Search for the Teenaged Brain
Heather Harlan, Certified Reciprocal Prevention Specialist
Phoenix Programs, Inc.
Columbia, MO
NAMI Missouri State Conference
Lake of the Ozarks
Port Arrowhead Conference Center
November 4, 2011
Learning Objectives
• Identify recent neurological discoveries in the
brains of adolescents.
• Understand needs of adolescents as a special
population in prevention, treatment and
recovery
• Empower advocacy for evidence-based
prevention, intervention, and treatment for
youth.
Identify recent neurological
discoveries in the brains of
adolescents.
Most everybody (including scientists) had
thought they knew what was different about
adolescents. . . .
. . . hair,
hormones,
and
pimples.
Didn’t connect astounding (irritating) changes in
behavior, appetite, attention span, poor judgment,
risky behaviors, and sleep patterns to their brains.
5
Scientists in 1997 were .
surprised!
Neuroscientist
Dr. Jay Geidd,
National Institutes of
Health
saw something
he didn’t expect to see.
6
What Dr. Jay Geidd noted was
neurological exuberance
7
Exhuberence?
Scientists knew human frontal lobes continue to
grow but thought it was over about age 2 yrs.
forming gray matter,
cell bodies—neurons
treelike branches—dendrites , THEN
• Age 11 for girls
• Age 12 for boys
8
It begins to kill off brain
connections.
Some connections thrive.
Used the most.
9
Use it or lose it.
Enables human brain to
specialize and adapt—
connecting all those brain
cells with neuropathways,
enabling parts of the brain
to work together
smoothly.
10
Human brain growing well in the mid-20’s
Ages 5
20
Blue represents maturing areas of the brain
Blue represents maturing portion of the brain.
11
Human Brain Matures
• Inside out
• Back to front
Last to mature—front
Pre-frontal cortex—right behind your eyes
and forehead
12
13
Pre-frontal cortex in humans
last to mature
• Reasoning
• Motivation
• Judgment
• Resist impulses
14
Pre-frontal cortex in humans
• Serves as “policeman”
• Chief executive
Helps us plan ahead.
Asks, “What might happen
IF . . . .?
15
Inhibitors demonstration
16
Inhibitors in the human brain:
• Part of brain that “inhibits” our behavior
• Keeps us from imitating everything we see/hear
• Matures about age 25
New Research (Hot off the press):
Published online
Nature Journal October 19, 2011 and
National Public Radio Health Blog
Research suggesting teens’ IQ is not set in stone.
IQ seems to be a gauge of acquired knowledge
that progresses in fits and starts.
• In this week's journal Nature, researchers at
University College London report documenting
significant fluctuations in the IQs of a group of
British teenagers.
• The researchers tested 33 healthy adolescents
between the ages of 12 and 16 years using brain
scans and IQ tests.
• They repeated the tests four years later and
found that some teens improved their scores by
as much as 20 points on the standardized IQ
scale.
"We were very surprised," researcher Cathy
Price, who led the project. She had expected
changes of a few points. "But we had
individuals that changed from being on the
50th percentile, with an IQ of 100, [all] the
way up to being in the (top) 3rd percentile,
with an IQ of 127." In other cases,
performance slipped by nearly as much, with
kids shaving points off their scores.
In other words:
Teen brains changing in even more ways
than we knew.
What is the ONE thing?
The one thing the adolescent
brain is best designed to do?
22
Primed, at the starting block,
geared up, ready to go?
23
Learn
24
Learn?
learning
Neurologically,
is the process
of developing effective neuropathways.
Reinforcers--neurotransmitters
Make it possible for us to learn.
26
Ummmmmm . . ..
What’s a
reinforcer?
27
Reinforcer.
A positive reward that increases a likelihood a
behavior will be repeated is a positive reinforcer.
or
A negative response that increases the likelihood a
behavior will diminish or stop.
In the brain it comes in the form of chemical
rewards.
28
When I think of my brain
There’s a lot at stake
So I’m gonna learn how
To make a good brain great.
Now from memory . . .
Skill set
Neurons fired together
are wired together.
Understand needs of
adolescents as a special
population in prevention,
treatment and recovery
Age of first use matters
Youth who begin drinking before age 15
are 4 times more likely to become
alcohol dependent than those who
wait until they are 21.
--PIRE
(Pacific Institute on Research and Development)
33
4 times more likely to
develop alcohol
dependency!
34
35
Times
Drug abuse starts early and peaks in the teen years
37
Adolescents more vulnerable
(hence a special population)
• Don’t have strong neruopathways developed to
pro-social reinforcers that require effort
• Addictive substances and behaviors only require
use, little pro-social effort—short cut
• Aren’t able developmentally to think through
consequences—need short-term goals of
treatment
• Transitions/stress/mental illness make the brain
more vulnerable
38
Anything that lowers ones pain
(emotional or physical) quickly
can have an addictive quality.
39
Adolescents
• Higher risk during
transitions
– Change in schools
– Significant losses
– Shift in family situation
• Puberty itself is a transition
• Stress—working to LEARN
new routines
It’s about the brain
40
• Haven’t developed other
coping skills.
• Don’t know it won’t last
forever
• Insufficient “roads in their
brains” to feel OK
• It’s all about here and now
41
Based on what we know today about the
teenaged brain . . .
. . . how can we empower advocacy for
evidence-based prevention, intervention, and
treatment for youth?
Understand . . .
These messages only tell youth and
young adults what NOT to do.
These messages don’t help youth LEARN what TO do!
Support opportunities to
LEARN and experience
•
•
•
•
Positve, pro-social activies
Effort driven rewards
Encouragement to “try again”
Affirmation and appreciation for the effort-- less
for the outcome.( example: “You worked really
hard on that. You spent a lot of time trying
different strategies.” instead of, “That’s good.” or
“You are so smart.”)
Advocate for
science or evidence-based
programs.
Ummmmmm . . ..
What’s an
evidence based
or
science-based
program?
46
Most substance abuse treatment programs
are based on PATT interventions:
1. Personal experience of the counselor
“Here’s what worked for me.”
2. Anecdotal evidence
“I heard of someone who . . . .”
3. Tradition
“We’ve always done it that way.”
4. Time
“We have a 21 day program.”
No seemed to be able to answer the
questions
“But how well does it work?”
“What’s the number of people it helps and
how does it help them?”
Substance use disorders and other
mental heal issues are
• Brain disorders
• Chronic health problems
How many approach a chronic health
condition this way?
Doc,
Just DO
something.
I don’t care
how well it
works—just
DO something.
Science or Evidence-based interventions
for youth and young adults:
Based on how well the program or intervention
helps teens and young adults as a special
population in areas we agree to measure
(with grant funders).
Not based on how great
the idea seems or
how good it makes us feel.
Example: APEX (youth and young adult
treatment program) at Phoenix Programs ages
12 thru 20
Adolescent Community Reinforcement
Approach/Assertive Continuing Care
ACRA/ACC
• 3 year SAMHSA grant –1 year overlap with• 2 years MO Foundation for Health grant
MFH grant focus on measuring suicide
prevention
How do you measure it if it didn’t
happen?
Objective 3: Within one year of grant funding, 50% of participants will who report
suicidal thoughts/actions will report a reduction in these symptoms after
completing participation in the Reach Out program and appropriate mental health
services.
Baseline data
• (N=50, 31 eligible for 6 month follow up – percentages based on eligible clients)
• 2 clients attempted suicide (4%)
• 8 clients thought about attempting suicide (16%)
• 5 clients had a plan to commit suicide (10%)
• 35 clients reported no suicidal thoughts or actions (70%)
Follow Up Data (N = 26)
• 0 clients attempted suicide at follow up interview (0%)
• 1 client thought about attempting suicide at follow up interview (3%)
• 0 clients had a plan to commit suicide at follow up interview (0%)
• 25 clients reported no suicidal thoughts or actions at follow up interview (97%)
Data demonstrates that clients had a reduction in suicidal thoughts/actions from intake to follow up.
Other examples where we have proven,
measured outcomes in programs based
on intake info and follow up interviews :
•
•
•
•
Lower substance abuse
Increase of days clean/sober
Fewer hospitalizations
More social support at home
and in community
• More able to find/keep housing
• Fewer legal problems and days incarcerated
Locations of Assertive Adolescent Family Therapy Grants in US from
Fed. Gov. (Substance Abuse and Mental Health Services Administration)
SAMHSA
2006-2010
Substance Use and Abuse Problems
100%
90%
77%
80%
73%
70%
66%
63%
60%
50%
40%
30%
20%
10%
0%
Reduction from intake of at least 50% or no problems on the
Substance Frequency Scale
17724 Columbia (N=123)
Reduction from intake of at least 50% or no problems on the
Substance Problem Scale
02 - AAFT2 Total (N=1732)
Juvenile Justice/Criminal Justice and Illegal
100%
90%
80%
77%
72%
72%
70%
60%
55%
52%
51%
50%
70%
45%
40%
30%
20%
10%
0%
Reduction from intake of at
P90
least
no illegal activity at last follow
50% or no problems on the Illegal
up
Activity Scale
No past month Juvenile
Justice/Criminal Justice
involvement at last follow up
No illegal activity at 3 Month
interview\20
17724 Columbia (N=123)
\20 When L3d=0 (number of days you thought you were doing something that is against
02 - AAFT2 Total (N=1732)
Emotional, Behavioral, and Health Problems
100%
90%
79%
80%
70%
60%
64%
81%
79%
79%
66%
57%
56%
55%
52%
51%
50%
40%
44%
38%
39%
30%
20%
10%
0%
Reduction from
intake of at least
50% or no
problems on the
Health Problems
Scale
Reduction from
intake of at least
50% or no
problems on the
Emotional
Problems Scale
Reduction from
intake of at least
50% or no
problems in
Behavioral
problems\26
No major health
problems at last
follow up
No major mental No major health No major mental
health problems at
problems at 3
health problems at
last follow up
Month interview\21
3 Month
interview\22
17724 Columbia (N=123)
\21 When P9b=0 (number of days you had medical problems that kept you from meeting your responsibilities)
\22 When M1g=0 M2q=0 and M3c<13
\26 When M3c=0 (number of day problems paying attention)
02 - AAFT2 Total (N=1732)
Family, Social, and Recovery Environment
100%
92%
89%
90%
80%
77%
74%
70%
60%
51%
50%
45%
46%
42%
40%
30%
23%
20%
15%
11%
10%
7%
0%
Reduction from intake of Reduction from intake of Reduction from intake of
Past month in the
P90 no family/home
at least 50% or no
at least 50% or no
at least 50% or no
community at last follow problems at last follow
problems in Family
problems on the Social
problems on the
up
up
problems\24
Risk Index
Recovery Environment
Risk Index
\23 When E2d=0, E2e=0, E1d=0 and E3<13
\24 When E3=0 (number of days gotten into trouble at home or with family)
No family/home
problems at 3 Month
Interview\23
17724 Columbia (N=123)
02 - AAFT2 Total (N=1732)
Site: 17724 Columbia (N=123)
Strongly Disagree
Treatment Satisfaction Part - 1
5.0
4.6
4.7
4.8
4.8
4.8
4.6
4.4
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Did a good job
Were fair with
clients/ patients
Explained the
rules of the
program
Had the time to
Respected
Staff and you
Explained what
see you
clients/ patients agreed on what your treatment
your problems was supposed to
were
accomplish
Site:17724 Columbia (N=123)
Treatment Satisfaction Part - 2
5.0
4.7
4.5
4.6
4.6
4.4
4.4
4.4
4.7
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
Asked for your
Staff and you
Helped you do
Staff and you
Helped you do
opinions about agreed on what to something about agreed on what to something about
your problems and do about your
your substance
do about your
your other
how to solve them substance use
use
other problems
problems
Were sensitive to Gave you enough Mean score of all
your cultural
help for now
questions
background
provided there are
at least 3
responses
Three questions when looking for
science or evidence-based treatment:
1. What do you DO for people who have this
situation?
(should be able to name a type or model of
treatment not length of the program)
2. Upon what science do you base your programs?
(vs. It’s what’s traditionally done. . . .)
3. Where can I learn more about that?
(website, book, article, brochure?)
Another challenge to science-based
treatment:
“We already do that.”
Inquire about certifications
Science-based treatment
•Isn’t required by State of MO now
•Counselors aren’t required to be
certified on any particular “model”
or way of doing treatment
•Is much different that traditional,
12 step treatment for youth
•Even if certified, easy to “drift”
away from effective treatment
•Can be given lip service
Registry of Evidence-Based Practices
and Programs (NREPP)
Go to www.nrepp.samhsa.gov and search for
Adolescent Community Reinforcement
Approach
Enter criteria for other science-based programs.
Acknowledgements:
Phoenix Programs, Inc
Project APEX Team, APEX and REACH OUT
participants and parents/caregivers
Dr. Susan Godley and Dr. Mark Godley,
Chestnut Health Systems; Bloomington, IL
Dr. Robert Meyers and Dr. Jane Smith;
University of NM, Albuquerque
Substance Abuse and Mental Health Services
Administration (SAMSHA)
Missouri Foundation for Health
It is hard to convince a high-school student that
he will encounter a lot of problems more
difficult than those of algebra and
geometry. ~Edgar W. Howe
Heather Harlan, Certified Reciprocal Prevention Specialist
Phoenix Programs, Inc.
Columbia, MO
Email to request copy of Power Point presentation 573-875-8880 x 2142
hharlan@phoenixprogramsinc.org
www.phoenixprogramsinc.org
Funding for this project was provided in part by the Missouri
Foundation for Health. The Missouri Foundation for Health
is a philanthropic organization whose vision is to improve
the health of the people in the communities it serves.
For individuals. For families. For over 35 years.