The adolescent spurt in skeletal and muscular dimensions is closely related to the rapid development of the reproductive system that takes place at this time. The acceleration of penis growth begins on average at about age 121/2 years, but sometimes as early as 101/2 and sometimes as late as 141/2. The completion of penis development usually occurs at about age 141/2, but in some boys is at 121/2 and in others at 161/2. There are a few boys, it will be noticed, who do not begin their spurts in height or penis development until the earliest maturers have entirely completed theirs. At ages 13, 14, and 15 there is an enormous variability among any group of boys, who range all the way from practically complete maturity to absolute preadolescence. The same is true of girls aged 11, 12, and 13.

The psychological and social importance of this difference in the tempo of development, as it has been called, is great, particularly in boys. Boys who are advanced in development are likely to dominate their contemporaries in athletic achievement and sexual interest alike. Conversely the late developer is the one who all too often loses out in the rough and tumble of the adolescent world, and he may begin to wonder whether he will ever develop his body properly or be as well endowed sexually as those others whom he has seen developing around him. An important part of the educationist’s and the doctor’s task at this time is to provide information about growth and its variability to preadolescents and adolescents and to give sympathetic support and reassurance to those who need it.

The sequence of events, though not exactly the same for each boy or girl, is much less variable than the age at which the events occur. The first sign of puberty in the boy is usually an acceleration of the growth of the testes and scrotum with reddening and wrinkling of the scrotal skin. Slight growth of pubic hair may begin about the same time but is usually a trifle later. The spurts in height and penis growth begin on average about a year after the first testicular acceleration. Concomitantly with the growth of the penis, and under the same stimulus, the seminal vesicles, the prostate, and the bulbo-urethral glands, all of which contribute their secretions to the seminal fluid, enlarge and develop. The time of the first ejaculation of seminal fluid is to some extent culturally as well as biologically determined but as a rule is during adolescence and about a year after the beginning of accelerated penis growth.

Axillary (armpit) hair appears on average some two years after the beginning of pubic hair growth; that is, when pubic hair is reaching stage 4. There is enough variability and dissociation in these events, so that a very few children’s axillary hair actually appears first. In boys, facial hair begins to grow at about the time that the axillary hair appears. There is a definite order in which the hairs of moustache and beard appear: first at the corners of the upper lip, then over all the upper lip, then at the upper part of the cheeks, in the midline below the lower lip, and, finally, along the sides and lower borders of the chin. The remainder of the body hair appears from about the time of first axillary hair development until a considerable time after puberty. The ultimate amount of body hair that an individual develops seems to depend largely on heredity, though whether because of the kinds and amounts of hormones secreted or because of variations in the reactivity of the end organs is not known.

Breaking of the voice occurs relatively late in adolescence. The change in pitch accompanies enlargement of the larynx and lengthening of the vocal cords, caused by the action of the male hormone testosterone on the laryngeal cartilages. There is also a change in quality that distinguishes the voice (more particularly the vowel sounds) of both male and female adults from that of children. This is caused by the enlargement of the resonating spaces above the larynx, as a result of the rapid growth of the mouth, nose, and maxilla (upper jaw).

In the skin, particularly of the armpits and the genital and anal regions, the sebaceous and apocrine sweat glands develop rapidly during puberty and give rise to a characteristic odour; the changes occur in both sexes but are more marked in the male. Enlargement of the pores at the root of the nose and the appearance of comedones (blackheads) and acne, while likely to occur in either sex, are considerably more common in adolescent boys than girls, since the underlying skin changes are the result of androgenic (male sex hormone) activity.

During adolescence the male breast undergoes changes, some temporary and some permanent. The diameter of the areola, which is equal in both sexes before puberty, increases considerably, though less than it does in girls. In some boys (between a fifth and a third of most groups studied) there is a distinct enlargement of the breast (sometimes unilaterally) about midway through adolescence. This usually regresses again after about one year.

In girls the start of breast enlargement—the appearance of the “breast bud”—is as a rule the first sign of puberty, though the appearance of pubic hair precedes it in about one-third. The uterus and vagina develop simultaneously with the breast. The labia and clitoris also enlarge. Menarche, the first menstrual period, is a late event in the sequence. Though it marks a definitive and probably mature stage of uterine development, it does not usually signify the attainment of full reproductive function. The early cycles may be more irregular than later ones and in some girls, but by no means all, are accompanied by discomfort. They are often anovulatory; that is, without the shedding of an egg. Thus there is frequently a period of adolescent sterility lasting a year to 18 months after menarche, but it cannot be relied on in the individual case. Similar considerations may apply to the male, but there is no reliable information about this. On average, girls grow about six centimetres (about 2.4 inches) more after menarche, though gains of up to twice this amount may occur. The gain is practically independent of whether menarche occurs early or late.

Sex dimorphism

The differential effects on the growth of bone, muscle, and fat at puberty increase considerably the difference in body composition between the sexes. Boys have a greater increase not only in stature but especially in breadth of shoulders; girls have a greater relative increase in width of hips. These differences are produced chiefly by the changes that occur during puberty, but other sex differentiations arise before that time. Some, like the external genital difference itself, develop during fetal life. Others develop continuously throughout the whole growth period by a sustained differential growth rate. An example of this is the greater relative length and breadth of the forearm in the male when compared with whole arm length or whole body length.

Part of the sex difference in pelvic shape antedates puberty. Girls at birth already have a wider pelvic outlet. Thus the adaptation for childbearing is present from an early age. The changes at puberty are concerned more with widening the pelvic inlet and broadening the much more noticeable hips.

Physical and behavioral interaction

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Children vary greatly in their tempo of growth. The effects are most dramatically seen at adolescence, but they are present at all ages from birth and even before.

The concept of developmental age, as opposed to chronological age, is an important one. To measure developmental age, there is need of some way of determining how far along his own path to maturity a given child has gone. Therefore, there is need of a measure in which everyone at maturity ends up the same (not different as in height). The usual measure used is skeletal maturity or bone age. This is measured by taking an X ray of the hand and wrist. The appearances of the developing bones can be rated and formed into a scale of development; the scale is applicable to boys and girls of all genetic backgrounds, though girls on average reach any given score at a younger age than do boys; and blacks on average, at least in the first few years after birth, reach a given score younger than do whites. Other areas of the body may be used if required. Skeletal maturity is closely related to the age at which adolescence occurs; that is, to maturity measured by some sex character developments. Thus the range of the chronological age within which menarche may normally fall is about 10 to 161/2, but the corresponding range of bone age for menarche is only 12 to 141/2. Evidently the physiological processes controlling progression of skeletal development are in most instances closely linked with those that initiate the events of adolescence. Furthermore, children tend to be consistently advanced or retarded during their whole growth period, at any rate after about age three.

There is little doubt that being an early or a late maturer may have repercussions on behaviour and that in some children these repercussions may be considerable. There is little enough solid information on the relation between emotional and physiological development, but what there is supports the common-sense notion that emotional attitudes are clearly related to physiological events.

Larger size and earlier maturation

The rate of maturing and the age of onset of puberty are dependent on a complex interaction of genetic and environmental factors. Where the environment is good, most of the variability in age at menarche in a population is due to genetical differences. In many societies puberty occurs later in the poorly off, and, in most societies investigated, children with many siblings grow more slowly than children with few.

During the last hundred years there has been a striking tendency for children to become progressively larger at all ages. This is known as the “secular trend.” The magnitude of the trend in Europe and America is such that it dwarfs the differences between socioeconomic classes.

The data from Europe and America agree well: from about 1900, or a little earlier, to the present, children in average economic circumstances have increased in height at age five to seven by about one to two centimetres (0.4 to 0.8 inch) per decade, and at 10 to 14 by two to three centimetres (0.8 to 1.2 inches) each decade. Preschool data show that the trend starts directly after birth and may, indeed, be relatively greater from age two to five than subsequently. The trend started, at least in Britain, as early as 1850.

Most of the trend toward greater size in children reflects a more rapid maturation; only a minor part reflects a greater ultimate size. The trend toward earlier maturing is best shown in the statistics on age at menarche. The trend is between three and four months per decade since 1850 in average sections of western European populations. Well-off persons show a trend of about half of this magnitude, having never been so retarded in menarche as the worse off. The causes of the secular trend are probably multiple. Certainly better nutrition is a major one and perhaps in particular more protein and calories in early infancy. A lessening of disease may also have contributed. Hot climates used to be cited as a potent cause of early menarche, but it seems that their effect, if any, is considerably less than that of nutrition. Some authors have supposed that the increased psychosexual stimulation consequent on modern urban living has contributed, but there is no positive evidence for this.