A Dinner Party During the Kitchen Remodel: Life with the Adolescent Brain

1
A Dinner Party During the Kitchen Remodel Life
with the Adolescent Brain

• Chris McCurry, Ph.D.
• Associates in Behavior and Child Development,
  Inc.Seattle, WA

2

• Teresa Piacentini, Ph.D. [phone]
• Russ Hanford, Ph.D. [phone]
• Brian Neville, Ph.D. [phone] (425)
  481-5700
• Greg Greenberg, Ph.D. [phone]

3
Socrates

• Adolescents are
• inclined to contradict parents and tyrannize
  their teachers

4

• I would that there were no age between ten and
  twenty three for there is nothing in between but
  getting wenches with child, wronging the
  ancientry, stealing, fighting
• Wm. Shakespeare
• The Winters Tale Act III

5
If they fit, we can return them
6
Adolescence Storm and Stress?

• Significant adolescent difficulties are neither
  inevitable nor universal
• Research on large populations of adolescents
  indicates that teens experience more rapid mood
  changes, but no more depression or anxiety than
  in adult samples
• Studies show that most adolescents describe
  themselves as mostly happy and adequately
  adjusted

7
Yet, 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

8
Is It Hormone Poisoning?

• Recent research shows that much of the behavior
  which has been attributed to hormones is probably
  related also to changes in brain structure
• During adolescence, behavior is often more
  governed by the emotional centers than the
  thinking centers of the brain, especially during
  high arousal situations and in peer presence

9
(No Transcript)
10
(No Transcript)
11
Executive Functioning and the Prefrontal Cortex

• Planning ahead and goal setting
• Time Management
• Reasoning- weighing the costs, benefits and risks
  of various options
• Control of the Attention Spotlight
• Seeing the Big Picture
• Impulse control

12
Open for Business During Renovation

• Just before puberty there is a growth spurt in
  the frontal lobes and corpus callosum
• From age 11 to 16 the prefrontal cortex of the
  adolescent will prune away 30-40 of its neural
  branches
• 30,000 connections per second, gone
• Use it or lose it
• Myelination continues
• The brain does not fully mature until the mid to
  late-20s

13
(No Transcript)
14
Teen Brain NASCAR Analogy

• Big enginematuring bodies, independence-striving
• Poor driverimmature PFC and judgment, poor
  attention
• Faulty brake systemimmature inhibitory
  mechanisms in PFC
• High octane fuelhormones

15
How Important are Executive Skills?

• Compared to I.Q. scores, measures of self-control
  in childhood have TWICE the power to predict
  success in adult life

16
The Executive Skills

• Thinking Skills
• Working Memory
• Planning/Prioritizing
• Organization
• Time Management
• Metacognition

• Doing Skills
• Response Inhibition
• Task Initiation
• Sustained Attention
• Goal-Directed Persistence
• Flexibility

17
Development of the Executive Skills

• Origins in temperament Can be seen as early as
  preschool in terms of flexibility, tempo,
  persistence, impulse control
• Task initiation, sustained attention,
  organization, time management show up as school
  is beginning
• Metacognition emerges slowly in later school-age
  and into adolescence

18
The Frontal Lobes Emerge

• Preschool
• Simple one-step tasks Get your shoes from the
  bedroom
• Inhibit behaviors Dont touch the stove
• Kindergarten to 2nd Grade
• Two-step directions
• Brings papers to and from school

19
The Frontal Lobes March On

• Third to 5th Grade
• Tasks with time delay remembers to do something
  after school
• Inhibits behavior in spite of mood
• Middle School
• Plan and carry-out long-term projects
• Inhibit rule-breaking in the absence of visible
  authority

20
The Frontal Lobes Home Stretch

• High School and Beyond
• Makes plans/decisions in light of long-term
  goals Selects electives with college in mind
• Manages appetites sex, drugs, rock-and-roll
• Inhibits reckless behavior

21
Procedural Roadblocks

• Any physical or behavioral impediment to
• Obtaining necessary information
• Accessing necessary materials
• Initiating, persisting in, or completing tasks
• Getting work turned in

22
(No Transcript)
23
Max

• Fourteen and a high school Freshman
• Cant find anything amongst the piles of stuff
  school stuff, soccer stuff, game and toy stuff
• Doesnt write the assignments down in planner
• Inconsistent homework time and place
• Avoids getting started on work wont quit
  screens
• Starts in on whatever he first pulls out of his
  backpack
• Work is eventually completed but doesnt get into
  his backpack and then to school to be turned in

24
Executive Skills to Work On?
25
The Executive Skills

• Thinking Skills
• Working Memory
• Planning/Prioritizing
• Organization
• Time Management
• Metacognition

• Doing Skills
• Response Inhibition
• Task Initiation
• Sustained Attention
• Goal-Directed Persistence
• Flexibility

26
Executive Skills to Work On?

• Organization
• Planning/Prioritizing
• Task Initiation
• Metacognition

27
The 7 Deadly I Dont Knows Plus 1

1. I dont know what the assignment is or that I
   even have one
2. I dont know how to do
3. I dont know that I can do it
4. I dont know that I need help or what help I need

28
The 7 Deadly I Dont Knows Plus 1

• I dont know when its due 
• I dont know where it is  
• I dont know whether its done or not  
• I dont know how it gets turned in

29
Executive Skills to Work On?

• Organization
• Consistent homework time and place
• Invest in getting stuff sorted out, culled, and
  organized
• Planning/Prioritizing
• Make screen-time contingent on using his planner
• Sort out all the homework before beginning any of
  it

30
Executive Skills to Work On?

• Task Initiation
• Set a limited amount of time for homework
• Reward for getting started within X number of
  minutes
• Metacognition
• Discuss and visually lay out the complete set of
  steps for any procedure such as homework right
  through to turning it into the teacher

31
(No Transcript)
32
Waiting for the Motivation Fairy
33
We acquire virtues by first having put them
into action we become just by the practicing of
just actions, self-controlled by exercising
self-control, and courageous by performing acts
of courage

• Aristotle

34
Commitment and Acceptance Two Sides of the Same
Coin

• Effort, Frustration, Sacrifice

To Be A Good Student
35
Everyday Executive Skill Building

• Frontal lobe activity is frontal lobe activity
• Attached process words/concepts to thinking and
  doing
• Keeps the brain active during long school breaks
• Engages the child in activities that can enhance
  a sense of mastery and good self-esteem

36
Everyday Executive Skills

• Post Cards
• Navigator on Trips
• Planning and Cooking Meals
• Tongue Twisters
• Exploring inferences about anothers behaviors
  and underlying motivations

37
Emotional Roadblocks

• Anxiety
• Shame / Humiliation
• Doubt
• Boredom (leaning away)
• Resentment and other thoughts

38
Thinking Roadblocks

• Im stupid
• Im no good at writing/math/particle physics
• Im not your slave
• Im not weak
• Im not a nerd
• I hate my teacher
• My teacher hates me
• Its more mature than I want to be

39
Fiona

• Seventeen and a Junior in high school
• Volleyball, viola, theater, swimming, ballet,
  student government, and choir
• Spends five to six hours per night on homework
• Perfectionism needs yet another on-line
  citation, an hour adjusting the font
• Increasingly more tired, frantic and rigid as the
  night wears on

40
Executive Skills to Work On?
41
The Executive Skills

• Thinking Skills
• Working Memory
• Planning/Prioritizing
• Organization
• Time Management
• Metacognition

• Doing Skills
• Response Inhibition
• Task Initiation
• Sustained Attention
• Goal-Directed Persistence
• Flexibility

42
Executive Skills to Work On?

• Metacognition
• Planning/Prioritizing
• Time Management
• Flexibility
• Response Inhibition

43
Executive Skills to Work On?

• Metacognition
• As with Max, discuss and diagram essential
  procedures with the endpoint in mind
• Process over content
• Planning/Prioritizing
• Agree on the purpose/goals of school assignments-
  to demonstrate what you know and to learn these
  very executive skills including efficiency

44
Executive Skills to Work On?

• Time Management
• Set agreed upon time limits and deadlines
• Be empathetic but firm
• Flexibility Response Inhibition
• Discuss areas where Fiona gets stuck
• Validate (see below)
• Come up with coping strategies or pivotal
  responses
• Return to Metacognition

45
Graybars First Law of Human Behavior

• All behavior is a message, and a behavior wont
  begin to change until the person knows his
  message has been received

46
Validation

• Closes the communication loop message received
  
• Provides accurate and nuanced emotional
  vocabulary
• Replaces ineffective reassurance in many
  situations
• Says nothing about your agreeing with them or the
  appropriateness of that thought or feeling at
  the time

47
Validation Strategies

• Simple and specific statements
• Youre feeling
• Youre having those I cant do it ideas
• Identify expectations
• You thought your friends would be able to help
  you
• You werent expecting it to take so long
• I wonder and Ah statements

48

• Mommy needs to get mad at you in a weird calm
  voice now

49

• Whole Body Validation

50
When people listen to you, you listen better
51
(No Transcript)
52
The Role of Attention

• The word attention comes from the Latin
  attendere, meaning
• to stretch forward
• As opposed to vigilance

53
The Attention Spotlight

• Orienting to an affect neutral stimulus
  breathing, muscle tone
• Shifting attention from negative private events
  to actionable goals
• The distraction paradox

54
Breathing Exercises

• Belly Breath
• Finding Your Breath
• Ferris Wheel Breath
• Up and Over Breath
• Darth Vader Breath
• Alien Breath

55
I am resilient!

• I can solve problems
• I can cope with/adapt to conditions
• I have a support system, which I take care of
  with my social skills
• I can take on challenges
• I can learn and grow from experience

56
Growing Stress-Resilient Kids

• Healthy diet
• Support a range of hobbies and chores (without
  becoming over-scheduled)
• Healthy competition
• Regular exercise

57
As Heard on NPR Yesterday

• Possible Mechanisms Explaining the Association
  Between Physical Activity and Mental Health
• 7,000 11 to 16 year-olds in the Netherlands
• Statistical analyses showed that, compared with
  respondents who were physically active, inactive
  respondents were at higher risk for both
  internalizing (mood) and externalizing (behavior)
  problems
• The underlying mechanisms are not clear Direct
  or physiological effects and/or indirect effects
  (improved self-image, confidence, socialization)?
  Distress tolerance and goal-directed behavior?
  Body as object vs. body as process?
• The study found some support for the self-image
  and social interaction hypotheses

58
Growing Stress-Resilient Kids

• Promote friendships and community
• Create context and narrative (spiritual,
  philosophical, historical) so that effort and
  struggle have meaning
• Good sleep habits

59
Sleep Learning and Memory

• Increasing evidence that sleep is fundamental to
  consolidation of learning (including procedural
  learning as well as explicit memory)

60
The School-Sleep Squeeze

• Despite average school night bedtimes of 1115 pm
  in high school seniors, the average wake-up time
  on school days is 615 am
• 10 of high school students must get up before
  530 am to catch buses
• 15 of high school students report averaging 6
  or less hours of sleep per night on school days

61
Contributing Factors

• Late bedtimes/sleep onset times
• Biologic tendency for sleep delay
• Social influences toward sleep delay
• Greater freedom to self-select bedtimes
• Access to light and stimulating activities
• Stress/anxiety/excitement Difficulty Falling
  Asleep
• Major circadian shift on weekends/vacation
• Work, Sports, Homework, Projects, Meds...

62
Good Sleep is a Product of

• Sufficient tiredness
• Low levels of stimulation
• Habit/Routine

63
Growing Stress-Resilient Kids

• Listen and validate
• Clear and (reasonably) consistent expectations
• Natural and logical consequences
• Model stress management and self-regulation
  Think out loud as you (effectively) cope and
  problem solve
• Acknowledge mistakes and move on

64
Let me help you, Dear