The Biden administration has released a proposal to raise standards in nursing homes. Why one expert calls it the most significant development for the industry in decades -- and why it might still not be enough.
Guest Host: Susan Page
If you think your teenagers are moody, impulsive and overly concerned about what others think, you’re right. But don’t blame them. Blame their brains. Over the last several years, neuroscience has revealed a number of striking things about the teenage brain. The part in charge of planning and judgment is not as developed as in adults. And yet, the portion of the brain that experiences pleasure is larger than at any other time of life. Understanding this, experts say, can have a profound effect on how we teach and parent teens, as well as on public policy regarding everything from the driving age to juvenile justice. We look at the science behind the “terrible teens.”
- Laurence Steinberg Professor of psychology, Temple University; author of "Age of Opportunity: Lessons from the New Science of Adolescence"
- Nicole Joseph Clinical psychologist in private practice.
- Dr. Frances Jensen Chair of department of neurology at the Perelman School of Medicine at the University of Pennsylvania; author of "The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults"
MS. SUSAN PAGEThanks for joining us. I'm Susan Page of USA Today sitting in for Diane Rehm. She's recovering from a voice treatment. The teenage years can be rough for parents, for teachers, not to mention for teens themselves. Yet, it's also a time of life that produces some of our most vivid memories and profound moments of growth. Experts are increasingly turning to brain research to explain why.
MS. SUSAN PAGEJoining me in the studio to talk about the emerging science of adolescence is Nicole Joseph, a clinical psychologist in private practice near Washington, D.C. Welcome to "The Diane Rehm Show."
MS. NICOLE JOSEPHThanks for having me back.
PAGEAnd joining us from a studio in Philadelphia, Dr. Frances Jensen of the University of Pennsylvania's Perelman School of Medicine. Welcome.
DR. FRANCES JENSENGreat to be here.
PAGEAnd also, Laurence Steinberg of Temple University, thanks for joining us.
MR. LAURENCE STEINBERGThank you.
PAGEWe invite our listeners, whether they be teens or the parents of teens or the parents of future teens, to join our conversation later in this hour. You can call our toll-free number, 1-800-433-8850. You can always send us an email at email@example.com or you can find us on Facebook or Twitter. Well, I'm the mother of two former teens and, Dr. Jensen, I've got to say there were many times when they were teenagers when they made stupid, risky decisions quite to my exasperation.
PAGEYou're saying, I think, in your research, you've found that there's a reason why. Why?
JENSENWell, there is actually, news flash, neurobiology to explain that perplexing behavior. And actually, it's all very new research that's been going on, say, in the last decade and a half, which I think the public should know about. There's reasons that the teenage era has special skills and there's other biological reasons why they are lacking things that adults have. It's important for us to remember the brain is the last organ in the body to mature.
JENSENIt takes the middle to late 20s to complete and there's a -- males are about two years behind females on that trajectory. And that there are big differences. These are not adults with fewer miles on them. They are essentially quite different. They have some special skills that they're carrying over from childhood, which is an enhanced ability to learn that they should take advantage of, but it also brings some vulnerabilities. And, in a nutshell, another big way they're different is that they don't have the same connectivity to an area of your brain called the frontal lobe and the prefrontal cortex that's involved in decision-making, impulse control, empathy and judgment.
JENSENAnd that is the -- gets connected, if you will, over the process of life until about your mid-20s so they're not running with full connectivity to their frontal lobes. So that helps us explain why they're impulsive, novelty-seeking, are fast learners, but also kind of very vulnerable to the effects of the environment and that's a conversation that needs to be had.
PAGELaurie Steinberg, you focus on another part of the brain that's different during adolescence, the reward center. Tell us about that.
STEINBERGWell, I think that adolescence is best understood in terms of the competition and cooperation between two different brain systems, one that Dr. Jensen mentioned, which is localized mainly in the prefrontal cortex and that's the system that helps us control ourselves. It's the breaking system. It's also the part of the brain that's most important for advanced cognitive abilities and that's why there's such growth in intellectual development during adolescence because of the development of the prefrontal lobe and its connections to other parts of the brain.
STEINBERGBut at the same time, there are changes going on in an area of the brain called limbic system, which is a deeper structure inside the brain. And a part of the limbic system that we've been interested in in our work, is what is often referred to as the reward center. It's a small structure in the brain called the nucleus accumbens. And what we now know is that that system of the brain, the reward centers system becomes much more easily aroused during adolescence.
STEINBERGSo the metaphor that we've used to describe adolescence is that it's a time when the accelerator is pressed down to the floor, but there's not yet a good braking system in place.
PAGEAnd to both of you, is there an evolutionary reason why we have these people who can look like adults, but their brains are not really in a fully mature state? Why is that?
JENSENWell, one thing is, it's a time of -- that novelty-seeking, teleologically, should be rewarded. It's the way you get more experience and you're preparing yourself, your scaffolding your brain with experience for life. So novelty-seeking that uses the reward system and it's a big unbridled because it doesn't have the frontal lobe to say maybe you shouldn't go there is an important part of brain development. It's trial and error.
JENSENIt causes you to build circuits and, of course, we build circuits, and this is something we can talk about in a little while, we build connections between our brain cells. These connections are called synapses. And synapses, actually, grow larger when they're used more and so this process of -- we call it synaptic plasticity, meaning it's moldable by experience, the more you use it, the stronger the connection -- that process is how we scaffold our brain and they have -- teens actually have more synapses, as do children, than adults.
JENSENAnd this process, all the machinery that goes into building synapses, is actually set genetically at higher levels during that part of development. So it's a great time to be building your brain. But there's the downside and is if you, you know, they are doing it without the inhibition of their frontal lobe, but a very, very strong reward center. So this is why, I think, this research is so important for teachers and parents who are tearing their hair out, going -- and even the teens themselves, like why did I do that, that was -- I shouldn't have done that.
JENSENBut it's a relief to know that there's biology behind it and I think it makes parents a little bit more patient, teachers a little bit more understanding and, especially, you know, there's gender differences. There's all kinds of things that can be explained, at least, to help you step back and not respond, as an adult, with the same kind of emotional response. After all, the last I checked, adults do have their frontal lobes connected and should step back and kind of process it, the way their teenagers behave, better.
PAGEAnd, of course, understanding this may help us figure out ways to deal with some of the negative aspects of a teenage brain, while encouraging the more positive ones. Well, Nicole Joseph, you are a clinical psychologist. You work with a lot of teens. Do you see these factors in your practice?
JOSEPHAbsolutely. And if I can just say, it's very important, I believe, for clinicians to be informed about the research underpinning all of this, being an important consumer of this research because I do share this research with the parents who I see. I often have parents, regardless of the reason, bringing teens in who are just worried sick about their teens, worried about their decision-making, worried about their judgment, exactly what we're talking about in terms of reward centers and frontal lobe issues.
JOSEPHSo I do often tell my parents about what's going on with the frontal lobes and what's going on in their teen's brain, especially to moderate their expectations. I think sometimes, as a parent, we do expect teens to be little adults or we expect, oh, because my teen knows lesson A, they should also know lesson B, and that's not necessarily the case. In terms of development, I often work with parents on expectations that they should not necessarily expect a linear development process, right?
JOSEPHSo they should expect kind of peaks and valleys of good judgment, good behavior and then some faltering as well. And this is, you know, teens not only trying to get better experiences, but also trying to work on defining the boundaries of their own identity, as it's being formed.
PAGEWell, here's a comment, though, from Tamara who writes us on our Facebook page, she writes "isn't it interesting that there weren't teenagers before the 20th century? Before that, people were married and had children and worked arduous hours in their teens." I can see both of our Philadelphia guests shaking their heads. Dr. Jensen, what do you think?
JENSENWell, I'll let Larry start because I think he shook his head before mine, but I certainly have something to add.
STEINBERGThanks. Of course, there were teenagers before the 20th century. What has changed has to do with the roles that we ask young people to fill. But if you go back to the very earliest writings about adolescence, if you look at Aristotle, for example...
STEINBERG...and Shakespeare, that people have been talking about the impulsive and rash behavior of young people for centuries. So even though, yes, it is true that in the 19th century, 18th century people of the age that we now have in high school were often working, they actually were not married at that point in time. That still didn't mean that they weren't necessarily impulsive and perhaps not terrific decision-making on their jobs.
STEINBERGSo I think we need to distinguish between adolescence as a neurobiological and biological phenomenon, which has always been with us, versus adolescence as a social construction, which has changed and which will continue to change.
JENSENWell, I think that the knowing the neuroscience, which is all quite new and evolving literally by the month -- I keep picking up, you know, when I wrote my book, which came out in January, I've now got much more information that just is coming out even since January. There's this -- research is just folding out of the basic science and clinical sciences around this window of development. But it's -- the research is new. The understanding is new, but the biology is old. It's been, you know, with us since humans were, you know, first on the planet.
JENSENSo our society has a very ambivalent way of treating, I think, teenagers and it's a lot of mixed messages. Look, you know, you can take a young male that hasn't got their frontal lobes fully attached and send them to war, but you don't let them drink alcohol or you have to drive with an adult or, you know, it just -- voting rights were, you know, on either side of late teenage years. And it's not an arbitrary thing.
JENSENNothing magical happens at 12:01 on your 18th birthday. It's a process, as, you know, Dr. Joseph just eluded to. It's variable. It's very individual. The research can tell us about average development, but you're going to have boys, for instance, that are ahead of the curve, girls that are behind the curve, people who are developing different parts of their brain, you know, unequally.
PAGEWe're gonna take a very short break. When we come back, we're going to talk about some survival tips for parents and for teens in dealing with the teen years and we'll take your calls and questions. Our phone lines are open, 1-800-433-8850. Stay with us.
PAGEWelcome back. I'm Susan Page of USA Today, sitting in for Diane Rehm. And we're joined from WRTI in Philadelphia by Larry Steinberg. He's a professor of psychology at Temple University. He's the author of "Age of Opportunity: Lessons from the New Science of Adolescence." And Dr. Frances Jensen, she's chair of the Department of Neurology at the Perelman School of Medicine at the University of Pennsylvania. She's the author of "The Teenage Brain: A Neuroscientist's Survival Guide to Raising Adolescents and Young Adults." And in the studio with me, Nicole Joseph, she's a clinical psychologist in private practice in the Washington area.
PAGEWell, Dr. Jensen, let's talk about your book. It's called a survival guide. Of course there's all kinds of survival. Do you mean actual, physical survival? Is it a risky time, a dangerous time to be a teenager?
JENSENYes, in some respects. I think the word survival has multiple meanings. In this case, it was to help the parents and teachers sort of survive their time as interacting with their teenagers in their world. If I was a parent myself, a neuroscientist and neurologist, and I was watching my two sons sort of morph in front of me, and they became somewhat unrecognizable, literally, over those years, and it was a way -- I was like, I've got to understand this. I'm a -- I'm a developmental biologist. I should be able to look this up.
JENSENAnd I went into the literature and found all this new information and would share it on the sidelines of football games. And my co-parents were, like, really? So that's why they do that. So this is -- and that made, I think, a big difference. So, you know, it made sense to write this up. I was doing Teen Brain 101 talks, and it was helping teenagers and their parents, as well. We would give the same information to both, and teachers, I think it gives everybody a moment to sort of step back and, like, use information to understand why they're doing what they're doing.
JENSENAnd with respect to survival, the other part is that our world is changing, right, and so the fact that they have these up-regulated reward systems, which are biologically connected ahead of their frontal lobe, by the way, so they have -- they're running on emotional energy and mood. They're -- you know, it explains their moodiness and emotional energy without the gating of their frontal lobe. So this environment we have now, and we'll talk about this, I'm sure, with respect to the trouble they can get into, if you will, the risks they can take are potentially much higher now than they might have been 100 years ago.
JENSENAnd that's, I think, a really important thing for people to sort of take pause.
PAGEAnd in fact teenagers, American teenagers tend to be really healthy, but they have a higher death rate than younger children, mostly I guess from accidents. I think you call it the accident hump. It's really a time where you're at risk of doing something that puts you in peril.
STEINBERGRight. Adolescence generally is a very healthy period in terms of disease and illness, but yet there's a 200- to 300-percent increase in morbidity and mortality between childhood and adolescence, and that's because adolescents do things that can endanger their own well-being and that of those around them.
STEINBERGWe have an interesting example that I think most people don't recognize. If you look at data on age differences and accidental drownings, what you see is that accidental drownings are actually higher during the mid- and late teenage years than they are before or after. Now, that can't be due to insufficient stamina or energy. Adolescents are quite strong. So there's no -- there's no good reason why 16-year-olds should drown more often than 35-year-olds, but they do.
STEINBERGSo we think that it probably has to do with bad judgment and bad decision-making, and it's that kind of thing that really threatens the well-being of teenagers, here and in other countries, as well.
JOSEPHYeah, and to just carry on from what he's saying, biologically because their brains are so impressionable, because they have this special ability of their synapses to adapt to things in their environment, this can be for good reasons, so they can learn faster than adults. You can actually change your IQ during your teenage years in a good direction, but you can also change it in a bad direction by using substances.
JOSEPHAnd this brings me to an important point that addiction, which is -- actually teenagers, you know, again, debunking a myth, they are not resilient to everything. They actually get addicted faster, harder, longer, stronger than adults, just like they can learn facts harder, stronger, longer, faster. It turns out that addiction is the same form of plasticity, growing connections between brain cells, except in their reward center, and they get addicted harder.
JOSEPHYou know from your own experience people that, for instance, let's just say smoked as teenagers. It's much harder for them to quit as adults than somebody who picks it up later. You start to hardwire yourself when you get addicted as a teenager, and you're much more vulnerable to getting addicted. So that plus a frontal lobe that tells you not to say no, that just says sure, I'll try it, puts them -- it's like a double jeopardy. And that's something I think teenagers need to know about themselves.
STEINBERGI think that we need to remember that adolescence is this duel-edged sword, right? And because the brain is so plastic and so malleable and so open to experience, because it's a time of novelty-seeking, it's -- it creates an opportunity, which is why I called the book "Age of Opportunity." And I think that a lot of what we talk about, when we talk about adolescence, has to do with the vulnerability of the period, but we have to remember that the same aspects of the brain that make it a vulnerable time make it an opportune time.
STEINBERGSo I think the discussion needs to include, of course, how can we protect kids from doing the things that are going to hurt them, but it also needs to include how can we take advantage of what adolescence is in order to promote healthy and positive development during this time period.
PAGEYou know, we have an email from Joey that's along these lines. Joey writes us, oh, like our adult brains are superior. Give me a break. The adolescent brain has so much potential, so much enthusiasm for life, so willing to solve all of the world's problems in a heartbeat, no wonder they think they know everything. It's because they're not adults, who have decided it's not worth their while, let someone else handle it, it's none of their business.
PAGESo Nicole Joseph, in your practice...
PAGEWhat do you say to teens who are at risk of making poor decisions, of abusing drugs or starting to smoke or take risky behaviors? What kind of tips do you give them to handle situations so that they make better decisions?
JOSEPHI'm really glad you asked that. Yeah, and I really -- can I just say, I really like Joey's comment because I really think it's difficult, very difficult to be a teen, and we don't often give teens enough credit. I love the idea that it's the age of opportunity, as well. Yes, I often have conversations with teens in which I'm not necessarily saying one thing. I don't know that there's one thing that you can say to a teenager that will change behavior.
JOSEPHHowever, if teenagers are receptive, I will have a really detailed discussion with them about, you know, what would you do in this specific situation. So you have this party coming up. How are you going to deal with this with your parents? How are you going to build trust with your parents so you're allowed to go to this party? How are you going to deal with it when the entire group, you know, your peer group wants to do something, and you don't feel comfortable with that?
JOSEPHSo we talk a lot about contingencies. We use language and talk together about how to use language that feels comfortable and that's readily accessible for the teenager, so they can say hey guys, I'm not cool with that, I'm not going to do that right now. And I think those things are very, very helpful for my teens.
PAGESo like, for instance, if you were kind of role-playing, you're going to this party, people are going to -- maybe people are going to offer you Jell-O shots.
PAGEWhat do you tell the teen to do? What should the teen be thinking about so that he or she is going to be prepare to make a smart decision?
JOSEPHWell, I've often ask them, how would you feel about that? That's probably inevitably going to happen. Are you comfortable with that, or are you not? How do you make sure you're making good decisions if you do choose to, you know, have a Jell-O shot or not? What are you going to say if you don't feel comfortable doing that? Are you going to have a friend there as backup?
JOSEPHPeer groups are extremely important to teens, and something that I often get in my practice is teens will read me all of their text messages from the week, from their boyfriend or from their best friend. What is she thinking? What do they think about me? So peer groups is a really important part of this conversation, as well.
PAGELarry Steinberg, I know that you've written a lot about peer pressure. How big a phenomenon is that for a teen?
STEINBERGIt's a huge phenomenon. We know that there are changes in the brain that make adolescents much more sensitive to social cues and social information, which is what makes them want to pay so much attention to what people think about them. But peers influence adolescent behaviors in some ways that are surprising. It's not simply explicit peer pressure. One of the things that we've been studying here at Temple for the last 15 years is the impact that peers have on adolescent risk-taking even when the peers are not speaking to them at all.
STEINBERGAnd what we found in a series of experiments is that if an adolescent is playing a risk-taking game and playing that game with two of her friends in the room with her, she'll take twice as many risks, even if her friends aren't speaking to her, than she will if she plays the game by herself. And we don't see that effect with adults.
STEINBERGSo peers activate the brain's reward center during adolescence in ways that make the potential rewards of a risky choice even more salient.
PAGEWell, in fact I know that you've written about these mouse studies that found what mice do when you get more of them together, when they got more peers around, what happens?
STEINBERGWe did a study in which we raised a group of mice, and then we raised them in cages so that they had two other mice from different litters with them. So we created these adolescent peer groups. And we raised the mice and tested half of them when they were juveniles, right after they went through puberty, and tested the other half of them when they were fully grown adults.
STEINBERGAnd the test was to see whether they would drink more alcohol if they were alone versus with their two cage mates. And what we found was twice as much alcohol was consumed by the adolescent when they were with their friends than when they were alone, but there were no differences in consumption among the adult mice between when they were alone and with their friends, which I think reaffirms the notion that adolescence is not simply a social construction, it's a hard-wired feature of development that we see across mammals. It's not just limited to humans.
PAGEAnd Dr. Jensen, what should -- what's your advice to parents in light of what we know about the teenage brain, you as not only a scientist but also as the mother of two teenagers?
JENSENWell, I tried -- so the thing about this generation is they are a very fact-driven, information-driven group of people. They have lived and grown up with the Internet. They have a great deal of respect for facts, I noticed, and they actually -- one tends to be a more effective parent when you say, you know, think about don't do this because, not because -- the wrong way to approach is it because I'm telling you not to. The right way is because actually there's a study that shows this or that. When something that -- use examples from things that'll happen in their everyday lives.
JENSENDrunk -- you know, sadly on OUI and other mishaps that happen to teenagers, bring them to the dinner table and talk about them. Say, you know, this happened because of that, and you realize that you, like Dr. Joseph was just saying, that -- you know, that you have a propensity to take risks. Please be careful. Do you know this? Do you know you can get addicted faster? You know, these kind of -- this sort of information I did discuss with my kids.
JENSENAnd, you know, they're not perfect kids. Nobody -- no teenagers are perfect. They're not adults. We as adults only think adults are perfect, but teenagers are going through a stage of life that is their very own. And I think we also have to really pull what Dr. Steinberg just said, is that they, and I put a lot about this in my book, too, it's an age of unbelievable ability to scaffold your brain and get it ready for adulthood.
JENSENAnd by the way, you're not -- brain isn't done by the time you finish high school or start college, and it's not even done by the time you end college. So college is also a time where you can really learn a lot, and I say bring on the late bloomer. And our -- luckily our educational system in this country allows people, you know, at 16 and 17, to really seize the opportunities because they still have this plasticity, whereas, you know, other educational systems kind of shut you out if you're not a scholar by 14, for instance.
PAGEI'm Susan Page, and you're listening to the Diane Rehm Show. We're taking your calls, 800-433-8850. Let's go to Holland, Michigan, and talk to Gwen. Gwen, thanks for calling us.
GWENYeah, I have read the neurologist's book about the teenage brain, and I'm wondering, I understand the plasticity, I understand opportunity. I'm wondering what character has to do with it. I have four teenagers in the house. I'd say three of them are introverts, and I have one who is an extreme extrovert who is getting into a lot of trouble.
PAGEAll right, Gwen, let me turn your question over to Dr. Steinberg and Dr. Jensen.
JENSENSo it would be nice if we had a way to tell you where your child's brain is along the developmental spectrum. One day, with advanced imaging, who knows? It might be something that's done commonplace. But at this point in time, we can tell you that everybody develops at a different rate. But they all go in the same direction, and they follow the same pattern.
JENSENBut you're right. You can have two children in the same family with the exact same environment bringing them up that have really developed -- they appear to be extremely different in the way, you know, you could say extrovert versus introvert, and it's a mixture of the genes and the environment. It's sort of nature and nurture making each person who they are.
JENSENSo I think you do have to look at each child on an individual basis, and you can't treat your extrovert the same way you treated your introvert. Sometimes -- I guess you sort of got off easily with the introverts, but, you know, the extrovert is there to challenge you and needs more of -- you need to do a frontal lobe assist, I always say to parents, with these risky, risk-taking children, especially when they're under 18, when you can really still, you know, be responsible for them.
STEINBERGI think we need to remember that when we talk about brain development during adolescence, we're describing an underlying process, not the outside behavioral manifestation. And that is going to be affected by a child's temperament, it's going to be affected by the context that the child is growing up in. Some kids will manifest adolescent risk-taking in ways that are dangerous. Others will manifest it by doing things like trying out for the school play or going out for a sport that they are worried about whether they'll make the team.
STEINBERGWe've just finished a study of 5,000 adolescents and young adults in 11 countries, and when we look at the underlying processes of things like impulse control and sensation-seeking, they're identical around the world. These are countries that range from Sweden to Kenya, so quite different from each other. But when we look at actual rates of risk-taking in these countries, they're very, very different.
STEINBERGYou know, so in places like the United States and Scandinavia and parts of Western Europe, adolescents drink a lot. That's not true in China, even though Chinese adolescents and the American adolescents go through the same changes in reward-seeking an impulse control. They manifest it in different ways. So temperament is one of those factors that interacts with brain development.
PAGENicole Joseph, Gwen says she has four teens at home. One can only imagine what life is like on -- every day for Gwen. Are there special challenges when there are a couple teens in a family and when they're different, as I think a lot of kids would be in that situation?
JOSEPHAbsolutely. I think it's very important for parents to keep in mind that every teen is extremely individual. So oftentimes I'll hear parents say, well, my first -- my first didn't do this, or my other children don't do this, and absolutely they're right. But every child is individual and different. So I think parents using their parental intuition, which they've had since before the time when their child was verbal to understand what their specific child needs in different situations is very important.
PAGEAnd the different kinds of kids need different treatment even though sometimes that may not seem fair to one sibling that they're getting different treatment than the other. Is that right?
JOSEPHAbsolutely. If I had a penny for every time I heard that's not fair. Absolutely you're right. No, and I think that it's important for parents to do exactly what Dr. Jensen was saying, which is work on scaffolding with each child, work on talking about decision-making and planning and saying, you know, you're not the same person as your brother, so therefore we're going to make different decisions for you than we were -- than we're going to for your brother.
PAGEWe're going to take a short break, and when we come back, we're going to talk about the very difficult issue of teen suicide and how the development of the teen brain may be affecting that. And we're going to go back to the phones and take your calls and questions, 800-433-8850. Stay with us.
PAGEWelcome back. I'm Susan Page of USA Today, sitting in for Diane Rehm. In the studio with me, Nicole Joseph, a clinical psychologist, and joining us from Philadelphia, Dr. Frances Jensen from the Perelman School of Medicine at the University of Pennsylvania. She's author of "The Teenage Brain." And Laurence Steinberg, a professor of psychology at Temple University. He's the author of "Age of Opportunity: Lessons from the New Science of Adolescence."
PAGEHere's an email from Josie. She writes, we all know some adults who still act impulsively and seek personal pleasure without regard to others. Do their brains look more like teens than adults? And when you have those teens who are very mature and not impulsive, do their brains look more like adult brains? What do you think?
JENSENWell, actually this is something that's currently under study in a lot of laboratories. There has been an emergence of tons of information coming from what we call advance neuro-imaging, brain imaging, using something called functional MRI and tracked connectivity studies that are really showing us the wiring diagram of the brain. And this is, like, 10 to 15 years old, and it's just getting better every -- every year they make a better magnet and better magnetic resonance imaging, MRI, machine.
JENSENAnd we can actually study the way people process information or attend to tasks, and yes, there's -- these studies have shown that this is a progression that gradually involves more of your brain as you grow into adulthood, involving, as we've talked about, you know, the prefrontal and frontal cortex being connected up by pathways that are becoming insulated over time. So they have faster conduction.
JENSENAnd what we see is that adolescents, we know that it always proceeds, but some people are years later than others, and it'll be very interesting as more data gets gathered to sort of understand are there ways we can tell where their frontal -- you know, how connected they are without having to do an MRI on them. I mean, it'll take some time and research.
JENSENNow yes, there's also studies on advanced imaging and people with different kinds of issues that relate to their impulsivity, and sometimes there can be patterns that are seen that they're not -- they look more immature. But again, this is still very new information. And one of the big cautionary things is that certainly in the legal system, there has been a temptation to go to neuro-imaging, to, like, say this person was competent or not competent. And I think right now, the medical field, the neuroscience field, is saying don't do it yet, we are not ready, we are so not ready, the MRI is not a lie detector, it is not -- it can't tell you whether you're legally competent or not.
JENSENSo, you know, we'll see. It's a really exciting area, though.
PAGEHere's an email from Rob, who's listening to our show in Baltimore. He writes, I hope this discussion touches on the juvenile -- on the justice system judging teenagers as adults. And of course this has been a great debate in this country, at what age are you really responsible for your behavior when -- especially when you commit a really terrible crime. What are your -- what are your thoughts on that, Larry Steinberg? Is there a point at which teens should be held fully responsible for criminal behavior, or should we treat them in a different way?
STEINBERGI think we should treat them in a different way. I've been active, as I think Dr. Jensen has been active, in the recent Supreme Court cases that abolished the juvenile death penalty and placed limits on the use of life without parole as a sentence for teenagers. And we know that there is continued brain development into the early and mid-20s in areas of the brain that are relevant for making legal judgments about people's culpability and criminal responsibility.
STEINBERGSo if it's the case that adolescents are not as able as adults to control their impulses or are more susceptible to coercion than adults for reasons that aren't voluntary, for reasons that have to do with the inherent nature of brain development during that time period, then we shouldn't be treating adolescents as if they are adults.
STEINBERGOne of the exciting things that's happening right now in the legal field is responding to the newest research, which suggests that not only are adolescents different from adults, that people in their early and mid-20s are different from people who are older. And how should the legal system now respond to people who are, let's say, between 18 and 22 who are currently legal adults but we know developmentally still not quite there yet.
PAGEBut does the judicial system at this point treat them any differently?
STEINBERGIt doesn't in terms of the statutes that are on the books, but it can in terms of punishment. So we need to distinguish between finding somebody guilty or not guilty of a crime versus deciding for somebody who's been found guilty what's an appropriate sentence or punishment for that person. And I have been involved in a number of cases recently in which the guilty person was somebody who was 19 or 20 at the time of the crime and where the judge is raising questions about whether the appropriate sentence for somebody of that age should not be as harsh as it would be for somebody who's somewhat older.
PAGEYes, Dr. Jensen?
JENSENYeah, I totally agree, and I too have been involved in some amicus briefs to the Supreme Court about this. And one of the -- the flip side of this is also because they have synaptic plasticity, and there's a positive, they might be -- have opportunity for rehabilitation to a much greater extent than an adult at a later time in life. And so that's the other side of it, to sort of understand, can we tell which person is rehabilitatable because this is a critical period for them. They might be able to turn themselves around.
JENSENI mean, as I mentioned earlier, this idea of a late bloomer with respect to scholarly capacity, you can -- you can acquire a lot of new knowledge and new behavioral patterns in this window of development. So, you know, the legal system should be paying attention to that because it might very much bear on their capacity to help change someone during the -- you know, during the rehabilitative process.
PAGENicole Joseph, has your practice included teens who are -- actually have committed crimes, have gotten into trouble with the law? And if so, how do you handle that?
JOSEPHGenerally at Child and Family Counseling Group, where I practice, I don't tend to see that population of children. However, in my background, I have worked at an evaluation unit with severely emotionally disturbed children, and I did find that exact same thing, what Dr. Jensen is discussing, which is that children did seem to have the ability to kind of learn their lessons with the plasticity. So I completely, wholeheartedly agree.
JOSEPHAnd I think this is an issue that's going to be increasingly in the media, and topically I had just seen that the Slender Man stabbing case with the two adolescents who were, I believe, 12 years old at the time of the crime, have I think recently plead not guilty for the crime. So I think this is going to keep coming up over and over again in the media, as well.
PAGEYou know, Victor is calling us from Cincinnati. I think he works in -- with law enforcement officers. Victor, hi, you're on the air.
VICTORHi, thanks for taking my call. And yes I do. I teach police officers about safe and effective interaction with persons who are mental illness, and one of the most effective parts that I find when I'm training them is teaching them that behavior is rooted in the brain, and that's why I teach them why the brain develops and what goes wrong and so they can better understand who and what they're dealing with.
VICTORBut I also get questions about, well, how do I deal with what parents can do and what the legal system can do, but these kids get in trouble, and the police have to interact with them. So what -- what are some things that police or law enforcement or anybody that has to deal with unruly kids can keep in mind when they're interacting with a kid who's in trouble because their brain's not finished, and they're, you know, they're reacting from this limbic overreaction, and the frontal part isn't connected yet?
PAGEAll right, Victor, thanks so much for that call and that question. Any responses? Larry Steinberg, what do you think?
STEINBERGI think the most important thing that a law enforcement officer can do, which is also the most important thing that a parent can do or a teacher can do, is to understand that the impulsive adolescent is going to most likely grow up to be a perfectly normal, non-impulsive adult. I mean, the big difference between an impulsive 17-year-old and an impulsive 40-year-old is that that 17-year-old, 90 percent of the time, is going to be an adult who has perfectly fine self-control, but the impulsive 40-year-old is probably always going to be impulsive.
STEINBERGSo I think patience and understanding, which can come from understanding brain development, psychological development during this time period, can go a long way for how all of us as adults interact with people during this age.
PAGEVictor, thanks so much for your call. Here's an email from Barbara. She writes, is risky and impulsive behavior in teen brains also a catalyst in teen suicide? And we had another email from Chris, writing us from Ontario. We have a 15-year-old daughter who seems to me to be very grounded and very wise. She is so much more together than I was at that age. But she also had a brother who had severe mental and emotional disorders, and he committed suicide nearly 10 years ago. I think that experience is why she is so grounded. What can you tell us about rates of teen suicide, Dr. Jensen?
JENSENWell, there -- the teenage period is, and early adulthood is, a time where you see a bump in suicide, especially in males but in both sexes. But it's important to put that in the context of what's going on in the brain at that point in time. We've just talked about impulsivity. There is an element of impulsivity in an act of suicide. So, like, oh, maybe I didn't mean to do that, but it's too late now, right. And so that's one big thing. But the other is to really realize that it's not just the impulsivity, it's the fact that your brain is developing, and you start to enter, to the end of your brain development through the adolescent period, you enter a period of vulnerability to mental illness, the onset of mental illness.
JENSENNow what's really fascinating about this is that it takes an adult-like brain to sort of do mental illness. So people can have the propensity to go on to develop schizophrenia or bipolar disorder, for instance, or depression, through their childhood but not show any symptoms, but when their prefrontal cortex and their frontal cortex connects in, they suddenly now start to manifest the pattern of schizophrenia or depression or bipolar disorder.
JENSENSo it turns out that many, most, of the affective disorders, schizophrenia, bipolar, depression, have their onset in late teens and early adolescence. And this is something that's concerned colleges to a great degree because they, you know, it's locum parentis, right, they have to be very concerned about the onset. This is a classic time for people to have their first psychotic break or become highly depressed.
JENSENAnd the sad thing that your peers at that point in time, because they don't necessarily have the full empathy skills needed, they're not very supportive to these very same people, to their peers that are beginning to manifest something they don't understand. So that's playing a very important role, and I think parents and teachers, they need to watch carefully when a child begins to, like, become a little different and start to, you know, appear depressed or seems to be not connected to reality. This may not just be a phase. They have to be aware that this might be, just might be, a -- you know, the onset of a mental illness.
STEINBERGOne of the -- one of the discoveries that's come out of brain science in the last couple of decades is that the hormones that trigger puberty, the bodily changes, sexual changes of adolescence, also make the brain more stress responsive. So the adolescent brain and the young adult brain is more affected by exposure to different kinds of stress, whether social stress or physical stress, than is the adult brain or the child's brain, and that's another reason that this is a such a vulnerable time to serious mental illness.
JOSEPHI just wanted to put a plug in here. I certainly -- I don't have an inclusive list of reasons why kids should go to therapy, but to piggyback off of what the -- my other two colleagues were saying, significant, sustained change in behavior, this is a reason to come to therapy or for parents to seek out professional advice, even their pediatrician. Change in grades or desire to attend school, big life transitions or losses. If your child asks to come to therapy, and this is increasingly the case, which is lovely because there's less stigma associated with therapy, less and less over the -- over time. And of course any concern of self-injury is a purposefully unsafe behavior are other reasons that parents should consider having their teens come to therapy.
PAGEI'm Susan Page, and you're listening to the Diane Rehm Show. Well, let's go to a parent who's giving us a call. Elizabeth is calling us from Fairfax, Virginia. Elizabeth, hi.
ELIZABETHHi, good morning, and I'm sorry I'm on speakerphone, but somebody in the house broke my regular phone. And of course no one will admit to it. Mine is, I think, probably a very basic question that a lot of parents have. I've gone -- I have a single child, and she's gone from being a really laid-back, easygoing child and to a -- she's hit puberty, and now she's 17, is a senior. She's so mercurial. It's impossible to have, like, a normal conversation with her. It could start off about 30 seconds, and then it gets combative.
ELIZABETHAnd to be honest, I'm exhausted with arguing. And, you know, I don't know -- I mean, I don't want to give up, and I don't know what to do. And I -- any advice would be greatly appreciated.
PAGEAll right, Elizabeth, let's get you some advice. Let's start with Nicole.
JOSEPHSo Elizabeth, I completely feel your pain and understand where you're coming from, and I have many parents who come to me with this exact same complaint. So if I could just say, hang in there. You know, one thing to give you some encouragement about it is you've gone through this before. You may not have remembered it, and your child may have been cuter at the time. When children are two, they're not unlike they are when they're teenagers in the sense that they are really working for the separation and individuation.
JOSEPHSometimes healthy, very well-put-together, you know, teens and future adults do a lot of pushback with parents, and this sometimes can be a very positive sign of working on independence. One other thing I would like to add, just to help you, is, you know, a lot of people feel very pessimistically, my teen doesn't listen to me, they're -- I don't understand them, I'm not getting through.
JOSEPHWell, you know, as a therapist I have teens come in all the time who will say, I just can't have my mom say to me one more time X, Y and Z. So teens are listening. They're hearing you even though it feels frustrating, it feels like you're not getting through to them. So you're their number one advocate, and hang in there.
PAGEDr. Jensen, do you have some advice for Elizabeth?
JENSENYes, I think that this is along the same lines. Knowledge is golden for adults dealing with teenagers because, A, it's validating that there is a reason they're behaving this way. It doesn't explain it fully, but it helps you understand why they're doing some of the things they do. And it also allows you -- the advice I always give is count to 10. Know that -- don't respond with your limbic system. Use your frontal lobe when you interact with your teenager. You do have a frontal lobe, and you need to use it for both of your sake.
JENSENAnd when you want to get so angry, just go back and think about, well, part of this is because they actually didn't even know that they shouldn't have done this, they didn't put two and two together. And then the other big piece of advice I always give is don't alienate your teen because anger will start to alienate them, and then your communication does break down, and this is a time when you really do need to be quite tight in a -- not in a helicopter parent way but in a way that you're aware, you have family dinners together, you have some awareness of their day-to-day experience because you can help them.
JENSENYou can help model for them how to problem-solve, just like Dr. Joseph was saying. You know, like, you could help, like what would you do hypothetically if this happened or that happened. Help them think through. That's where you can give them a frontal lobe assist, and I think don't alienate your kid, and you'll get through this. This, too, shall pass.
PAGEElizabeth, we hope you find that advice helpful. I'd just like to close with comments from two listeners. Caroline, who's listening in Durham, North Carolina, says, I'm confused. Why is risk-taking bad when we say entrepreneurs are all about taking risks? And finally here's an email from Dennis, who writes us. Medal of Honor winners are mostly males under 25. Maybe judgment arrives later in life for the good of the tribe rather than the individual. I did a few dumb things in Vietnam that I would not do now.
PAGEWell, I want to thank our panelists for joining us this hour for this really interesting conversation about the teenage brain and how to understand it. Nicole Joseph, here in the studio with me, and in Philadelphia, Dr. Frances Jensen, Laurence Steinberg. Thank you so much for being with us this hour.
PAGEI'm Susan Page of USA Today, sitting in for Diane Rehm. Thanks for listening.
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