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Search for the Teenaged Brain. Heather Harlan, Certified Reciprocal Prevention Specialist Phoenix Programs, Inc. Columbia, MO. NAMI Missouri State Conference Lake of the Ozarks Port Arrowhead Conference Center November 4, 2011. Learning Objectives.

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Search for the Teenaged Brain

Heather Harlan, Certified Reciprocal Prevention Specialist

Phoenix Programs, Inc.

Columbia, MO

NAMI Missouri State Conference

Lake of the Ozarks

Port Arrowhead Conference Center

November 4, 2011


Learning objectives
Learning Objectives

  • Identify recent neurological discoveries in the brains of adolescents.

  • Understand needs of adolescents as a special population in prevention, treatment and recovery

  • Empower advocacy for evidence-based prevention, intervention, and treatment for youth.


Identify recent neurological discoveries in the brains of adolescents.


Most everybody (including scientists) had thought they knew what was different about adolescents. . . .


. . . hair,

hormones, and

pimples.

Didn’t connect astounding (irritating) changes in behavior, appetite, attention span, poor judgment, risky behaviors, and sleep patterns to their brains.


.

Scientists in 1997 were surprised!

Neuroscientist

Dr. Jay Geidd, National Institutes of Healthsaw something he didn’t expect to see.


What dr jay geidd noted was neurological exuberance
What Dr. Jay Geidd noted wasneurological exuberance


Exhuberence
Exhuberence?

Scientists knew human frontal lobes continue to grow but thought it was over about age 2 yrs.

forming gray matter,

cell bodies—neurons

treelike branches—dendrites , THEN

  • Age 11 for girls

  • Age 12 for boys


It begins to kill off brain

connections.

Some connections thrive.

Used the most.


Use it or lose it
Use it or lose it.

Enables human brain to

specialize and adapt—connecting all those brain cells with neuropathways, enabling parts of the brain to work together smoothly.


Ages 5 20 blue represents maturing areas of the brain

Human brain growing well in the mid-20’s

Ages 5 20Blue represents maturing areas of the brain

Blue represents maturing portion of the brain.


Human brain matures
Human Brain Matures

  • Inside out

  • Back to front

    Last to mature—front

    Pre-frontal cortex—right behind your eyes and forehead


Pre frontal cortex in humans last to mature
Pre-frontal cortex in humans last to mature

  • Reasoning

  • Motivation

  • Judgment

  • Resist impulses


Pre frontal cortex in humans
Pre-frontal cortex in humans

  • Serves as “policeman”

  • Chief executive

    Helps us plan ahead.

    Asks, “What might happen IF . . . .?



Inhibitors in the human brain
Inhibitors in the human brain:

  • Part of brain that “inhibits” our behavior

  • Keeps us from imitating everything we see/hear

  • Matures about age 25


New Research (Hot off the press): Published onlineNature Journal October 19, 2011 andNational Public Radio Health Blog

Research suggesting teens’ IQ is not set in stone.

IQ seems to be a gauge of acquired knowledge that progresses in fits and starts.


  • In this week's journal Nature, researchers at University College London report documenting significant fluctuations in the IQs of a group of British teenagers.

  • The researchers tested 33 healthy adolescents between the ages of 12 and 16 years using brain scans and IQ tests.

  • They repeated the tests four years later and found that some teens improved their scores by as much as 20 points on the standardized IQ scale.


  "We were very surprised," researcher Cathy Price, who led the project. She had expected changes of a few points. "But we had individuals that changed from being on the 50th percentile, with an IQ of 100, [all] the way up to being in the (top) 3rd percentile, with an IQ of 127." In other cases, performance slipped by nearly as much, with kids shaving points off their scores.


In other words
In other words: the project. She had expected changes of a few points.

Teen brains changing in even more ways

than we knew.


What is the one thing
What is the ONE thing the project. She had expected changes of a few points. ?

The one thing the adolescent brain is best designed to do?


Primed, at the starting block, geared up, ready to go? the project. She had expected changes of a few points.


Learn the project. She had expected changes of a few points.


Learn
Learn? the project. She had expected changes of a few points.

Neurologically, learning is the process of developing effective neuropathways.


Reinforcers neurotransmitters
Reinforcers the project. She had expected changes of a few points. --neurotransmitters

Make it possible for us to learn.


Ummmmmm
Ummmmmm the project. She had expected changes of a few points. . . ..

What’s a reinforcer?


Reinforcer
Reinforcer the project. She had expected changes of a few points. .

A positive reward that increases a likelihood a behavior will be repeated is a positive reinforcer.

or

A negative response that increases the likelihood a behavior will diminish or stop.

In the brain it comes in the form of chemical rewards.


When I think of my brain the project. She had expected changes of a few points.

There’s a lot at stake

So I’m gonna learn how

To make a good brain great.


Now from memory . . . the project. She had expected changes of a few points.


Skill set
Skill set the project. She had expected changes of a few points.

Neurons fired together are wired together.


Understand the project. She had expected changes of a few points. needs of adolescents as a special population in prevention, treatment and recovery


Age of first use matters
Age of first use matters the project. She had expected changes of a few points.

Youth who begin drinking before age 15

are 4 times more likely to become

alcohol dependent than those who

wait until they are 21.

--PIRE

(Pacific Institute on Research and Development)


4 times more likely to develop alcohol dependency! the project. She had expected changes of a few points.


Times the project. She had expected changes of a few points.


Drug abuse starts early and peaks in the teen years
Drug abuse starts early and peaks in the teen years the project. She had expected changes of a few points.


Adolescents more vulnerable hence a special population
Adolescents more vulnerable the project. She had expected changes of a few points. (hence a special population)

  • Don’t have strong neruopathways developed to pro-social reinforcers that require effort

  • Addictive substances and behaviors only require use, little pro-social effort—short cut

  • Aren’t able developmentally to think through consequences—need short-term goals of treatment

  • Transitions/stress/mental illness make the brain more vulnerable


Anything that lowers ones pain (emotional or physical) quickly can have an addictive quality.


Adolescents
Adolescents quickly can have an addictive quality.

  • Higher risk during transitions

    • Change in schools

    • Significant losses

    • Shift in family situation

  • Puberty itself is a transition

  • Stress—working to LEARN new routines

    It’s about the brain


  • Haven’t developed other coping skills. quickly can have an addictive quality.

  • Don’t know it won’t last

    f o r e v e r

  • Insufficient “roads in their brains” to feel OK

  • It’s all about here and now


Based on what we know today about the teenaged brain
Based on what we know today about the teenaged brain . . . quickly can have an addictive quality.

. . . how can we empower advocacy for evidence-based prevention, intervention, and treatment for youth?


Understand
Understand . . . quickly can have an addictive quality.

These messages only tell youth and

young adults what NOT to do.

These messages don’t help youth LEARN what TO do!


Support opportunities to learn and experience
Support opportunities to LEARN and experience quickly can have an addictive quality.

  • Positve, pro-social activies

  • Effort driven rewards

  • Encouragement to “try again”

  • Affirmation and appreciation for the effort-- less for the outcome.( example: “You worked really hard on that. You spent a lot of time trying different strategies.” instead of, “That’s good.” or “You are so smart.”)


Advocate for
Advocate for quickly can have an addictive quality.

science or evidence-based programs.


Ummmmmm1
Ummmmmm quickly can have an addictive quality. . . ..

What’s an evidence based or

science-based program?


Most substance abuse treatment programs are based on patt interventions
Most substance abuse treatment programs are based on PATT interventions:

  • Personal experience of the counselor

    “Here’s what worked for me.”

  • Anecdotal evidence

    “I heard of someone who . . . .”

  • Tradition

    “We’ve always done it that way.”

  • Time

    “We have a 21 day program.”


No seemed to be able to answer the questions
No seemed to be able to answer the questions interventions:

“But how well does it work?”“What’s the number of people it helps and how does it help them?”


Substance use disorders and other mental heal issues are
Substance use disorders and other mental heal issues are interventions:

  • Brain disorders

  • Chronic health problems


How many approach a chronic health condition this way
How many approach a chronic health condition this way? interventions:

Doc,

Just DO something.

I don’t care how well it works—just DO something.


Science or evidence based interventions for youth and young adults
Science or Evidence-based interventions for youth and young adults:

Based on how well the program or intervention helps teens and young adults as a special population in areas we agree to measure (with grant funders).

Not based on how great

the idea seems or

how good it makes us feel.


Example: APEX (youth and young adult treatment program) at Phoenix Programs ages 12 thru 20Adolescent Community Reinforcement Approach/Assertive Continuing CareACRA/ACC

  • 3 year SAMHSA grant –1 year overlap with-

  • 2 years MO Foundation for Health grant

    MFH grant focus on measuring suicide prevention


How do you measure it if it didn’t happen? Phoenix Programs ages 12 thru 20


Objective 3: Within one year of grant funding, 50% of participants will who report suicidal thoughts/actions will report a reduction in these symptoms after completing participation in the Reach Out program and appropriate mental health services.

Baseline data

  • (N=50, 31 eligible for 6 month follow up – percentages based on eligible clients)

  • 2 clients attempted suicide (4%)

  • 8 clients thought about attempting suicide (16%)

  • 5 clients had a plan to commit suicide (10%)

  • 35 clients reported no suicidal thoughts or actions (70%)

    Follow Up Data (N = 26)

  • 0 clients attempted suicide at follow up interview (0%)

  • 1 client thought about attempting suicide at follow up interview (3%)

  • 0 clients had a plan to commit suicide at follow up interview (0%)

  • 25 clients reported no suicidal thoughts or actions at follow up interview (97%)

    Data demonstrates that clients had a reduction in suicidal thoughts/actions from intake to follow up.


Other examples where we have proven, measured outcomes in programs based on intake info and follow up interviews :

  • Lower substance abuse

  • Increase of days clean/sober

  • Fewer hospitalizations

  • More social support at home

    and in community

  • More able to find/keep housing

  • Fewer legal problems and days incarcerated


Locations of Assertive Adolescent Family Therapy Grants in US from

Fed. Gov. (Substance Abuse and Mental Health Services Administration)

SAMHSA

2006-2010


Three questions when looking for science or evidence based treatment
Three questions when looking for science or evidence-based treatment:

  • What do you DO for people who have this situation?

    (should be able to name a type or model of treatment not length of the program)

    2. Upon what science do you base your programs?

    (vs. It’s what’s traditionally done. . . .)

    3. Where can I learn more about that?

    (website, book, article, brochure?)


Another challenge to science based treatment
Another challenge to science-based treatment: treatment:

“We already do that.”


Inquire about certifications
Inquire about certifications treatment:

  • Science-based treatment

  • Isn’t required by State of MO now

  • Counselors aren’t required to be certified on any particular “model” or way of doing treatment

  • Is much different that traditional, 12 step treatment for youth

  • Even if certified, easy to “drift” away from effective treatment

  • Can be given lip service


Registry of evidence based practices and programs nrepp
Registry of Evidence-Based Practices and Programs (NREPP) treatment:

Go to www.nrepp.samhsa.gov and search for Adolescent Community Reinforcement Approach

Enter criteria for other science-based programs.


Acknowledgements
Acknowledgements: treatment:

  • Phoenix Programs, Inc

  • Project APEX Team, APEX and REACH OUT participants and parents/caregivers

  • Dr. Susan Godley and Dr. Mark Godley, Chestnut Health Systems; Bloomington, IL

  • Dr. Robert Meyers and Dr. Jane Smith; University of NM, Albuquerque

  • Substance Abuse and Mental Health Services Administration (SAMSHA)

  • Missouri Foundation for Health


It is hard to treatment:convince a high-school student that he will encounter a lot of problems more difficult than those of algebra and geometry.  ~Edgar W. Howe


Heather Harlan, Certified Reciprocal Prevention Specialist treatment:

Phoenix Programs, Inc.

Columbia, MO

Email to request copy of Power Point presentation 573-875-8880 x 2142

[email protected]

www.phoenixprogramsinc.org

Funding for this project was provided in part by the Missouri Foundation for Health. The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves.


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