1. Implications of the new research for adolescent public health Dr Bruce Dick Independent Consultant (Adolescent Health) Senior Associate Johns Hopkins Bloomberg School of Public Health

2. Overview of the Presentation Some reflections on why the new research is important for adolescent health policies, programmes and advocacy: – Adolescent health and the broader public health context – How the research confirms, corrects and challenges current public health approaches to adolescent health

3. The Child Survival Revolution: GOBI

4. The early years of developing programmes for adolescent health Parents and Guardians PeersTeachers and Service Providers Community and Religious Leaders Policy Makers Information and Life Skills Services and Counselling Safe and Supportive Environment Opportunities to participate

5. Child Survival and Development: the brain in early childhood

6. The impact of neglect in early childhood Perry, BD and Pollard, D. Altered brain development following global neglect in early childhood. Society For Neuroscience: Proceedings from Annual Meeting, New Orleans, 1997

7. Brain Development in adolescence: what’s going on? Acknowledgement: The Mentor Foundation www.mentorfoundation.org

8. Brain Development: what it looks like Acknowledgement: The Mentor Foundation www.mentorfoundation.org

9. Changes in the Adolescent Brain that have implications for policies and programmes Increased synaptic pruning and increased myelination in the pre- frontal cortex Enhanced amygdala reactivity to emotional stimuli Exaggerated reactivity to rewarding stimuli Reduced sensitivity to aversive stimuli 200 220 240 46810121416182022 Age in years Volume in Frontal Grey Matter Acknowledgements: Linda Spears and Marc Potenza

10. The new research: support for advocacy The importance of the language that we use (adolescents: risk-takers or a time to take risks?) 10-19 year olds are a VERY diverse group, and age is a proxy for defining adolescence! Need to think along the life-course Interventions in the first decade will not ensure healthy transitions to adulthood at the end of the second decade: for many adolescents the second decade may be a time for second chances Essential to focus on individual adolescents and their environment The new research confirms, corrects and challenges current policies and programmes

11. The new science confirms Adolescents take risks: they are hard wired to take risk, and societies want young people to take risks! Adolescents are influenced by their peers and in some ways they are programmed to want to be part of “the group” Its not just about information: the importance of life skills and executive functions Limit access to highly rewarding substances Support for scaffolding approaches that respond to the changes taking place (e.g. graduated drivers licences) Support for more integrated programming: need to focus on a range of problems that are often inter- related and in which similar pathways in the brain are activated

12. Common Determinants for different behaviours (risk and protective factors) Risk & Protective factors for adolescents Early SexSubstance Use Depression A positive relationship with parents A positive relationship with adults in the community Engaging in other risky behaviours Conflict in the family A positive school environment Friends who are negative role models Having spiritual beliefs *”Broadening the Horizon” Evidence from 52 countries: h ttp://www.who.int/child_adolescent_health/documents/en/

13. The new science corrects and challenges The need to move beyond the individual focus: epigenetics stresses the importance of also focusing on the environment The need to move beyond trying to prevent risk behaviours: the importance of harm reduction interventions - opportunities for safe risk taking “You will get cancer in 30 years” type messages not likely to be effective Questions the rationale for punishment based interventions: adolescents more motivated by reward (and if their emotions are touched) Contributes to discussions about informed consent, mature minors and human rights: need to make sure that we have systems in place that really support the “best interests” of adolescents

14. Implications for all aspects of programming Parents and Guardians PeersTeachers and Service Providers Community and Religious Leaders Policy Makers Information and Life Skills Services and Counselling Safe and Supportive Environment Opportunities to participate

15. The early childhood brain 1.The brain development that takes place during the prenatal period and in the first year of life is more rapid and extensive than we previously realized. 2.Brain development is much more vulnerable to environmental influence than we ever suspected. 3.The influence of early environment on brain development is long lasting. 4.The environment affects not only the number of brain cells and number of connections among them, but also the way these connections are "wired.” 5.We have new scientific evidence for the negative impact of early stress on brain function. Carnegie Corporation (1994): Starting Points – meeting the needs of our youngest children Nearly 20 years later, we can now say much the same about the adolescent brain!

16. Thank You