1. 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

2. Adolescent challenge in HIV/AIDS
Unprotected sex
Sharing needles
2.1m adolescents aged 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

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

4. 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 , NeuroImage

5. 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 , NeuroImage

6. 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

7. The Social Brain

8. 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

9. Somerville et al., 2013, Psychological Science

10. 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

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

12. 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

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

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

15. 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

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

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

18. 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

19. 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

20. 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

21. 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

22. Adolescents are not an ‘average’ Each is unique

23. 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

24. 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