ADOLESCENCE: The Transition

Adolescence can be defined as a transitional period between childhood and adulthood. It is a stage of life that is bracketed on one end by puberty, a physiological process, and on the other end by the ability of an individual to assume social responsibilities assigned to adults in the society. It is during this period of time that a youth separates from the dependence on the family and begin to explore the world at large. In order to function independently the individual has to develop certain skills that allow them to reflect, conceptualize and strategize alternative solutions before engaging in action. The individual has to demonstrate the ability to work toward future goals, following a sequence of steps and delaying immediate rewards for longer term gains. All of these functions are mediated by the brain region that is under construction during adolescence known as the prefrontal cortex.

The second decade of life is a time of enormous change in brain architecture but these changes are just the product of processes that began in utero and early in life.  The brain is going through a major upgrade where processes are becoming more effective and efficient during adolescence. Early in life, these same functions are just emerging from genetically–driven and environmentally modified neuronal structures.

There are many people who exaggerate the changes taking place in the adolescent brain while others attempt to minimize the impact of these events. The facts are clear, however, that the adolescent brain is different from and eight year old and different from an adult’s brain.  During adolescence, there is an elimination of nearly 40% of the synaptic connections that were over produced earlier in life. The majority of these connections are excitatory in nature. The percentage of inhibitory neurons is greater in adults than children and adolescents. (A.L Spenssort, K.J. Plessen, and B.S. Peterson, 2004)

Although we are still researching the causes for this significant reduction, the best hypothesis is that it occurs from a combination of genetics and experience dependent processes; the concept of “use it or lose it” where neurons that are activated with enough frequency become stronger and those that are not used get reabsorbed.

The adolescent’s reward system is also being modified. An increase in receptors and the phaseal release of the neurotransmitter, dopamine, has been related to increase sensation seeking and a focus on short term rewards at the expense of longer term gains (Steinberg, 2009). For most teenagers this change in the reward system stabilizes in early adolescence while self regulation skills do not mature until late adolescence. This means that younger adolescents are being driven toward high risk situations with an immature internal control system. No wonder middle school presents such a challenge to teachers and parents.

One of the most significant changes taking place in the brain of the adolescent is the wiring being insulated within the prefrontal cortex, between the cortical regions and in sub-cortical regions. This allows information and energy to flow 1oo times faster. The supportive glial cells are forming a fatty sheath around the axons of the neurons in a process called myelination. The speed of information flow allows adults to integrate past associations, analyze current information, and make better decisions. It isn’t that adolescents cannot problem solve, it just that they have difficulty processing information on multiple levels simultaneously (Giedd, 2004).

In our society, one of the things that makes adolescence so unique is that this is a time when we begin to pay the price for not providing the appropriate level of social scaffolding to adequately support a child’s development. The best time to insulate adolescents from the threats present in their environment such as drugs, crime, unprotected sex and major accidents, is not at age twelve but at conception. The parts of the brain that regulate resource allocation are not in the cortex but in the brain stem. The brain stem is being organized in the last trimester of gestation. Relational templates are being organized during the first three years of life. When children learn that adults are both a source of protection and rewards they demonstrate the capacity to use these relational connections as scaffolding.

Scaffolding is the supports that are put in place to reinforce a structure that is not fully capable of supporting itself. The scaffold remains in place until the structural remodeling is complete. Adolescents need adults to stay connected, attentive and attuned to both their needs for engagement and for disengagement, just as the caregiver does for a newborn. Development always takes place within a relational context.

Tips for parents:

1)      Parents should talk with their teenager, even when they roll their eyes.  If your child is expressing perceptions of life that are not consistent with your own, remember to celebrate the fact they are talking with you. If you can keep them talking you have a better chance of helping them think through their decisions.

2)      Engage teachers, coaches and other interested adults as partners.  Believe it or not it does take a clan to raise a child.   

3)      Adolescents need structures that are consistent but not rigid.  Don’t maintain a rigid structure that eliminates opportunities for the adolescent to practice problem solving and negotiating skills.

4)      Place them in social and academic situations that challenge them but also create a high likelihood for success. You can adjust the structure to increase successful outcomes without lowering you expectations of their efforts. They are much more likely to be motivated to work hard if they believe they have a chance to be successful.     

5)      Set limits on the adolescent’s behavior but not on them as individuals. Remember, their identity is being formed and they are vulnerable to confusing negative feedback as a reflection of their identity rather than their decisions.

6)      Encourage and support engagement in structure activities (athletics, clubs, music, dance). Think carefully before using these activities as consequences for the adolescent’s actions.

7)      Above all make sure to tell them how much they are loved! 

Bibliography

A.L Spenssort, K.J. Plessen, and B.S. Peterson. (2004). Neuroimaging Of Developmental Psychopathology: The Importance of Self-Regulation and Neuroplastic Processes in Adolescence. In R. E. Dahl, & L. Patia-Spear, Adolescent Brain Development (pp. 86-87). New York: New York Academy of Science.

Giedd, J. N. (2004). Structural Magnetic Resonance Imaging of the Adolescent Brain. In R. E. Dalh, & L. Patia-Spear, Adolescent Brain Development:Vulnerabilities and Opportunities (pp. 77-104). New York: New York Academy of Science.

Steinberg, L. (2009). Should the Science of Adolescent Brain Development Inform Public Policy? Retrieved 10 2011, from psycnet.apa.org: http://psycnet.apa.org/journal/amp/64/8/739.html

Self-Control & Delayed Gratification Lead to Long-Term Success

While surfing the internet I came upon an article by Maia Szalavitz, “The Key To Health, Wealth and Success: Self-Control."  In the article she reports on the outcome of a study that follows 1,000 children from birth to age 32 years old. Children who exhibited early self regulatory skills were less likely to develop substance abuse problems or be involved with crime as adults. These children turned out to be healthier and more successful financially.

The findings were consistent with previous research conducted by Walter Mischel, a Stanford professor, which showed that children with low ability to delay gratification were more likely to exhibit behavioral problems at home and school.  Their lack of self control at age four resulted in consistent difficulty managing stressful situations and less effective problem solving abilities. There turned out to be a 210 point difference on High School S.A. T. scores between children with low delay and high delay ability.

Delay of gratification requires the child to tolerate internal distress and use higher cortical functions to regulate and modulate impulsive responses. These capabilities are developed slowly, within the context of early interpersonal relations with an attentive, attuned and responsive caregiver. When a caregiver is able to accurately read the cues of the infant, form a hypothesis about the infants needs and then respond accurately, the infant’s arousal system is quieted.  After thousands of these attuned interactions, the infant’s neurobiology is modified to reflect these regulatory interactions. The child learns to read his or her own internal signals, tolerate the internal distress generated by his orher unmet needs, and then develops strategies that result in personal satisfaction. These children have developed an internal template of the world that it is a positive place where they are eventually capable of having their needs met.  With this positive internal representation of themselves, of others and  of the world,  they are able to identify their needs, establish long term plans and then work toward achieving their desired outcomes. These children are able to establish and maintain relationships and engage others' support when needed.

The capacity for self-control remains undeveloped for the child who grows up in a chaotic, unsafe, unresponsive relational environment.   As the infant's internal needs are stimulated, their arousal system is activated.  Without the assistance of a responsive caregiver, the infant's coping capacity is overwhelmed. These children are forced to rely on alternative self soothing strategies because they are unable to meet their needs independently.  Their template of the world is that it is  a scary, unsafe, and unpredictable place that cannot be trusted. If there is something they need they should take it because it might not be available later. Focused on short term survival strategies, they are unable to allocate resources toward longer term achievements. Later in life these children are at greater risk of turning to drugs, alcohol, food and sex to satisfy their early unmet needs. Their engagement in these high risk coping strategies exposes them to negative social experiences and the risk for involvement in crimes. Once you are on the wrong track, the destinations you pass are different and very dangerous.

Science is beginning to demonstrate that early childhood relational interactions creates genetic markers that increase or decrease the expression of our genetic codes. These epigenetic influences increase tolerance or sensitivity to stress and our ability to inhibit, organize and modulate reflexive behavioral responses. Even though both groups of children may possess equal genetic potential, some get exposed to the experiences that allow them to express their potential. The question is whether you can change the trajectory of these children's lives once they have been set on course. The answer to that question is YES.

If children are placed in healthy relational environments that provide them with the opportunity to associate with attentive, attuned adults who respond to the child in a developmentally appropriate manner, self-control can be improved. If we can educate new parents and caregivers about the need to actively attend to infants we can increase the probability for a healthy start. When we identify a child in a daycare or pre-school, we shouldn’t wait until they experience multiple failures before intervening. An intervention may include educating the providers about developmental activities and strategies that can be used to activate the brain regions necessary to develop self regulation. The longer we wait,  the intensity, frequency and duration of therapeutic interventions increase, along with the costs.

TEEN PREGNANCY: Truth and Consequence

Human development always takes place within the context of a relational environment.  These relationships serve to support us or hinder us as we transition from one developmental level to the next.   As I wrote in my last blog, development can be conceptualized as a system moving from a state of organization, to disorganization and then reorganization.  For women, pregnancy presents some incredible growth opportunities but also some very real challenges.  When the new mother is a teenager, the risks are significantly greater.  The United States ranks number one amongst western industrialized nations in the number of teenage births.   The statistic reports that for every 1000 girls between the ages of 15-20, 42.5 will become teenage mothers.   Children of the adolescent mothers often display developmental and behavioral problems and are more likely to go on to become teenage mothers themselves.

Adolescence is a time when it is developmentally expected that the individual will demonstrate increased self-centeredness, mood instability, risk-taking and a focus on short term rewards without weighing out of all the consequences of one’s actions.  These developmental changes are in contrast to the sacrifices and commitments required of parents.  Some lifestyle choices such as eating habits, smoking, drinking and sexual relations must change in order to protect the developing fetus.   

Babies born to mothers who smoke during pregnancy are at increased risk for premature births, low birth weights, pregnancy complications, and sudden infant death syndrome (SIDS).  Teenagers are less likely to get early and regular prenatal care.  A teen mother is at greater risk for high blood pressure, anemia and the presence of a sexually transmitted infection.  These delays in medical attention place both the mother and developing child at significantly greater risk for complications. 

A premature baby’s lack of developmental maturity can result in under-developed organs.  The brain of the infant is faced with more challenges than when the child is in utero.  In the womb, no food is ingested directly into the stomach but is processed through the mother’s digestive system.   The fetus does not have to breathe on their own because the mother’s body takes care of that function.  In the womb, the fetus can see and hear but cannot yet regulate sensory input in the same way a full term infant is capable of processing.  The premature infant is extremely dependent upon their caretaker to regulate their physiology.  Their immature, internal systems can be flooded and overwhelmed.  Because the brain of an infant is being organized by the patterned and repetitive sensory experiences, they are vulnerable to chronic stress.   This stress can alter the sensitivity of the infant’s alarm system, leading to long-term mental, medical and social issues.   

So we have a high risk situation where a developmentally immature mother is caring for a developmentally immature infant.  Further complicating this scenario is the high incidence of family and community poverty, single parenthood, high rate of limited education and disrupted extended family relations.  When the mother and infant need the most support, they are often left alone and vulnerable. 

Many teenage mothers, with the support of their family, are able to negotiate all of these obstacles and are incredible success stories.  Yet many the hurdles are way too high and their resources are way too low.   Seventy-five percent of all unmarried teen mothers will depend upon welfare within 5 years of the birth of their first child (marchofdimes.com/medical resources).

Early and regular prenatal care and supportive services can make an enormous difference in the lives of these teen mothers and children.  Education regarding proper nutrition, stress management, and the benefits of continuing their education within the context of a supportive relational environment can scaffold the developing teen mother and her new born through this important transitional period.   Supporting teen mothers can result in an early return on our relational investments.

Our Children Are Watching

Survival of any biological system requires the establishment of homeostatic equilibrium and the flexibility to change in response to environmental challenges. 

This tension between maintaining stability and adapting to change is the canvass on which development is painted.  Development is a process of perturbing a system enough so that a new homeostatic set point (or “comfort zone”) is established.  Development can be conceptualized as a system moving from a state of organization, to disorganization and then reorganization.  It is not a continuous  upward progression but of peaks and valleys.  In the weeks prior to a toddler beginning to walk they may have difficulty sleeping through the night.  These developmental transitions are pivotal points that present children and their family members with both     opportunities and challenges.

However, if the mother’s attachment templates are associated with inconsistency, unpredictability, abandonment and threat then the thoughts of the infant trigger anxiety and distress.  To cope with this stress, some mothers may recapitulate her early experience and distance herself from her infant.  These mothers may not experience the same level of pleasure and struggle to meet the anticipated demands of their new role.  The mother might interpret the movement within her body as irritating, demanding, already overwhelmed and anticipate the worst after birth.  She may begin to question her own capacity to care for the infant but not see others as a resource.  Some mothers think that the baby will provide them the love they never felt earlier in their lives.  In these situations the mother knows the fetus is a part of her but she struggles to hold on to their separateness. 

After birth the mother can experience a sense of loss, depression or an overall sense of being overwhelmed.   A mother with a history of unhealthy attachments may not exhibit the same biological drive to be present and attuned to her newborn.  She does not derive a sense of pleasure when interacting with the infant.  This lack of pleasure or stress is communicated nonverbally to the infant through facial expressions and tactile interactions.  The infant’s own pleasure centers are not activated and his/her stress responses are not soothed.  Associations to other humans are weak and unsatisfying.  In an attempt to survive, experiences their mother can tolerate are ruled in and actions that cause her to withdraw are ruled out.  These rules are the framework for relational templates that guide future social interactions.

If an infant has access to other caregivers (fathers, relatives, and community members), they can form more positive, rewarding associations that allow them to compensate for the unresponsive maternal figure.   In today’s society, however, many parents are separated from their families of origin and isolated from community resources.   It is only after a child has been abused or severely neglected that the larger community gets involved.  

 There is no greater investment a society can make than to invest in the well being of its children.  In order to protect children, we must first protect the women in our society.  By creating opportunities for women to express their genetic potential, protecting them from abuse, providing access to quality health care and creating a supportive community, we develop the foundation for growth facilitative environments for our children.  Dr Bruce Perry says “The best time to help a child is 100 years before they are born”.   We cannot afford to wait.  Our children are  watching. 

 

REAPING WHAT WE SOW

A vast majority of the young people treated in the Child Protection, Mental Health and Juvenile Justice Systems have experienced exposure to chaotic, abusive, neglectful or violent environments in their lives. Although the exact prevalence of abuse and neglect varies, there is agreement that a significant number of youth served in these populations have survived exposure to overwhelming adverse life experiences. The impact of their exposure to traumatic stress has resulted in long term biological, psychological and social changes (www. childtrauma.org).  Isolated traumatic events tend to produce a conditioned, biological response to cues associated with the memory of that event.

 In contrast, there is a distinctively more pervasive effect on the development of youth who grow up experiencing chronic maltreatment and then find themselves victims of an isolated traumatic experience, such as a sexual or physical assault. Developmental trauma and chronic exposure to maltreatment during early childhood interferes with the organization and functioning of the brain’s regulatory systems.  Logically, this results in an increased need for mental healthcare and correctional measures as well as medical and other social services.  Research confirms that exposure to early childhood maltreatment sets a negative developmental pathway that ultimately leads to serious problems for the victim that impact all relationships that the child encounters throughout his or her life.

The Adverse Childhood Experience Study provided a link between childhood exposure to violence and other traumatic events and later developing psychiatric and physical disorders as well as substance abuse. The study found a significant relationship between adverse childhood experiences and depression, suicide attempts, substance abuse, sexual promiscuity and other high risk behavior. Additionally, the study found that the higher the number of adverse experiences reported, the higher the risk for developing not only psychiatric symptoms, but medical problems as well including heart disease, cancer, diabetes and liver disease (http://www.acestudy.org/).  The advances in neuroscience over the past two decades have led to new insights on how traumatic experiences early in life can influence an individual's development and often result in changes in perceptions, feelings, cognitions and behavior. One's behavior is a reflection of the world in which they have lived. High-risk, abusive behaviors toward themselves, others, or property can be understood as a way the youth adapted to early life relational experiences, which ultimately became wired into their neurobiology.

Scientific knowledge continues to demonstrate that early childhood maltreatment causes permanent damage to the structures and functioning of the developing brain. These changes impact the child’s stress response systems, immune systems and neuroendocrine system. In 2002, the President’s New Freedom Commission on Mental Health report stated that mental illness ranks first among illnesses that cause disabilities in the United States, Canada and Western Europe. In 1997 the United States spent 71 billion dollars on treating mental illness. In addition, the indirect cost of mental illness to the economy was estimated to be 79 billion dollars in lost productivity.

This information suggests that  part of the our nation's strategy for fixing the healthcare system must include investment in abuse prevention, early interventions and mental health training . Protecting and caring for our children is not only the right thing to do, it is the most economically sound thing to do as well.

We must begin to change the way we look at, treat and educate the most vulnerable members of our society.

Brain Development in Toddlers: What Happens and Why

The brain—unlike other vital organs in the body, whose organization and processes are completely functional at birth and then grow in a linear manner along with the body—is unfinished and immature in its development at birth. Brain development is front-loaded, with the majority of neurological systems being developed within the first three years of life.

This explosion of the brain and nervous system is constructed through interactions of our genetic programming and environmental influences. Over 70% of the brain’s organization takes place after birth. By exposure to patterned, repetitive stimulation from the external sensory and the internal biochemical environment, neurons are modified and the connections between them are established, strengthened, or eliminated. Neurons that are activated simultaneously form connections that increase the probability that these same neural patterns will be activated together in the future. Those cells or neural networks that are not activated die and get reabsorbed. This neurological architectural sculpturing process of overgrowth of neuronal synaptic connections, followed by a pruning back of unused cells is a principal labeled “use- or experience-dependent development.” Cells that fire together are wired to get together.

A two-year-old has twice as many synaptic connections as an adult. The incredible capacity of the brain to change in response to sensory information, store that input, and then use the information to guide our behavior allows humans to adapt to a wide range of environments. This ability to adapt is a gift but it also leaves children extremely vulnerable to long term consequences from maltreatment. The most powerful stimuli during this critical developmental period are the interactions with caretakers. The sensory interactions between a caretaker and an infant actually wire the brain and create the internal relational representations that will guide our behavior throughout life.

The brain, which is going through such explosive development from conception to age four, is most sensitive to exposure to growth facilitative or growth inhibiting experiences. Experiences we have early in life have the greatest impact on our long term cognitive, emotional and social functioning.  The experiences we expose our children to with the greatest frequency will influence not only their behavior but alter the way their genes are expressed and the way their brains process information, Two children with equal genetic potential, one raised in a safe, predictable and nurturing environment and one raised in a threatening, chaotic environment will have very different developmental trajectories. The first will be capable of tolerating stress, engaging in and succeeding in the complex social environments of school, peers and later work. The second child will struggle to feel safe, have trouble engaging others and maintaining healthy relationships and be at greater risk for mental health, academic, medical and substance abuse problems throughout their lives.

The best way to help children is through preventive measures that raise the awareness of the potentials and vulnerabilities of our children in our communities. By educating parents, grandparents, physicians, teachers, coaches, and other adults that interact with children to be sensitive to their developmental needs, we can increase exposure to those experiences that allow the expression of our children's genetic potential and minimize exposure to those that increase risk factors. For those unfortunate children exposed to abuse, neglect and violence, early identification and interventions from mental health professionals that are trauma-informed will have the greatest impact and result in best outcomes.

Welcome Dr. Jerry!



Dr. Jerry Yager
DCAC's Director of Education & Training

 We would like to give a huge WELCOME to Dr. Jerry Yager as our Director of Education & Training.

Dr. Yager is a Clinical Psychologist with more than 25 years of experience in the assessment and treatment of traumatized children and adolescents. He specializes in working with adolescents who exhibit self-destructive behavior and have severe mental illness such as clinical depression, bipolar mood disorder, post-traumatic distress disorder and psychosis. Before joining DCAC, Jerry was the Executive Director of the Denver Children's Home, which shares a mission with DCAC to provide high quality mental health care for low-income children whose problems would otherwise go undiagnosed and untreated. Jerry received his Doctorate in Psychology from Nova University, and a Bachelor of Arts in Psychology from the University of Colorado.  He is a ChildTrauma fellow with the ChildTrauma Academy, and conducts professional training in Colorado and nationally.

In this newly created position, Jerry will lead the expansion of DCAC's training program for mental health professionals and community members, with a dual focus on child abuse prevention and the assessment and treatment for child trauma. The multi-level training program is designed to equip all those who work with children-therapists, foster parents, social service caseworkers, police, prosecutors, victim advocates, medical doctors, school personnel and family members-with the tools to meet the complex needs of children along the continuum of need from at-risk to severely traumatized. By providing high quality training, DCAC's goal is to create a seamless web of care for children in our state.

I know you will want to visit this blog weekly to see what Dr. Jerry has to share.  You may contact him directly by CLICKING HERE with your questions and responses.

Welcome, Dr. Jerry.  We're happy to have you aboard!