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Title: ADOLESCENT BRAIN DEVELOPMENT


1
ADOLESCENT BRAIN DEVELOPMENT
  • TIME OF TURMOIL AND TRIUMPH
  • BARBARA SULLIVAN, Ph.D.
  • September 14 and 15, 2009

2
GOALS
  • To increase participant understanding of
  • the structures, functions, and stages of
    development of the brain
  • how adolescence has changed over the last 150
    years
  • the differences between adult and adolescent
    thinking
  • the impact of abuse and neglect on the brain
  • current trends in adolescent alcohol use
  • the impact of alcohol use on the brain
  • what clinicians, prevention specialists, and
    communities can do to support healthy
    adolescent development

3
CAVEATS
  • New discoveries research is still in its
    infancy
  • Do NOT over-interpret or interpret too
    simplistically
  • Research is not to the point that it can inform
    causal models
  • Most research has been conducted on male animals
    we assume the information transfers to people
  • Behavior is the result of complex interactions
    among individual, environment, genetics,
    situation, cultural expectations, and numerous
    other factors

4
  • BRAIN STRUCTURES AND FUNCTIONS

5
BRAIN FACTS
  • Brain weighs approximately 3 pounds
  • Brain has approximately 100 billion neurons and 1
    trillion supporting cells
  • Neurons grow and organize themselves into
    efficient systems that operate a lifetime
  • Brain controls ALL activities
  • Emotion and cognition are intertwined
  • Neurons can re-route circuits
  • Brain and environment involved in delicate duet
  • Brain never stops adapting and changing

6
(No Transcript)
7
Illustration by Lydia Kibuik, 2003
8
EVOLUTION OF THE NEW BRAIN
Every mammals brain has the same basic
structure- cortex, cerebellum, and brain
stem cortical surface area is key
9
CHALLENGE OF UNDERSTANDING THE BRAIN
  • What is the link between the anatomy of a brain
    and the workings of the mindour thoughts,
    emotions, memories, and behaviors?
  • There are no moving partsit does not operate
    mechanically as our hearts, legs, hands, and
    lungs do. So what is going on in there?

10
BRAIN STRUCTURES
  • Frontal Lobe
  • Parietal Lobe
  • Temporal Lobe
  • Occipital Lobe
  • Cerebellum
  • Corpus Callosum
  • Brain Stem

11
INTEGRATION OF THE LOBES
  • The different lobes of the brain work together
    like instruments in an orchestra to play music or
    letters in the alphabet to form words
  • Each area makes specialized contributions to
    certain functions, but many brain regions
    participate in forming human thoughts and
    behaviors

12
FRONTAL LOBE
  • Seat of personality, judgment, reasoning, problem
    solving, and rational decision making
  • Provides for logic, understanding of
    consequences, and emotional/behavioral regulation
  • Governs impulsivity, aggression, ability to
    organize thoughts, and plan for the future
  • Controls capacity for abstraction, attention,
    cognitive flexibility, and goal persistence
  • Undergoes significant changes during adolescence
    not fully developed until mid 20s (Geidd, 2002)

13
FRONTAL LOBE
  • As the prefrontal cortex area of the frontal
    lobe matures, through experience and practice,
    teens can reason better, develop more impulse
    control, and make better judgments
  • Prefrontal cortex is one of the last areas of the
    brain to fully develop (Sowell, 2001)
  • Increased need for struc-
  • ture, mentoring, guidance

14
COMPONENTS OF EXECUTIVE FUNCTIONS AND SAMPLE
BEHAVIORS
15
Brown et al., 2008
16
TEMPORAL LOBES
  • Responsible for hearing, understanding speech,
    and forming an integrated sense of self
  • Responsible for sorting new information and for
    short term memory
  • Contains the limbic-reward system (amygdala,
    hippocampus, nucleus acumbens, and vta)
  • Developmental delays, deficits, or
    over-stimulation of the limbic area may increase
    vulnerability to high risk behaviors (Clark,
    Thatcher, Tapert, 2008)
  • Matures around ages 18-22

17
TEMPORAL LOBE/LIMBIC SYSTEM
  • Limbic system regulates emotions and motivations
    particularly those related to survivalsuch as
    fear, anger, and pleasure (sex and eating)
  • Feelings of pleasure/reward are very powerful and
    self-sustaining. Pleasurable behaviors activate
    a circuit of specialized nerve cells in the
    limbic area that is devoted to producing and
    regulating pleasure called the reward system

18
REWARD SYSTEM
  • Drugs of abuse activate the reward system in the
    limbic area of the brainproducing powerful
    feelings of pleasure
  • Desire to repeat drug using behavior is strong
  • Drugs of abuse can/do exert powerful control over
    behavior because they act directly on the more
    primitive, survival limbic structures over-ride
    the frontal cortex in controlling our behavior

19
PARIETAL LOBES
  • Integrate auditory, visual, and tactile signals
  • Right lobe coordinates visual/spatial
    relationships
  • Left lobe coordinates spoken or written language
  • Matures around ages 16-17

20
OCCIPITAL LOBES
  • Primarily responsible for coordinating sight
  • Primary visual area where pictures are received
    from the eyes and relayed to other parts of the
    brain for interpretation
  • Visualization requires more than seeing the
    primary visual cortex processes information,
    temporal lobe recognize what we see, and the
    parietal lobes process information as we move
    through the space we see.

21
  • INFO FROM DANA BOOK

Robert Finkbeiner, Dana Brain Book
22
CEREBELLUM
  • Located at the base of the brain
  • Responsible for motor coordination
  • Recent research suggests that it is involved in
    coordinating thinking processes mental
    clumsiness (Geidd, 2002)
  • Physical exercise is important for the
    development of the cerebellum undergoes
    significant change during adolescence

23
CORPUS CALLOSUM
  • Thick bundle of nerves that connects the two
    sides of the brain and relays information between
    the two cerebral hemispheres
  • Involved in creativity and problem solving
  • Influences language, learning, and associative
    thinking
  • Changes significantly during adolescence (Geidd,
    1999)

24
BRAIN STEM
  • All nerve fibers pass through this area
  • Performs sensory, motor, and reflex functions
  • Contains vital nerve centers that control
    breathing, heart rate, body temperature, and
    gastrointestinal activity
  • Connects the brain with the body

25
BRAIN CIRCUITRY
26
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
    chemically communicates with another neuron

Brain Facts, The Society for Neuroscience, 2002
27
(Illustration by Lydia Kibiuk, 1996)
28
BRAIN CIRCUITRY
  • Neurons communicate by transmitting electrical
    impulses along their axons
  • Axons send chemical neurotransmitter messages
    across a synapse to the receiving dendrite of the
    target neuron
  • Each neuron has an average of 6,000 dendrite
    receptors
  • Dendrite receptor sites are specialized areas
    lock and key or molecular handshake

29
BRAIN CIRCUITRY
  • A neuron may receive many different messages at
    the same time (Prioritize)
  • Each neuron has to interpret incoming messages
  • Neuronal communication is currently under intense
    study because it plays such a critical role in
    health and well being

30
BRAIN CIRCUITRY
  • Electrical impulses travel along axon at speeds
    up to 250 mph (mylenation)
  • Neurons forging connections with other neurons
    underpin learning
  • Our brains are adaptable and can reflect on and
    learn from experience
  • Neural connections are shaped by genetics and
    experience

31
BRAIN CIRCUITRY
  • Gray matter contains neurons that are responsible
    for thinking (100 billion)
  • White matter contains suportive cells with
    nutritive roles (dendrites1 trillion)
  • Myelin is a layer of insulation that
    progressively insulates these supportive cells
    and is whitish in color
  • Myelin makes white matter more efficientjust
    like insulation on electric wirescontributes to
    overall cognitive functioning (100x faster)
  • Myelin affects the speed and quality of brain
    activity (Paus, et al., 1999)

32
NEUROTRANSMITTERS
  • All messages are passed to connected neurons
    through a form of chemicals called
    neurotransmitters
  • Neurotransmitters are released from the end of
    the axon, cross the synapse, and bind to the
    specific receptors on the dendrites of the
    targeted neuron
  • Neurotransmitters bind with specific receptor
    sites on the receiving dendrite

33
MAJOR NEUROTRANSMITTERS
  • Acetylcholine regulates memory
  • Dopamine produces pleasure through the reward
    system multiple functions including controlling
    movement, regulates hormonal responses, important
    to cognition and emotion abnormalities in
    dopamine levels have been implicated in
    schizophrenia
  • Serotonin plays a role in sleep involved in
    sensory perception and involved in controlling
    emotional states such as anxiety and depression

34
MAJOR NEUROTRANSMITTERS
  • Glutamate excites the firing of neurons, aids
    process of memory
  • Gamma-aminobutyric (GABA) inhibits the firing
    of neurons

35
DEVELOPMENTAL VULNERABILITY
  • During adolescence, the prefrontal cortex (PFC),
    limbic system areas, and the white matter myelin
    are undergoing many changes (Chambers, 2003
    Spear, 2000)
  • These areas serving cognitive, behavioral, and
    emotional regulation may be particularly
    vulnerable to adverse alcohol effects
  • Deficits or developmental delays in these
    structures and their functions may underlie
    vulnerabilities to alcohol use/abuse (Clark,
    Thatcher, Tappert, 2008)

36
OVERPRODUCTION AND PRUNING
  • CRITICAL PEAKS OF BRAIN DEVELOPMENT

37
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

Begley, 2000 Geidd, 1999
38
PRUNING
  • These 3 critical phases are quickly followed by a
    process in which the brain prunes and organizes
    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
  • Children/teens need to understand that they
    decide which synapses flourish and which are
    pruned away (Geidd, 1999)

39
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 (Geidd, 1999)

40
What sorts of media are young people consuming?
Every year young people will see about 1,000
commercials advertising beer. 2/3 of young people
have a TV in their room, 61 have no parental
guidelines. Annually alcohol manufactures spend
over 1 BILLION in TV, radio, print, and internet
advertising.
Young people sped an average of 1-2 hours daily
listening to music. 63 of rap songs make
reference to drug use, as do 10 of songs in
other genres.
Young people spend an average of 10 hours per
week on the internet. 58 of young people have
accessed websites of a violent or sexual
nature. 82 of websites target youth.
41
BRAIN DEVELOPMENT
  • Continued synaptic pruning, neural
    connection/integration, capacity to process
    information, and mylenation (driven by experience
    and practice) these structural changes are
    believed to underlie the functional integration
    of frontal regions with the rest of the brain
    adolescent into adult (Luna Sweeny, 2004)

42
BRAIN DEVELOPMENT
  • White matter development may underlie advancing
    executive functioning (Luna and Sweeney, 2004
    Luna et al., 2001)
  • Delays or deficits in the development of PFC may
    result in neurodevelopmental dysmaturation
    which can lead to psychological dysregulation
  • Psychological dysregulation is a deficiency in
    the ability to regulate attention, emotions, and
    behavior in response to environmental challenges
    (Clark and Winters, 2002)

43
PSYCHOLOGICAL DYSREGULATION
  • Alcohol Use Disorders (AUD) typically do not
    happen in isolation instead they appear to be
    correlated with persistent behavioral
    characteristics including
  • attentional deficits ADD, ADHD
  • conduct disorders anti-social
  • irritability aggression, diminished
    constraint
  • major depressive disorder depression, anxiety

Clark et al., 2005 Tappert et al., 2002 Chassin
et al., 1999 Tarter et al., 1999
44
DEFINING ADOLESCENCE
45
ADOLESCENCE HAS ALWAYS BEEN CHALLENGING
  • Youth are heated by nature as drunken men by
    wine Aristotle (350 B.C.)
  • I would that there were no age between 10-23,
    for theres nothing in between but getting
    wenches with child, wronging the ancientry,
    stealing, fighting Shakespeare The Winters
    Tale, Act III (..1594)

46
DISPARITIES OF ADOLESCENCE
  • Adolescence is a time of triumph, high energy,
    great potential, resilient health, new found
    skills, creativity, humor..
  • Adolescence is also a time of turmoil often
    associated with high risk behaviors, impulsivity,
    and poor decision making
  • Dramatic increase in death, disability, suicide,
    homicide, serious accidents, aggression,
    violence, emotional disorders, substance use, and
    risky sexual behaviors

47
REWARD SENSITIVITY
  • Changes in reward sensitivity that occur at
    puberty lead adolescents to seek more novelty and
    require a higher level of stimulation to achieve
    the same subjective feeling of pleasure
  • Changes in the limbic system, neuro-
    endocrinology, and an immature self regulatory
    system are implicated (Steinberg, 2004)

48
ADOLESCENCE
  • Awkward period between sexual maturation and the
    attainment of adult roles and responsibilities
  • Begins with the domain of physical/biological
    changes related to puberty, but it ends in the
    domain of social roles
  • Encompasses the transition from the status of a
    child (one who requires monitoring) to that of an
    adult (responsible for behavior) Dahl, 2003

49
STUDY OF ADOLESCENTS
  • G. S. Hall, psychologist, began the modern study
    of adolescence about 100 years ago
  • Increase in adolescent-related research in the
    early 1990s second increase began focusing on
    adolescent brain development in 1998
  • Most research is conducted on babies and toddlers

50
ADOLESCENCE
  • Adolescence is much broader and longer than the
    teenage years alone (has changed significantly
    over the past 150 years)
  • Adolescence now stretches across more than a
    decade, with pubertal onset often beginning by
    age 9-12 and adult roles delayed until mid
    twenties (Worthman, 1995)

51
ADOLESCENCE
  • In the early 1900s, the interval between puberty
    and achieving adult status was typically 2 years
    for girls and 4 years for boys (Schlegel and
    Barry, 1991)
  • While puberty is occurring earlier in many
    industrial societies, marriage and other adult
    roles are often delayed in the U.S. the average
    age of menarche is 12 and average age of 1st
    marriage is 26 (Dahl, 2004)

52
ADOLESCENCE
  • Most elements of cognitive development show a
    trajectory that follows age and experience rather
    than the timing of puberty (Dahl, 2004)
  • Research conducted by Martin, 2003, demonstrates
    a significant positive correlation between
    pubertal maturation and sensation seeking

53
ADOLESCENCE
  • PUBERTY
  • Romantic motivation
  • Sexual interest
  • Emotional intensity
  • Sleep cycle changes
  • Appetite
  • Risk for affective disorders (girls)
  • Increase in risk taking, sensation seeking, and
    novelty seeking
  • AGE/EXPERIENCE
  • Planning
  • Logic, reasoning
  • Inhibitory control
  • Problem solving
  • Understanding consequences
  • Affect regulation
  • Goal setting and pursuit
  • Judgment and abstract thinking

Dahl, 2004
54
ADOLESCENCE VS. ADULTS
  • Being a responsible adult requires developing
    self-control over behavior and emotions must be
    able to appropriately inhibit behaviors despite
    STRONG FEELINGS
  • The ability to integrate these multiple
    components of behavior, cognition, and affect in
    the service of long term goals involves
    neurobehavioral systems that are among the last
    regions of the brain to fully mature (Dahl, 2004)

55
NAVIGATING ADOLESCENCE
  • The most widely implicated factor associated with
    maladaption vs. resilience in adolescence is
    REGULATORY CAPACITY (RC) Kupfer Woodward,
    2004
  • Behavioral control (RC) requires tremendous
    effort adolescents need practice being
    consistent and integrating RC
  • PFC and white matter development are needed for
    regulatory capacity

56
NAVIGATING ADOLESCENCE
  • What makes this possible?
  • Driven by experience and practice
  • Psychological regulation of attention, emotions,
    and behavior
  • Continued synaptic pruning and mylenation
  • Mentoring appropriate response patterns in the
    face of everyday life and decision making

57
Critical Differences Between Adult and Adolescent
Thinking
58
Why is it that a young person is not able to
drive a car until 16, vote until 18, drink
alcohol until 21, rent a car from a commercial
agency until 25, but in some states, can stand
trial for murder at age 12 or 13? (Dahl, 2004)
59
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,
    risk taking, facing insecurities, creating an
    identity, mood swings, self-absorption, etc.

60
ADOLESCENT BRAIN DEVELOPMENT
  • Underdevelopment of the frontal lobe/prefrontal
    cortex and the limbic system make adolescents
    more prone to behave emotionally or with gut
    reactions (Yurgelun-Todd, 1999)
  • Adolescents tend to use an alternative part of
    the brain the AMYGDALA (emotions aggression)
    rather than the prefrontal cortex (reasoning) to
    process information

61
Illustration by Lydia Kibiuk, 2003
62
ADOLESCENT BRAIN DEVELOPMENT
  • Amygdala and nucleus acumbens (limbic system
    within the temporal lobes) 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 (Dahl, 2004)

63
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

64
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 (Dahl, 2003)
  • 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.

65
HOT AND COLD COGNITION
  • Adolescent brain is a vulnerable system that
    could fail under hot high demanding situations
    where the circuitry is not sufficiently
    established to sustain adult level cognitive
    control of behavior in the face of heightened
    states of emotion, motivation, distracting
    stimuli, or competing tasks (Luna Sweeny, 2003)

66
ADOLESCENT BRAIN
  • DLPFC is linked to the ability to inhibit
    impulses, weigh consequences, prioritize, and
    strategize this area is still under
    construction until late 20s (Giedd, 1999)
  • Wernickes area (reception of speech) and Brocas
    area (production of speech) undergo substantial
    changes during the teen years impacts ability
    to listen and express oneself

67
ADOLESCENT BRAIN DEVELOPMENT
  • Adolescents are not very skilled at
    distinguishing the subtlety of facial expression
    (excitement, anger, fear, sadness, etc.)results
    in a lot of miscuesleads to lack of
    communication and inappropriate behavior
  • Differences in processing, organization, and
    responding to information/events leads to
    misperceptions and misunderstanding verbal and
    non-verbal cues

68
Adult Brain
Adolescent Brain
YURGELUN-TODD, 1999
69
ADOLESCENT BRAIN DEVELOPMENT
  • To appreciate consequences of risky behavior, 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, organize it, and
    understand it in the same way that adults dothey
    have to learn how to do this

70
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 (difference in evaluating positive
    negative consequences Fromme et al., 1997)
  • Adolescents may know right from wrong, but they
    may not be able to prioritize when stressed with
    social/peer pressure
  • NEVER assume that you and a teen are having the
    same understanding of a conversation

71
ADOLESCENT BRAIN DEVELOPMENT
  • Risky adolescent behaviors are not simply
    impulsive behaviors, but generally occur in the
    context of evaluating positive and negative
    consequences and immediate vs. delayed rewards
    (Wulfert et al., 2002)
  • PFC activation during risk-reward conflict
    appears less active in adolescents compared to
    adults (Bjork et al., 2007)

72
ADOLESCENT VULNERABILITY
  • Adolescents who prefer immediate rewards vs
    delayed rewards may have underdeveloped neural
    circuitry for maintaining motivation and
    inhibiting behaviors
  • These adolescents may also anticipate that risky
    behaviors will lead to positive outcomes
    (Chambers et al., 2003)
  • Deficits in cognitive, behavioral, and emotional
    regulation comprise a common vulnerability for
    increasing risk for AUDs

73
ADOLESCENT BRAIN DEVELOPMENT
  • With experience and PFC development, 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

74
ADULT GUIDANCE
  • Adult monitoring is too frequently and too
    prematurely withdrawn during the vulnerable
    period leaving the adolescent to navigate
    difficult situations alone or with peers
    (Dahl,2004)

75
ADULT GUIDANCE
  • Adult thinking is guided by self regulation and
    delayed gratification
  • Interrupting risky behavioral trajectory
    getting off a runaway train
  • Thinking before acting jumping the gun
  • Choosing between two alternative courses of
    action-- doing the right thing (Steinberg,
    2004)
  • Risk perception, internal planning, endogenous
    control of behavior (functions of the PFC)

Steinberg, 2004)
76
ADOLESCENT BRAIN DEVELOPMENT
  • Critical developmental changes in brain pathways
    controlling emotions, cognitive and attentional
    functions, and reward sensitivity during
    adolescence
  • Strong increases in the connectivity between the
    amygdala (critical for emotional learning) and
    the PFC (critical for decision making) Kelly,
    Schochet, Landry 2004

77
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, romances, academic
    pressures, immediate gratification vs long term
    goals, moral dilemmas, and success or failure

78
IMPACT OF ABUSE ON BRAIN DEVELOPMENT AND FUNCTION
79
SCARS THAT WONT HEAL
  • Growing evidence of altered brain development and
    functioning as the result of abuse and neglect
  • Our interactions with the world organize our
    brains development and shapes the person we
    become (Shore, 1997)
  • Brain will develop to respond to a positive or a
    negative environment

80
BRAIN ADAPTATION
  • Life experiences (positive or negative) set off
    cascades of change that influence gene expression
    and brain organization (Masten, 2004)
  • Life experiences exert a profound influence on
    brain architecture (Spessot, Plessen,
    Peterson, 2004)

81
SCARS THAT WONT HEAL
  • Chronic stress, abuse, and neglect sensitize
    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) (Perry, 2000)
  • 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

82
BRAINS RESPONSE TO THREAT
  • Brain is uniquely designed to mobilize 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 (DeBellis, 2001)
  • 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
    (attitudinal change?)

83
BRAINS RESPONSE TO STRESS
  • PFC is extraordinarily sensitive to stress. Even
    mild stressors can impair PFC cognitive
    functioning if the person feels no control over
    the stressor (frequent in teens)
  • High levels of Dopamine are released during
    stress this impairs the regulation of thought
    and behavior may explain why teens are
    vulnerable to loss of judgment and insight during
    emotional or stressful situations (Arsten
    Shanksy, 2003)

84
GENDER DIFFERENCES IN RESPONSE TO STRESS
  • Corticosterone response to stress differs in male
    and female rats (in females-greater overall
    response, faster rise in blood levels, and blood
    levels binding increased) Young Altemus, 2003
  • Estrogen may amplify many aspects of the stress
    response significant implications for our
    understanding of depression and anxiety in
    females

85
STRESS AND LEARNING
  • Hormones involved with the HPA axis have profound
    influence on brain circuits that are integral to
    learning, memory, emotional regulation, and
    behavioral affect (Cameron, 2003)
  • Neurobiological factors that amplify
    stress-induced PFC dysfunction during
    adolescence, may increase susceptibility to
    impaired judgment, substance abuse, and
    psychiatric disorders (Arsten Shanksy, 2003)

86
NEUROBIOLOGY OF ABUSE
  • Chronic activation of certain parts of the brain
    involved in the fear response -
    hypothalamic-pituitary-adrenal-(HPA) axis can
    wear out other parts of the brain such as the
    hippocampus (memory, cognition, communication)
  • HPA axis significantly influences cognitive
    development as well as behavioral and emotional
    regulation
  • Abuse and addiction impact learning, behavior,
    and psychological and moral development on a
    cellular level (issue of choice?)

87
JANUARY 22, 2007 A CHILD HOLDS A WEAPON IN A
BAGHDAD PROTEST IN DECEMBER, 2006
88
NEUROBIOLOGY OF ABUSE
  • Chronic stress may have neurotoxic effects and
    lead to learning and concentration impairments
    secondary to the damage to the hippocampus
    including
  • -- accelerated loss of neurons (Smythies,
    1997)
  • -- delays in myelination (Dunlop, 1997)
  • -- abnormalities in developmentally
    appropriate pruning (Todd, 1992)
  • -- inhibition of neurogenesis (Tanapat, 1998)

89
Child Abuse and Neglect
OUTCOMES
PTSD Symptoms in Childhood
Compromised Cognition Psychosocial Effects
Alterations of the Catecholamine HPA Axis
Changes in Brain Metabolism (enhanced neuron
loss, anterior cingulate dysfunction)
Adverse Effects on Brain Development (smaller
cerebellum, corpus callosum)
De Bellis, 2001
90
THE EFFECTS OF ABUSE AND NEGLECT
  • Diminished growth in the left hemisphere may
    increase risk for depression (Teicher, 2000)
  • Irritability in the limbic system can set the
    stage for the emergence of panic disorder and
    post-traumatic stress disorder (Teicher, 2000)
  • Smaller growth in the hippocampus can increase
    the risk for dissociative disorders and memory
    impairment (Teicher, 2000)

91
CLINICAL PRESENTATION
  • Cognitive problems
  • Anxiety
  • Suicidal ideation
  • Depression
  • Attention problems
  • Attachment problems
  • Impulsive behavior
  • Aggression
  • Acting out
  • Antisocial behaviors
  • Persistent fear
  • Hyper-arousal
  • Dissociation
  • Disrupted attachments
  • Lack of empathy
  • Sleep problems
  • Tachycardia
  • Hypertension
  • Memory problems
  • Explosive anger

(Perry, 2000)
92
CURRENT TRENDS IN ADOLESCENT ALCOHOL USE
93
More Adolescents Use Alcohol Than Use Cigarettes
Or Marijuana
Percent
The Surgeon Generals Call to Action to Prevent
and Reduce Underage Drinking, 2007
94
Adolescents Drink Less Often But More Per
Occasion Than Adults
Usual number of drinks/occasion
Drinking days/month
The Surgeon Generals Call to Action to Prevent
and Reduce Underage Drinking, 2007
95
Among Adolescents Who Drink, The Number Of Binge
Drinking Days Increases With Age
Days
Age
The Surgeon Generals Call to Action to Prevent
and Reduce Underage Drinking, 2007
96
18-20 Year Olds Have The Highest Prevalence Of
DSM-IV Alcohol Dependence
Percent
Age
The Surgeon Generals Call to Action to Prevent
and Reduce Underage Drinking, 2007
97
Alcohol Use and Binge Drinking Vary by
Race/Ethnicity and Gender
Percent
Gender and Racial/Ethnic Subgroups
Source SAMHSA, Office of Applied Studies, NSDUH
(special data analysis)
98
ALCOHOL AND ADOLESCENTS
  • Alcohol is the drug of choice among Americas
    adolescents used more than tobacco or illicit
    drugs (Johnson et.al., 2006a)
  • Underage drinking is deeply embedded in our
    culture many view it as a rite of passage
  • Parents can influence a teens thinking about
    drinking
  • A substantial number of adolescents begin
    drinking at a very young age and this often
    occurs at home this increases their chances of
    developing an alcohol use disorder

99
ALCOHOL AND ADOLESCENTS
  • Nearly 1/3 of American youth begin drinking
    before age 13 (Grunbaum et.al., 2004)
  • The peak years for alcohol initiation are 7th
    8th grades (Faden, 2006)
  • Underage drinking contributes to serious
    adolescent health and social problems including
    death from injuries, risky sexual behaviors
    (Cooper Orcutt, 1997), increased risk of
    physical sexual assault (Hingson et al., 2005),
    and academic failure (Grunbaum et al., 2005)
  • Parents need to talk to their teens about
    drinking and set specific no-use expectations

100
IMPACT OF ALCOHOL ON ADOLESCENT BRAIN DEVELOPMENT
101
ALCOHOL AND ADOLESCENTS
  • The developing adolescent brain may be
    particularly vulnerable to negative effects from
    alcohol (Brown, et al., 2000 Crews, et al., 2000
    De Bellis, et al., 2000)
  • Youth with school, personal, or family problems
    are more likely to begin drinking early (Brown
    Tappert, 1999)
  • Youth who begin drinking prior to age 14 have a
    41 chance of developing alcohol dependence
    during their lifetime compared with those who
    wait until age 21 when lifetime risk is reduced
    to 10 (Brown Tappert, 1999)

102
ALCOHOL AND ADOLESCENTS
  • Hippocampus (memory area of the brain) is
    sensitive to the acute effects of ethanol during
    adolescence (White and Swartzwelder, 2004)
  • Hormonal fluctuations, differences in metabolism,
    gender specific drinking patterns may account
    for the mounting evidence that female teens
    suffer greater alcohol related problems than male
    teens

103
ALCOHOL AND ADOLESCENTS
  • Compared with controls, adolescents with AUDs
    have been found to have smaller prefrontal white
    matter volumes (DeBellis, 2005)
  • Some research has suggested that adolescents and
    adults with AUDs have smaller amygdala,
    hippopocampal, and ventral striatum volumes than
    controls (Koob, 1999 Mill et al., 2001 Makris
    et al., 2004)
  • Implications for reward sensitivity, inhibition,
    impulsivity, and decision making

104
ARE ADOLESCENTS MORE SUSCEPTIBLE TO ALCOHOL THAN
ADULTS?
  • Adolescent rats are LESS sensitive to the
    aversive effects of alcohol such as sedation,
    hang over, motor impairment effects
    (consequently they may drink more than adults)
    Doremus et al., 2003 Varlinskaya Spear, 2004
  • Adolescent rats are MORE sensitive to the social
    disinhibition induced by alcohol use
    (consequently they feel the stimulating/fun
    aspect of drinking sooner than adults) Doremus
    et al, 2003 Varlinskaya Spear, 2004

105
ALCOHOLS EFFECTS
  • Family characteristics, such as history of
    alcoholism, psychopathology, gender, and age of
    first use, must be carefully considered when
    studying the influence of teen drinking on
    cognition (Brown Tappert, 2004)
  • Extensive literature suggests that COAs (children
    of alcoholics) exhibit verbal, non-verbal, and
    memory deficits on cognitive tests (Hill, 2004)

106
ALCOHOLS EFFECTS
  • Alcohol use during adolescence may lock in the
    insensitivity to alcohols sedative effects
    (Varlinskaya Spear, 2004 White Swartzwelder,
    2004)
  • Changes in the neurochemical components of
    insensitivity may raise the hedonic (pleasure
    seeking) set point leading to compulsive alcohol
    and drug use (Hill, 2004)

107
ALCOHOL EXPECTANCIES
  • Alcohol expectancies form early and shift over
    time
  • 3-5 year olds associated alcohol with neutral,
    adult behavior
  • 9-10 year olds associated alcohol with
    negative, wild, dangerous behavior
  • 10-12 year olds associated alcohol with more
    positive, fun behavior

Windle et al., 2008
108
Brain Circuits Involved in Drug Addiction
OFC
SCC
MOTIVATION/ DRIVE (saliency)
109
One mechanism contributing to addiction may be
the ability of drugs to induce damage in the
nucleus acumbens impacting the serotonin and
dopamine neuromodulator systems (both implicated
in impulsivity) further promoting impulsive
choices and drug taking behaviors (Cardinal,
Winstanley, Robbins, Everitt, 2004)
110
CONTROL CIRCUITS
  • fMRI studies demonstrate abnormalities in the
    PFC area for decision making and inhibitory
    control
  • These abnormalities could be involved in the
    changes in decision making, judgment, and
    cognitive control that occur in addiction
  • Changes in the PFC could lead to loss of
    self-directed/willed behavior in favor of
    automatic sensory driven behavior (Goldstein and
    Volkow, 2002)

111
WHAT PREVENTION AND TREATMENT STAFF AND
COMMUNITIES CAN DO
112
ADOLESCENTS AND ALCOHOL
  • Underage alcohol use is a highly complex problem
  • Biological, social, familial, cultural, genetic,
    environmental factors all contribute to an
    adolescents decision to use alcohol
  • Parents, schools, governments, and the entire
    community need to be involved in prevention
    underage drinking

113
PROGRAMMING AND POLICY ISSUES
  • Teens are not adults BRAIN development is not
    complete
  • Teens operate from the emotional, impulsive,
    reward oriented part of the brain
  • Communication is a complicated process
  • Technology is transforming the world
  • Disparities between knowing/feeling
    understanding/behaving

114
PROGRAMMING AND POLICY ISSUES
  • Adolescent alcohol use is influenced by the
    availability, price, cultural and subcultural
    norms, adult monitoring (schools, family, law
    enforcement), and peers as well as individual
    motives, desires, expectancies, values, and
    vulnerabilities (Masten et al., 2008)
  • Prevention and treatment interventions must
    address the physical, relationships, cultural
    groups, and media/virtual contexts that
    adolescents live in

115
PROGRAMMING AND POLICY ISSUES
  • Teens need strong, consistent social scaffolding
    structures/people that provide support, guidance,
    constraints, monitoring, encouragement, a
    safety net (Dahl, 2004)
  • Emergence of teen regulatory skills requires a
    solid, consistent foundation and maturation of
    the PFC (Masten, 2004)

116
PREVENTION INTERVENTIONS
  • Domain family, school, neighborhood, peers,
    workplace, policy, or multiple domains
  • Target Population adolescent, parents, siblings,
    peers, or community
  • Type of Strategy universal, selective, or
    indicated
  • Most successful strategies are multi-component
    which place emphasis on increasing parenting
    skills and increasing adolescent regulatory
    capacity

117
PREVENTION INTERVENTIONS
  • Consider including strategies addressing
  • alcohol expectancies,
  • peer/sibling use (everybody does it)
  • hot/cold situational role plays
  • impulse/inhibition activities
  • strategy/team activities
  • group problem solving activities

118
DEVELOPMENTAL PROCESSES/TRANSITIONS THAT MAY
AFFECT RESPONSES TO PREVENTION OR TREATMENT
INTERVENTIONS
119
(Wagner, 2008)
120
TREATMENT INTERVENTIONS
  • Most treatment interventions are borrowed from
    adult treatment system
  • Adolescent focused treatment can be effective
  • Maturation of PFC and limbic system including
    self-regulation, executive function, and
    cognitive capacity, as well as family conflict,
    depression, and aggression need to be considered
    and addressed in treatment

121
TREATMENT INTERVENTIONS
  • Successful treatment models include
  • Family based, multisystemic therapy,
  • Motivational Enhancement therapy,
  • Behavioral therapy,
  • Cognitive behavioral therapy
  • Pharmacotherapy
  • Reward sensitivity needs to be considered and
    addressed in treatment
  • Because 2/3 of adolescents relapse within 6
    months of treatment, ongoing aftercare needs to
    be enhanced and expanded

122
AREAS TO REVIEW
  • Policies
  • Procedures
  • Interactions
  • Expectations
  • Protocols/ Services
  • Sanctions

123
CORTICAL INTEGRATION
  • Strengthens the frontal cortexjudgment,
    reasoning, rational decision making, problem
    solving, etc
  • Increases the ability of the cortex to process,
    inhibit, and organize reflexes, impulses,
    information, and emotions
  • Increases ability to engage thought with affect,
    words with emotion, and reason with unconscious
    behavior (Seigal,1999)

124
LIMBIC REGULATION
  • Limbic system plays a critical role in the
    regulation of emotion and memory
  • Primed clients need to re-wire their brains by
    learning new skills/options
  • Clients need to be in a state of attentive calm
    to learn new cognitive or behavioral
    skills/options
  • Emotions/impulses Logic/reason

125
ELEMENTS OF EFFECTIVE THERAPEUTIC INTERACTIONS
  • COMPREHENSIVE ASSESSMENT -- conduct
    comprehensive assessment that includes substance
    abuse issues, mental health issues, head trauma
    information, cognitive impairment, and
    abuse/neglect history
  • HOPE -- provide an internalization of a better
    way of life, change is possible, re-wiring the
    brain is possible, world does not have to be a
    negative and threatening place

126
ELEMENTS OF EFFECTIVE THERAPEUTIC INTERACTIONS
  • SAFETY provide understanding of persistent fear
    and hyper vigilance. Help client develop a state
    of attentive calm. Calm client uses cortex and
    can engage in abstract thinkinganxious client
    uses limbic system and focuses on non-verbal
    information and survival.
  • ROLE PLAYING, MUSIC, IMMEDIATE REWARDS, AND ROLE
    MODELS provide corrective experiences, activate
    several areas of the brain including frontal
    cortex, and create new memories/options

127
ELEMENTS OF EFFECTIVE THERAPEUTIC INTERACTIONS
  • CORRECTIVE THINKING correct false assumptions,
    reframe thinkingclient is not bad, stupid, sick,
    or damaged
  • STRUCTURE provide a safe, predictable,
    consistent environment that helps to reduce
    anxiety
  • DISCERNMENT provide experiences in which
    clients practice reading facial expressions
    and social situations

128
ELEMENTS OF EFFECTIVE THERAPEUTIC INTERACTIONS
  • INFORMATION help clients understand how their
    brains develop how brain function impacts
    behavior and process for re-wiring the brain
  • HOT/COLD COGNITION during stressful, emotional,
    or threatening situations problem solving
    information in the cortex is not easily accessed
    clients need practice and concrete ways to access
    information and skills

129
SUMMARY
  • Coping behaviors are the result of an
    interaction between genetics and environment. 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.

130
SUMMARY
  • Professionals need to educate themselves and
    their clients about brain development
  • Interventions must activate those portions of the
    brain that have been altered or underdeveloped
    (Perry, 2000)
  • Positive therapeutic experiences can contribute
    to healing and growth

131
SUMMARY
  • Start efforts as early as possible preschool
  • Engage teens in discussing the rules and
    consequences
  • Provide monitoring and mentoring for teens
  • Provide opportunities to practice decision making
    during hot cognition situations

132
SUMMARY
  • Educate teens regarding health risks
    consequences of their decisions
  • Provide high stimulation pro-social activities
  • Provide opportunities for teens to be involved in
    community service (bigger picture)
  • Provide repetition (neural connections)

133
SUMMARY
  • Stay actively involved in teens lives
  • Despite scientific advancements basic tenets of
    spending loving, quality time with teens is
    critical to provide strong scaffolding
  • Provide supportive services when difficulties
    occur do not assume that teens will grow out
    of it

134
LEARNING IS A PROCESS OF CREATING AND
STRENGTHENING NEURAL SYNAPSES AND CORTICAL
INTEGRATION
135
Barbara Sullivan, Ph.D.Utah Addiction
CenterUniversity of Utahbarbara.sullivan_at_hsc.uta
h.edu
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