What Are They Thinking!!!: Pediatric Brain Development

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Brian M. Fidlin, Psy.D.

Froedtert Hospital and Health Center

Mequon Health Center

Clinical Psychologist

Intellectual Development�Conception – Cell Division/Specialization

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Brain Cell

Brain Cells -continued

The Brain

• Gray Matter vs. White Matter
• Plasticity Concept
• Neurotransmitter

How Brain Cells Communicate

To send a message, a brain cell releases a chemical (neurotransmitter) into the space separating two cells called the synapse. The neurotransmitter crosses the synapse and attaches to proteins (receptors) on the receiving brain cell. This causes changes in the receiving brain cell and the message is delivered.

Seratonin and Stress

• Wide Pathways vs Narrow Pathways
• Response to Stress
• Simple Stressors
• Complex Stressors
• Decision-Making
• With normal Seratonin levels
• With low Seratonin levels
• Seratonin and Depression

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Practical Application - Stress

• How would I rate my child’s ability to manage stress? High/Medium/Low
• How much does my child have “on their plate”? (Tip: think typical vs. temporary, positive vs. negative, past/present/future)
• What are the signs my child displays when they are not stressed/stressed/overwhelmed?
• What level of stress do I want my child functioning at? What if that means turning opportunities down?
• What will we do when we are stressed and more demands (positive or negative) arrive?

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Practical Application - Plasticity

• Clear, consistent, repeated messages are the easiest to learn.
• Remember, unless a bridge exists – information in one pattern may not be available to another pattern. Think about the various patterns in your child’s life – Are you present in each pattern?
• Be Here Now! – how do we discourage interference.
• Bringing work home/homework.
• Cell phone/Social media issues
• Establishing family routine/patterns

Timeline: 3 to 6 months following conception

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• Proliferation

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• Brain reaches maximum brain cell density

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• Brain cells compete for space/nutrients

Timeline: 6 months following conception to Birth

• Massive pruning

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• Cells deemed not needed are ‘pruned’

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• Mistakes can occur
• One theory suggests Autism is the result of an insufficient or abnormal pruning process

Timeline: Birth to 6

• The brain grows to approximately 90 to 95% of it’s adult size

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• Brain cell numbers do not increase

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• Capable of absorbing tremendous amounts of material

Timeline: 6 years to tweens

• Massive proliferation – expansion of synaptic connections

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• Girls—11 years old
• Boys—12 ½ years old

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• Vast capability but rather clumsy.
• Curious, questioning, exploration

Timeline: Adolescence

• Massive Pruning: Synaptic connections are reduced to increase efficiency

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• How is this done?
• Genetics
• ‘Use it or Lose it Principle’

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• So, what is your kid doing right now?

Practical Application

• We all have limits. We cannot do everything.
• Everyone is different.
• We must budget/spend our resources wisely.
• What skills do we, as parents, value and think our child needs to have to function independently in the world?
• What path is my child on? What skills do they need? What skills do they not need?
• Are we providing the opportunity to develop that skill?
• Academic, Daily Life, Emotions, Communication, Persistence, Patience, Relationships, Money Management, etc…

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Brain Maturation

• 1^st
• Structures that mediate direct contact with the environment (senses/motor functions)
• 2^nd
• Areas that coordinate these functions (patterns)
• Last
• Pre-Frontal cortex (executive functions) including planning, setting priorities, organizing thoughts, suppressing impulses, and weighing consequences

Images of Brain Development in Health Children and Teens (5-20)

* Blue represents maturing brain areas

Source: Copyright PNAS USA. 2004 May 25; 101(21):8174—9. Epub2004 May 17.

Emotional Development:�Hormones

Limbic Systems - Flashpoint

Limbic System – Thrill Seeking

Limbic System – Emotional Cues

Practical Application

• Do NOT get into an emotional fight with an adolescent.
• When our emotional regions become activated they ‘drain’ power from cognitive regions.
• Groups of adolescents – flashpoint issues becomes cluster-bomb issues
• Thrill seeking (very genetically driven)needs to be guided.
• These issues are genetically driven to encourage one to move away from the familiar and drawn to the unfamiliar. There is a species survival mechanism at play.
• Because they are in unfamiliar territory, their system is designed to be overly self-protective/paranoid (Amygdala=fight/flight/freeze).
• Sympathetic cells and parenting

Dopamine

Practical Application

• Adolescents are prone to addictive behaviors.
• How much freedom/independence can my child handle? (Real world/social media/internet/etc…)
• How are we going to set limits to prevent the establishment of dangerous/negative behaviors?
• Consider that some things are not clear cut negatives (i.e. academic studies)
• What can we do to help encourage the establishment of healthy/positive behaviors?

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• Parents need to be involved.

High Intensity Emotions + Immature Cognitive Abilities = ???

Moral/Spiritual Development:�Motivation, Boredom, Brains, and Pirates

• Dr. Adrian Galvan from UCLA was examining a particularly interesting structure within the brain associated with motivation and boredom.

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• The nucleus accumbens lights up with dopamine, under a fMRI, whenever we find something exciting or pleasurable.

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• Galvan was studying differences between young children, adolescents, and adults.

• She had them play a pirate video game while inside of a fMRI where their efforts could earn them either a single gold coin, a small stack of gold coins, or a large jackpot of gold coins.
• (Galvan et al, 2005)

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Motivation, Boredom, Brains, and Pirates

• Young kids nucleus accumbens activated no matter what they won.
• Adults nucleus accumbens activated in relation to what they won; i.e. single coin – small response
• Adolescents had an usual response. There nucleus accumbens did not activate up at all for a single coin or a small stack, in fact they dipped below baseline.
• Only when they got the jackpot did their nucleus accumbens activate and when it did it’s response was significantly higher that the young child’s or the adult’s response.

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• Their response curve is essentially the same as a seasoned drug addict Their reward center could only be stimulated by big doses - not small doses

Motivation, Boredom, Brains, and Pirates

• She also noticed that when the nucleus accumbens was experiencing intense excitement their prefrontal cortex functioning (executive function, foreseeing consequences, gauging risk) began showing a diminished response.
• Thus, in abstract situations adolescents can evaluate risks just like adults but in exciting real life circumstances this rational part of the brain is overridden by the reward center.
• Galvan had subjects previously complete questionnaires on how often they participated in risky behaviors within their life (getting drunk, fireworks, vandalizing property) and whether they found these activities fun. She found that those who said that the risky behaviors sounded like fun also had higher spikes in their reward center when they won the jackpot of gold in the pirate video game.
• Therefore, some teens are just wired to be risk takers to get their reward centers lit up.

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I know I should not have done it, but…

• Dr. Abigail Baird also put adolescents and adults in a fMRI and examined how their brains responded to whether a particular activity was a good or bad idea (i.e. biting a light bulb)
• She found that adults answered instantaneously and that areas of the brain that signal distress and danger lit up automatically.
• Adolescent answered the same as adults but they took longer and they had no automatic responses – they were weighing the decision in the cognitive parts of their brains. They were thinking about it not feeling it.
• Adolescent brains can think abstractly but not feel abstractly because they don’t have life experiences to draw on. And feeling like it’s a bad ideas is what it would take to stop oneself from doing it. (Baird et al, 2006)

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Persistence

• Neural network running through frontal cortex and ventral striatum
• Intervenes when there is a lack of immediate reward
• When activated, it encourages the brain to persist in it’s efforts
• The circuit can be trained through intermittent reinforcement.
• Therefore, a person who grows up getting too frequent rewards will not have persistence – because they quit when the rewards disappear
• Clients need to be frustrated and learn that they can tolerate these experiences.

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(Cloninger)

Practical Application

• Rewarding during adolescence is different than at any other time.
• Short-term objective rewards will be more effective than long term abstract rewards.
• The more exciting something is the less likely an adolescent will be able to THINK through it.
• To build persistence, one needs to work at a task and be frustrated before getting the reward upon completion.
• Adolescents need to earn privileges through the demonstration of putting in the effort. We as adults can help encourage the effort.
• Does your child get because they ask?
• Do you give because they have earned it or for other reasons?

Getting them to talk… and be honest

• To learn from one’s experiences, one need to do a honest examination.
• Dr. Nancy Darling found that lying is common amongst adolescents but that parents who were lied to the least were the ones who had rules and enforced them consistently but found a way to be flexible.

Honesty… at a cost

• Families who had lower levels of lying has higher levels of arguing and complaining.
• Adolescents often told the truth in hopes that their parents would give in on an issue or request. Usually this would result in an argument, but it would be worth it if their parent would compromise.
• “Moderate conflict with parents during adolescence is associated with better adjustment than either no-conflict or frequent conflict” (Smetana)
• Major differences in how conflict was perceived:
• 46% of mothers rated arguments as destructive to the relationship
• 23% of daughters rated arguments as destructive.
• Daughters often believed that arguments strengthened their relationship – a way to see their parent in a new way
• Daughters who rated arguments as destructive had parents who would ‘stonewall’ them rather than collaborate.
• Parents who negotiate are ultimately better informed. Parents with unbending strict guidelines make it a tactical issue for kids to find a way around them. (Laird)

Practical Issues

• Spend time with your children.
• Get to know their interests.
• Share your interests with them.
• Do NOT become friends. It is not possible to be their friend and their parent.
• There is no such thing as quality time without quantity/consistency.
• Listen.

Physical Development:�Sleep Recommendations

• Newborns to 18 months: 10-18 hours of sleep per day (including naps)
• 18 months to 3 years: 12-14 hours a day (including naps)
• 3 to 5 years: 11-13 hours a night
• 5 to 12 years: 9-11 hours a night
• Teens: 9 hours a night

National Sleep Foundation Findings

• 90% of American parents believe their child is getting enough sleep.

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• 60% of high school ages children report extreme daytime sleepiness
• 25% of them believe their grades have suffered because of it.
• 20-33% of high school students admit to falling asleep in class at least 1 time per week.

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National Sleep Foundation Findings

• 50% of adolescents get less than 7 hours of sleep on weeknights
• Average = 6.5 hours of sleep per night
• Only 5% of high school seniors average 8 hours

When I was your age...

• Kids, from elementary school to high school, are averaging 60 minutes less of sleep per night than kids 30 years ago.

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• Even kindergarteners are getting 30 minutes less than they did 30 years ago.

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Possible causes…

• Overscheduled kids
• Excessive homework
• Lax bedtimes
• Televisions/Videogames/Computers/Phone
• Parental Guilt

I’m not tired …(yawn)

• Impact of Chronic Sleep Deprivation
• Children’s brains are still a ‘work in progress’
• Academic performance
• Emotional stability
• Moodiness, Depression, Binge Eating
• Obesity epidemic
• Attention Deficit Hyperactivity Disorder (ADHD)

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Academics

• 4^th grade and 6^th grade students
• Equipped with actigraphs
• Random assignment:
• Stay up later (50% 4^th, 50% 6^th)
• Go to bed earlier (50% 4^th, 50% 6^th)
• Difference was 61 minutes between groups
• After 3 days – tested for neurobiological functioning (Computerized version of Wechler Intelligence Scale for Children subtests)
• Highly predictive of current academic achievement
• Highly predictive of how teacher’s rate a child’s ability to maintain attention within a classroom setting.

Academic – results

• The performance gap between groups was larger than the gap between normal 4^th graders and normal 6^th graders.

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• A slightly sleepy 6^th grader will perform in class similar to a 4^th grader

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• A loss of one hour of sleep is equivalent to the loss of 2 years of cognitive maturation and development

Cognitive effects

• Almost all children go to bed later and wake up later on weekends.
• They are not getting less sleep – just shifting their sleep pattern

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Cognitive effects

• Every hour of weekend shift costs a child 7 points on a standardized IQ test (LeBourgeois)
• “Sleep disorders can impair children’s IQ as much as lead exposure.” (Surrott)

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Cognitive Effects by Age

• The correlation between sleep and school grades holds regardless of age.
• Dramatically increases during adolescence.
• Teens who received A’s averaged 15 minutes more sleep than those who received B’s, who in turn averaged 15 minutes more sleep than those who received C’s.
• Every 15 minutes counts.

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But why ???

• Tired children having difficulty remembering what they have just learned because neurons lose their plasticity.
• Attention issues may be due to the fact that sleep loss debilitates the body’s ability to extract glucose from the blood stream – prefrontal cortex (executive functioning) suffers.
• Not surprisingly, tired people have difficulty with impulse control, abstract thought, and are prone to perseveration.

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But why ???

• During sleep, our brain shifts material into long term storage regions.
• For example, studying a foreign language involves learning vocabulary, auditory memory for sounds, and motor skills to correctly enunciate words.
• Vocabulary is synthesized through the hippocampus early in the night during ‘slow wave sleep’, deep sleep without dreams
• Motor skills of enunciation are processed suring stage 2 non-REM sleep
• Auditory memories are encoded across all stages
• Memories that are emotionally laden get processed during REM sleep

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• The more you learn during the day, the more you need to sleep at night

But why ???

• To reconsolidate memories, genes are involved.
• A particular gene is essential for synaptic plasticity – strengthening connections
• The brain does synthesize some memories during the day – but they are enhanced and solidified during the night.
• This leads to new insights, inferences, associations the next day.
• Just sleep on it…

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But why ???

• Children spend more than 40 % of their time in slow-wave sleep
• Adults spend 4% of their time in slow-wave sleep

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• Consider what we are asking of children to learn

Emotions and Sleep

• The emotional context of a memory affects where it is processed.
• Negative stimuli are processed through the amygdala.
• Positive and neutral stimuli are processed through the hippocampus.
• Sleep deprivation affects the hippocampus much more than the amygdala,
• Therefore, sleep deprived people have difficulty recalling pleasant memories but recall negative memories just fine.

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• Walker, sleep deprived college students memorizing lists of words. Able to remember 81% of negative connotation words like ‘cancer’ but only 31% of positive of neutral words like ‘sunshine’ or ‘basket”.

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• Dropping below 8 hours of sleep doubled the rate of clinical-level depression

Adolescents and ‘phase shifting’

• During puberty, the circadian system phase shifts for adolescents.
• Melatonin is released 90 minutes later than typical – staring at the ceiling, I want to sleep but I can’t.
• Early mornings mean less quality sleep.
• This has some school districts considering later start times for high school students

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Adolescents, Sleep, SAT

• Edina, Minnesota, affluent suburb of Minneapolis
• Changes start time from 7:25am to 8:30am
• Most dramatic for bright kids, top 10%
• Preceding year math/verbal: 683/605
• Present year math/verbal: 739/761
• Students also reported higher levels of motivation and lower levels of depression
• Brian O’Reilly, Executive Director of SAT: “Truly flabbergasting”

Adolescents, Sleep, Driving

• Young adults responsible for 50% of the 100,000 ‘fall asleep’ crashes annually
• Lexington, Kentucky changed start time to 1 hour later.
• Teenage car accidents in Lexington were down 25%, compared to the rest of the state

Dr. Mark Mahoward

• Director of the Minnesota Regional Sleep Disorders Center

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• “Schools are scheduled for adult convenience: there’s no educational reason we start schools as early as we do.”

• Several scholars have argued that the typical traits of adolescence – moodiness, impulsiveness, disengagement – are also signs of chronic sleep deprivation

The Next Michelangelo ???

Self Esteem Revolution

• Nathaniel Braden considered self esteem to be the single most important facet of a person (The Psychology of Self Esteem, 1969)
• This lead to a movement to protect children’s self esteem at all costs.
• Belief that praise, self esteem, and performance are dependent upon one another
• Explosion of research: 15,000 scholarly articles written from 1970 – 2000
• Results confusing, contradictory, inconclusive

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Self Esteem: Confusion to Clarity

• Dr. Roy Baumeister, leading proponent of the self esteem movement
• 2003 – Association for Psychological Science
• Evaluated 15,000 studies, vast majority flawed
• 200 employed a scientifically sound means to measure self esteem and its outcomes

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Self Esteem: Confusion to Clarity to Disappointment

• Conclusion
• High self esteem did not improve grades
• High self esteem did not improve career achievement
• High self esteem did not reduce alcohol usage
• High self esteem did not lower violence of any sort

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• “The biggest disappointment of my career.”

One Major Bright Spot

• Studies had shown that praising a child for their intelligence would increase their self confidence.
• Carol Dweck of Columbia University questioned these findings.

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Dweck – Part One

• 400 – 5^th grade students in New York
• 4 female research assistants
• Single child given nonverbal IQ test involving 5^th grade level puzzles.
• All children did well.
• Research assistants provided the child with their score and a single line of praise
• “You must be smart at this.”
• “You must have worked really hard”

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Dweck – Part Two

• Subjects given a choice
• A more difficult test than their first but that they would learn a lot attempting the puzzle
• An easy test, just like the first.

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• Those praised for intelligence, majority took the easier test.

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• Those praised for effort, 90% took the harder test challenging themselves

Dweck – Part Three

• Participants had no choice
• Were given 7^th grade level puzzles
• Everyone failed
• Those praised for intelligence assumed that they were not smart enough and gave up quickly. Many showed visible signs of distress
• Those praised for effort immersed themselves in the task attempting multiple solutions taking a significant amount of time. Many commented that this was their favorite portion of the test.

Dweck – Part Four

• All subjects provided 5^th grade level puzzles
• Those praised for intelligence performed 20% worse in comparison to their 1^st round of puzzles.
• Those praised for effort performed 30% better in comparison to their 1^st round of puzzles.

Dweck - Conclusions

• Praising intelligence may lead to underperformance
• Praising intelligence discounts the importance of effort
• Those praised for intelligence may consider showing effort as a sign that they lack intelligence.

Supporting Research

• For college students on the verge of failing, self esteem building praise actually caused their grades to sink lower (Baumeister).
• Children younger than 7 years take praise at face value, older children are just as suspicious about praise as adults (Dweck)
• By the age of 12 years, children believed praise from a teacher is not a sign that you did well but a sign that you lack ability and that the teacher thinks you need encouragement (Meyer)
• Adolescents discounted praise to such an extent that they believed a teacher’s criticism, not praise, conveys a positive belief in a student’s aptitudes (Meyer).
• Teachers who praise a child may unintentionally be signaling that the child has reached their limit of innate abilities. Whereas, a teacher’s criticism signals that they can improve their performance (Willingham).

Supporting Research, continued

• When a child interprets praise as meritless, they discount not just the insincere praise but sincere praise as well (Brook)
• Heavily praised college students become ‘risk adverse’ and lacked perceived autonomy. They would drop classes rather than receive an average grade and struggled to committ to a major (Reed).
• Over-praised children become highly competitive and socially destructive with peers. Major emphasis is placed on image maintenance (Dweck)
• Over-praised children strongly consider cheating as a means to maintain their image (Dweck)

QUESTIONS