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Adolescent/Young Adult Adolescent/Young Adult Brain DevelopmentBrain Development
And DrugsAnd Drugs
Dean Blumberg, PhD, LMFT, Dean Blumberg, PhD, LMFT, CADCCADC
Kaiser CDRP, San FranciscoKaiser CDRP, San [email protected]@kp.org
2
OBJECTIVESOBJECTIVES
Review:
Adolescent brain development Gender differences Effects of substance abuse and
chemical dependency on adolescent development
Substance abuse prevention for parents
3
THE JOURNEYTHE JOURNEY
Storm and Stress:Storm and Stress:Not alwaysNot always
(Offer and Offer, 1975)
4
3 Pathways (rides) through adolescence
(Caviola & Kane- Caviola, 1989,) :(1) The Kiddy Roller Coaster – continuous
growth group (23%) - well-adjusted teens who meet the demands of this stage.
(2) Go For a Ride or 2 on the Big Roller Coaster - surgent growth group (35%) comprised of reasonably well-adjusted youngsters, who may have difficulty coping with unexpected trauma.
5
3 Pathways (rides) through adolescence
(Caviola & Kane- Caviola, 1989,) :
(3) Go For the Biggest, Scariest Roller Coaster You Can Find - tumultuous growth group (42%) characteristic of the adolescent turmoil hypothesized by the ‘storm and stress’ theorists.
6
Which One?(1) The Kiddy Roller Coaster
(2) Go For a Ride or 2 on the Big Roller Coaster
(3) Go For the Biggest, Scariest Roller Coaster
7
THE TASKSTHE TASKS
Individuation and Individuation and SeparationSeparation
8
Identity Development EXPLORATION
“Sex, Drugs and Rock ‘n Roll”
Hip Hop”
“Teenagers define their identity through risk-taking . . .”
- Shedler and Block
“. . . balance exploration with commitment to formulate a sense of identity.” (Trad, 1994)
9
Identity Development Exploration –
Oppositional as a Transitional Step
“not trusting adults” to develop identity
When CD: pseudoindividuation (Haley)
10
Identity Development EXPLORATION –
Neurological Basis The reward/pleasure system. Dopamine (DA) is the final
neurotransmitter.
11
Identity Development EXPLORATION –
Neurological BasisDopamine (DA) is depleted in teens’
reward system.
Because DA has migrated to help develop the prefrontal cortex
12
Identity Development EXPLORATION –
Neurological Basis Teens often need more stimulating
activities to get the same kick as adults get.• DA increases w/high risk-taking in the
nucleus accumbens (NAc). (Strauch,97; Galvin, et. al., 2006)
13
Identity Development EXPLORATION –
Neurological Basis NAc Activity in response to rewards
(Galvan, A., et al., 2005 and Galvan, A., et al., 2006):•Adults: Corresponds to level of reward. •Children: The same despite level of
reward. “. . . Kids were happy to play the game . . .”
•Teens: All-or-Nothing - High to high rewards. Low to moderate and low rewards.
14
Identity Development EXPLORATION –
Neurological Basis Evolutionary basis:
• Explorers for the tribe• Broaden the gene pool?
One Consequence: More susceptible to substance abuse & chemical dependence.
15
Neurological Development Phases of Growth
DEVELOPING POTENTIAL (childhood – 11/12 y.o.)
DEVELOPING ABILITIES (puberty – 19 y.o.)
BECOMING CONSISTENT & EFFICIENT (19 – 26 y.o.)
16
Neurological Development Developing Potential –
Childhood - Prepuberty
Brain thickening – Dendrite Growth• Grey matter over-production
until 11 y.o.- girls & 12 y.o. boys
• 4 million dendrites/neuron
Brain highly receptive to new information & skills
Primed to acquire new skills
17
Neurological Development Developing abilities -
Puberty – 19 y.o.
Pruning and Shaping• Developing abilities
18
Neurological Development Developing abilities - Puberty – 19
y.o.
“Use It or Lose It”
“You are hard-wiring your brain in adolescence. Do you want to hard-wire it for sports and playing music and doing math . . .
or for lying on the couch in front of the TV?”
Jay Giedd, MD, NIMH
19
Neurological Development Developing abilities - 15 – 19
y.o.
“Use It or Lose It”
20
Neurological Development Phases of Growth
19 – 26 y.o.: Myelination• Becoming consistent and efficient
21
Neurological Development Becoming consistent & efficient – 19 – 23 -> 26 y.o.
Electrical charge travels 100x times faster on a myelinated axon than on unmyelinated one.
Speeds and smoothes signals• Less jumping to unintended neuron
> 200 miles per hour
22
Neurological Development Intelligence & Skills
Don’t use it, you lose it =Don’t use it, you lose it =
•less dendrites.less dendrites.•less myelination SO messages less myelination SO messages
travel slowertravel slower
==
23
Neurological Development Intelligence & Skills
More dendrites/connections + Thicker More dendrites/connections + Thicker myelination/faster message travels = myelination/faster message travels = INTELLIGENCE!INTELLIGENCE!
24
Neurological Development Direction of Growth
Growth begins at the back and moves to the front of the brain.
25
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Neurological Development Growth
27
Neurological Development Frontal lobes
The brain’s so-called chief executive.
Fully developed frontal lobes =
grown-up.
Executive functioning: planning, organization, decision making, emotional processing, response inhibition
28
Neurological Development Frontal lobe
The brain’s chief executive.
The human frontal lobe comprises:
30%
29
Neurological Development Frontal lobe
Dogs?
7%
30
Neurological Development Frontal lobe
Cats?
3%
31
Neurological Development Executive
Functioning
Onset of puberty begins remodeling.• DA migrates to frontal lobes as part of
development DA involved in ability to recognize when
something is important and take action
32
Neurological Development Executive Functioning
This growth spurt and pruning of synapses leads to leads to relative inefficiency in circuitry. For ex.:•Speed can identify emotions drops
by as much as 20%.
•Returns to normal levels only at age 18 or older. (McGivern, 2002)
33
Neurological Development Executive
Functioning
Younger teens use the more crocodile like amygdala part of their brain to process emotions. (Yurgelun-Todd, 1999)
34
Neurological Development Executive
Functioning
Often misread facial expressions.• For ex., frequently mislabel
fear as anger.
35
Neurological Development PreFrontal Cortex
Impulse Control-The Brain’s Police
36
Neurological Development Amygdala
Lots of connections between amygdala and prefrontal cortex (PC)
“Do something part of the brain”
37
Neurological Development PreFrontal Cortex
Amygdala: Robust @ 9 weeks old • Neg. emotions have a more powerful and longer
impact than positive emotions so can survive.
38
Neurological Development Amygdala
Hormonal Influence Due to surge in hormones: amygdala
hyperactive Hyperactive amygdala + not-fully
developed prefrontal cortex = “the roller coaster”
Not uncommon for early adolescents to experiment with SDB like cutting as part of general exploration, to get some temp. pain relief and increase DA in reward pathway.
39
TMI?
Too Much Information?
40
Neurological Development The Low Road
The amygdala, reward pathway and other emotional centers along w/the “reptilian,” automatic brain responses
comprise the FAST MOVING, LOW-ROAD of the brain.
The “GO” part of the brain.
41
Neurological Development The High Road
The cortex, particularly the frontal cortex, is the “thinking
brain” that is the SLOW MOVING, HIGH-ROAD of the brain.
42
Neurological Development PreFrontal Cortex
The “STOP” part of the brain:
43
Neurological Development PreFrontal Cortex
15 y.o. brain does not have the biological machinery to inhibit impulses in the service of long-range planning. • One reason teens can “flip out” @ a
moments notice
“Adolescents make a lot of decisions that the average 9 yr. old would say [were] a dumb thing to do.”
Ronald E. Dahl, MD, Univ. of Pittsburgh Medical Center, NYAS Magazine 2003
44
Neurological Development Phineas Gage Syndrome
1848-Phineas Gage first taught us about the frontal lobes: impulse control and personality.
He was a foreman of a railroad construction crew laying tracks in Vermont.
He was honest, reliable, hardworking, smart and respectful, a very likeable guy.
Tamping down a dynamite charge when it exploded. It launched a 13 lb., 4 ½ foot tamping rod through his left cheek and
out the top of his head. It didn't kill him. He remained conscious. Phineas became a belligerent, cursing, dishonest schemer. Sometimes, teens PFCs stop working . . .
45
Neurological Development
PreFrontal Cortex
Immortality and Omnipotence•Rates of mortality in youth ages 10–
24, by cause: Motor vehicle accidents - 32% Unintentional injuries - 12% Homicide - 15% Suicide - 12% All other causes - 29%
46
Neurological Development PreFrontal Cortex
Adolescent dilemma: “ . . . want to be adults andthey’re exposed to a semi-adult culture, but they don’thave the prefrontal cortexto regulate those adult behaviors.”
(Giedd, MD)
47
Neurological Development PreFrontal Cortex
Adolescent dilemma:
“They have the passion and the strength but no brakes and . . . may not get good brakes until . . . twenty-five.” (Giedd, MD)
48
Neurological Development PreFrontal Cortex
Parents, teachers and therapists task:
“Sometimes need to act as though they are their teenagers’ “frontal cortex . . . talking through possibilities and options. They have to function like a surrogate set of frontal lobes, an auxiliary problem solver.””
49
Neurological Development Sleep effects
•Sleep cycle-circadian rhythm Night owls to guard the cave,
keep the fire going?•Too little sleep impairs a teenager’s thinking ability and can cause a variety of problems . . .
•Teenagers are most sleep-deprived segment of pop.
50
Neurological Development Sleep effects
•Most adol. need to sleep ~9 hours.
• Dendrites grow during sleep, if you get enough sleep.
• Get enough sleep, all neurons fire and rehearse learning.
Also, can’t learn if tried to learn too much the day before.
51
Cognitive Development Formal Operations
Use of logic hypothesis development and validation through
experimentation (Brisbon & Chambers). “Capacity to engage in propositional thinking,
go beyond the here and now to understand abstract concepts . . .” (Caviola & Kane- Caviola, 1989, 17)
Ex. of hypothesis testing looking for honesty:– Teen who called in early AM 12 step members who
didn’t seem sincere re/giving their #’s.
52
Cognitive Development Formal Operations
Decision making/problem solving
Predicting the probable outcomes of behavior
Weighing options and selecting alternatives
53
Cognitive Development Formal Operations
Females: 14 -16 y. o. Males: 16 – 18 y. o. Full ethical/moral:
~ 24 – 26 y.o.
54
Cognitive Development Formal Operations
Abstraction/Ideals
Teen hypocrisy: “To an adolescent expressing an ideal is equal to living up to it.” (Caviola & Kane- Caviola, 1989, 18)
“Hypercritical of parents, . . . able to imagine the perfect parents or perfect family and now realizing that yours is not perfect makes for a critical, argumentative adolescent.” (Caviola & Kane- Caviola, 1989, 17)
“At a certain point, many teenagers start a rash of lying, . . . a way of solving problems and could again point back to the development of the frontal lobes.” 119
55
Hormonal Changes Hormones with feet. Terrible 2's in big bodies.- Lack of
impulse control.• Puberty is developing 2 yrs. earlier in
girls-and somewhat earlier, in boys than 100 yrs. ago.
Speculation that puberty/menses is starting earlier in girls due to hormones in food.
• Increase in thrill-seeking behavior . . . “an engine w/o a driver.” (Strauch, 96)
56
Hormonal Changes Poor parental relations:
High testosterone sons - more likely to engage in risky behavior, e.g., skipping school, sex, lying, drinking, and stealing.
Low testosterone sons - more likely depressed. Low testosterone daughters - who had poor
relations with their mothers - more likely to do risky things.
Low testosterone daughters who had bad relations with their fathers - more likely depressed. (Strauch,142)
With good relationships, high and low testosterone levels don’t matter at all.
57
Gender Differences
80% of women and 20% of men havesimilar brain architecture:
Better better designed for info. processing, language development and relational skills.
58
Gender Differences
80% of men and 20% of women havesimilar brain architecture:
Built for action, motorskills, spatial reasoning,problem solving.
59
Gender Differences Boys Are From Pluto Uranus
Boys are ‘‘wired’’ to act on their emotions rather than work through them with language.
Boys have more Cerebrospinal fluid (CSF): The main purpose of CSF appears to be to cushion the brain in the case of trauma to the cranium
60
Gender Differences The Hemispheres
The brains of men consistently show more hemispheric asymmetry than women•Men’s left hemisphere ‘‘looks’’
different from the right; function more independently.
•Women’s two hemispheres are essentially indistinguishable either by MRI or at autopsy
61
Gender Differences Connecting the Hemispheres
Corpus Collusum (CC): Use both hemispheres for abstract thinking, communication, writing, multitasking.• Women’s CC: Freeway• Men’s CC: Dirt road
62
Gender Differences Stress
Women under stress: release Oxytocin, cuts off connection to amygdala. •One reason can have a child again;
doesn’t let burn into the HC. Oxytocin: female more susceptible
to caring, nurturing, and connection/ bonding
63
Gender Differences Stress
Men under stress produce testosterone = ACTION!•Boys are nearly twice as likely to
report having been in a physical fight and nearly 5x as likely to have carried a weapon.
64
Gender Differences Stress
When do male brains produce “the cuddle hormone,” Oxytocin?
65
Gender Differences Stress
Under sexual conditions.
66
Gender Differences Two recommendations for boys
Give an adolescent male some time to get ready to discuss how he is feeling.• For example, if a parent needs to talk to a boy
about his poor report card, it is better to say to him, ‘‘I’d like to talk to you about your report card when you are ready,’’ rather than confront him without warning.
Boys also may have an easier time ‘‘unlocking’’ their emotions if they are allowed to move around.• Taking a walk or shooting baskets while
discussing tough issues is likely to be more rewarding than sitting him down on the couch.
67
Gender Differences
Middle-school girls who ate with their families at least 5x/week were much less likely to use alcohol, tobacco or marijuana 5 years later.
Boys: No association between Boys: No association between family meals and substance-using family meals and substance-using behavior.behavior.
Girls could be picking up on subtle Girls could be picking up on subtle reinforcing messages from family reinforcing messages from family members — signals that boys may members — signals that boys may tend to miss.tend to miss.
Journal of Adolescent Health Journal of Adolescent Health , August 2008, Pages 151-156 , August 2008, Pages 151-156
68
Gender Differences RISK TAKING & SELF-
ESTEEM
• Risk taking - correlated to high self-esteem
• Boy’s brain: produces testosterone• Primed to take risks w/little thought,
• Girl’s brain: produce oxytocin • Help girls take a risk by putting into
a relationship/caring context
69
Risk of Developing Chemical Dependency
Due to brain development, adolescent brain is very susceptible to CD:• Increased receptor sites
50% more receptors for nicotine Adol. rats given typical nicotine of daily
smoker produced 2x the nicotine receptors in VTA (craving)
70
Risk of Developing Chemical Dependency
Decreased DA in reward pathway Poor impulse control (prefrontal cortex) Psychological stress
Stress can reduce DA receptor sites Lower susceptibility to negative side
effects: sedation, motor problems, hangovers, etc.,
71
Alcohol Dependence OnsetAlcohol Dependence Onset
Past-year DSM-IV Alcohol Dependence by Age in the United States Source: NIAAA 2001-2002 NESARC data (18-60+ years of age) and SAMHSA 2003 NSDUH
(12-17 years of age)
Copyright restrictions may apply.
Compton, W. M. et al. Arch Gen Psychiatry 2007;64:566-576.
Drug Dependence OnsetDrug Dependence Onset
Hazard rates for age at onset of DSM-IV drug abuse and dependence
74
Chemical Dependency: RisksChemical Dependency: Risks Inherited predisposition (genetics)Inherited predisposition (genetics) Childhood trauma or abuse*Childhood trauma or abuse* Unwanted sexual involvement before age 13*Unwanted sexual involvement before age 13* Mental Illness: depression, anxiety, personality Mental Illness: depression, anxiety, personality
disorder (teen or other family member)*disorder (teen or other family member)* Attention Deficit Hyperactive Disorder (ADHD)Attention Deficit Hyperactive Disorder (ADHD) Learning disabilities/school failureLearning disabilities/school failure Parental discord or divorce*Parental discord or divorce* Parental substance abuse*Parental substance abuse* Subjected to teasing, bullyingSubjected to teasing, bullying Acne and/or obesityAcne and/or obesity Other than heterosexual orientationOther than heterosexual orientation Social rejectionSocial rejection Onset of drug use before age 16Onset of drug use before age 16 Enabling environmentEnabling environment IgnoranceIgnorance Using energy drinks Using energy drinks
* * Rothman, Emily F., Edwards, Erika M., Heeren, Timothy, Hingson, Ralph W. Adverse Childhood Experiences Predict Earlier Age of Drinking Rothman, Emily F., Edwards, Erika M., Heeren, Timothy, Hingson, Ralph W. Adverse Childhood Experiences Predict Earlier Age of Drinking Onset: Results From a Representative US Sample of Current or Former Drinkers Pediatrics 2008 122: e298-e304Onset: Results From a Representative US Sample of Current or Former Drinkers Pediatrics 2008 122: e298-e304
Copyright ©2008 American Academy of Pediatrics
Masten, A. S. et al. Pediatrics 2008;121:S235-S251Data source: 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions.7
FIGURE 6 Association of age of initiation of alcohol use and lifetime dependence (meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for dependence at some point in one's life)
76
Chemical Dependency: Resilience Chemical Dependency: Resilience FactorsFactors
No family history of addictionNo family history of addiction Good mental healthGood mental health Academic competenceAcademic competence Positive relationship with an adultPositive relationship with an adult Family eats dinner together 5 days/wkFamily eats dinner together 5 days/wk Positive peer group participationPositive peer group participation Participation in sportsParticipation in sports Participation in music, drama or danceParticipation in music, drama or dance Involvement in faith-based activities Involvement in faith-based activities Taking care of petsTaking care of pets Volunteer activitiesVolunteer activities Social acceptanceSocial acceptance Environment disapproves of drug useEnvironment disapproves of drug use Immediate, appropriate scaled consequences for alcohol/drug Immediate, appropriate scaled consequences for alcohol/drug
use.use. Early intervention for alcohol/drug useEarly intervention for alcohol/drug use
77
Impact of Chemical Dependency
Teens who drink avg of 2 drinks/day for 2 yrs. or weekend binge drinking for 1 yr.:10% smaller HC and recall 10% less• = to at least one grade lower
Adult rats need 2x as much beer as an adol. rat for equivalent amt. of HC damage (Strauch, 177)
78
Impact of Chemical Dependency
MARIJUANA:MARIJUANA:
16 y.o.2 year history of daily abuse
underside surface view of prefrontal and temporal lobe activity© 2006 Amen Clinics Inc
Normal
79
Neurogenic DenialNeurogenic Denial MARIJUANA:MARIJUANA:
18 y.o. 3 year history of 4x/week
underside surface view of prefrontal and temporal lobe activity© 2006 Amen Clinics Inc
Normal
80
The Need to Deny Chemical Dependency
The PET-scan images to show the brain’s response to the avalanche of dopamine in the nucleus The PET-scan images to show the brain’s response to the avalanche of dopamine in the nucleus accumbens of people with dependencies. To relieve the chronic stimulation of its neurons, the accumbens of people with dependencies. To relieve the chronic stimulation of its neurons, the nucleus accumbens simply reduces the nucleus accumbens simply reduces the number of dopamine receptorsnumber of dopamine receptors that they have. that they have.
In these images of the brain, the red areas indicate large numbers of dopamine receptors. These In these images of the brain, the red areas indicate large numbers of dopamine receptors. These images show that people who are alcoholic, obese, or cocaine-dependent have fewer dopamine images show that people who are alcoholic, obese, or cocaine-dependent have fewer dopamine receptors than normal people do.receptors than normal people do.
81
Impact of Chemical Dependency
MARIJUANA & Memory:MARIJUANA & Memory:
16 y.o.2 year history of daily abuse
underside surface view of prefrontal and temporal lobe activity© 2006 Amen Clinics Inc
82
Impact of Chemical Dependency
MARIJUANA & Virtual Novelty
Instant Interest & Fun, BUT . . .
Leads to More Boredom So, want to use more
Memory & learning problems Slower Reactions
Pilots 24 hrs. later
83
Marijuana & Cancer
70% increased risk of testicular cancer*associated with current marijuana use
The risk is particularly elevated for: Current, at least weekly use
orUse that began in adolescence.
* approx 1 in 36,266 or 7,500 people in USA/yr.Rate increasing 3 – 6%/yr for past ~ 50 yrs.
5-HT levels in monkey after MDMA (two 5 mg/kg daily for 4 days)
(Hatzidimitriou et al., J. Neurosci. 19 [1999] 5092)
2 weeks 7 years
• Result:
-long-term loss of 5HT fibers in monkeys
-some recovery
(caudate nucleus)
Image courtesy of Dr. GA Ricaurte, Johns Hopkins University Bloomberg School of Medicine
86
Impact of Chemical Dependency
Teen heavy smokers: 4x more likely to develop
depression with in a year. 15x greater risk of developing
panic attacks as adults. •Anxiety levels were no higher than
others to begin with . . . Possibly due to respiratory prob. which can trigger panic attacks. After
a few years of smoking , lung capacity is reduced, smokers take in less oxygen, and exhale less carbon dioxide. Carbon dioxide in the blood stimulates breathing and too much of it sends a signal to the brain that it’s suffocating, setting off a false alarm and a panic attack. (Strauch,184)
87
Delayed or Arrested Development• The phenomena of early stage physical
symptoms with middle and late stage emotional impairment.
•Liquid Courage
Ex.: Empathy Difficulties - Rely on drugs for coping so delayed development of relationship coping skills. • Difficulty understanding other’s point of
view.• Narcissism?
Impact of Chemical Dependency
88
Use drugs or drink:
Short term Short term gaingain, long term , long term painpain
Don't go for the easy, quick Don't go for the easy, quick high:high:
Short term Short term painpain, long term , long term gain!gain!
Impact of Chemical Dependency
89
Prevention GoalsPrevention Goals
Prevention Goals
I. EducationII. Commitment to not drink/use drugs
and drive or ride with others who are intoxicated
III. Support primary objective of no ATOD use under 21
90
Drank alcohol at least 1x in past yr.Drank alcohol at least 1x in past yr.
Source: Pride Surveys National Summary for Parents, 2004-05Source: Pride Surveys National Summary for Parents, 2004-05
Parents’ Perceptions of Teen Alcohol Parents’ Perceptions of Teen Alcohol UseUse
91
Used a drug at least 1x in past yr.Used a drug at least 1x in past yr.
Source: Pride Surveys National Summary for Parents, 2004-05Source: Pride Surveys National Summary for Parents, 2004-05
Parents’ Perceptions of Teen Drug Parents’ Perceptions of Teen Drug UseUse
92
Prevention LOVE, LIMITS & LISTENING Don’t:Don’t:
•LectureLecture•NagNag•Preach or Preach or •Give unwanted adviceGive unwanted advice
Don’t Inflict Help! Don’t Inflict Help!
93
Prevention
LISTEN, LISTEN, LISTEN•Bite your tongueBite your tongue•They need you to hold up the They need you to hold up the
mirror . . .mirror . . .•Adolescence: Learner’s permit on Adolescence: Learner’s permit on
lifelife•Mistakes are an opportunity to Mistakes are an opportunity to
learnlearn
94
PreventionLISTEN, LISTEN, LISTEN CONT’D:
Teens need you to respect their “No’s,” before they will give you a “Yes.”
DON’T INFLICT HELP!DON’T INFLICT HELP! Earn the right to ask Earn the right to ask 11 time: time:
•““Would you like to know what I Would you like to know what I think?, Would you like a think?, Would you like a suggestion?,” etc.suggestion?,” etc.
95
PreventionLISTEN, LISTEN, LISTEN CONT’D:
If don’t want your advice/opinion:If don’t want your advice/opinion:•““You’ve got a good head on your You’ve got a good head on your
shoulders, I’m sure you’ll figure it shoulders, I’m sure you’ll figure it out . . .”out . . .”
•““I trust you to know when to ask for I trust you to know when to ask for help when you need it . . .” help when you need it . . .”
•““I have faith in you . . .” I have faith in you . . .”
96
PreventionLISTEN, LISTEN, LISTEN CONT’D:
Positive One on One Time**Positive One on One Time**– Break the coercion “log jam.”Break the coercion “log jam.”– Spend positive time with your teen first.Spend positive time with your teen first.– Take a sabbatical from teaching, judging, Take a sabbatical from teaching, judging,
lecturing, directing, correcting, etc.lecturing, directing, correcting, etc.– 15-20 min. 3-4x per week.15-20 min. 3-4x per week.– Let your teen choose something enjoyableLet your teen choose something enjoyable
oror Notice when your teen is doing a fun Notice when your teen is doing a fun
activity, approach, make positive activity, approach, make positive comments, and stick aroundcomments, and stick around
** ** From “Your Defiant Teen,” Barkley, Robin, & Benton, 2007From “Your Defiant Teen,” Barkley, Robin, & Benton, 2007
97
Prevention LIMITS:LIMITS:
•+ and – consequences+ and – consequences•Written downWritten down
They need “They need “No'sNo's”” to develop self- to develop self-disciplinediscipline
No limits = No limits = DDDDDD•DDiscipline iscipline DDeficit eficit DDisorder isorder D. Walsh, PhDD. Walsh, PhD
August 4, 2008Vol. 17, Issue 31
SOURCE: Adapted by CESAR from Tucker, J.S., Ellickson, P.L., and Klein, D.J., “Growing Up In a Permissive Household: What Deters At-Risk Adolescents from Heavy Drinking?,” Journal of Studies on Alcohol and Drugs 69(4):528-534, 2008. For more information, contact Dr. Joan S. Tucker at [email protected].
Heavy Drinking in 9th Grade Heavy Drinking in 11th Grade0%
20%
40%
60%
80%
100%76% 74%
8%27%
Permissive Household (n=313) Nonpermissive Household (n=397)
Percentage of South Dakota Students Reporting Heavy Drinking in 9th and 11th Grades,
by Permissiveness of Household
*Data are from a sample of 3,687 7th grade students recruited from 48 South Dakota schools in 1997-1998, with follow-up assessments conducted in grades 8, 9, 10, and 11. Nonpermissive households (n=397, 10.3% weighted) were defined as parents being “very upset” to know that their child drank alcohol or used marijuana, knowing “all of the time” where to find their child, and telling the child “all of the time” what time to be home. Permissive households (n=313, 10.2% weighted) were defined as having at least three of these four characteristics: parents being “not at all” or “a little” upset to know that their child drank alcohol or used marijuana, knowing “sometimes” or less often their child’s whereabouts, and telling the child “sometimes” or less often what time to be home. The remaining 79.5% (n=2,977) of the sample were from households that fell in between these two extremes in terms of permissiveness and were not analyzed.
99
Prevention LIMITS:LIMITS: When angry, don’t act, take a When angry, don’t act, take a
break, and think about what you break, and think about what you want to do.want to do.• ““When you feel like taking the wind out of When you feel like taking the wind out of
his sails . . . take your sails out of his his sails . . . take your sails out of his wind.”wind.”
•Mirror neuronsMirror neurons
Apologize when you make a Apologize when you make a mistakemistake
Let them get the last wordLet them get the last word
100
Prevention Giving Effective CommandsGiving Effective Commands
– Make sure you mean itMake sure you mean it– Make it simple, direct, in a business like Make it simple, direct, in a business like
tone, not a question (there is no choice)tone, not a question (there is no choice)– Tell what to do rather than what not to doTell what to do rather than what not to do– Make sure you have teen’s full attentionMake sure you have teen’s full attention– If giving time limit, give teen a timer to use.If giving time limit, give teen a timer to use.– Give limited choices.Give limited choices.
** Start off w/things you know ** Start off w/things you know they’ll do: go to the mall, have they’ll do: go to the mall, have another dessertanother dessert
101
Prevention
If can only do one of the 3 L’s:If can only do one of the 3 L’s:
LOVELOVE
102
The Primal Teen, Barbara Strauch
Marijuana: What’s a Parent to Believe?, Timmen Cermak
Why Do They Act That Way? A Why Do They Act That Way? A Survival Guide to the Adolescent Survival Guide to the Adolescent Brain for You and Your TeenBrain for You and Your Teen, , David WalshDavid Walsh
Inside the Teenage Brain- Inside the Teenage Brain- http://www.pbs.org/wgbh/pages/frontline/shows/teenhttp://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/interviews/giedd.htmlbrain/interviews/giedd.html
Selected References
103
Don't panic. You can do this.
http://timetoact.drugfree.org/
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Safe Safe DrinkingDrinking Guidelines Guidelines for Adultsfor Adults
Moderate Drinking is…Moderate Drinking is…
For Men: no more than 2/day, For Men: no more than 2/day, 14/week 14/week or 5 drink toleranceor 5 drink tolerance
For Women/Elderly: no more than For Women/Elderly: no more than
1/1/ day, 7/week or 4 drink tolerance day, 7/week or 4 drink tolerance
(M) 2 - 14 - 5 (W) 1 - 7 - 4(NIAAA, 2000)
105
Prevention
106
Neurological Development Direction of Growth
Occipital, parietal and temporal lobes largely mature in older adolescents.• Parietal – logic and spatial reasoning.• Temporal – language.