UCL Great Ormond Street Institute of Child Health Understanding Adolescent Cognitive Neurodevelopment in the context of HIV treatment, prevention and care Understanding adolescent neurocognitive development in the context of HIV treatment, prevention and care Dr Anne-Lise Goddings UCL Great Ormond Street Institute of Child Health

Adolescent challenge in HIV/AIDS Unprotected sex Sharing needles 2.1m adolescents aged 10-19 with HIV 2016 – up 30% from 2005 Between 2010 and 2016 new HIV infections in older adolescents ranged from 27% increase in E europe and Central asia to 21% decline in E and S Africa 5.7million new adoelscent hiv infecitons since 2000 Low ART coverage – 36% Since 2010 AIDS related deaths in adolescence decreased by 5%, halved in children Testing and diagnosis Challenges with adherence

Insights from developmental neuroscience 1. The Social Brain 2. The Prefrontal cortex 3. Subcortical development

Adolescent brain: Region-specific development This will be a video on a loop if AV works, slide as back up if not working Importance of regional development in terms of function Tamnes et al. 2012, NeuroImage

Adolescent brain: Region-specific development This will be a video on a loop if AV works, slide as back up if not working Importance of regional development in terms of function Tamnes et al. 2012, NeuroImage

The Social Brain The regions that take the longest to develop are part of a functional network of brain regions called the social brain network

The Social Brain

Social emotions Basic emotions Guilt You accidentally broke your friend’s necklace Embarrassment You were eating with your friend and you dribbled down your top. Basic emotions Fear Your friend told you that a spider was climbing up your neck. Disgust You and your friend had to clean vomit out of the sink. VS. . Burnett et al., 2009 J Cog Neuroscience

Somerville et al., 2013, Psychological Science

Adolescents are particularly susceptible to social influence Opportunities Peer-led teaching and interventions Positive role models Vulnerabilities Self-discovery and rejection of ‘who you were’ The power of social exclusion Greater peer influence on negative than positive behaviours

Prefrontal cortex Executive functioning Flexibility Inhibition Planning Multitasking Judgement / synthesis Decision making

Control condition: Ignore the objects in boxes with grey background Move the top truck left Control condition: Ignore the objects in boxes with grey background Dumontheil, Apperly & Blakemore 2010 Developmental Science 12

Director experimental No-director control No-director experimental 7-27 years old Dumontheil, Apperly & Blakemore 2010 Developmental Science 13 13

A ‘simple’ decision Mills, Goddings and Blakemore 2014 Frontiers for Young Minds

The prefrontal cortex is still developing Opportunities Capable of processing facts and making judgments More open to new ideas Fewer concrete opinions Vulnerabilities Judgment and decision-making more impacted by environment Long-term consequences less influential on decision-making Planning susceptible to changes in routine

Subcortical development Emotional processing Memory Learning Reward processing Motivation Amygdala Hippocampus Putamen Globus pallidus Caudate Nucleus accumbens

Reward processing in adolescence Braams et al., 2015, J Neurosci

Risky decision-making and peer How does social pressure (presence of peers) affect executive function (deciding whether to take a risk)? Steinberg et al, 2008 Chein et al., 2011

Emotional and reward processing regions are online Opportunities Adolescents can be passionate, motivational, determined drivers for change Susceptibility for reward-based interventions Vulnerabilities Tendency towards rewarding/risky decisions in stimulating situations Susceptibility to negative emotional responses

Adolescent neurodevelopment and Education in HIV/AIDS Adolescent brain can process facts about health risk behaviours How to manage real-life Experiential learning Socioemotional development Peer-led education Empower young people to know their brains

Adolescent neurodevelopment and HIV/AIDS prevention and management Separating decision-making from stimulating situations PrEP Linking long-term goals to short-term benefits ‘Undetectable is untransmittable’ Positive, supportive social environments and reducing stigma Empower young people to know their brains

Adolescents are not an ‘average’ Each is unique

A long way to go… Individual differences Interaction between adolescent neurodevelopment and HIV/AIDS (and all chronic disease) Global data Impact of interventions on brain activation

Thanks and Acknowledgements to: Prof. Russell Viner Prof Sarah-Jayne Blakemore Kate Mills Stephanie Burnett-Hayes Iroise Dumontheil Prof Jay Giedd Laura Wolf Megan Herting Christian Tamnes Emily Garrett