Vol. #15, No. 7
Welcome to the October edition of Tips & Topics (TNT). Thanks for joining us this month.
David Mee-Lee M.D.
On the August 25, 2017 edition of Science Friday, I was introduced to some different thinking and research on dangerous teenage behavior. Ira Flatow, the host, introduced the segment with this: “Not long ago, the most popular explanation for any dangerous teenage behavior was what? Remember? Raging hormones. Fast-forward a few years and the explanation changed – the teenage brain is actually biologically different. Teens’ prefrontal cortex is less developed than in adults… that’s kind of current.”
What caught my attention in that broadcast was the work of Dr. Dan Romer from the University of Pennsylvania. This suggests that the risky behavior of youth is driven by something else entirely different from the current theory that the teenage brain is still developing.
If you want to listen to Science Friday August 25, 2017
Consider a different explanation for risky teenage behavior: “experience-seeking” rather than an “imbalance” in brain maturation.
Current theories on Adolescent Brain Development
* Sensation-seeking increases in adolescence. Recent findings from developmental neuroscience suggest the adolescent brain is biologically too immature to control impulsive drives and risky behavior.
* The decision-making center of the brain is the prefrontal cortex. This center is still developing up until age 25 or so. It’s the last area of the brain to fully develop, so the adolescent prefrontal cortex is less developed than an adult one.
* The time-lag in brain maturation creates an imbalance between the decision-making center and those regions in charge of motivation and reward, which have already matured.
* Researchers use this to explain why teens have poor impulse control or why they take risks adults probably wouldn’t. The reward center is motivating the teen, however the prefrontal cortex just isn’t prepared to put the brakes on that.
* Dr. Dan Romer and colleagues looked at the research literature and they didn’t see evidence for immature brain development being the cause of bad decision-making.
What was the evidence they saw?
(a) Most teens are not impulsive. They’re somewhat hyper-rational. Teens choose risky behavior because they are trying to gain experience. This ‘gaining of experience’ provides teens with a learning opportunity to gather information that helps in future decision-making.
(b) If it is biology (brain maturation imbalance) which explains risky behavior, many more teens would demonstrate that problem. But only a handful of teens, relatively, makes impulsive decisions to drink and drive, have unprotected sex or drive at high speeds. There should be a much higher prevalence if it was due to biology.
(c) If the cause of risky behavior is imbalance in decision-making versus reward center, then you’d expect teens to have difficulty controlling their urges for a quick reward, but that is not actually the case.
Give a teen the choice between $2 now or a 50/50 chance that they can get $4 later or could get nothing. If the problem is that the decision-making prefrontal cortex is immature and cannot put the brakes on the urge for a quick reward, teens would take the $2. However they are better at weighing the choices in this case.
In studies where teens are given enough information to decide about their chances for a reward or a loss, they are able to use that information to make a successful decision.
(d) Teens are still going to be risky, even if it’s not because of the prefrontal cortex being underdeveloped. They’re still going to make risky decisions. This is especially the case when teens don’t have enough information available to them. When they’re making decisions without all the information pertaining to a risky behavior, they’re going to choose to take the risk more than adults would, because they’re going to want that new experience (of driving fast, having sex, bungee jumping- whatever it is.)
Conclusion: A complete understanding of developing self-control over risky behaviors is not easily explained by the existence of the imbalance between decision-making and reward regions. Individual differences must be considered.
Understand the explanation for adolescent sensation-seeking and drug use.
Dr. Romer’s results are consistent with one explanation given for the rise in risk-taking that is characteristic of adolescence. Their results replicate findings from an earlier study showing that the peak in sensation-seeking during adolescence can explain a good deal of the variation in youth drug use.
It is the surge in dopamine activity in subcortical reward centers which explains the peak in sensation-seeking during adolescence.
- Increased drug use in adolescence is related to a rise in sensation-seeking.
- Less drug use later on in life is related to the decline in sensation-seeking that occurs later in adolescence, as well as transition to adult roles. Neither of these may require greater frontal brain control as the explanation.
- Experience gained during the adolescent period may help adults to recognize the hazards of some forms of risk-taking or to cultivate skills to limit such risky behavior.
- Youth with greater sensation-seeking show that they are better in their ability to delay gratification. This idea may seem odd at first, but it suggests that experience with risk-taking is itself a promoter of self-control and helps them to think before acting impulsively.
- This finding is also consistent with another apparently odd finding that adolescent criminal offenders are better at self-control as they age. Their repeated arrests provide the experience to weigh the odds and make a decision for self-control.
When it comes to developing control over adolescent risk-taking, maturation of the prefrontal cortex and its executive functions and decision-making may indeed play a critical part. But Dr. Romer’s results suggest that at least some of this control develops as a consequence of experience.
Romer, Daniel, Duckworth, Angela L., Sznitman, Sharon, Park, Sunhee (2010): “Can Adolescents Learn Self-control? Delay of Gratification in the Development of Control over Risk Taking” Prevention Science 2010 Sep; 11(3): 319-330. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2964271/
These explanations of risky behavior and sensation-seeking in youth have implications for prevention and treatment.
How to find the balance between sensation-seeking and promoting life experiences.
Youth will try risky behaviors both because of the surge of dopamine in the reward centers, but also because they want to experience new situations and learn from them.
How to protect high sensation-seeking youth from negative outcomes while at the same time promoting life experiences to facilitate learning and the development of good decision-making and life skills?
The answer lies in providing adolescents with increasing experience with risky activities but under supervised conditions.
An example that works:
Graduated driver license programs have been shown to reduce dramatically the crash risk of teenage drivers. When such programs supervise the young driver’s experience with risky activities, this is one way to satisfy a teen’s high sensation-seeking needs as well as protecting youth from their own risky behavior.
- An experienced driver knows that if the car wheels slide off the side of the shoulder of the road, reflexively jerking the steering wheel back could actually turn the car over.
- Giving the teen the supervision needed to gradually and gently guide the wheels back to the road can prevent the more dangerous reflex to jerk the steering wheel.
- Allowing the young driver to experience loss of traction of the car tires that starts the fishtailing sway of the back of the car can satisfy the need for a risky thrill. Showing the teen how to steer their way out of that dangerous situation can provide life-saving experience to prevent the car spinning and crashing.
Preventing the use, or negative consequences, of addictive drugs
- Encouraging activities stimulating to the dopamine system (such as sports and physical activity) can be a way to safely channel sensation-seeking.
- Direct your prevention efforts for high sensation-seeking youth to providing high-thrill, safe activities. The goal is to increase control over risk-taking impulses without experiencing adverse consequences. e.g. rock-climbing
Strong sensation-seeking tendencies lead adolescents into novel situations that may potentially hinder their adjustment. Nevertheless, this does teach them the importance of considering future benefits and consequences.
Our youngest daughter (now 31 and well-adjusted) was what you may describe as the “spirited child”. When she was an older teen, we were away one weekend and she had the house to herself. She decided that would be a great time to have a “little” party.
- A “few” friends came over. Then the word got out to the teens of the town that it was party time at the Mee-Lee’s.
- Uninvited “friends” were banging on the front door, climbing over the back fence, assembling in the backyard, smashing bottles in the street…you get picture.
- Neighbors noticed the commotion!
- She quickly realized things were getting out of hand and called the police to help.
That never happened again, not because we yelled at her or because of our harsh punishment, but because she learned from that experience.
Additionally, in retrospect, although we certainly talked about alcohol and other drug use with our children, we didn’t do well enough with further guidance/strategies:
- “Whatever you decide to do about substance use, really do it with your eyes wide open about the dangers e.g., riding with others who are intoxicated; knowing how much could cause an overdose of alcohol”
- “If you do use, call us anytime rather than ride with someone intoxicated or drive yourself home.”
- “Talk to us about anything. There are no silly questions and you are not alone. If you don’t want to talk to us, we’ll find someone you are comfortable to talk with.”
Remember the Five Ss
When this same youngest left for college, I reiterated my parting and ongoing advice to her that we had shared with all three children: “Remember the five S’s.” These are the areas of life critical to have thought through ahead of time – to examine one’s values, practices and their consequences. It is too late to consider what to do in the heat and immediacy of the moment – the results can be irreversible and profoundly life-changing.
I first wrote about these in the SOUL section of the August 2004 edition of Tips & Topics
Here are the five Ss:
- Substances – Besides addiction which is treatable, there are consequences that can be irreversible: acute intoxication causing a fatal accident or overdose, or a head injury with permanent cognitive impairment.
- Sex – In the midst of making out, it is not the time to examine your values and practices about abstinence, safer sex, pregnancy and abortion.
- Speed – I don’t mean stimulants, I mean cars and driving fast. When the tire blows out and the car rolls, or the car upfront suddenly stops, or the road is wet and the brakes don’t work well – that is too late to think about speeding.
- Seat belts – When the car is rolling or you are heading for the windshield, it is too late to buckle up.
- Sleepiness – A sleepy driver is as dangerous to self and others as a drunk driver. When my son sideswiped the median barrier dozing off for a split second after a late date, sleepiness was added to the list.
It is our family’s joke to mention the five S’s. But hopefully it will prevent some pain with your family or loved ones and save lives and that’s no joke.
I imagine any man who has knowingly committed sexual harassment is feeling quite nervous right now. With the current empowerment (correctly so) of women to speak up and speak out that it has happened to “me too”, men who have abused their power and position are on notice.
I can’t imagine that I have every sexually harassed a woman. But then the 41st President George H.W. Bush age 93, wheelchair bound and with his wife right there next to him probably didn’t imagine he could be accused of sexual harassment either….and twice at that! Read about it:
At least 45th President Trump is open and honest about how he sees nothing wrong with abusing his power as a celebrity to kiss, grope and try to have sex with women he finds attractive. At one point in the 2005 Access Hollywood video with host Billy Bush, Donald Trump says, “Grab them by the p—y” and “when you’re a star, they let you do it.” Washington Post article on President Trump
Of course abuse of power, especially sexual abuse of any kind, is so damaging and wrong. But then I got to thinking how regular people like you and me can also abuse the power we have in relationships.
Do you have any of these attributes or privileges that give you power over another?
- Education or high intelligence
- Sexual orientation
- Skin color
- Social class or socio-economic status
And then what about these relationship dyads with inherent opportunities for abuse of power?
- Parent – child
- Counselor/therapist – client
- Doctor – patient
- Supervisor – supervisee
- Older sibling – younger sibling
- Rich – poor
- Housed – homeless
- Landlord – renter
- Husband – wife
- Expensive fast-car owner – modest low horsepower, slow car owner
I bet that everyone one of us has something where we have power over another… and either have or are tempted to abuse that power.
But it is also true that the Biblical “to whom much is given, much will be required” or “with great power comes great responsibility.”
“There but for the grace of God go I.”
Until next time
I’m glad you could join us this month. See you in late November.