Transcript Slide 1

A Dinner Party During the
Kitchen Remodel: Life with
the Adolescent Brain
Chris McCurry, Ph.D.
Associates in Behavior and Child Development, Inc.
Seattle, WA
Teresa Piacentini, Ph.D. (206) 361-6884
Russ Hanford, Ph.D. (206) 409-9613
Brian Neville, Ph.D.
(206) 214-7482
(425) 481-5700
Greg Greenberg, Ph.D. (425) 637-7700
Socrates
Adolescents are
“inclined to contradict parents
and tyrannize their teachers”
I would that there were no age
between ten and twenty
three… for there is nothing in
between but getting wenches
with child, wronging the
ancientry, stealing, fighting…
Wm. Shakespeare
The Winter’s Tale; Act III
“If they fit, we can return them”
Adolescence: “Storm and Stress”?
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Significant adolescent difficulties are
neither inevitable nor universal
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Research on large populations of
adolescents indicates that teens experience
more rapid mood changes, but no more
depression or anxiety than in adult samples
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Studies show that most adolescents
describe themselves as “mostly happy” and
adequately adjusted
Yet, Many Adolescents Do Struggle
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Overall morbidity and mortality rates
increase 200-300% between middle
childhood and late adolescence/early
adulthood
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Onset of problems such as nicotine
dependence, alcohol and drug use, poor
health habits, etc. that will show up as
mortality in adulthood
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Many adult onset problems such as
depression can be traced to early episodes in
adolescence
Is It Hormone Poisoning?
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Recent research shows that much of the
behavior which has been attributed to
hormones is probably related also to
changes in brain structure
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During adolescence, behavior is often
more governed by the emotional centers
than the thinking centers of the brain,
especially during high arousal situations
and in peer presence
Executive Functioning and the
Prefrontal Cortex
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Planning ahead and goal setting
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Time Management
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Reasoning- weighing the costs, benefits and
risks of various options
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Control of the “Attention Spotlight”
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Seeing the Big Picture
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Impulse control
Open for Business During Renovation
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Just before puberty there is a growth spurt
in the frontal lobes and corpus callosum
From age 11 to 16 the prefrontal cortex of the
adolescent will prune away 30-40% of its
neural branches
30,000 connections per second, gone
Use it or lose it
Myelination continues
The brain does not fully mature until the
mid to late-20’s
Teen Brain NASCAR Analogy
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Big engine—maturing bodies,
independence-striving
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Poor driver—immature PFC and
judgment, poor attention
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Faulty brake system—immature
inhibitory mechanisms in PFC
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High octane fuel—hormones
How Important are Executive Skills?
Compared to I.Q. scores,
measures of self-control in
childhood have TWICE the
power to predict success in
adult life
The Executive Skills
Thinking Skills
Doing Skills
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Working Memory
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Response Inhibition
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Planning/Prioritizing
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Task Initiation
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Organization
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Sustained Attention
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Time Management
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Metacognition
Goal-Directed
Persistence
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Flexibility
Development of the Executive Skills
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Origins in temperament: Can be seen as
early as preschool in terms of flexibility,
tempo, persistence, impulse control
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Task initiation, sustained attention,
organization, time management show up
as school is beginning
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Metacognition emerges slowly in later
school-age and into adolescence
The Frontal Lobes Emerge
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Preschool
Simple one-step tasks; “Get your
shoes from the bedroom”
 Inhibit behaviors: “Don’t touch
the stove”
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Kindergarten to
nd
2
Grade
Two-step directions
 Brings papers to and from school
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The Frontal Lobes March On
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Third to 5th Grade
Tasks with time delay: remembers
to do something after school
 Inhibits behavior in spite of mood
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Middle School
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Plan and carry-out long-term projects
Inhibit rule-breaking in the absence of
visible authority
The Frontal Lobes: Home Stretch
High School and Beyond
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Makes plans/decisions in light
of long-term goals: Selects
electives with college in mind
Manages “appetites”: sex, drugs,
rock-and-roll
Inhibits reckless behavior
Procedural Roadblocks
Any physical or behavioral impediment to:
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Obtaining necessary information
Accessing necessary materials
Initiating, persisting in, or completing
tasks
Getting work turned in
Max
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Fourteen and a high school Freshman
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Can’t find anything amongst the piles of stuff; school
stuff, soccer stuff, game and toy stuff
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Doesn’t write the assignments down in planner
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Inconsistent homework time and place
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Avoids getting started on work: won’t quit screens
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Starts in on whatever he first pulls out of his backpack
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Work is eventually completed but doesn’t get into his
backpack and then to school to be turned in
Executive Skills to Work On?
The Executive Skills
Thinking Skills
Doing Skills
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Working Memory
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Response Inhibition
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Planning/Prioritizing
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Task Initiation
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Organization
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Sustained Attention
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Time Management
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Metacognition
Goal-Directed
Persistence
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Flexibility
Executive Skills to Work On?
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Organization
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Planning/Prioritizing
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Task Initiation
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Metacognition
The 7 Deadly “I Don’t Know”s Plus
1
1.
I don’t know what the assignment is
or that I even have one
2.
I don’t know how to do
3.
I don’t know that I can do it
4.
I don’t know that I need help or
what help I need
The 7 Deadly “I Don’t Know”s Plus
1
5.
I don’t know when it’s due
6.
I don’t know where it is
7.
I don’t know whether it’s done or
not
8.
I don’t know how it gets turned in
Executive Skills to Work On?
Organization:
Consistent homework time and place
 Invest in getting stuff sorted out, culled, and
organized
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Planning/Prioritizing:
Make screen-time contingent on using his
planner
 Sort out all the homework before beginning
any of it
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Executive Skills to Work On?
Task Initiation:
Set a limited amount of time for homework
 Reward for getting started within X number
of minutes
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Metacognition:
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Discuss and visually lay out the complete set
of steps for any procedure such as homework;
right through to turning it into the teacher
Waiting for the
Motivation Fairy
“We acquire [virtues] by first
having put them into action… we
become just by the practicing of just
actions, self-controlled by
exercising self-control, and
courageous by performing acts of
courage”
Aristotle
Commitment and Acceptance:
Two Sides of the Same Coin
To Be A
Good
Student
Effort,
Frustration,
Sacrifice
Everyday Executive Skill Building
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Frontal lobe activity is frontal lobe
activity
Attached process words/concepts to
thinking and doing
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Keeps the brain active during long
school breaks
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Engages the child in activities that can
enhance a sense of mastery and good
self-esteem
Everyday Executive Skills
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Post Cards
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Navigator on Trips
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Planning and Cooking Meals
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Tongue Twisters
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Exploring inferences about another’s
behaviors and underlying motivations
Emotional Roadblocks
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Anxiety
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Shame / Humiliation
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Doubt
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Boredom (leaning away)
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Resentment and other thoughts
Thinking Roadblocks
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“I’m stupid”
“I’m no good at writing/math/particle
physics”
“I’m not your slave”
“I’m not weak”
“I’m not a nerd”
“I hate my teacher”
“My teacher hates me”
“It’s more mature than I want to be”
Fiona
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Seventeen and a Junior in high school
Volleyball, viola, theater, swimming,
ballet, student government, and choir
Spends five to six hours per night on
homework
Perfectionism; needs yet another on-line
citation, an hour adjusting the font
Increasingly more tired, frantic and rigid
as the night wears on
Executive Skills to Work On?
The Executive Skills
Thinking Skills
Doing Skills
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Working Memory
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Response Inhibition

Planning/Prioritizing

Task Initiation
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Organization
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Sustained Attention
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Time Management
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Metacognition
Goal-Directed
Persistence
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Flexibility
Executive Skills to Work On?
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Metacognition
Planning/Prioritizing
Time Management
Flexibility
Response Inhibition
Executive Skills to Work On?
Metacognition
As with Max, discuss and diagram essential
procedures with the endpoint in mind
 Process over content
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Planning/Prioritizing
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Agree on the purpose/goals of school
assignments- to demonstrate what you know
and to learn these very executive skills
including efficiency
Executive Skills to Work On?
Time Management
Set agreed upon time limits and deadlines
 Be empathetic but firm
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Flexibility & Response Inhibition
Discuss areas where Fiona gets stuck
 Validate (see below)
 Come up with coping strategies or ”pivotal
responses”
 Return to Metacognition
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Graybar’s First Law of Human
Behavior
“All behavior is a message, and
a behavior won’t begin to
change until the person knows
his message has been received”
Validation
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Closes the communication loop: “message
received”
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Provides accurate and nuanced emotional
vocabulary
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Replaces ineffective reassurance in many
situations
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Says nothing about your agreeing with
them or the “appropriateness” of that
thought or feeling at the time
Validation Strategies
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Simple and specific statements;
“You’re feeling …”
 “You’re having those ‘I can’t do it’ ideas”
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Identify expectations;
“You thought your friends would be able to help
you”
 “You weren’t expecting it to take so long”
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“I wonder” and “Ah” statements
“Mommy needs to get mad at you in a
weird calm voice now”
Whole Body
Validation
When people listen
to you, you listen
better
The Role of Attention
The word “attention” comes
from the Latin attendere,
meaning
“to stretch forward”
As opposed to “vigilance”
The Attention Spotlight
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Orienting to an “affect neutral”
stimulus: breathing, muscle tone
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Shifting attention from negative
private events to actionable goals
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The distraction paradox
Breathing Exercises
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Belly Breath
Finding Your Breath
Ferris Wheel Breath
Up and Over Breath
Darth Vader Breath
Alien Breath
I am resilient!
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I can solve problems
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I can cope with/adapt to conditions
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I have a support system, which I take
care of with my social skills
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I can take on challenges
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I can learn and grow from experience
Growing Stress-Resilient Kids
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Healthy diet
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Support a range of hobbies and chores
(without becoming over-scheduled)
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Healthy competition
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Regular exercise
As Heard on NPR Yesterday
Possible Mechanisms Explaining the Association Between Physical
Activity and Mental Health
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7,000 11 to 16 year-olds in the Netherlands
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Statistical analyses showed that, compared with respondents who
were physically active, inactive respondents were at higher risk for
both internalizing (mood) and externalizing (behavior) problems
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The underlying mechanisms are not clear: Direct or physiological
effects and/or indirect effects (improved self-image, confidence,
socialization)? Distress tolerance and goal-directed behavior? Body
as object vs. body as process?
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The study found some support for the self-image and social
interaction hypotheses
Growing Stress-Resilient Kids
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Promote friendships and community
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Create context and narrative (spiritual,
philosophical, historical) so that effort
and struggle have meaning
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Good sleep habits
Sleep: Learning and Memory
Increasing evidence that sleep is
fundamental to consolidation
of learning (including
procedural learning as well as
explicit memory)
The School-Sleep Squeeze
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Despite average school night bedtimes of
11:15 pm in high school seniors, the
average wake-up time on school days is
6:15 am
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10% of high school students must get up
before 5:30 am to catch buses
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15 % of high school students report
averaging 6 or less hours of sleep per
night on school days
Contributing Factors
Late bedtimes/sleep onset times:
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Biologic tendency for sleep delay
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Social influences toward sleep delay
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Greater freedom to self-select bedtimes
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Access to light and stimulating activities
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Stress/anxiety/excitement = Difficulty Falling Asleep
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Major circadian shift on weekends/vacation
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Work, Sports, Homework, Projects, Meds...
Good Sleep is a Product of
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Sufficient tiredness
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Low levels of stimulation
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Habit/Routine
Growing Stress-Resilient Kids
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Listen and validate
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Clear and (reasonably) consistent expectations
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Natural and logical consequences
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Model stress management and self-regulation:
Think out loud as you (effectively) cope and
problem solve
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Acknowledge mistakes and move on
“Let me help you, Dear”