regulations of the IT architecture of large corporations like Mitsubishi requires knowledge, flexibility, and strong industry expertise. Each software development company has its own architecture standards and frameworks for building new systems but many face difficulties when working with the existing systems and modifying them to the new requirements.

Intersog has no such problems. We approached Mitsubishi’s case with strong industry expertise and flexibility to account for all the client’s needs and specifications of the existing system. Obviously, following the client’s architecture regulations requires a profound understanding of said regulations, which is why information gathering is an integral phase of the software development life cycle.

Requirements Gathering

The requirements gathering phase can take anywhere from just a couple of days to several weeks. Working with complex and multi-layered legacy systems like the one used by Mitsubishi requires serious analysis and information gathering. In the case of Mitsubishi, our dedicated team had to gain a clear understanding of how the legacy system functions, create new software specifications, map out the development process, gather and create all the necessary documentation, track all the issues related to the functioning of the legacy system, outline the necessary solutions, and allocate all the resources to achieve the project’s goals in the most efficient manner. 

Working on the Mitsubishi project, our team has been gathering all the required information for up to 4 weeks. This included a profound examination of the legacy system, mapping out all of its flaws and specifications, bridging the gaps between the current state of the system and the requirements of the client, and outlining the development process. 

• Can Advanced Digital Tools Revolutionize Communication in Remote Teams?

The design stage includes all the integral decisions regarding the software architecture, its makeover, the tech frameworks that would be used in the system’s rework. During this stage, developers discuss the coding guidelines, the tools, practices, and runtimes that will help the team meet the client’s requirements. Working with large corporations like Mitsubishi, a custom software development team has to work closely with the company’s own developers to better understand the specifics of the architecture and create a design that reflects all the requirements. 

After all the requirements are gathered, we initiated the design stage based on all of the client’s specifications and came up with a number of solutions that matched Mitsubishi’s specs:

• Convenient data model meant to optimize data duplication;
• Permission system that differentiated the users by their access levels;
• Appealing user interface mockup to improve the comfortability of user-system interaction;
• Integration with the legacy RPG system;
• Notifications for the partners to keep them up with the important activities.

This set of essential solutions has been discussed and approved in the course of the design stage that lasted for 2 months. During this stage, Intersog and Mitsubishi development teams worked closely to come up with the solutions that matched the client’s requirements to the tee. Proper functioning of the supply chain is vital for the entire corporation, which is why it was critical to do everything flawlessly. 2 months might seem like quite a timeline, but for this case study on software development life cycle, it was not that long considering how complex Mitsubishi’s legacy system was. 

Solution Development

After approving the solution design, the team can move to develop those solutions. That’s the core of the entire project, a stage at which the teams meet the goals and achieve the outcomes set during previous stages. The success of the development stage depends heavily on how good a job the teams did during the design stage – if everything was designed with laser precision, the team can expect few if any, surprises during the development stage. 

What happens during the development stage is the teams coding their way towards the final product based on decisions that have been made earlier. With Mitsubishi, we followed the guidelines we came up with earlier and implemented a set of essential solutions:

• We built a convenient data model that minimizes the risk of human error by reducing redundant and repetitive data entry and duplication. 
• Improved Mitsubishi’s security system to differentiate the users by their level of access and give them the respective level of control over the data.
• Added the notifications for the users so that they could react to the relevant changes faster.
• Designed an appealing and comfortable user interface using the AJAX framework to make the user-system interaction more comfortable and time-efficient. 
• Deployed the platform running on the IBM AS400 server with the integration of DB2 databases.
• Integrated the existing RPG software into the new system.
• Migrated the existing spreadsheets and all the essential data into the new system.

All of these solutions took us 6 months to implement, which is rather fast for a project of such scale. Such a time-efficiency was possible only thanks to the huge amount of work we’ve done throughout the research and design stages. The lesson to learn from these software development life cycle phases for the example case study is that the speed of development would depend heavily on how well you prepare. 

Depending on the scale of the project, you might be looking at different timelines for the development stage. Small scale projects can be finished in a matter of weeks while some of the most complicated solutions might take more than a year to finish. In the case of the Mitsubishi project, it was essential for the client to get things done faster. Rushing things up is never a good idea, but you can always cut your development timeline by doing all the preparation work properly and having a clear understanding of what needs to be done and in which order.

Quality Assurance                   

Quality assurance is as vital for your project’s success as any other stage; this is where you test your code, assess the quality of solutions, and make sure everything runs smoothly and according to plan. Testing helps you identify all the bugs and defects in your code and eliminate those in a timely manner. Here at Intersog, we prefer testing our software on a regular basis throughout the development process. This approach helps us to identify the issues on the go and fix them before they snowball into serious problems. 

That’s it, quality assurance is a set of procedures aimed at eliminating bugs and optimizing the functioning of the software solutions. Here at Intersog, we run both manual and automated tests so that we can be truly sure of the quality of solutions we develop for our clients. With Mitsubishi, we ran tests throughout the development process and after the development stage was over. It took us an additional month to test all the solutions we’ve developed, after which we were ready for the implementation stage.

Would you like to learn more

about talent solutions

Integration and Support

Following the testing, and once we are sure all the solutions work flawlessly, the development team gets to the implementation stage. Also known as the integration stage, this is where we integrate the new solution into the client’s pre-existing ecosystem. Basically, you are putting new gears into a complex mechanism that has been functioning for many years, and it is essential to make sure all of those gears fit perfectly. 

With such a complex system as the one employed by Mitsubishi and a vast amount of accumulated data, our developers had to be incredibly precise not to lose anything. We are talking about surgical precision because Mitsubishi’s suppliers amassed thousands upon thousands of spreadsheets full of critical data on supplies, material and product deliveries, accounting data, and more. All of that had to be carefully integrated with the new automated solution. 

After 2 months, the solutions have been fully integrated with Mitsubishi’s existing ecosystem. Intersog usually backs the clients up by offering support and maintenance services to ensure flawless functioning of the system over time, but this time, our client was fully capable of maintaining the new system on their own. As said, Mitsubishi has its own development team that is able to take care of the system maintenance, so that our cooperation was finished after the integration stage. 

Final Thoughts and Outtakes

A software development life cycle depends on many factors that are unique for each company. In the case of Mitsubishi, we’ve managed to get things done in just under a year, which is rather fast for a project of such an immense scale. Different projects have different life cycles, and it depends on the scale, the client’s ability to explain their needs, and the development team’s ability to understand those needs, gather all the necessary information, design the appropriate set of solutions, develop said solutions, ensure their quality, and implement them fast.

Related Posts

It strategy intersog gains game-changer status on clutch, it strategy harnessing staff augmentation in the tech industry: a data-driven approach, software development blogs ai is boosting retail sales.

This website uses these cookies: