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The Teen Years Explained

a CDC Prevention Research Center at the Johns Hopkins Bloomberg School of Public Health

Jayne Blanchard

HIV POC Administration Meeting

September 20, 2011

Parkville, MD

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Presenter Disclosures

•HIV POC Administrative Meeting

–There are no financial interests to disclose

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Workshop Objectives

explain adolescence as a developmental process

discuss adolescent brain development as a major phase

identify positive influential role of adults

Feel better prepared to support adolescents

Today we are really going to focus on development in the adolescent years. We will discuss the impact of that development on important tasks areas such as decision making and long-term planning, and provide suggestions for working with adolescents to help them develop the skills they need while “bridging” the areas that are still in development. We will also discuss ways to provide support for you and your colleagues when you are working with adolescents.

We think that this is an important topic because adolescent development is intimately tied into adolescent behavior and risk taking. If we are going to support young people and promote their healthy development, we need to do it in a developmentally appropriate way. Whether we are talking about supporting young people to make appropriate decisions about sexual activity, substance use, or physical activity and diet, we are asking them to avoid risks and make good decisions…

At the end of the workshop today, you will be able to…

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Training Opportunities

•Half Day
•Full Day
•Two Day

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Bingo

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www.jhsph.edu/adolescenthealth/

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Why did we write it?

•Request from community partner
•Nothing else on the market like it
•Desire to tackle head-on negative myths about teens

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What is its purpose?

•Explain the science behind adolescent development

–Challenge and empower adults to invest more attention and more time in young people
–Empower professionals to work with young people in developmentally appropriate ways

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True or False

•In small groups, discuss the statements and decide if each is true or false.

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Popular Myths About Adolescents

Myth

•Most teens think they are invincible

Reality

•Teens assess certain risks better than adults do

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Popular Myths About Adolescents

Myths

•Most teens only listen to friends

Reality

•Adults matter

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Popular Myths About Adolescents

Myths

•Most adolescents live to push your buttons

Reality

•Teens often view conflict as expressing themselves

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Popular Myths About Adolescents

Myths

•Most teens can eat whatever they want & burn it off

Reality

•Obesity rates have tripled since 1980

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Popular Myths About Adolescents

Myths

•Teens need 8 hours of sleep

Reality

•Teens need 9 to 10 hours of sleep per night

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Popular Myths About Adolescents

Myths

•Good self-esteem keeps teens away from risky behavior

Reality

•Sometimes risky behavior brings status and teens with high self-esteem are more likely to participate

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How Is It Structured?

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Boxes Take You Inside Teen Brain

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Charts And Graphs

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Sidebars And How Tos

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Stand Alone Pages

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Themes of the book

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Positive youth development

•Adolescents are resources to be developed, not problems to be solved

The Positive Youth Development approach recognizes that all adolescents have strengths and that children and youth will develop in positive ways when these strengths are aligned with resources for healthy development in the various settings in which adolescents live and interact. Research indicates that the more exposure that adolescents have to positive resources and experiences—

and where synergy between multiple settings can be established—the more likely it is that they will develop positively. As afterschool providers you are poised to invest the time and attention in young people and you will be able to support their development more effectively when you understand it.

In a recent review of pyd programs, 15 of the 30 programs were found to impact sexual health outcomes and pyd programs have shown impact on other outcomes such as substance use and mental health. What is important is that the review showed that programs that were successful were more likely to….

Recent review…

Strengthen the school context

Deliver activities in a supportive environment

Provide opportunities for recognition

Build skills, enhance bonding

Engage youth in real roles and activities, empower youth communicate expectations

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Positive youth development

•Promote the 5 C’s

connection
competence
caring
character
confidence

Developmental scientists have suggested that positive youth development encompasses psychological,

behavioral, and social characteristics that reflect what they call the “Five Cs.” Those “Cs” are

competence, confidence, connection, character, and caring/compassion. A child or adolescent who

develops each of these Five Cs is considered to be thriving

In order for healthy adolescent development to occur, adults need to create opportunities for young people to develop the 5Cs.

Competence—Positive view of one’s actions in specific areas, including social, academic, cognitive, health, and vocational. Social competence refers to interpersonal skills (such as conflict resolution). Cognitive competence refers to cognitive abilities (e.g., decision making). Academic competence refers to school performance as shown, in part, by school grades, attendance, and test scores. Health competence involves using nutrition, exercise, and rest to keep oneself fit. Vocational competence involves work habits and explorations of career choices. Afterschool programs can play a large role in structuring opportunities for young people to develop competence in many of these areas.

In your programs you can incorporate skill building in specific areas such as academic tutoring, health and nutrition, conflict resolution, and decision making as well as specific skill building activities like art or sports. The important thing is that young people have the opportunities to build their skills

Skill-building may lead directly to other Cs…

Confidence—an internal sense of self efficacy and positive self worth, which is often fostered when young people develop competence.

Connection—positive bonds with people and institutions… this is a natural fit for school and afterschool programs. It is the connection young people feel with the adults in the program that will retain those young people in the program. We would argue that understanding young people and how they develop will help facilitate those connections.

Character—a sense of right and wrong (morality), integrity, and respect for standards of correct behavior. Apart from formal character education programs, a focus on appropriate structure within your program can help to foster character among the young people you serve. A clear set of rules that are consistently enforced is an excellent way to model character.

Caring—a sense of sympathy and empathy for others. Adolescents don’t read facial expressions well, so taking the time to explain how you feel and giving them the opportunity to name their own feelings can help them develop their social and emotional skills.

In a study of positive youth development out of Tufts University, how young people spent their time afterschool is one of the most important factors predicting positive youth development. So you are poised to make a great impact on young people at a crucial time in their lives.

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Time of opportunity

When we appreciate what is really happening with adolescents, we can see it as the time of opportunity that it is

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The ever-expanding teenage brain

•Changes in the brain impact a young person’s physical, emotional, sexual, and spiritual development

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Adults and settings matter—a lot

Development doesn’t

happen in a vacuum,

or by itself

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Out of Sync Is Completely Normal

Healthy development can occur unevenly or out of sync

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Profiles of Development

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What do we know about teen risk-taking?

•Capable of assessing risk (they do not feel invulnerable)
•Get greater rewards from risk than do adults

–the emotional rewards are higher
–the meaning is different

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What do we know about teen risk-taking?

•Do not have the cognitive skills to regulate impulses and novelty-seeking as well as adults do
•Social context—peers, adults, media diet—affect how teens act on impulses and seek out new thrills

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What do we know about teen risk-taking?

•Risk-taking is necessary to transition to adulthood

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To reduce teen risk behaviors settings must take into account …

•How teens understand and regulate emotions—theirs and others
•Teens’ capacity to resist impulses
•Utility of novelty-seeking and sensation-seeking
•Meaning of risky behaviors for teens
•Peer influences
•Adult influences

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Brain Development

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Gray Matter

Birth 3 months 2 years

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“We now know through science that the first three years of life is the most critical time period when the brain develops at a greater rate than any time during the course of a person’s life… but by age 10 your brain is cooked and there’s nothing much you can do.”

- Rob Reiner, National Governor’s Association Speech, February 1997

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The second period: Adolescence

Dr. Giedd et al., 1999

•Longitudinal study on 145 children/adolescents
•Two waves of gray matter over-production

–Conception to 18 months
–Adolescence

•each wave of over-production followed by a period of “pruning” of synapses and increased white matter

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Teen Brain

•Short talk, huh?
•They found one?
•Contradiction of Terms?
•Next talk on Loch Ness Monster?

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Different not Defective

•The Adolescent Brain is not a broken or defective adult brain
•It is exquisitly forged by the forces of evolutionary history to have different features than adults or children.

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Gray vs. White Brain Matter

Gray Matter

•Neurons’ cell bodies and dendrites
•“Thinking” portion of the brain

White Matter

•Insulation for neurons = myelination
•Enhances efficiency

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Gray vs. White Brain Matter

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Efficiency

•Increased White Matter = Increased Efficiency

–Efficiency of communication is a better predictor than activity

•Memory and resistance to peer pressure

•Fundamental Pattern

–Increased cognitive activity relies on tying together and integrating information from different sources

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The Adolescent Brain

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Prefrontal Cortex

•Prefrontal cortex

•Advanced Reasoning

•Planning
•Cause and Effect
•Manage Impulses

The prefrontal cortex is responsible for memory, advanced reasoning, which encompasses the ability to plan, understand cause and effect, think through scenarios (including thinking abstractly), and manage impulses. This part of the brain is sometimes called the CEO of the brain since it. While the research is still young and there isn’t a lot of work tying the development to behavior, it seems logical that there may be an important link between brain development and an adolescent’s ability to stop to consider end results, develop logical plans, or filter thoughts before blurting them out.

The brain changes continue up to at least age 21, and some scientists believe maturation is not complete until 25. Brain development seems to vary so much between individuals that it is impractical to pinpoint a specific age or cutoff point at which young people reach full maturity in thinking and reasoning. Interestingly connectivity, as indicated by the volume of white increases throughout childhood and adolescence and continues to grow until women reach their 40s and men their 30s.

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Prefrontal Cortex

•Gray matter loss occurs latest in Prefrontal cortex

–reaches adult levels in 20s

•Sowell et al. 1999

•Compared MRI scans of 23-30 year olds to 12 – 16 year olds
•Areas of frontal lobe showed the largest differences among these two groups

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Risk Taking in Adolescence

•Brain regions developing at different rates
•Limbic system in early adolescence
•Frontal lobes later

–More areas involved in processing emotions
–Self-control develops

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What did you do?

•Take a couple minutes and think about the teenage you…

–Think of one risk you took without thinking twice that you would never dream of taking today.

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Dam sliding

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Risk Taking in Adolescence

•It will never happen to me

–Invulnerability as a stage of development

•Adolescents do feel vulnerable, however being aware of risks doesn’t stop them from taking action

–Reward vs. avoidance
–Hot vs. cold cognition

For decades, we thought that adolescents underestimate risk.

Teens, it was thought, feel invincible: This perceived sense of invulnerability was thought to be a stage of cognitive development that adolescents had to pass through on the way to adulthood.

We now have considerable scientific evidence that adolescents do feel vulnerable at the prospect of contracting a sexually transmitted disease or getting sick from drinking too much. In fact, several studies have found that adolescents perceive more risk in certain areas than adults, such as the chance of getting into an accident if they drive with a drunk driver. Teenagers also are not as optimistic about avoiding injuries and illness as their parents. However, they are less likely than adults to believe poor health will result from experimenting with sex, drinking/drugs, or smoking.

For many adolescents, being aware of the risks involved in a given action fails to stop them from participating. Research is starting to show that adolescents judge the benefits of partaking in risky behaviors differently than adults do, and this difference in judgment may have a biological basis in the brain. Functional MRI studies have shown that when players are winning at gambling, the “reward” center lights up more in teens’ brains than in adults’ brains. Conversely, when players are losing, the “avoidance” center lights up less in teen brains compared to adults.

Teens also may discern social benefits from smoking and drinking, or peer acceptance with sexual activity. In schools and communities where the popular students are more likely to smoke, drink, and be sexually experienced, trying out these risky behaviors could be viewed by young people as a rational and, one could even argue, low-risk strategy for getting approval from their friends and fellow students. Remember, this is experimentation, not habitual behavior.

Psychological tests are usually conducted under conditions of “cold cognition”—hypothetical, low-emotion situations. However, real-world decision making often occurs under conditions of “hot cognition”—high arousal, with peer pressure and real consequences.

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Risk Taking in Adolescence

•Taking risks allows young people to take on new challenges

–Younger adolescents – help them take safe risks
–Older adolescents– help them strengthen their capacity for cognitive control

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Reflection Exercise

•Reflection Discussion: Given what you have learned today about the teen brain and teen risk-taking, how does your curriculum and workshops with young people reflect this knowledge?
•What are you currently doing?
•How could you modify or change your approach?

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cognitive development

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Understanding Cognitive Development

•Strengthened advanced reasoning skills

–What if?

•Abstract thinking skills

–Faith, love, trust, beliefs

•Meta-cognition

–Thinking about thinking

Throughout the brain development process, the capacity for advanced reasoning, abstract thinking, and meta-cognition (thinking about thinking) expands and improves.

In adolescence, cognitive development occurs in three main areas. First, young people strengthen their advanced reasoning skills, which includes thinking about multiple options and possibilities, pondering things hypothetically (the age-old “what if…?” questions), and following a logical thought process.

Second, teenagers start to develop abstract thinking skills, meaning they think about things that cannot be seen, heard, or touched. These topics might embrace faith, love, trust, beliefs, and spirituality, as well as higher mathematics.

Third, they enlarge their capacity to think about thinking, a process known as “meta-cognition.” Meta-cognition allows young people to consider how they feel and what they are thinking, and also involves being able to think about how one is perceived by others.

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I Don’t Think That’s Fair

•Early advances in reasoning tend to lead adolescents to view things in the extremes

–Need practice to develop these skills

•View conflicts from

different perspectives

–Is a clean room a
personal choice or a
reflection of morals?

I don’t think that’s fair

Advances in reasoning skills can cause teens to become interested in fairness or justice. They are quick to point out inconsistencies between adults’ words and their actions. However, the developing adolescent brain makes it difficult for them to see shades of gray or nuances in arguments and opinions. They tend to view things in the extremes of black and white, seeing little room for error. Hone their reasoning skills by encouraging teens to talk about their views, whether it is their political or spiritual beliefs or something they saw on the internet or in a magazine.

Researcher Laurence Steinberg, PhD, has suggested adults and adolescents have different views of conflict. It is the parents who get stressed out by dust-ups over daily mundane matters. A possible reason for this is that adults see matters as stemming from moral issues of right and wrong, traditions, social customs, and core beliefs. Teens tend to view them as matters of personal choice.

Take a clean bedroom. Adults view the issue from a moral standpoint (cleanliness is next to godliness; cleaning your room is the right thing to do). An adolescent is more committed to the issue of fairness—my room is my domain; it is not fair for parents to dictate whether my room is neat or messy, and what does it matter in the grand scheme of things? An adolescent is less interested in the moral standpoint, so the conflict may not be as meaningful for them. Therefore, the parent may walk away upset—and stay stressed—more often than the young person.

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What Adults Can Do

•Ask open-ended questions.
•Highlight the role of emotions in decision-making processes.
•Focus on strengths youth bring to the decision-making process.
•Get youth actively practicing decision making

Freshly acquired reasoning and logic skills are like a new gadget adolescents are just itching to try out. Here are some ways you can help young people effectively use their developing brains:

Ask open-ended questions that will help adolescents consider their range of options and how each choice should be carefully weighed.

-Example of an open-ended question: “How do you think it will benefit you and/or harm you to quit your after-school job to join the basketball team?” (invites thought and debate)

-Example of a close-ended question: “Will you regret quitting your after-school job to join the basketball team?” (solicits a yes or no response)

Make sure teens grasp the role of emotions in the decision-making process—feelings like anger, fear, sadness or elation can cloud judgment. Decisions, especially important ones, should be made when calm and revisited after “sleeping on it.”

Realize teens bring a variety of strengths—logic, common sense, creative approaches—to the decision-making process.

Given the developmental directive to experiment, it is not surprising that scare tactics and “just say no” campaigns have proven to be ineffective with young people. More successful strategies engage youth in using their emerging critical-thinking skills. For example, taking a young person through the risks of a certain action or activity and having them assess the situation’s consequences at every juncture allows them to develop future-thinking techniques and makes them feel more in control. This tactic challenges their intellect, while simply forbidding them to do something only challenges their sense of autonomy.

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What Adults Can Do

•Be patient when teens “test drive” their newly acquired reasoning skills.
•Never correct or put down an adolescent’s logic.
•Don’t take it to heart when teens criticize adult opinions and behaviors.

Teens enjoy practicing their budding ability for lively debate. For them, conflicts may just be a way of expressing themselves. Adults, on the other hand, tend to take arguments personally and might view them as intense and disruptive.

Be patient when teens “test drive” their newly acquired reasoning skills and encourage healthy, respectful debate by setting “rules of engagement.”

Disrespect should never be tolerated by either an adolescent or an adult.

Never correct or put down an adolescent’s logic; simply listen and acknowledge their feelings. A better strategy is to ask them how they got to the thoughts or conclusions they are expressing.

Don’t take it to heart when teens criticize adult opinions and behaviors. They may challenge you, but they still need you.

Unless a teen has a history of problem behavior, do not worry if he or she demonstrates melodramatic tendencies.

Remember, not every disagreement is a conflict.

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What pushed your buttons?

Take a couple moments to think about a situation when you lost it, when you were very frustrated with a young person and their behavior…

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SOS

•Stop

–Breathe

•Orient

–Take a moment to reflect on the situation

•What are we upset about?

•Self-Check

–Am I being respectful?
–Can I address the current issue?

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social and emotional development

a quest for social and emotional competence

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What is social and emotional competence?

•Emotional competence: the ability to perceive, assess and manage one’s own emotions
•Social competence: the capacity to be sensitive and effective in relating to other people.

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Emotional/Social development

•Self-awareness
•Social awareness
•Self-management
•Peer relationships

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Self-awareness

•What do I feel?

–learning to recognize and name emotions
–going deeper means a teen may discover he feels anxious about a test or she feels sad when a love interest kicks her to the curb
–identifying the source of a feeling leads to constructive ways to resolve problems

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Social awareness

•What do other people feel?

–also known as developing empathy
–understanding the thoughts and feelings of others and appreciating the value of human differences are the cornerstones of social awareness

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Social Awareness Tough for Teens

•Adolescents actually read emotions through a different part of the brain than adults do.

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What do you see?

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Social Awareness Tough for Teens

•MRIs were taken of adult and teen brains as they were shown faces expressing fear

–All adults correctly identified fear
–Half the teens got it wrong

•Adults used multiple areas of their brains, teens did not

Source: Inside the teenage brain: Introduction. Retrieved January 18, 2007 from http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/etc/synopsis.html

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Ways adults can help

•Tell teens exactly how you are feeling

–For example, an adult can say “I’m not mad at you, just tired and crabby”

•Help teens learn to describe how they are feeling to others

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Emotions can (and should) be managed

•Self-management is monitoring and regulating one’s emotions.
•In young people, it involves using their developing reasoning and abstract thinking skills.

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Here come those peers

•Decisions about how to act are often made in group situations, settings that rouse intense feelings and impulses

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Peers and risk

•When participants were alone, the levels of risky driving were the same for all 3 groups
•When they played the game in front of friends, risky driving doubled for teens & went up by 50% for college students
•The level stayed unchanged for adults

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Peers and risk

•In a follow-up study, Laurence Steinberg and colleagues used MRIs to map brain activity during the video driving game
•Brain scans showed teen brains responding differently with friends:

– reward parts of the brain lit up, suggesting that risk behaviors are even more tempting in the presence of peers

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Establishing social status

•The experience of social acceptance is more rewarding for teens than adults

the reward center in the brain is more active when teens experience peer acceptance

•Implication: taking risks to impress or go along with the crowd has clear benefits

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Dating: the positives

•Dating leads to emotional growth

–through dating teens experience happiness, excitement, disappointment & despair

•Both boys & girls value emotional intimacy in romantic relationships

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Dating: the consequences of inexperience

Most teens don't understand what a healthy relationship is, often mistaking the controlling behaviors that characterize abuse for signs of love

In a study by Dr. Liz Miller (UC Davis), 100% of middle school students said possessiveness and jealousy are part of true love

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Where might those messages come from?

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What adults can do

•Model healthy romantic relationships
•Explain what healthy relationships “look like”
•Help teens work on skills to identify their own emotions and resolve conflicts in relationships
•Given that most adults don’t manage their own emotions and resolve conflicts in mature ways, this is a tall order!

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Identity formation

Who am I, and what do I think about that?

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what is identity?

•Self-concept: what a person believes about herself

Influenced by:

religious or political beliefs
gender and ethnicity
family and friends
Media

•Self-esteem: how a person feels about her self-concept

Ebbs and flows, especially in early adolescence
Not necessarily the magic bullet we once thought

Before we explore the 5 themes, we need to know and understand “Identity”

Identity is one’s sense of self. During the adolescent years, teen began to ask themselves questions like, who am I? Who do I want to be? Teens might try different things in order to answer these questions. They are looking for examples. They may choose friends as that example or they may choose you!

When trying to form and Identity, self concept and self esteem come in to play. Self Concept is what a person believe about him or herself. While Self Esteem is how one feels about their self concept.

So If I believe that I’m a pretty nice looking talented kid, then I may see that as being great qualities and have good self esteem. On the other hand- if I believe that I cant do anything right and I’m always getting in trouble because I don’t think- then I might see that as negative and not have great self esteem.

Self concept—or what a person believes about him or herself—is determined by a person’s perceptions about his or her talents, qualities, goals, and life experiences. Self concept can also include religious or political beliefs. For example, a teen’s self concept may be based on her belief that she is smart, artistic, politically conservative and interested in becoming a doctor. A teen’s self-concept is also likely to be influenced by identification with an ethnic group and the experiences he or she has as a result of that connection.

Self esteem, on the other hand, refers to how a person feels about his or her self concept—that is, do they have high regard for who they are? Self esteem is affected by approval from parents and other adults, the level of support from friends and family, and personal success. Ups and downs in self-esteem are normal during adolescence, particularly in the early teenage years (around middle school). Self esteem becomes more stable as teens grow older.

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forming an identity

•5 themes during the identity formation process

creating a sense of achievement

trying on different identities

seeking autonomy

examining sexual identity and capacity for intimacy

establishing social status

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Concluding comments

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Developmental context of adolescent risk-taking

•Brain development
•Social and emotional development
•Cognitive development
•Extreme importance of settings and adults
•Promoting healthy development in as many arenas as possible is key

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Implications for programming

•Teen risk-taking is not simply the result of an accumulation of risk factors

–reducing risk factors is not sufficient

•Teen risk-taking is not simply due to underestimating risk

–throw away the health belief model (or at least supplement it)

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Implications for programming

•Teen risk-taking is related to cognitive development

–help adolescents develop reasoning and thinking skills

•Teen risk-taking is more rewarding with peers

–focus on policies that affect the peer context (but we don’t know how to do this very well yet)

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Implications for programming

•Teen risk-taking is necessary for the transition to adulthood

– focus on creating safe spaces for risk-taking, where consequences are not severe

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Questions?

www.jhsph.edu/adolescenthealth

•Jayne Blanchard, jblancha@jhsph.edu
•Beth Marshall, bmarshal@jhsph.edu
•Katrina Brooks, klbrooks@jhsph.edu

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References & resources

•Capaldi, D.M., H.K. Kim, and J.W. Shortt (2007). Observed initiation and reciprocity of physical aggression in young, at-risk couples,” Journal of Family Violence, 22, 101-111.
•Giedd, J.N., Blumenthal, J., Jeffries, N.O., et al. (1999). Brain developpment during childhood and adolescence: A longitudinal MRI study. Nature Neuroscience, 2(10), 861-863.
•Giordano, P. (2007). Recent research on gender and adolescent relationships: Implications for teen dating violence research/prevention. Presentation at the U.S. Departments of Health and Human Services and Justice Workshop on Teen Dating Violence: Developing a Research Agenda to Meet Practice Needs, Crystal City, Va., December 4.
•Giordano, P.C., Longmore, M.A. & Manning, W.D. (2006) Gender and the meanings of adolescent romantic relationships: A focus on boys. American Sociological Review, 71, 260-287.

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References & resources

•Mulford, C. & Giordano, P.C. (2007) Teen dating violence: A closer look at adolescent romantic relationships. NIJ Journal, 261, 34-40.
•O’Leary, K.D., A.M. Smith Slep, S. Avery-Leaf, and M. Cascardi, “Gender Differences in Dating Aggression Among Multiethnic High School Students,” Journal of Adolescent Health 42 (2008): 473-479.
•Pollack, W. (1999) Real Boys: Rescuing Our Sons from the Myths of Boyhood. New York: Henry Holt & Company.
•Steinberg, L. (2007) Risk taking in adolescence: New perspectives from brain and behavioral science. Current Directions in Psychological Sciences, 16(2), 55-59.
•Steinberg, L. (2008) A social neuroscience perspective on adolescent risk-taking. Developmental Review, 28, 78-106.