Adolescent Brain Development: What Does it Mean for Families and Working with Families

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Adolescent Brain Development What Does it Mean
for Families and Working with Families?
Dr Alex Hassett Senior Consultant (CAMHS) Manager
CAMHS Practice Improvement Programme
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OVERVIEW

• Defining
• Adolescence
• Mental Health
• Brain Structure and Development
• Adolescent Brain Development
• Implications

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Defining our discussions

• What do we mean by adolescence?
• What do we mean by mental health?

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Conceptualising Adolescence

• Youth are heated by Nature as drunken men by
  wine

Aristotle
inclined to contradict parents and tyrannize
their teachers
Socrates
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Conceptualising Adolescence
I would that there were no age between ten and
twenty threefor there is nothing in between but
getting wenches with child, wronging the
ancientry, stealing, fighting
Shakespeare (The Winters Tale Act III)
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Defining adolescence

• Defined in different ways
• Not just puberty
• Adolescence is the transition from childhood to
  adulthood. From dependence to independence
• No distinct beginning and end but roughly 10-20
  years of age
• Adolescence is a transitional process not a stage

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Dahl (2006) offers this definition of adolescence
that awkward period between sexual maturation
and the attainment of adult roles and
responsibilities.
Begins
Ends
Physical / biological changes related to puberty
Domain of social roles
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Adolescent Development
Physical
Cognitive
Psycho-Social
Biopsychosocial Approach
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Summary of Tasks of Adolescents

• Cope with physical changes

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Summary of Tasks of Adolescents

• Establish sexual identity/sexual orientation
• Establishing an identity
• Establishing autonomy
• Prepare to live independently
• Separate and develop new relationships with
  family of origin
• Develop moral code
• Establish peer relationships
• Establish intimate relationships
• Ruth Talbot, YoungMinds

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Different Views on Adolescence
Historical
Cultural
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What do we mean by mental health?
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What do we mean by mental health?
Young People are saying .
Feeling in control
Feeling balance
It doesnt mean being happy all the time but it
does mean being able to cope with things.
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Mental Health Definition

• A state of well-being in which the individual
  realises his or her own abilities, can cope with
  the normal stresses of life, can work
  productively and fruitfully, and is able to make
  a contribution to his or her community.

World Health Organization, 2004
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What is mental health

• From NHS Advisory Service (1995) review of Child
  and Adolescent Mental Health Services Together
  We Stand
• Children with good mental health have
• The ability to develop psychologically,
  emotionally, intellectually and spiritually.
• The ability to initiate, develop and sustain
  mutually satisfying personal relationships.
• The ability to become aware of others and to
  empathise with them.
• The ability to use psychological distress as a
  developmental process, so that it does not hinder
  or impair further development..

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Continuum of Mental Health and Mental Disorders
Mental Distress
Mental Disorders
Emotional Well-being / Mental Health
Mental Health Problems
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Brain Development
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Caution!!!!

• New discoveriesresearch is still in its infancy
• Do NOT over-interpret or interpret too
  simplistically
• Some research has been conducted on animals we
  assume the information transfers to people
• Behaviour is the result of complex interactions
  among individual, environment, genetics,
  situation, cultural expectations, and numerous
  other factors

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Structure of the Brain
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Brain Circuitry

• NEURON specialized cell designed to transmit
  information to other nerve cells and muscles
• Each neuron consists of a cell body, axon, and
  dendrite
• Axon an electricity conducting fiber that
  carries information away from the cell body
• Dendrite receives messages from other neurons
• Synapse contact point where one neuron
  communicates with another neuron

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Brain Circuitry

• Neurons communicate by transmitting electrical
  impulses along their axons
• Axons send messages across a synapse to the
  receiving dendrite of the target neuron

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OVERPRODUCTION AND PRUNING

• Brain development occurs in 2 basic stages
  growth spurts/overproduction of neurons and
  pruning
• Critical phases in utero
• 0-3 years
  overproduction
• 10-13 years
• Overproduction results in significant increase in
  the number of neurons and synapses
• Exuberant growth during these 3 phases gives the
  brain enormous potential

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PRUNING

• These 3 critical phases are quickly followed by a
  process in which the brain prunes and organises
  its neural pathways
• LEARNING is a process of creating and
  strengthening frequently used synapses (brain
  discards unused synapses)
• Brain keeps only the most efficient and strong
  synapses
• Experience determines which synapses flourish and
  which are pruned away

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PRUNING

• USE IT OR LOSE IT Reading, sports, music,
  video games, x-box, hanging outwhatever a
  child/teen is doingthese are the neural synapses
  that will be retained
• How children/teens spend their time is CRUCIAL to
  brain development since their activities guide
  the structure of the brain

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THE ADOLESCENT BRAIN
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New research on brain development during
adolescence

• Adolescent brain is neuroplastic undergoing
  specific and significant remodelling
• Grey matter white matter
  
• Process of fine tuning brain developments
• Use it or lose it
• Adolescence and young adulthood is a time of
  great potential for change and development

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Brain Maturation
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Adolescent Brain Development

• Brain development now extends into the adolescent
  years
• Most off this development occurs in the frontal
  lobe
• Executive functions
• Planning
• Reasoning
• Impulse Control

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Key findings the Role of Experience

• Experience plays an important role in determining
  connections made
• The types of brain activities engaged in during
  adolescence probably have a significant impact on
  what cognitive abilities people will have for the
  rest of their lives
• Over or under stimulation of certain responses
  can lead to mis-communication between different
  areas of the brain

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Complexity of the process
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IMPACT OF NEGATIVE LIFE EXPERIENCE ON BRAIN
DEVELOPMENT AND FUNCTIONING
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Impact of ongoing stress
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SCARS THAT WONT HEAL

• Growing evidence of altered brain development and
  functioning as the result of negative life events
  and experiences
• Our interactions with the world organise our
  brains development and shapes the person we
  become
• Brain will develop to respond to a positive or a
  negative environment

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SCARS THAT WONT HEAL

• Chronic stress, and neglect sensitise certain
  neural pathways and over-develop certain regions
  of the brain (limbic region) involved in anxiety
  and fear. This often results in the
  under-development of other regions of the brain
  (frontal lobe)
• Chronic stress from fear, violence, abuse,
  hunger, pain, etc. focuses the brains resources
  on survival and other areas of the brain are not
  available for learning social and cognitive
  skills

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BRAINS RESPONSE TO THREAT

• Brain is uniquely designed to mobilise the body
  in response to threatall body responsefight or
  flight
• Neurochemical systems cause a cascade of changes
  in attention, impulse control, sleep patterns,
  and fine motor control
• Chronic activation of the neural pathways
  involved in fear creates memories which shape a
  persons perception of and response to the
  environmentindelible perception of the world

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Summary

• It appears that aggressive, submissive, and
  frustration behaviors may become structurally
  encoded.
• If relationships are negative, threatening,
  and/or fear inducing, the lower brain responses
  become dominant and the cognitive regulating
  structures do not develop to their full capacity
  consequently, an individual may not develop the
  cognitive ability to control emotions or behavior.

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THE ADOLESCENT BRAIN
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Adolescent brains are different to adults
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They may look like adults, they may behave like
adults, they may even come to the same
conclusions as adults but what is going on in
their brain is differentTeenage brains are a
work in progress
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Key findings Executive Functioning and
Prefrontal Cortex

• Prefrontal Cortex is still underdeveloped
• Executive functioning, controlling and
  coordinating thought and behaviour, directing
  attention and thinking about future consequences,
  are limited
• This impacts on aptitudes such as response
  inhibition, emotional regulation, analysing
  problems and planning

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DISPARITIES OF ADOLESCENCE

• Adolescence is a TRANSITIONAL period during which
  a child is becoming, but is not yet, an adult
• Adolescent brains are far less developed than we
  previously believed
• Normal adolescent development includes conflict,
  facing insecurities, creating an identity, mood
  swings, self-absorption, etc.

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ADOLESCENT BRAIN DEVELOPMENT

• Underdevelopment of the frontal lobe/prefrontal
  cortex make adolescents more prone to behave
  emotionally or with gut reactions
• Adolescents tend to use an alternative part of
  the brain the AMYGDALA (emotions) rather than
  the prefrontal cortex (reasoning) to process
  information

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ADOLESCENT BRAIN DEVELOPMENT

• Amygdala and limbic system tend to dominate the
  prefrontal cortex functions this results in a
  decrease in reasoned thinking and an increase in
  impulsiveness
• Because of immature brains, adolescents do not
  handle social pressure, instinctual urges, and
  other stresses the way adults do
• A major part of adolescence is learning how to
  assess risk and consequences adolescents are
  not yet skilled at these tasks

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ADOLESCENT BRAIN DEVELOPMENT

• To appreciate consequences of risky behaviour,
  one has to have the ability to think through
  potential outcomes and understand the permanence
  of consequences, due to an immature prefrontal
  cortex, teens are not skilled at doing this
• Teens do not take information, organise it, and
  understand it in the same way that adults do -
  they have to learn how to do this

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ADOLESCENT BRAIN DEVELOPMENT

• Important to understand that teens often fail to
  heed common sense or adult warnings because they
  simply may not be able to understand and/or
  accept reasons that seem logical and reasonable
  to adults
• NEVER assume that you and a teen are having the
  same understanding of a conversation

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ADOLESCENT BRAIN DEVELOPMENT

• With experience, teens are able to temper their
  instinctive gut reaction with more rational,
  reasoned responsesthey are able to apply the
  brakes to emotional responses. During this time
  of development, teens need adult mentors and
  role-models who demonstrate how to make good
  decisions and how to control emotions

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HOT AND COLD COGNITION

• Thoughts and emotions are intertwined teens
  need to develop a balance between cognitive and
  affective systems of the brain
• COLD cognition refers to thinking under
  conditions of low emotions and/or arousal
• HOT cognition refers to thinking under
  conditions of strong feelings or arousal
• Decisions made under conditions of strong affect
  are difficult to influence by cool rational
  thought alone

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HOT AND COLD COGNITION

• Decision making in teens cannot be fully
  understood without considering the role of
  emotions and the interaction between thinking and
  feeling
• Teen decisions are unlikely to emerge from a
  logical evaluation of the risk/benefits of a
  situation rather decisions are the result of a
  complex set of competing feelings desire to
  look cool, fear of being rejected, anxiety about
  being caught, excitement of risk, etc.

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ADOLESCENT BRAIN DEVELOPMENT

• Adolescence involves the maturation of
  self-regulation of behavior and emotionsteens
  need to learn how to navigate complex social
  situations under conditions of strong emotions
  such as social anxieties, romantic relationships,
  academic pressures, desires for immediate
  gratification vs. long term goals, moral
  dilemmas, and success/failure

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Key findings Risk Taking and Rewards

• Response to rewards is different respond less
  to small rewards, have bigger response to larger
  rewards but soon have no impact

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Key findings Risk Taking and Rewards

• Risk taking and exploration of new activities

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Key findings Risk Taking and Rewards

• Reward centre in overdrive coupled with planning
  regions that are not fully functional could make
  an adolescent an entirely different creature to
  an adult when it comes to seeking pleasure

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Key findings Mentalisation

• Mentalisation or perspective taking capacity dips
  during puberty.
• Ability to empathise teenagers hardly use the
  area of the brain that is involved in thinking
  about other peoples emotions and thought when
  considering a course of action less able to
  imagine emotional reactions and to read the
  emotions of other which can led to
  misunderstandings and over reactions
• The ability to hold in mind an intention to carry
  out an action at a future time also dips

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Key findings Mentalisation

• Adolescents are not very skilled at
  distinguishing the subtlety of facial expression
  (excitement, anger, fear, sadness, etc.) -
  results in a lot of miscues -leads to lack of
  communication and inappropriate behavior
• Differences in processing, organisation, and
  responding to information/events leads to
  misperceptions and misunderstanding verbal and
  non-verbal cues

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Key findings Mentalisation
Adolescent Brain
Adult Brain
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Key findings Mentalisation

• The ability to hold in mind an intention to carry
  out an action at a future time also dips

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Key findings Sleep

• The Biological Clock
• Sleep Debt
• Sleep, Learning, and Memory

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Key findings Sleep
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• Mismatch between emotional and cognitive
  regulatory modes
• Results in powerful emotional responses (e.g.
  urges for sexual behaviour, independence and the
  formation of social bonds) which they cannot
  easily regulate, contextualise, create plans
  about or inhibit.

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• Too much, too young
• Self-restraint in the face of emotional
  experience
• Required to make decision and have high degree of
  agency

STRUGGLING!
STRESSED OUT!

• Brains are developing!
• Expectations may prove
• to be too much for them

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Developmental period in which there is increased
vulnerability to negative environmental
experiences and enhanced receptivity to positive
life experience both which have long term
consequences on adult life
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What is critical

• Brain of young people particularly in infancy and
  in adolescence is very malleable
• Experience both positive and negative plays a
  crucial role
• Neural systems that are chronically activated by
  threat can change in permanent ways

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• Experience impacts on brain development
• This impacts on the emotional development of the
  young person
• This change in brain structure has long term
  impacts on the young person

NURTURE Becomes NATURE
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Normal adolescent behaviour consists of changes
in

• Sleeping and eating habits
• An increase in conflict with family members
• A desire to be with ones friends
• Resistance to messages form authority
• Irritability
• Risk taking
• Proclamations of sheer boredom

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Increased risk-taking in adolescence is
normative, biologically driven and inevitable
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Adaptive role of adolescence

• A biological wedge is naturally driven between
  parents and adolescents to aid their transition
  from dependence to independence.
• These changes compel adolescents to explore the
  deeper end of the gene pool and acquire the
  skills competence and confidence necessary to
  survive on their own
• You need to engage in high-risk behaviour to
  leave your village and find a mate
• At the same time as risk taking soars hormones
  kick in for adolescents to find sexual partners

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Risk and Exploration
Peer Relationship
Conflict with authority
Resistance to authority
Sexual Maturation
INDEPENDENCE
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They may encounter problems along the way.
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Many Adolescents Do Struggle

• Many (perhaps most) adolescents navigate this
  period with minimal difficulties
• However, empirical evidence for
• increased conflicts with parents (intensity)
• mood volatility (and increased negative mood)
• increased risk behaviour, recklessness, and
  sensation-seeking

Arnett (1999) Review Of Storm And Stress
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Many Adolescents Do Struggle

• Overall morbidity and mortality rates increase
  200-300 between middle childhood and late
  adolescence/early adulthood
• Onset of problems such as nicotine dependence,
  alcohol and drug use, poor health habits, etc.
  that will show up as mortality in adulthood
• Many adult onset problems such as depression can
  be traced to early episodes in adolescence

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• Mental Health Problems and Disorders in Young
  People

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Issues with diagnosis in adolescence

• Normal variations of mood and temporary deviant
  behaviours are seen as mental health problems
• OR
• Problems are dismissed as just being part of
  being an adolescent

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Continuum of Mental Health and Mental Disorders
Mental Distress
Mental Disorders
Emotional Well-being / Mental Health
Mental Health Problems
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Adolescents
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YoungMinds argues that 16-25 year olds require
particular consideration in terms of access to
and acceptability of mental health services
because of the stresses and strains they face in
making the transition from adolescence to
adulthood, which can compound problems already
being faced by young people who are vulnerable to
mental ill health.
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Implications for work with young people

• If were making decisions about how to treat
  teenagers legally, socially and educationally we
  need to take the new brain research into account.
• Implications for
• Youth justice
• Drug and alcohol services
• Mental health services
• Teenage Pregnancy etc

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What does this mean for families and
practitioners?
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Implications for you

• Learn about youth development and keep up to date
  with current research
• May need to revaluate how we view young people
  during this development period as well as how we
  most effectively serve and support them and their
  families
• Educate adolescents about what is going on in
  their heads and how it affects them.
• Engage parents and teachers and others who work
  with young people in learning new ways to
  describe to youth the invisible aspects of
  development that parallel the more visible
  changes associated with puberty about which they
  already learn.

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Implications for you

• Ensure that schools recognises young peoples
  developmental immaturity as well as ways to
  strengthen and build their developmental assets
• Forge meaningful and guiding bonds between youth
  and adults by allowing youth to do what is
  developmentally expected of them while ensuring
  and creating environments and opportunities that
  give youth healthy and safe ways to explore
  decision-making, judgement and testing their own
  limits, personal power and or influence.

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Implications for you

• The challenge for those working with young people
  is to allow them to do what is developmentally
  expected of them while ensuring and creating
  environments and opportunities that give youth
  healthy and safe ways to explore decision-making,
  judgement and testing their own limits, personal
  power and or influence.
• Need to remember
• Rebelliousness and risky behaviours need to be
  checked and steered but they cannot be suppressed
• Many of the erratic and seemingly defiant choices
  made during adolescence share a common origin a
  brain under construction

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What is most important?

• Relationships
• Parents

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Understanding adolescents

• Not about controlling them
• Understanding meteorology controlling tornados
• However understanding is better than not
  understanding it
• Need to shift our focus from controlling to
  mentoring adolescent

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CHEFS AND COOKS
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