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

1
Kevin Leehey M.D.Child, Adolescent, and Adult
PsychiatryBoard Certified

• 296-4280
• leeheymd.com

2
Salpointe Catholic High School Community of
Concern

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

3
The left side of the brain is shown.
Source Shaywitz Overcoming Dyslexia
4
Brain development proceeds from the back and base
of the brain toward the front and top. The
Cerebellum governs coordination of movement and
develops early. This is one reason teens are
often driven to be active, to take their new
bodies out for a test drive.
5
The Amygdala is part of the Limbic system and is
located in the Temporal Lobe next to the
Hippocampus close to our ears. It manages
emotions, fear or lack of fear, lability,
volatility. The Amygdala is partly developed in
teens and not yet balanced well by the Frontal
Cortex.
6
The Nucleus Accumbens is a collection of neurons
within the Striatum that play a major role in
reward, pleasure, addiction, and motivation. Its
only partially developed status in teens
contributes to why teens often prefer high
reward, stimulating, thrilling, lower effort
activities (eg. video games)
7
The Pre-frontal cortex is the last area to reach
adult maturity. It is our reasoning center which
we use to ride herd on our impulses and emotions.
The cortex is the main part of the brain that
humanizes us.
8

• The Teen brain is wired for seeking sensation,
  novelty, new experience, excitement, thrills, and
  risk.
• Although this includes impulsivity, sensation and
  thrills are often carefully planned.
• Teens take more risk not because they dont
  understand the dangers but because they weigh
  risk vs. reward differently if risk can get
  them the reward they want, they value reward more
  heavily than adults do. (Natl Geographic
  article)
• And especially in the company of peers.
• They dont think it will happen to them.
• Overall this has evolutionary advantages for the
  greater population but injury or death for at
  least some individuals.
• Peak risk taking is 12-18, highest around age 17.
• Peak substance use is around age 18.

9
(No Transcript)
10
(No Transcript)
11
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
  and changes the brains structure.
• Teach self control (stop and think) and
  perseverance (try, try again). These traits best
  predict success and happiness.

12
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.

13

• Healthy Subject watching video of using

• Substance abuser in remission watching video of
  using

14
Causes of death ages 15-24

• Accidents -primarily motor vehicle, many are
  substance impaired.
• Suicide
• Homicide
• Unintentional Drug Overdoses
• These 4 account for 75 of all deaths in our
  kids. Suicide and homicide are mostly by guns and
  many are substance impaired.

15
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.

16
2012 Trends

• Teen birth rate lowest in 70 years
• MVA deaths lowest in 60 years
• Teen use of methamphetamine, alcohol, ecstasy,
  cocaine, cigarettes are slightly down
• Youth suicide rate is down again
• Rate of violent crime decreased again
• Prescription meds and Marijuana abuse continue to
  rise
• Youth 1 alcohol, 2 marijuana, 3 tobacco, 4
  pills Adderall (stimulants), opiates, benzos,
  DXM, Soma
• Spice, K-2, synthetic Research Chemicals (legal)
  cannabanoids, bath salts, hallucinogens fake
  urine, drug test masking, bongs, Salvia, Smoke
  (Head) shops
• erowid.org opiophile.org
• Drugs kill more than cars do in gt 20 states

17
AZ High School Graduation Rate

• 2009 72.3 29th in US (73.4)
• 2008 67
• 2007 68.2
• 2006 68.6
• 2005 73.3
• 2004 68.4
• 2003 69.6
• 2002 66.1
• 2001 67.4
• 2000 58.4
• 1999 48.2

18

• Most of the increase is due to prescription
  opiate pain meds. This increase parallels
  increased prescriptions. Some is due to cocaine.
  Some is due to heroin.

19

• Teen traffic deaths dropped 62 since 1975.
• AZ- 15 ½, permit gt6 month, 20 hr day10 hr night,
  written test
• G Graduated DL- unless guardian in front
  passenger seat cant drive MN to 5 AM for 6
  months or have gt1 passenger except sib till 18
• Parental involvement. Eg, Fords MyKey limits
  speed, radio volume, no radio till seat belt.
  Supervised practice/teach/coach.
• Advanced (defensive) driver training courses.
• Safer Cars.

20
Actual Causes of Preventable Deaths
21
Opiates and more

• Vicodin, Percodan, Percocet, methadone, oxycontin
• Oxycontin 50c/mg Heroin snort, smoked, foil,
  40/g, IV
• Benzos Xanax bars, Klonopin, Ativan, Valium
• Sleeping pills - Ambien
• Triple Cs, DXM, Robitussin,
  dextromethorphan
• Synthetics, salvia, DXM, etc dont show on drug
  tests
• ADHD medicine abuse, stimulants like Adderall
• Meth, Crystal, methamphetamine, E made from meth
• Soma, muscle relaxers
• Ecstasy, club drugs, hallucinogens, PCP,
  Inhalants
• Hookah, Shisha do contain nicotine
• energy drinks caffeine, guarana, taurine, Four
  Loco
• Be aware, legal drugs medicines are just as
  dangerous to abuse as illegal drugs are.
• Youth drink to get drunk - binge on as much as
  possible as fast as possible. Drinking games.

22

• FIGURE 1. Medical Marijuana Registrants per
  Physician in Coloradoaa Data from the Colorado
  Department of Public Health and the Environment,
  provided to the authors in December 2010. The Ns
  for the seven categories in the bar graph are,
  from left to right, 911, 242, 39, 49, 2, 2, and
  1. (30 by 5, 80 by 54 Drs)
• FIGURE 2. Medical Marijuana Registrants in
  Colorado, by Qualifying Conditiona

23
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
• MJ use in teens lowers Intelligence

24
Teen Driving True or False

• Car crashes kill more teens than, homicide,
  suicide, AIDS, cancer, and all disease together
• The 1 reason teens get into car crashes is
  speeding.
• Teens are less likely to crash at night because
  theres less people on the road.
• Its best for teens to drive the old clunker.
• A teen who knows better will not get into a car
  with a drunk or drugged driver.
• Texting while driving is safer than calling.

25
Parenting Teens 101 True or False ?

• Asking my teen about suicide will put the idea in
  their head
• Theres nothing a parent can do about texting and
  calling in school or sleep hours.
• Adult supervised teen drinking results in less
  teen alcohol use problems.
• gt 50 teens go thru adolescence with hardly a
  ripple.
• What I say as a parent matters more than what I
  do.
• Nothing good ever happens after midnight
• Sleepovers and campouts are fine for teens.
• Its not worth upsetting my teen or troubling her
  friends parents to ask if _____ is really
  happening and supervised.
• I can just trust what my teen says about _____ .
• I only have to worry about illegal drugs.
• Teens get drugs from dealers.

26
Parenting Teens 101 True or False ?

• My kids dont need a computer or Facebook, etc.
  till at least college.
• Dont be silly, a phone is not a computer.
• I dont need to know how to supervise or check
  their phone, computer, gaming consoles, or
  handhelds.
• If I had a 24 hour phone, iPod, computer, TV, and
  Xbox in my room as a teen Id never come out
  either.
• My teens responsible. We can leave her home when
  we go away and we can rent him a hotel room after
  formal or prom or whenever they want.
• Adults should not hold teens accountable because
  their brains are not fully developed.
• Adults should limit, monitor, and supervise teens
  stepwise as they attain and demonstrate growth in
  their brain and overall developmental abilities.

27
Parenting Tips

• Cell phones make flash parties possible.
• 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.
• 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.
• gt 33 of teens sext

28
Parenting Tips

• 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 !

29
More Useful Information

• drugfree.org Six Componets of Effective
  Parenting and A Parents Guide to the Teen
  Brain
• National Geographic, October 2011, Teenage
  Brain
• The Social Animal by David Brooks
• Yes, Your Teen Is Crazy  by Michael Bradley Ed.D.
• Parenting With Love and Logic  by  Foster Cline
  M.D. and Jim Fay (Get the Teen version)
• Read the C of C booklet - its very useful !
• Thank you and Good Luck !
• Kevin Leehey MD
• leeheymd.com
• 296-4280

30
Its not Nature vs. Nurture

• Nature means biology, inheritance, genetics.
• Nurture means environment, experiences.
• 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.

31

• 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.
• Brain development proceeds from back to front and
  bottom to top.
• By the time a child is 6, his or her brain is 90
  of adult size.
• Between age 6 and 12 neurons grow bushier by each
  neuron adding millions of connections based on
  what is reinforced by learning and experiences.
• Neuron connections peak at 11 in girls and 12 to
  13 in boys before pruning gets serious in the
  teen years.
• 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.

32

• 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 Teen brain is becoming more efficient but
  also losing some of its raw potential for
  learning and ability to recover from trauma,
  drugs, alcohol, or injury.
• Synapses that are used often are kept and
  reinforced. Those that are not used are lost.
• Thus, how you spend your time and the
  experiences you have or dont have, both good and
  bad, are critical.
• Experiences shape and reshape the structure of
  the brain.
• The Frontal Lobe, which controls impulses,
  motivation, and improves judgement is the last to
  develop.
• This part of the brain that makes teens more
  mature and responsible is still under
  construction.

33
Normal Sleep Architecture
34
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

35
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
36

• Youth drink to get drunk - binge on as much as
  possible as fast as possible. Drinking games.
• 60 HS seniors have had intercourse.
• gt 50 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

37

• 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

38

• 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.
• JAACAP Vol 49 Issue 12 pgs 1189-1201

39
Suicide Rate for Age Group 15-19 by Year
AACAP NEWS
40
Teen and Young Adult Suicide

• 1) Depressed, angry, substance use
• 2) the person no one would ever guess
• 3) Eating disorder
• 4) Severe mental illness
• 90 have a diagnosable mental health condition
• connectedness, relationships, belonging, family
  disruption
• 3x as many boys complete suicide tho 4x as many
  girls attempt. Guys use more lethal methods. 75
  guns in AZ
• Self harm
• Family history
• disciplinary crisis
• Treatment helps, prevent, intervene, teach
  alternate coping strategies, target the
  underlying problems