1. RISKY BUSINESS: Why Teens Do What they Do
Caryl Oris, MD
RISKY BUSINESS: Why Teens Do What they Do

2. Public Health Context
Adolescence is generally considered a time of good health and little disease
Accidents account for half of all deaths in teens, and motor vehicle accidents account for 73% of all unintentional injuries.
The majority of teen deaths are due to accidents, homicide, and suicide, considered preventable. This makes this a public health problem.

3. QUIZ TIME!
Teenagers generally see themselves as more invincible, or invulnerable, than other age groups.
Teenagers have poor decision making skills
Teenagers generally do not consider the consequences of their actions
Teen behavior is due to raging hormones
The teenage brain is essentially fully formed before adolescence

4. The Reality Reasoning ability is fully developed by the age of 15.
Adolescents are just as adept as adults in their ability to logically assess whether something is dangerous, and to use logical thinking.
During adolescence, the brain goes through enormous changes which can affect teen behavior

5. Death Rate for Teens 12-19: Rate per 100,000. CDC statistics

6. Leading Causes of Death in Teens

7. Other Reasons for Teen Mortality
Crime rates increase through adolescence and peak at the age of 18.
Adolescents drown more often than any other time of life

8. Suicide Attempts and Self-Harm

9. Unintentional Drowning

10. So Why Do Teens Do What they Do?
It’s all about their brains!
The emotional center of the brain, and the reward center, develop earlier than the control center (PFC). It develops around puberty, while PFC development is not complete until late adolescence or early adulthood
This makes the ages of the most vulnerable for risk taking behavior.

11. The Brain

12. How the Brain Grows
Built over time, from back to front and from inside out
The brain of the young child is soaking up knowledge, growing neurons.
The two most important spurts of brain growth:
0-18 months
10-13 years
Adolescence is a Unique Period of Development:
Pruning: USE IT OR LOSE IT
Myelination: Faster, more efficient connections. The brain is becoming more specialized.

13. So Why Do Teens Take Risks?
First, it is important to point out that teenagers are just as adept as adults to assess danger and to think logically.
Teenage thinking is affected more by other factors than at any other stage of life:
The limbic system (emotion, memory and motivation) more sensitive and easily triggered
The teen brain craves more reward and gratification: Hyperrational Thinking: the reward or excitement outweighs the negative.
The chief predictor of teen behavior is not the perception of the risk, but the anticipation of the reward DESPITE the risk.
Gratification is at the heart of their impulsivity: a teen will continue to engage in risky behavior if they did not have any negative consequence in order to get that gratification.
Less prefrontal cortex control
Influence of Peers: the need to belong
Increased release of DOPAMINE

14. DOPAMINE!!
Increase activity of dopamine in the teen brain, and increased release in response to pleasure.
Leads teens to focus on the positive reward of an activity, while placing less value on the potential risk and danger. They put more weight on the excitement and thrill.
Gratification is at the heart of their impulsivity: if you engage in risky behavior and never had a negative consequence, you will keep repeating the risky behavior: drug use, sex

15. Addiction in Teens
Addiction is rooted in adolescence: Most adult addictions start in adolescence
Try a drug before age 18: 25% chance of addiction
Try a drug after age 18: % chance of addiction
The teenage brain is changing rapidly, and is more vulnerable. Addiction develops faster and stronger.
The earlier the age of onset, the more severe the addiction.
Addiction is a form of memory and learning. The teen brain is primed to learn., Anything that is learned that stimulates dopamine release is construed as a reward, so the brain craves more of that learning. When the drug wears off, dopamine plummets, and you need to use more of the drug to get your dopamine to surge again.
Remember that dopamine can surge even when thinking about the drug, or with friends that you used the drug with.
Once a teen is addicted, it is much harder to overcome the addiction than if you become addicted later in life.

16. The Power of Peers
Teens have a drive to feel rewarded and they crave novelty, and intense social engagement is a key part of adolescence.
Move away more from parent figures and towards peers. But teens still need important adult figures in their lives for advice and for guidance.
Risky behaviors increase in company of peers: driving alone vs driving with friends

17. DRIVING: Alone vs with Peers

18. Teens Face Many Challenges
Normal separation from parents
Establish an identity of their own
Acceptance by peers
Responsibility and autonomy
Digital world and social media: FOMO, peer pressure, lack of sleep
Study of 467 teens age 11-17: Nighttime social media and emotional investment related to poorer quality of sleep, lower self-esteem and increase in anxiety and depression. Pressure to be available 24/7.
Most girls who are worried or anxious seek solace from social media rather than talking to parents.

19. Stress During adolescence, more than any other time, emotions rule.
Half of all psychiatric conditions begin by the age of 14.
Because of delayed maturation of frontal lobes, teens cannot inhibit and manage emotions well. And adolescent brain is firing neurons more intensely than in adult brain.
Stress inhibits learning. Stress leads to increased levels of cortisol, How do most teenagers handle stress? .

20. WHAT PARENTS NEED TO DO: Share your PFC!!!
IMPORTANCE OF PARENTAL INVOLVEMENT: they need our PFC!!!
Practice decision making skills
Help with planning, time management. Write notes, use calendars.
Set clear limits and boundaries
Being connected to an adult is linked to decreased stress, anxiety, depression, self-harm, substance use and teen pregnancy.
Sleep, good nutrition
Since the teenage brain is WIRED FOR RISK, we have an obligation to steer teens to taking POSITIVE RISKS. Give them the opportunities to take risks in healthy ways:
Try a new skill or sport
Volunteer work
Audition for a part in the school play
Summer employment

21. What Should Parents Say?
Remember that teenagers pay less attention to danger and risks: BEST TO STEER AWAY
Limit their opportunities to use immature judgment:
Parties
Driving
Talk to them about:
THEIR BRAINS!!
How to avoid negative peer pressure: give them scenarios
Help them manage stress:
Organization
Schedules
Time management
SLEEP!!!
Be available to LISTEN!!!!

22. Learning: What it means for the teen
This is the time to invest in strengths and emerging talents
This is the time when remediation and extra help can give best results
IQ can actually increase (or decrease) in teenage years
Just as their brains are able to learn better and faster, however, they are also overwhelmed by the emotional center of the brain. So we need to:
Stay calm when talking to them: avoid anger. Take a time out.
Use as little criticism as possible
Don’t judge
Help them examine different points of view, role play scenarios
Validate their emotions

23. Let’s Try to Change our Thinking
Not helpful to think teens have “raging hormones” or “immature brains” or “this is just a bad time that will pass”
Adolescence is not just a stage to “get over’, but is an important developmental stage that has implications for the rest of one’s life
Acknowledge and respect the changes in the teen brain

24. What Parents Can Do
Acknowledge the need for teens to crave rewards and thrills. This can be healthy.
Encourage new skills, new adventures that are not harmful. Help teens channel their need for thrills in safe, creative ways.
“Don’t Do It!” doesn’t do it! Promote positive, healthy activities.
Communicate with your teen about this brain science. Help them understand the changes their brains are experiencing.

25. “This will be the only phone you ever own!!”

26. The ESSENCE of Adolescence
Dr. Daniel Siegel: “Brainstorm”:
Emotional Spark
Social Engagement
Novelty
Creative Exploration
Give teens opportunities
Have adults lost these qualities? Are we jealous of our kids?
Perhaps we need to recognize the adolescent in all of us.

27. Thank you!
Questions, Comments!