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Adolescent Brain Development: A Framework for Understanding Unique Vulnerabilities and Opportunities
Ronald E. Dahl, M.D.Ronald E. Dahl, M.D.
University of PittsburghUniversity of PittsburghMedical CenterMedical Center
Goals of This Presentationnn To address To address pragmatic problemspragmatic problems in youth linked to in youth linked to
behavioral and emotional development & disordersbehavioral and emotional development & disordersnn Emphasize brain/behavior/social context Emphasize brain/behavior/social context interactionsinteractions
in the developmental pathway to some disordersin the developmental pathway to some disordersnn Highlight research indicating puberty/adolescence: Highlight research indicating puberty/adolescence: uu is a sensitive developmental period in the is a sensitive developmental period in the
integration of regulatory systems (especially integration of regulatory systems (especially goals + emotions)goals + emotions)
uu creates unique vulnerabilities and opportunities creates unique vulnerabilities and opportunities for intervention (i.e. for intervention (i.e. anotheranother period of plasticity).period of plasticity).
Pragmatic Problems: The Health Paradox of Adolescencenn Measures of most abilities indicate adolescence is the Measures of most abilities indicate adolescence is the
healthiest and most resilient period of the lifespan healthiest and most resilient period of the lifespan nn From Childhood to Adolescence: From Childhood to Adolescence: uu Improvements in strength, speed, reaction time, Improvements in strength, speed, reaction time,
mental reasoning abilities, immune function …mental reasoning abilities, immune function …uu Increased resistance to cold, heat, hunger, Increased resistance to cold, heat, hunger,
dehydration, and most types of injury …dehydration, and most types of injury …nn Yet: overall morbidity and mortality rates Yet: overall morbidity and mortality rates increaseincrease
200200--300% from childhood to late adolescence300% from childhood to late adolescence
Sources of Morbidity and Mortality in Adolescence: nn Primary causes of death/disability are related to Primary causes of death/disability are related to
problems with problems with control of behavior and emotion.control of behavior and emotion.nn Increasing rates of accidents, suicide, homicide, Increasing rates of accidents, suicide, homicide,
depression, alcohol & substance use, violence, depression, alcohol & substance use, violence, reckless behaviors, eating disorders, health reckless behaviors, eating disorders, health problems related to risky sexual behaviors… problems related to risky sexual behaviors…
nn Increase in riskIncrease in risk--taking, sensationtaking, sensation--seeking, and seeking, and erratic (emotionallyerratic (emotionally--influenced) behavior.influenced) behavior.
AdolescenceYouth are heated by NatureYouth are heated by Nature
as drunken men by wine.as drunken men by wine.----AristotleAristotle
I would that there were no age between I would that there were no age between ten and twenty three…for there is nothing ten and twenty three…for there is nothing in between but getting wenches with child, in between but getting wenches with child,
wronging the wronging the ancientryancientry, stealing, fighting…, stealing, fighting…----Shakespeare (The Winter’s Tale; Act III)Shakespeare (The Winter’s Tale; Act III)
Scientific Questionsnn What is the empirical evidence that adolescents What is the empirical evidence that adolescents
are “heated by Nature”?are “heated by Nature”?nn Are these changes based in biology? In the Are these changes based in biology? In the
hormones of puberty? hormones of puberty? nn Are there specific brain changes that underpin Are there specific brain changes that underpin
some behavioral and emotional tendencies & some behavioral and emotional tendencies & problems that emerge in adolescence?problems that emerge in adolescence?
nn What are the implications of understanding these What are the implications of understanding these questions regarding intervention?questions regarding intervention?
Normal (?) Adolescent Behavior: An Illustrative Anecdote
Amidst the festivities of a grand party a young Amidst the festivities of a grand party a young guy notices a strikingly guy notices a strikingly beautiful 13beautiful 13--yearyear--old girl old girl and is immediately smittenand is immediately smitten……
He approaches her and begins to flirt boldlyHe approaches her and begins to flirt boldly……
She tries to rebuff him but is flattered by his She tries to rebuff him but is flattered by his attention and finds him quite attractiveattention and finds him quite attractive……
Romantic feelings kindle rapidly…
By the time he departs the scene, with a kiss followed by By the time he departs the scene, with a kiss followed by a second kiss, these two have exchanged less than a a second kiss, these two have exchanged less than a hundred wordshundred words——yet, both are swooning with sensations yet, both are swooning with sensations of falling, desperately, in loveof falling, desperately, in love……
All mental processesAll mental processes——thinking, planning, goals, thinking, planning, goals, feelings, and feelings, and motivationsmotivations have been suddenly have been suddenly transformedtransformed……these brains have been completely gripped these brains have been completely gripped by this brief encounterby this brief encounter
Longing, obsession, and desire….
In the hours after this meeting, these two cannot In the hours after this meeting, these two cannot stop thinking about each otherstop thinking about each other
The intensity of desire is so strong that each The intensity of desire is so strong that each would happily forego food, sleep, comfort, and all would happily forego food, sleep, comfort, and all competing pleasures, simply to be in each othercompeting pleasures, simply to be in each other’’s s presence again presence again
A Second (Clandestine) Rendezvous Ensues …
Passionate feelings now accelerate at a feverish Passionate feelings now accelerate at a feverish pitchpitch……
Within a few days their deepest wish is to be Within a few days their deepest wish is to be joined together until the end of time joined together until the end of time
Each begins to feel as if the entire universe has Each begins to feel as if the entire universe has always meant for them to be togetheralways meant for them to be together
All priorities have been re-ordered; now value each other above all else…
Both are willing to spurn friends and family, risk Both are willing to spurn friends and family, risk dangers, transcend pain and difficulties just to be dangers, transcend pain and difficulties just to be togethertogether…….soon begin to feel as if death itself .soon begin to feel as if death itself would be preferable to living apartwould be preferable to living apart
All this, All this, though they just met four days previously though they just met four days previously and barely know each otherand barely know each other
If seen by a psychiatrist who did notunderstand youthful passions:nn These adolescents could be judged as meeting These adolescents could be judged as meeting
diagnostic criteria for several major mental diagnostic criteria for several major mental disorders and cognitive impairments disorders and cognitive impairments
nn Without some empathy for the heat and power of Without some empathy for the heat and power of young love, this story would not seem young love, this story would not seem believablebelievable——it it would sound utterly ridiculouswould sound utterly ridiculous……..
yetyet……
Romeo and Juliet (1595): quite a popular and persevering storynn Basic elements date back to the writings of the Greek Basic elements date back to the writings of the Greek
novelist novelist XenophonXenophon ((4th century A.D)4th century A.D)nn Luigi Luigi dada Porto Porto ((1535) named the feuding families 1535) named the feuding families
MontecchiMontecchi and and CapellatiCapellati & set the scene in Verona& set the scene in Veronann French version: French version: SevinSevin (1542); (1542); nn Other Italian versions: poem by Other Italian versions: poem by CliziaClizia (1553), a novella (1553), a novella
by by BandelloBandello (1554), and a play by (1554), and a play by GrotoGroto (1578). (1578). nn An English poem version by Arthur Brooke (1562) was An English poem version by Arthur Brooke (1562) was
titled titled The The TragicalTragical History of History of RomeusRomeus and Juliet.and Juliet.
Shakespeare’s adaptation (1595): became one of the most successful dramas in history
nn In contrast to Luigi In contrast to Luigi dada PortoPorto’’s version where s version where GiulettaGiuletta was 18 years old and the courtship was was 18 years old and the courtship was slowslow--paced, developing over several weeks.paced, developing over several weeks.
nn Shakespeare made Juliet 13 and compressed the Shakespeare made Juliet 13 and compressed the entire romance into four days.entire romance into four days.
nn Given ShakespeareGiven Shakespeare’’s wisdom in human behavior, s wisdom in human behavior, whywhy a heroine so young in a romantic tragedy? a heroine so young in a romantic tragedy?
Choice is even more striking given historical changes in pubertal timingnn Age of menarche has decreased rapidly in US and Age of menarche has decreased rapidly in US and
Europe over past 200 years Europe over past 200 years nn Lack precise data on puberty in 16Lack precise data on puberty in 16thth century England century England
(& then as now likely a wide range of individual (& then as now likely a wide range of individual differences in rates of maturation). differences in rates of maturation).
nn Yet, the Yet, the average average 1313--yearyear--old girl in Shakespearean old girl in Shakespearean England was much less developed than the average England was much less developed than the average 1313--yearyear--old girl today. old girl today.
Shakespeare Was Dramatizing Natural Tensions of Adolescencenn Juliet has a physical appearance capable of Juliet has a physical appearance capable of
launching a Romeo into raging attraction and launching a Romeo into raging attraction and uncontrollable devotion uncontrollable devotion
nn Evidence of postEvidence of post--pubertal awakening of romantic pubertal awakening of romantic passions in her own behavior passions in her own behavior
nn Yet, she has the knowledge, judgment, and Yet, she has the knowledge, judgment, and emotional emotional skillsskills of a 13 yearof a 13 year--old child old child
Four Centuries Later…
nn Knowledge of adolescent development has Knowledge of adolescent development has expanded significantly through science expanded significantly through science
nn These dramatic tensions can now be examined in These dramatic tensions can now be examined in light of broader understanding of cognitive and light of broader understanding of cognitive and emotional development & the role of puberty in emotional development & the role of puberty in brain maturationbrain maturation
nn Perhaps an even greater appreciation for the Perhaps an even greater appreciation for the insights of Shakespeareinsights of Shakespeare……
Overview of Presentation
nn Part 1: Part 1: Conceptual modelConceptual model of adolescence as a key of adolescence as a key developmental period for brain/behavior/social developmental period for brain/behavior/social context interactionscontext interactions (plasticity)(plasticity)
nn Part 2: Developmental changes in Part 2: Developmental changes in sleep/arousal sleep/arousal regulationregulation as a specific example to illustrate key as a specific example to illustrate key features of the modelfeatures of the model
nn Part 3: Focus on Part 3: Focus on the development of affect the development of affect regulationregulation in adolescence within this modelin adolescence within this model
Part 1: What is Adolescence?
nn How do we conceptualize and define the How do we conceptualize and define the adolescent period? adolescent period?
nn Anthropologic look at adolescence in traditional Anthropologic look at adolescence in traditional societies as a framework for understanding societies as a framework for understanding
nn Why is it important to consider the underlying Why is it important to consider the underlying biologic and brain system level of changes?biologic and brain system level of changes?
nn A few examples of neuroscience studies A few examples of neuroscience studies illustrating key principlesillustrating key principles
Conceptualizing Adolescence
nn Aristotle: “youth are heated by Nature as drunken Aristotle: “youth are heated by Nature as drunken men by wine”men by wine”
nn Socrates: “inclined to contradict parents and Socrates: “inclined to contradict parents and tyrannize their teachers”tyrannize their teachers”
nn G.S. Hall (1904) a period of heightened “storm G.S. Hall (1904) a period of heightened “storm and stress”and stress”
nn 1960s and 1970s: attempts to understand the 1960s and 1970s: attempts to understand the problems as due to “raging hormones”problems as due to “raging hormones”
Arnett (1999) Review Of “Storm And Stress”nn Many (perhaps most) adolescents navigate this Many (perhaps most) adolescents navigate this
interval with minimal difficultiesinterval with minimal difficultiesnn However, empiric evidence for: However, empiric evidence for: uu Increased conflicts with parents (intensity)Increased conflicts with parents (intensity)uuMood volatility (and increased negative mood)Mood volatility (and increased negative mood)uu Increased risk behavior, recklessness, and Increased risk behavior, recklessness, and
sensationsensation--seekingseeking
Yet, Many Adolescents Do Struggle; Problems of Enormous Magnitude nn Overall morbidity and mortality rates increase Overall morbidity and mortality rates increase
200200--300% between middle childhood and late 300% between middle childhood and late adolescence/early adulthoodadolescence/early adulthood
nn Onset of problems such as nicotine dependence, Onset of problems such as nicotine dependence, alcohol and drug use, poor health habits, etc. that alcohol and drug use, poor health habits, etc. that will show up as mortality in adulthoodwill show up as mortality in adulthood
nn Many adult onset problems such as depression Many adult onset problems such as depression can be traced to early episodes in adolescencecan be traced to early episodes in adolescence
Defining Adolescence
nn That awkward period between sexual maturation and That awkward period between sexual maturation and the attainment of adult roles and responsibilities.the attainment of adult roles and responsibilities.
nn The transition from:The transition from:“child” status (requires adult monitoring) “child” status (requires adult monitoring)
to to “adult” status (“adult” status (selfself--responsibility for behavior).responsibility for behavior).
nn The developmental interval that encompasses the The developmental interval that encompasses the body and brain changes of puberty.body and brain changes of puberty.
Adolescence: Component Processes
nn Rapid Physical GrowthRapid Physical Growthnn Sexual MaturationSexual Maturationnn Secondary Sexual Characteristics Secondary Sexual Characteristics nn Motivational and Emotional ChangesMotivational and Emotional Changesnn Cognitive DevelopmentCognitive Developmentnn Maturation of Judgment, SelfMaturation of Judgment, Self--Regulation SkillsRegulation Skillsnn Brain Changes Linked to Brain Changes Linked to EachEach ComponentComponentnn Suite of Changes with Suite of Changes with RelativeRelative SynchronySynchrony
Puberty and Brain Development
nn Some brain changes Some brain changes precedeprecede pubertal increase in pubertal increase in hormones and body changeshormones and body changes
nn Some brain changes appear to be the Some brain changes appear to be the consequenceconsequenceof pubertal processes (e.g. hormone effects of pubertal processes (e.g. hormone effects feeding back upon the brain; estrogen receptor feeding back upon the brain; estrogen receptor betabeta distributed throughout the brain)distributed throughout the brain)
nn Some adolescent brain maturation appears to be Some adolescent brain maturation appears to be independentindependent of pubertal processesof pubertal processes
Herman-Giddens et al 1997 Study of 17,000 Girls in US Pediatric Practices With Complete PE: Percentage with Breast/Pubic Hair Development at Tanner 2 or above
05
101520253035404550
7 years 8 years
euro-americanafrican-american
Adolescence: An Anthropological Perspective
The past 150 years have witnessed a quiet revolution in human development that still sweeps
across the globe today: children nearly everywhere are growing faster, reaching
reproductive and physical maturity at earlier ages, and achieving larger adult sizes than
perhaps ever in human history.--Carol M Worthman, Ph.D.
Adolescence in traditional societies: interval between child and adult status nn End of childhood usually marked by puberty (ritual) End of childhood usually marked by puberty (ritual) nn Onset of adult status in traditional societies?Onset of adult status in traditional societies?
uu marriagemarriageuu work roles (e.g. hunting)work roles (e.g. hunting)uu owning propertyowning propertyuu becoming a parent becoming a parent uu independence (absence of monitoring) independence (absence of monitoring)
nn Interval between puberty & marriage as an indexInterval between puberty & marriage as an index
Puberty, Marriage, and Adult Roles in Traditional Human Societies
(Schlegel and Barry’s Anthropologic Study of 186 societies)
nn Among girls, marriage occurred Among girls, marriage occurred within two years of the within two years of the onset of pubertyonset of puberty in 63% of the societies studied. in 63% of the societies studied.
nn Among boys the ability to take a wife could require a Among boys the ability to take a wife could require a specific level of achievement (such as making a first kill specific level of achievement (such as making a first kill on a hunt or developing a specific set of skills that on a hunt or developing a specific set of skills that increased economic opportunities to provide for a family) increased economic opportunities to provide for a family)
nn Yet, even for males in these traditional circumstances Yet, even for males in these traditional circumstances 64% were married 64% were married within four yearswithin four years of puberty. of puberty.
Puberty, Marriage, and Adult Roles in Contemporary Society (United States)nn Average age of menarche is now age 12; Average age of menarche is now age 12;
average age of first marriage for females is 26. average age of first marriage for females is 26. nn This pattern reflects This pattern reflects recent recent changes: changes: uu In 1970 timing of first marriage in the U.S: In 1970 timing of first marriage in the U.S: tt age 21 for women age 21 for women tt age 23 for menage 23 for men
uuBy the 2000 census this had changed: By the 2000 census this had changed: tt age 26 for women age 26 for women ttAge 27 for men. Age 27 for men.
Puberty, Marriage, and Adult Roles in Contemporary Society (Japan)nn Average age of menarche has decreased four Average age of menarche has decreased four
years over the past centuryyears over the past centuryuu In Japan (1875) menarche at 16.5 years In Japan (1875) menarche at 16.5 years uu In 1975 average age of menarche: 12.2 yearsIn 1975 average age of menarche: 12.2 years
nn Average age at first marriage in Japan is nowAverage age at first marriage in Japan is nowuu 26 years of age in women 26 years of age in women uu 28.4 years of age in men 28.4 years of age in men
Puberty, Marriage, and Adult Roles in Contemporary Society nn Not simply changing attitudes about marriage. Not simply changing attitudes about marriage. nn Many adult social rolesMany adult social roles——starting careers, owning starting careers, owning
a home, choosing to become parentsa home, choosing to become parents——are now are now occurring a decade or more occurring a decade or more afterafter puberty. puberty.
nn These changes have advantages (especially These changes have advantages (especially academic and economic opportunities).academic and economic opportunities).
nn These changes have costs (and create These changes have costs (and create vulnerabilities).vulnerabilities).
nn ADOLESCENCE HAS EXPANDED from a 2ADOLESCENCE HAS EXPANDED from a 2--4 4 year interval in traditional societies to an 8year interval in traditional societies to an 8--15 15 year intervalyear interval in contemporary society.in contemporary society.
Historical Changes in Adolescence:Implications Regarding the Brain
nn The dramatic The dramatic expansionexpansion of the adolescent interval of the adolescent interval raises critical questions about brain developmentraises critical questions about brain development
nn Relevance of considering different components of Relevance of considering different components of adolescent developmentadolescent development
nn Evidence that some brain changes are linked Evidence that some brain changes are linked closely to puberty while other aspects of closely to puberty while other aspects of maturation are dependent on age/experiencematuration are dependent on age/experience
Puberty and Brain Development
nn Some brain changes Some brain changes precedeprecede pubertal increase in pubertal increase in hormones and body changeshormones and body changes
nn Some brain changes appear to be the Some brain changes appear to be the consequenceconsequenceof some pubertal processesof some pubertal processes
nn Some adolescent brain maturation appears to be Some adolescent brain maturation appears to be independentindependent of pubertal processesof pubertal processes
nn Potential for creating internal Potential for creating internal disdis--synchronysynchrony
Puberty versus Adolescence: Empirical Investigationsnn In most adolescent studies: age, level of pubertal In most adolescent studies: age, level of pubertal
development, and social experience are correlated & development, and social experience are correlated & difficult to disentangle difficult to disentangle (exception: endocrine disorder)(exception: endocrine disorder)
nn Requires studies designed to examine these issues:Requires studies designed to examine these issues:uu youth of the same age & social experience (e.g. youth of the same age & social experience (e.g.
all 13 year olds in the same grade) but varying in all 13 year olds in the same grade) but varying in level of pubertal maturation level of pubertal maturation
Sensation-Seeking in Subjects 11-13 Years of Age; No significant age correlation (Martin et al 2002)
00.05
0.10.15
0.20.25
0.30.35
0.40.45
Sensation Seeking
PubertalMaturation A
PubertalMaturation B
MalesFemales
*.26
NS
.1
**.45
*.34
Puberty and Motivation/Emotion
nn Strongest links to pubertal changes perStrongest links to pubertal changes per--se are in the se are in the domains of romantic motivation, sexual interest, domains of romantic motivation, sexual interest, emotional intensity, sleep/arousal regulation, appetite, emotional intensity, sleep/arousal regulation, appetite, and affective disorders [Pine to discuss more]and affective disorders [Pine to discuss more]
nn A general increase in riskA general increase in risk--taking, noveltytaking, novelty--seeking, seeking, sensationsensation--seeking (rewardseeking (reward--seeking).seeking).
nn Animal studies also show increase in noveltyAnimal studies also show increase in novelty--taking taking (risk(risk--taking?) in the taking?) in the periperi--adolescent period (Spear 2000). adolescent period (Spear 2000). [Kelley to discuss more][Kelley to discuss more]
Puberty and “Igniting Passions” in the Developing Brain nn Profound changes in romantic interest, motivationProfound changes in romantic interest, motivationnn Intensification of many types of goalIntensification of many types of goal--directed directed
behavior, including intense motivation for longbehavior, including intense motivation for long--term and abstract goals (particularly related to term and abstract goals (particularly related to socialsocial--status)status)
nn Relatively understudied aspect of adolescent Relatively understudied aspect of adolescent development (emotion and motivational changes)development (emotion and motivational changes)
Adult Status: Requires developing self-control of behavior & emotions:nn appropriately inhibit or modify behaviors to avoid appropriately inhibit or modify behaviors to avoid
negative future consequencesnegative future consequencesnn initiate, persist, sequence steps toward goalsinitiate, persist, sequence steps toward goalsnn navigate complex social situations despite strong affectnavigate complex social situations despite strong affectnn Skills in the selfSkills in the self--regulation of affect and complex regulation of affect and complex
behavior to serve longbehavior to serve long--term goalsterm goalsnn Involves neurobehavioral systems in PFC Involves neurobehavioral systems in PFC ---- among the among the
last regions of the brain to achieve full functional last regions of the brain to achieve full functional maturationmaturation
What Happens to Cognitive Development when Puberty is Early?nn Most measures of cognitive development correlate with Most measures of cognitive development correlate with
age and experience (not sexual maturation)age and experience (not sexual maturation)uu Planning, Logic, and Reasoning abilityPlanning, Logic, and Reasoning abilityuu Inhibitory controlInhibitory controluu ProblemProblem--solving; understanding consequencessolving; understanding consequences
nn Data consistent with a model that Data consistent with a model that thesethese aspects of brain aspects of brain maturation are timematuration are time--dependent (or experiencedependent (or experience--dependent) dependent) processes and relatively processes and relatively independenindependent of pubertal timingt of pubertal timing
nn These continue to develop These continue to develop long after puberty is overlong after puberty is over
Brain Development in Healthy Children and Adolescents: Longitudinal and Cross-Sectional Data (243 Scans from 145 Subjects) [Giedd et al]
Frontal Gray Matter
200
220
240
4 6 8 10 12 14 16 18 20 22
Age in years
Volu
me in
Brain Development by Anatomic Region (145 Children & AdolescentBrain Development by Anatomic Region (145 Children & Adolescents s age 4age 4--22 years of age who underwent 243 MRI Scans) [22 years of age who underwent 243 MRI Scans) [GieddGiedd et al]et al]
90%
95%
100%
105%
110%
115%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22Age (in years)
Total Brain CerebellumFrontal TemporalParietal
**Parietal
Frontal
Temporal
Total Brain Cerebellum
**
*
Peak Cerebellum vs. Other Peaks: * <.002, ** <.0001
Hypothesis: Starting the engines without a skilled driver
nn Earlier timing of puberty results in several years with a Earlier timing of puberty results in several years with a sexuallysexually--mature body and sexuallymature body and sexually--activated brain activated brain circuits (“igniting passions”)circuits (“igniting passions”)
nn Yet with Yet with relatively immature neurobehavioral systems relatively immature neurobehavioral systems necessary for selfnecessary for self--control and affect regulationcontrol and affect regulation
nn Predict: increased risk for disorders of selfPredict: increased risk for disorders of self--control; control; difficulties navigating complex socialdifficulties navigating complex social--emotional emotional situationssituations
Adolescence: Risk for behavioral and emotional disorders
nn Successful navigation of pubertal transition:Successful navigation of pubertal transition:uu increased cognitive (selfincreased cognitive (self--) control over emotions and ) control over emotions and
behavior behavior uu in accordance with abstract principles in accordance with abstract principles uu consideration of longconsideration of long--term consequencesterm consequencesuu complex social rulescomplex social rulesuu use of strategies, planning, and goalsuse of strategies, planning, and goalsuu requires cognitiverequires cognitive--emotional integrationemotional integration
Cognitive-Emotional Integration (cont’d)nn Affect regulation in complex & highlyAffect regulation in complex & highly-- arousing arousing
social situationssocial situationsnn DecisionDecision--making/behavioral choice under making/behavioral choice under
conditions of strong emotion (“hot” vs. “cold” conditions of strong emotion (“hot” vs. “cold” cognitive processes)cognitive processes)
nn Navigating behavior in ambiguous settings w/ Navigating behavior in ambiguous settings w/ strongly conflicting feelingsstrongly conflicting feelings
Adolescence, Social Roles, and External Constraints nn In many ways adolescence represents the interval In many ways adolescence represents the interval
between between the beginning of sexual maturation and the the beginning of sexual maturation and the attainment of adult roles and responsibilities in society.attainment of adult roles and responsibilities in society.
nn The transition from parental control to selfThe transition from parental control to self--control is control is usually framed in social context usually framed in social context
nn Many young adolescents are faced with enormous Many young adolescents are faced with enormous amounts of freedom in which to navigate complex amounts of freedom in which to navigate complex decisiondecision--makingmaking
ADOLESCENCE AS A SENSITIVE PERIOD: OPPORTUNITIES
nn Brain systems underpinning higher levels of Brain systems underpinning higher levels of cognitivecognitive--emotional integrationemotional integration
nn Establishing new links between more complex Establishing new links between more complex ways of thinking and new emotional experiencesways of thinking and new emotional experiences
nn Opportunities for early intervention/prevention in Opportunities for early intervention/prevention in identified highidentified high--risk samplesrisk samples
nn “Igniting passions” can be “Igniting passions” can be sculptedsculpted by experienceby experience
Part 2: Sleepless in Adolescence: Puberty, Arousal, & the Brain
Sleep is not only a biological necessity but also a Sleep is not only a biological necessity but also a physiologic drive. In today’s fastphysiologic drive. In today’s fast--paced world, paced world, though, sleep is often the first thing to go…..though, sleep is often the first thing to go…..Adolescence is the time of greatest vulnerability Adolescence is the time of greatest vulnerability from the standpoint of sleepfrom the standpoint of sleep….….
----William C. DementWilliam C. Dement
Sleep/Arousal Regulation as an Example to Illustrate Key Principlesnn Some developmental changes in sleep regulation Some developmental changes in sleep regulation
are are biologicbiologic & linked to puberty& linked to pubertynn Some changes in sleep regulation linked to Some changes in sleep regulation linked to socialsocial
influences, habits, and patternsinfluences, habits, and patternsnn Interactions Interactions betweenbetween these domains can lead to a these domains can lead to a
negative spiral of consequences negative spiral of consequences nn Small shift in motivation (tendency to stay up Small shift in motivation (tendency to stay up
later) can lead to dramatic changes in behavior later) can lead to dramatic changes in behavior
The Mystery of Sleep
nn Sleep is ubiquitous across speciesSleep is ubiquitous across speciesnn Sleep is necessary for life (survival without sleep Sleep is necessary for life (survival without sleep
is parallel to living without food)is parallel to living without food)nn Actual function/purpose of sleep is a complete Actual function/purpose of sleep is a complete
mysterymysterynn Sleep appears particularly important during early Sleep appears particularly important during early
development (reason unknown)development (reason unknown)
Sleep Vs. Rest
nn Sleep is an active process with many brain Sleep is an active process with many brain regions showing increased activityregions showing increased activity
nn The continuity, patterning, and timing of sleep is The continuity, patterning, and timing of sleep is essential to the restorative processessential to the restorative process
nn Behaviorally, sleep Behaviorally, sleep requiresrequires a decrease in a decrease in awareness/responsivenessawareness/responsiveness
nn Relative “disconnection” between Relative “disconnection” between neurobehavioral systems linked while awakeneurobehavioral systems linked while awake
Sleep: Evolutionary Biology
nn Since systems of vigilance, processing, and Since systems of vigilance, processing, and responding are disconnected from each other responding are disconnected from each other ----sleep is restricted to SAFE placessleep is restricted to SAFE places
nn Most species: Most species: uuphysical niches (burrows/ nests)physical niches (burrows/ nests)uu temporal niches (times of minimal predation)temporal niches (times of minimal predation)uubehavioral patterns behavioral patterns
Human Sleep:Evolutionary Biologynn Stage 4 sleep: completely unresponsiveStage 4 sleep: completely unresponsivenn REM sleep: loss of muscle tone (unable to sleep REM sleep: loss of muscle tone (unable to sleep
in trees or cliff ledges)in trees or cliff ledges)nn Human ancestral environment: filled with huge, Human ancestral environment: filled with huge,
nocturnalnocturnal--hunting carnivoreshunting carnivoresnn NO evidence of physically safe sleep sitesNO evidence of physically safe sleep sites
Human Sleep:Evolutionary Psychologynn Safety as a SOCIAL constructSafety as a SOCIAL constructnn In most social primates an alone primate is a dead In most social primates an alone primate is a dead
primateprimatenn Vigilance and stress/threat systems are wired Vigilance and stress/threat systems are wired
accordinglyaccordinglynn Power of social belonging/rejection influencing Power of social belonging/rejection influencing
human sleep patternshuman sleep patternsnn DEVELOPMENTAL CHANGESDEVELOPMENTAL CHANGES
Sleep and The Developing Brain
nn Average 2 year old child has spent Average 2 year old child has spent uu about 9,500 hours sleeping (about 13 months)about 9,500 hours sleeping (about 13 months)uuAbout 8,000 hours in all waking activities About 8,000 hours in all waking activities
combined (about 11 months)combined (about 11 months)nn From age 2From age 2--5 years about equal amounts of time 5 years about equal amounts of time
spent waking and sleepingspent waking and sleepingnn Sleep is the Sleep is the primaryprimary activity of the brain during activity of the brain during
early developmentearly development
Sleep: Learning and Memory
nn Increasing evidence that sleep is fundamental to Increasing evidence that sleep is fundamental to consolidation of learning (including procedural consolidation of learning (including procedural learning as well as explicit memory)learning as well as explicit memory)
nn Most of the neuroscience work in this area has Most of the neuroscience work in this area has been done in adult humans and animalsbeen done in adult humans and animals
nn Some compelling hints that these processes are Some compelling hints that these processes are even more crucial during developmenteven more crucial during development
Pubertal Influences on Sleep and Arousal Regulationnn Evidence that the need for sleep actually increases at Evidence that the need for sleep actually increases at
pubertypubertynn Greater daytime sleepiness ( increased need for sleep) Greater daytime sleepiness ( increased need for sleep)
even if obtaining as much night sleep as even if obtaining as much night sleep as prepubertalprepubertalchildrenchildren
nn Also a pubertal shift in circadian (biologic clock) to Also a pubertal shift in circadian (biologic clock) to preferringpreferring later bedtimes and riselater bedtimes and rise--times (adolescent times (adolescent “owl” tendencies vs. child “lark” tendencies)“owl” tendencies vs. child “lark” tendencies)
Historical Changes in Environment
nn In a social context > 100 years ago when it In a social context > 100 years ago when it became dark there were limited options for became dark there were limited options for stimulating activity: stimulating activity: uuMotivation to stay up later usually Motivation to stay up later usually balancedbalanced by by
motivation (need) for more sleepmotivation (need) for more sleepuuLimited options for multiLimited options for multi--day “sleepingday “sleeping--in”in”
nn Context of modern life alters this balance: access Context of modern life alters this balance: access to light, stimulation, arousal at nightto light, stimulation, arousal at night
Factors contributing to LATE bedtimes/sleep onset times:nn Biologic tendency for sleep delay +Biologic tendency for sleep delay +nn Social influences toward sleep delay +Social influences toward sleep delay +nn Greater freedom to selfGreater freedom to self--select bedtimes +select bedtimes +nn Access to light and stimulating activities +Access to light and stimulating activities +nn Stress/anxiety/excitement Stress/anxiety/excitement ⇒⇒ Difficulty Falling Asleep +Difficulty Falling Asleep +nn Major circadian shift on weekends/vacationMajor circadian shift on weekends/vacationnn Work, Sports, Homework, Projects, meds...Work, Sports, Homework, Projects, meds...
The School-Sleep Squeeze
nn Despite Despite averageaverage school night bedtimes of 11:15 school night bedtimes of 11:15 pm in high school seniors, the average wakepm in high school seniors, the average wake--up up time on school days is 6:15 am. time on school days is 6:15 am.
nn 10% of high school students must get up before 10% of high school students must get up before 5:30 am to catch buses5:30 am to catch buses
nn 15 % of high school students report averaging 6 15 % of high school students report averaging 6 or less hours of sleep per night on school daysor less hours of sleep per night on school days
Circadian (Biological Clock) Factors
nn During summers, vacations, and weekends, During summers, vacations, and weekends, adolescent sleep/wake schedules are phase adolescent sleep/wake schedules are phase delayed (e.g. 3 am delayed (e.g. 3 am -- noon)noon)
nn Circadian advance requires slow, steady changes Circadian advance requires slow, steady changes (students often partially(students often partially--adapted to school adapted to school schedules)schedules)
nn Delayed circadian phase contributes to difficulty Delayed circadian phase contributes to difficulty falling asleep, difficulty waking falling asleep, difficulty waking
Contributing Factors/vicious Cycle
nn “Catch“Catch--up” sleep on weekup” sleep on week--ends pushes circadian ends pushes circadian system to further delaysystem to further delay
nn Use of stimulants (caffeine and nicotine) can Use of stimulants (caffeine and nicotine) can contribute to DFA (difficulty falling asleep)contribute to DFA (difficulty falling asleep)
nn Full time students working greater than 20 Full time students working greater than 20 hours/week with significant sleep symptomshours/week with significant sleep symptoms
nn Stress and conflict contribute to emotional arousal Stress and conflict contribute to emotional arousal and further DFAand further DFA
What are the Consequences of Insufficient Sleep in Adolescents?nn Missed schoolMissed schoolnn Sleepiness (including microSleepiness (including micro--sleeps)sleeps)nn Negative synergy with alcoholNegative synergy with alcoholnn Tiredness (decreased motivation)Tiredness (decreased motivation)nn Irritability and lowIrritability and low--frustration tolerancefrustration tolerancenn Difficulties with selfDifficulties with self--control of attention, control of attention,
emotion, and behavioremotion, and behavior
Consequences of Insufficient Sleep in Adolescents (behavior & emotion)nn Difficulties with focused attentionDifficulties with focused attentionnn Irritability, Emotional labilityIrritability, Emotional labilitynn Affect regulation & Cognitive Emotional Affect regulation & Cognitive Emotional
IntegrationIntegrationnn Direct effects on learning, memory consolidationDirect effects on learning, memory consolidation
A Spiral of Negative Effects?
nn Late night/erratic schedules Late night/erratic schedules ⇒⇒ Sleep Deprivation Sleep Deprivation uu⇒⇒ erodes mood and motivation erodes mood and motivation uu ⇒⇒ ggreater stress and affective problems reater stress and affective problems uu ⇒⇒ interferes further w sleep/arousal regulation interferes further w sleep/arousal regulation uu ⇒⇒ greater DFAgreater DFA
nn The Balance of Sleep/Arousal RegulationThe Balance of Sleep/Arousal Regulationuu tilted HEAVILY toward chronic arousaltilted HEAVILY toward chronic arousal
Summary principles of sleep/arousal changes at pubertynn Relatively small changes in tendency to Relatively small changes in tendency to want want to to
stay up later (motivational shift that has a basis in stay up later (motivational shift that has a basis in neurobehavioral systems)neurobehavioral systems)
nn Can, in some social situations, result in a huge Can, in some social situations, result in a huge spiral of effects impacting every aspect of an spiral of effects impacting every aspect of an adolescents life. adolescents life.
nn Brain/behavior/socialBrain/behavior/social--context context Interactions Interactions are key are key to understanding this problemto understanding this problem
Part 3: Affect-regulation: the integration of cognitive goals & emotion/motivationnn How do children learn to control emotions and How do children learn to control emotions and
motivations in order to achieve long term goals?motivations in order to achieve long term goals?nn How are these skills challenged at puberty when How are these skills challenged at puberty when
the intensity of some emotions and motivations the intensity of some emotions and motivations undergo natural shifts (like the change in sleep)?undergo natural shifts (like the change in sleep)?
nn How do emotions/motivations influence the How do emotions/motivations influence the cognitive aspects of decisioncognitive aspects of decision--making (and vicemaking (and vice--versa)?versa)?
The Regulation of AffectThompson: “extrinsic and intrinsic processes responsible Thompson: “extrinsic and intrinsic processes responsible
for monitoring, evaluating, and modifying emotional for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal reactions, especially their intensive and temporal features, features, to accomplish one’s goalsto accomplish one’s goals.”.”uu What is being regulated?What is being regulated?
tt The expression of emotionThe expression of emotiontt The experience of emotionThe experience of emotionttArousal levelsArousal levels
uu Includes explicit (conscious) and implicit processes Includes explicit (conscious) and implicit processes (procedural learning and skill development)(procedural learning and skill development)
The Regulation of Affect
nn Modifying affect Modifying affect in accordance with goals, rules, or in accordance with goals, rules, or learned strategieslearned strategies
nn What is being regulated?What is being regulated?ttAttentionAttentiontt The expression of emotionThe expression of emotiontt The experience of emotionThe experience of emotionttArousal levelsArousal levelstt BEHAVIORBEHAVIOR
nn Includes explicit (conscious) and implicit processes Includes explicit (conscious) and implicit processes (procedural learning and skill development)(procedural learning and skill development)
The Development of Affect Regulation
nn Early strategies in childhood:Early strategies in childhood:uuDistraction and control of attentionDistraction and control of attentionuuSelfSelf--soothingsoothinguuSignaling for parent/adultSignaling for parent/adultuu ? Modifying affective experience/calibrating ? Modifying affective experience/calibrating
actionaction--tendenciestendenciesnn Later emergence of selfLater emergence of self--regulatory skills and regulatory skills and
cognitive strategies cognitive strategies
Affect Regulation/Dysregulation: Conceptual Issuesnn Concept of Concept of emotion regulationemotion regulation increasingly increasingly
popular among researchers and clinicians trying popular among researchers and clinicians trying to understand developmental psychopathologyto understand developmental psychopathology
nn Yet: Yet: uu relative lack of specificity in models regarding relative lack of specificity in models regarding
how how affect regulation is alteredaffect regulation is altereduu limited evidence of specificlimited evidence of specific changes in affect changes in affect
regulation regulation
Affect Dysregulation:EmotionalDisorders in Adolescencenn Rates of Depression increase sharply during Rates of Depression increase sharply during
adolescenceadolescencenn Gender difference in depression emerges in Gender difference in depression emerges in
adolescence (females 2X as likely to have MDD) adolescence (females 2X as likely to have MDD) nn Increase risk for MDD and panic disorder in Increase risk for MDD and panic disorder in
adolescent females appears to be linked to adolescent females appears to be linked to pubertypubertymore strongly than agemore strongly than age
Neurobehavioral Systems Framework to Affective Processesnn Emotional salience for two reasons: possible Emotional salience for two reasons: possible
rewardreward or possible or possible threatthreat (punishment)(punishment)nn Recognizing and preparing to Recognizing and preparing to approachapproach rewardsrewardsuu seeking seeking vsvs getting rewards; anticipationsgetting rewards; anticipations
nn Recognizing and preparing to Recognizing and preparing to escapeescape threatsthreatsuuThreat, anxiety, fear, painThreat, anxiety, fear, pain
nn Social contextSocial context
Adolescent Decision-making: Another source of paradoxnn In many measurable aspects of decisionIn many measurable aspects of decision--making making
adolescents are approaching adult levels of adolescents are approaching adult levels of competence by 15 years of age competence by 15 years of age
nn Yet, in real life situations adolescents show Yet, in real life situations adolescents show extremely high rates of “poor” decisionextremely high rates of “poor” decision--makingmaking
nn What is the reason that:What is the reason that:uuDriving age is 16; voting and most “adult” Driving age is 16; voting and most “adult”
decisions at age 18; drinking alcohol at 21; decisions at age 18; drinking alcohol at 21; renting a car from commercial agency at 25renting a car from commercial agency at 25
uuStanding trial as an adult for murder at age 14Standing trial as an adult for murder at age 14
Examples of Development of Decision-making & Behavioral Control that Emerge Gradually Across Adolescence
nn DamasioDamasio “gambling” task that relies upon “gambling” task that relies upon intuitive or “gutintuitive or “gut--feeling” learning about what is feeling” learning about what is rewarding and punishingrewarding and punishinguuLearning to avoid the “bad” decks of cards Learning to avoid the “bad” decks of cards uu Increasing selection of “good” decks without Increasing selection of “good” decks without
needing conscious awareness they are good.needing conscious awareness they are good.nn Voluntary Control of eyeVoluntary Control of eye--movementsmovements
Development of Advantageous Decision-making (Crone et al 2003)
18-25 years
TRIAL BLOCK
10987654321
choi
ces
10
8
6
4
2
0
GAIN
disadvantageous
advantageous
Development of Advantageous Decision-making (Crone et al 2003)
13-15 years
TRIAL BLOCK
10987654321
choi
ces
10,0
8,0
6,0
4,0
2,0
0,0
GAIN
disadvantageous
advantageous
Development of Advantageous Decision-making (Crone et al 2003)
10-12 years
TRIAL BLOCK
10987654321
choi
ces
10,0
8,0
6,0
4,0
2,0
0,0
GAIN
disadvantageous
advantageous
Development of Advantageous Decision-making (Crone et al 2003)
6-9 years
TRIAL BLOCK
10987654321
choi
ces
10,0
8,0
6,0
4,0
2,0
0,0
GAIN
disadvantageous
advantageous
Development of Eye-movement Control as Example to Illustrate Key Principles [Work of Bea Luna et al; U of Pittsburgh]nn Measure speed, accuracy, and precision of eyeMeasure speed, accuracy, and precision of eye--
movement control, including the ability to voluntarily movement control, including the ability to voluntarily override reflexive patternsoverride reflexive patterns
nn Learning how to control Learning how to control behaviorbehaviornn Advantage of wellAdvantage of well--mapped brain circuitrymapped brain circuitrynn Tasks easily adapted to brain imagining (Tasks easily adapted to brain imagining (fMRIfMRI) studies) studiesnn Some aspects develop very early; others lateSome aspects develop very early; others late
Central Fixation (1.5-2.5s)
Saccade to Peripheral Target (1.5s)
-30 -20 -10 0 10 20 30
Degrees of Visual Angle
Visually Guided Saccades
Saccade
Illuminated TargetsCorrect Gaze Location
Non-visible Target Locations
Laboratory of Neurocognitive Development (Luna et. al. )
Central Fixation
Saccade away fromPeripheral Target
-24 -16 - 8 0 8 16 24
Degrees of Visual Angle
Feedback
Illuminated TargetsCorrect Gaze Location
Antisaccades: Look awayfrom illuminated target
1.5
sec
1.5
sec
3 -5
sec
Laboratory of Neurocognitive Development (Luna et. al. )
Developmental Changes In Eye Movement Control nn Visually Guided Saccades (VGS)Visually Guided Saccades (VGS)uuYoung adolescents (age 11Young adolescents (age 11--15) perform as well 15) perform as well
as adultsas adultsnn Memory Guided Saccades (MGS)Memory Guided Saccades (MGS)uuYoung adolescents perform as well as adultsYoung adolescents perform as well as adults
nn AntisaccadesAntisaccades (AS)(AS)uu Adolescents do not perform at adult levels Adolescents do not perform at adult levels
until until after after 15 years of age15 years of age
8-1011-15
16-2021-25
26-3536-45
% o
f Tria
ls
15202530354045
Response Suppression Failuresp < 0.0001
Age Groups (In Years)
Laboratory of Neurocognitive Development (Luna et. al. )
ANTISACCADE
Antisaccade Trial
Antisaccades
36 sec.
36 sec. 36 sec.
Degrees
•Tasks Repeated for 7.5 cycles
VGS
- 8 - 4 0 4 8
Fixation
VGS Trial
Fixation
- 8 - 4 0 4 8
Luna et al. (2001) Neuroimage
IPS
Frontal Eye Fields, Intraparietal Sulcus, andSuperior Colliculus, activated more in adults:
Antisaccades vs. VGS8-13 yrs. 14-17 yrs. 18-30 yrs.
SC16.04.0t-value
5.0 6.0
R L
FEF
Luna et al. (2001) Neuroimage
8-13 yrs. 14-17 yrs. 18-30 yrs.
Lateral Cerebellum and Dentate Nucleus activated more in adults: Antisaccades vs. VGS
LateralCerebellum
DentateNucleus
R L
16.04.0t-value
5.0 6.0Luna et al. (2001) Neuroimage
Luna et al Development of Eye Movement Control
nn Adults employ the Adults employ the SCSC and and FEFFEF, which are , which are areas know to provide preparatory activity areas know to provide preparatory activity needed to successfully suppress saccadesneeded to successfully suppress saccades
nn Adults employ the Adults employ the lateral cerebellum,lateral cerebellum, which which may provide assistance in integrating function may provide assistance in integrating function with prefrontal cortex or in adjusting timing with prefrontal cortex or in adjusting timing elements of the antisaccade taskelements of the antisaccade task
Luna et al. (2001) Neuroimage
DLPFC and Basal Ganglia activated more in adolescents: Antisaccades vs. VGS
DLPFC8-13 yrs. 14-17 yrs. 18-30 yrs.
BG
R L
16.04.0t-value
5.0 6.0Luna et al. (2001) Neuroimage
Conclusions: Child & Adolescent Eye Movement Control
nn Adolescents demonstrated increased function Adolescents demonstrated increased function of DLPFC indicating that compared to adults, of DLPFC indicating that compared to adults, teens may experience this as a more difficult teens may experience this as a more difficult task.task.
nn Children demonstrated increased function in Children demonstrated increased function in posterior parietal cortex known to subserve posterior parietal cortex known to subserve visual spatial processingvisual spatial processing
Luna et al. (2001) Neuroimage
Luna et al: General Conclusions
nn Functional integration of widelyFunctional integration of widely--distributed distributed circuits circuits lays the groundwork for enhanced lays the groundwork for enhanced voluntaryvoluntary control of behavior during control of behavior during adolescent cognitive development adolescent cognitive development
nn This may occur through strengthening of This may occur through strengthening of circuitcircuit--level brain organization (i.e. faster level brain organization (i.e. faster connections across a set of neural systems)connections across a set of neural systems)
Luna et al. (2001) Neuroimage
“Hot” Cognition: Thinking Under Conditions of High Arousal and Emotionnn Steinberg et al compared performance on Steinberg et al compared performance on
computer simulation of risky driving scenario computer simulation of risky driving scenario (running yellow lights)(running yellow lights)
nn Adolescents and Adults were similar when tested Adolescents and Adults were similar when tested alonealone
nn When tested in the company of friends adults When tested in the company of friends adults showed no change but adolescents increased riskshowed no change but adolescents increased risk
Summary
nn Adolescent Affect Regulation/Adolescent Affect Regulation/DysregulationDysregulation and and emotional influences on decisionemotional influences on decision--making represents a making represents a crucial and exciting area of investigation.crucial and exciting area of investigation.
nn Need better integration of clinical, developmental, and Need better integration of clinical, developmental, and cognitive/affective neuroscience focused on adolescents: cognitive/affective neuroscience focused on adolescents: to understand brain/behavior/social context interactions.to understand brain/behavior/social context interactions.
nn Understanding mechanisms and developmental pathways Understanding mechanisms and developmental pathways to disorders can inform clinical and social policies to disorders can inform clinical and social policies regarding the vulnerabilities and opportunities in early regarding the vulnerabilities and opportunities in early adolescence .adolescence .
We search, on our journeys, We search, on our journeys, for a self to be, for other selves to love, for a self to be, for other selves to love,
and for work to do…and for work to do…We find by losing. We hold on by letting go.We find by losing. We hold on by letting go.
----Frederick Frederick BuechnerBuechner
