Kevin Leehey M.D. Child, Adolescent, and Adult Psychiatry Board Certified

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Kevin Leehey M.D.Child, Adolescent, and Adult
PsychiatryBoard Certified

• 296-4280
• leeheymd.com

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Salpointe Catholic High School Community of
Concern

• Whats Brain Got To Do With It ?
• leeheymd.com

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Nature vs. Nurture

• Nature means biology, inheritance, genetics.
• Nurture means environment, experiences.
• Color perception is almost purely genetic.
• Ability to learn language is genetic. But what
  language we learn is purely environmental.
• Neither controls how we turn out in life. Its
  both, the interaction of nature and nurture.

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• The brain develops at a different rate than the
  rest of the body.
• Brain development allows physical, intellectual,
  emotional, moral, and spiritual development to
  occur.
• The brain (biology, nature, genetics,
  inheritance) must interact with and be shaped by
  environment (experiences, nurture, parenting) to
  develop normally.
• Understanding the process of brain (and body)
  development clarifies the need for parenting.

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Brain Development

• If a child is not played with, interacted with,
  nurtured, exposed to stimuli, or is rarely
  touched he/she will develop a 25 smaller brain.
• Experiences shape and reshape the structure of
  the brain.

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• By the time a child is 6, his or her brain is 90
  to 95 of adult size.
• Between age 6 and 12 neurons grow bushier by each
  neuron adding dozens of connections based on what
  is reinforced by learning and experience.
• This is why such things as learning a second
  language, riding a bike, swimming, learning to
  play a piano, or to throw a ball are easier when
  young and can last a lifetime.

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• Neuron connections peak at 11 in girls and 12 to
  13 in boys.
• Unused connections are further pruned out in the
  teen years at the same time the white matter
  protective coating around neurons called Myelin
  Sheath cells increase.
• The brain is becoming more efficient but also
  losing its raw potential for learning and ability
  to recover from trauma, drugs, alcohol, or
  injury.

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• Synapses that are used often are kept and
  reinforced.
• Those that are not used are lost.
• How you spend your time and the experiences you
  have or dont have are critical.

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• The part of the brain that makes teens
  responsible is still under construction.
• Brain development proceeds from back to front
  and bottom to top.
• The Frontal Lobe, which controls impulses,
  motivation, and judgement is the last to develop.
• Teens inconsistent Melatonin production
  contributes to irregular sleep patterns.

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Normal Sleep Architecture
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• Neuron drawing grown in lab and
• as occur in layers in brain

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What is a memory ?

• A memory is merely the probability that a
  certain group of neurons will fire again in the
  same way
• Short term vs long term memory
• Role of dreams
• Hippocampus (temporal lobe)
• Thus cramming and little sleep is poor learning
  method
• What and when you eat matters too

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Normal Sleep Architecture
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The left side of the brain is shown.
Source Shaywitz Overcoming Dyslexia
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Phineas Gage
On 9/3/1848 at age 26, a 13 lb 3.5 feet long
tamping iron blasted through his left
ventromedial prefrontal lobe. He lived 12 more
years but Gage was no longer Gage
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A Neural Signature for DyslexiaUnder-activation
of Neural Systems in the Back of the Brain
Frontal (PFC, VMFC), Temporal (Limbic system -
Hippocampus, Amygdala etc) Basal Gangliagt
Striatumgt Nucleus Accumbens
Source Shaywitz Overcoming Dyslexia
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• Nucleus Accumbens is a collection of neurons
  within the Striatum with major role in reward,
  pleasure, addiction, and more.
• Amygdala is next to Hippocampus in the Temporal
  Lobe is key for emotional learning, fear
  conditioning and memory.
• MFB Medial Forebrain Bundle (collection of
  axons connecting these areas and more)
• VTA Ventral Tegmentum Area (in midbrain near
  basal ganglia)
• drawing from Psychology Today

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• In Children, neither PFC (self control, impulse
  control, cognitive control) nor Striatum (risk
  taking, pleasure seeking) have developed much.
• In Adolescents the Striatum has developed but not
  the PFC.
• Finally in Adults both Striatum and PFC have
  developed a balance.
• Note the Striatum (includes Nucleus Acccumbens)
  develops in a spurt in Adolescence while the PFC
  develops consistently but slower.
• This is one reason why teens who know better get
  in a car with a drunk driver.
• JAACAP Vol 49 Issue 12 pgs 1189-1201

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• A- sensation seeking and impulsivity with age
• B brain activity focused on reward (L) and
  effort needed for self control (R)
• JAACAP Vol 49 Issue 12 pgs 1189-1201

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Neurobiology of the Adolescent Brain and
Behavior Implications for Substance Use
Disorders by BJ Casey PhD and Rebecca Jones MS
JAACAP Vol 49 Issue 12 Dec. 2010 pages
1189-1201

• heightened vulnerability to risk taking in
  adolescence may be due to the combination of
  relatively higher inclinations to seek excitement
  and relatively immature capacities for self
  control

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ADHD Deficits in Brain Reward System JAMA
9/9/09 pgs 1084-91

• Nucleus Accumbens and midbrain are 2 key
  regions for reward and motivation
• impaired dopamine reward pathway in ADHD
• The reward deficits in ADHD are characterized by
  a failure to delay gratification, impaired
  response to partial schedules of reinforcement,
  and preference for small immediate rewards over
  larger delayed rewards.
• This explains why the attention deficits in ADHD
  are most evident in tasks that are considered
  boring (tasks or assignments that are not
  intrinsically rewarding.
• Dopamine reward deficit underlies the higher
  vulnerability to substance abuse in this
  population.

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The interaction of Nature and Nurture

• The Parenting you give to your child up to 18 to
  25 years old is how the Top Down cognitive,
  human thinking brains self control system
  develops and learns to over ride and integrate
  the emotional and sensation seeking animal
  brains focus on impulses and pleasures of the
  moment.

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Thus you must parent.

• You are the most powerful and important
  environmental (nurture) force.
• Remember its the interaction between nature
  (biology) and nurture (environment) that
  determines the outcome.
• Parenting is hands on thru 11-13, hands
  around thru 17-19, hands under thru 18-25,
  then hands off.
• Parenting is the building of character,
  instilling values and self discipline, and
  teaching independent living skills. This develops
  the brain.

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The teen brain is more vulnerable to the
stimulating, damaging, and addicting effects of
nicotine, alcohol, and other drugs.

• One in three teens who start smoking as a teen
  will die of a tobacco related disease.
• 90 of adult smokers began as teens.
• Almost 45 of kids who start drinking alcohol by
  13 will become alcoholic, while only 10 of those
  who wait till 21 will.
• Substance use in youth thus becomes hard wired in
  as a tendency for life. This is in addition to
  any genetic predisposition.

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• Healthy Subject watching video of using

• Substance abuser in remission watching video of
  using

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• Computers can be trained to recognize what a
  person is thinking about by comparing patterns of
  brain activation. For example, when a person
  thinks about hitting a tennis ball, the
  supplementary motor area and other regions are
  activated (blue), but when the same person thinks
  about moving from room to room, the
  parahippocampal place area and other regions are
  activated (red).
• (Reprinted) JAMA, January 19, 2011Vol 305, No.
  3 page 237

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Bad things can happen to Good kids

• Typically people dont say, I think Ill get a
  DUI and ruin lots of lives today.
• No one says or thinks, Gee, today Im gonna
  drink, smoke, or use a drug so I can become an
  alcoholic or addict.

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Causes of death ages 15-24

• Accidents -primarily motor vehicle, many are
  substance impaired.
• Suicide
• Homicide
• These 3 account for 75 of all deaths in our
  kids. Suicide and homicide are mostly by guns and
  many are substance impaired.

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Suicide Rate for Age Group 15-19 by Year
AACAP NEWS
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2011 Trends Good

• Teen birth rate lowest in 70 years
• MVA deaths lowest in 60 years safer cars, DUI
  enforcement, attitude change
• Teen use of methamphetamine, alcohol, ecstasy,
  cocaine, cigarettes are slightly down
• Youth suicide rate is down again

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2011 Trends Bad

• Drugs kill more than cars do in gt 16 states
• Prescription medicine and Marijuana abuse
  continue to rise
• Teens College age use
• 1 alcohol, 2 marijuana, 3 cigarettes, 4
  pills Adderall (stimulants), opiates, benzos,
  DXM, Soma
• Spice, K-2, synthetic (legal) cannabanoids

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2011 Trends - Ugly

• Smoke (Head) shops
• Cigarettes, snuff, dip, chew, cigars, hookah.
• Tobacco in all its forms is by far 1
  preventable cause of death. Alcohol is 3
• Opiates, Benzodiazepines, Ambien, Soma,
  Stimulants (includes ADHD meds), DXM
• Be aware, legal drugs medicines are just as
  dangerous to abuse as illegal drugs are

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Marijuana, pot, grass, weed

• Perceptual distortions
• Short term memory loss
• Apathy, lack of, motivation
• Out of touch with own feelings, denial of sad,
  mad, down, etc
• The point of substance use is to alter feelings,
  thoughts, perceptions, reality
• Relationship problems
• Self medication of MH and life problems
• MJ can cause or worsen mental illness

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Drugs now kill more people than cars do in 16
states.

• Safer cars more opiates abuse
• Drug related death rate doubled in 10 years.
• 8 states 2004 12 in 05 16 in 06 ? now
• Opiates (Vicodin, Oxycontin, oxy and hydrocodone,
  methadone, heroin), Cocaine
• MA, NH, RI, CT, NY, NJ, MD, PA, OH, MI, IL, CO,
  NV,OR, UT, WA

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Actual Causes of Preventable Deaths
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Opiates and more

• Vicodin, Percodan, Percocet, methadone, oxycontin
• Oxycontin 50 cents to 1/ mg
• HEROIN - smoked, foil, 40/gram, IV
• Benzos Xanax bars, Klonopin, Ativan, Valium
• Sleeping pills - Ambien
• Triple Cs, DXM, Robitussin,
  dextromethorphan
• Spice, K-2, Salvia, Head and Smoke shops fake
  urine
• ADHD medicine abuse, stimulants like Adderall
• Meth, Crystal, methamphetamine
• Soma, muscle relaxers
• Ecstasy, club drugs, hallucinogens, PCP,
  Inhalants
• Hookah, Shisha do contain nicotine
• energy drinks caffeine, guarana, taurine, Four
  Loco

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• Tobacco kills more than all drugs and alcohol
  together.
• Youth drink to get drunk - binge on as much as
  possible as fast as possible. Drinking games.
• 60 HS seniors have had intercourse.
• gt50 HS seniors drink regularly.
• 25 HS seniors smoke cigarettes.
• 33 HS seniors use other drugs
• 60 teens will try other drugs by end of HS

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Parenting Tips

• Dont leave town and leave your teen home alone.
  Dont rent hotel rooms, etc for kids.
• Cell phones make flash parties possible.
• Dont trust sleepovers and campouts.
• Call other parents.
• If youre the host check whats up.
• Have your teen wake you up when they come home.
  Talk to them, get close.
• Seat belts, air bags, slower speeds, less
  passengers, home before midnight, and safer cars
  save lives.

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Parenting Tips II

• Teens main source for alcohol and prescription
  medicines to abuse is your and their friends
  homes.
• 2 of us over age 40 smoke marijuana daily.
• Teens know homes where parents allow or give
  alcohol, weed, other drugs, or sex to your
  kids.
• If you want your kids to come out of their rooms
  keep the electronics out.
• Internet and gaming are best monitored out of
  their bedrooms.

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Parenting Tips III

• Social networking (Facebook, MySpace, Twitter,
  YouTube, etc) is here to stay. Check, know
  passwords, teach whats OK, not OK, why.
• High schools now require internet, word
  processing. College requires even more. Ensure
  they learn now with supervision.
• Offer a phone, computer, gaming with features
  that fit the age and developmental level of your
  child or teen. Increase with age and trust. Agree
  on a plan of you checking for appropriate use.
• You can control calling, texting, internet use,
  hours, phone numbers allowed and banned all of
  it. All cell companies have these controls use
  them.

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Parenting Tips IV

• YOU are your childs teens 1 influence !
• If they see you drunk/impaired/partying they are
  33 more likely to drink or use.
• If you say, imply, or even think its OK or
  inevitable that theyll drink or use, then they
  are 10X more likely to do so.
• If you repeatedly (not nag) tell them not to,
  then they are 10X less likely to drink or use.
• Say No, Dont try to be the Cool parents, and
  dont try to be your kids Best Friends !
• Read the C of C booklet - its very useful !

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Thank you and good luck

• Kevin Leehey M.D.
• leeheymd.com
• 296-4280