Biological Foundationsof Misconduct

Missouri Juvenile Justice ConferenceOctober 2012

Special Thanks to:Dr. Barbara Sullivan (Utah Addiction Center)The Dana Foundation

The challenge of working with Adolescents

• Parents and professional alike have been puzzled for years………• Is this NORMAL teenage

“baloney” or is it pathological?

Most common mistake?

• Viewing Adolescents as small adults• Physical size• “Act your age”• Not only physical, emotional,

moral social, but neurological

According to the CDC, 27,000 people between the ages of 10 and 24 die from bad decisions – primarily accidents, homicide, and suicide…… (Anderson & Smith (2005).

The adolescent years, in particular, are a period of heightened vulnerability to reckless behavior that occurs despite the fact that adolescents are more cognitively mature than children………. (Spear 2000).

Actuarial tables indicate that adolescents and young adults are more likely to drive recklessly and are more likely to drive under the influence of alcohol or drugs………… (Arnett J , 1993).

Viewed in hindsight, many of these adverse outcomes seem to be a result of a poor decision. Although nobody is immune from making bad decisions, adolescents and young adults seem to make a disproportionate share of ultimately fatal or debilitating ones; indeed, bad decisions are the greatest cause of morbidity and mortality in adolescents. (Berns, Moore & Capra, 2009)

• Earliest attempts to explain behavior of human beings…………..• Demonology• Trephaning

Possession The notion that psychopathology was caused by a possession of a spirit or god was a prevailing theory of mental illness throughout history.

DEMONOLOGICAL MODEL The demonological model, as an

explanation of psychopathology, has existed since the beginnings of

humanity. …..the causes of mental illness are due

to "spirits" entering the body and causing the host to become possessed.

The cure would be to release the spirit from the individual.

The methods for this were accomplished in several different ways including t

rephaning,exorcism , and a number of

purgative techniques , that would make the host's body unpleasant for

the spirit.

Trephaning was a technique used even in the

prehistoric period.

A small round hole in the skull would be made in order that the evil spirits could be released.

Ironically, this technique could have been successful for certain kinds of

psychopathology……….…

• The hole in the skull would have reduced the pressure on the brain caused by edema, or swelling,• eliminating the peculiar

behavior, or "releasing the spirit".

Biological roots

•Hippocrates “Humours”….(humors)

Chemical imbalance

The Greek physician Hippocrates, c. 460 - 377 B.C, is often called the “father of medicine”.

Perhaps the most important idea associated with Hippocrates is that of relying on facts, clinical observation and experiment.

HIPPOCRATES AND THE BIOLOGICAL MOVEMENT

Hippocrates had the notion that psychopathology was due to

disturbances within the balances of the four humours.

The Four Humors consisted of BLOOD, PHLEGM, YELLOW BILE and BLACK BILE, that are produced by several organs throughout the body.

• Diseases were caused by the over or under manufacturing of one of these substances causing disharmony.

Perspectives • Today we have several perspectives as ways of

explaining human behavior• Psychology has multiple theories of explanation:– Biological– Psychodynamic– Behavioral–Humanistic– Cognitive– Evolutionary

Biological Perspective• Study the physiological mechanisms in the brain

and nervous system that organize and control behavior

• Focus may be at various levels– individual neurons–areas of the brain– specific functions like eating, emotion, or

learning• Interest in behavior distinguishes biological

psychology from many other biological sciences

Brain Has Evolved

The Human Brain Weighing roughly three pounds, the human brain is about the size of a small cauliflower. Although your brain makes up only about 2 percent of your total body weight, it uses some 20 percent of the oxygen your body needs while at rest. The oxygen is used in breaking down glucose to supply the brain with energy.

BRAIN FACTS• Brain weighs

approximately 3 pounds

• Brain has approximately 100 billion neurons and 1 trillion supporting cells

• Neurons grow and organize themselves into efficient systems that operate a lifetime

• Brain controls ALL activities

• Emotion and cognition are intertwined

• Neurons can re-route circuits

• Brain and environment involved in delicate duet

• Brain never stops adapting and changing

CHALLENGE OF UNDERSTANDING THE BRAIN

• What is the link between the anatomy of a brain and the workings of the mind—our thoughts, emotions, memories, and behaviors?• There are no moving parts—it does

not operate mechanically as our hearts, legs, hands, and lungs do.

The Parts of the Human Brain

Focus•“White Matter”•Frontal Cortex•Caudate nucleus•Limbic System–Amygdala

Two Major Developmental Periods of Brain

• First 3 years of life

• Second burst about 11 for girls and 12 for boys– Shaping White Matter

• Full development about 25

By age six, the brain is already 95 percent of its adult size.

Although the brain is 80 percent developed at adolescence, research indicates that brain signals essential for motor skills and emotional maturity are the last to extend to the brain’s frontal lobe, which is responsible for many of the skills essential for driving.

Brain size does not equal intellectual or

emotional maturity

Structure of neurons and brain cell

White Matter: areas of the nervous system composed mostly of myelinated nerve fibers (those having MYELIN SHEATHS) constituting the conducting portion of the brain and spinal cord.

Gray matter: areas of the nervous system where the nerve fibers are unmyelinated

The Myelin Sheath of a neuron consists of fat-containing cells that insulate the axon from electrical activity.

White matter contains the protein myelin, which coats neurons' spindly axons as they reach toward other areas of the brain. Myelin is important for efficient signaling between neurons, and it is known to grow considerably between childhood and adulthood.

When adults reach age 20, white matter begins to spread, from the back of the brain forward, usually completing this process between 25 and 30 years of age.

One of the most familiar “white matter deficiency” diseases………….Multiple Sclerosis

Researchers have found a connection between increased white matter and reduced impulsivity

Young people whose brains mature early might be more prone to engage in adult activities and choices.

White matter of a 20-year-old man contains a staggering 176,000 km of myelinated axons (Marner et al., 2003).

Axons ensure smooth communication throughout the brain in two important ways: by conducting electrical impulses and by transporting various molecules and organelles from the cell body to the synapse (Barry et al., 2007).

Hence, the importance of maturational changes in white matter (WM) during childhood and adolescence for the child's cognitive development and mental health

Perrin, Herve, Leonard, et al……2008

"White matter is composed of bundles of myelinated axons connecting grey matter areas of the brain, and has been shown to continue to develop throughout adolescence. These systematic changes in white matter organization reflect not only maturation of interconnections but continued maturation of the brain as a whole.""White matter, and its integrity, are essential to the efficient relay of information within the brain…………

Susan F. Tapert, associate professor of psychiatry at the University of California

"Indicators of white matter integrity are linked to performance on a range of cognitive tests, including measures of reading, copying complex figures, and speeded coding of information. Abnormalities in white matter health could relate to compromised ability to consider multiple sources of information when making decisions, and to emotional functioning."

The white matter revelation has led some safety experts to suggest raising the minimum driving age to 18. But others have said this is an unnecessary change that would place an undue burden on parents. What’s more common is a push for the implementation of stricter graduated licensing laws, which would impose a multi-tiered licensing system to ease teenagers in to the responsibilities of driving without a parent in the car.

Those cells and connections that are used will survive and flourish. Those cells and connections that are not used will wither and die.

So if a teen is doing music or sports or academics, those are the cells and connections that will be hard-wired.

If they're lying on the couch or playing video games or MTV, those are the cells and connections that are going to survive.

"Use it or lose it" principleDr. Jay Giedd

The brain undergoes a significant structural re-modeling process which includes a substantial increase in white matter, and an overall decrease in grey matter attributable to the activity-dependent process of synaptic pruning.

Tom Wasiuta

-In many ways adolescence is the healthiest time of life. The immune system, resistance to cancer, tolerance for heat and cold and several other variables are at their peak. -Despite physical strengths, however, illness and mortality increase 200 percent to 300 percent. -As of 2005, the most recent year for which statistics are available, motor vehicle accidents, the No. 1 cause, accounted for about half of deaths. Nos. 2 and 3 were homicide and suicide.

Jay N. Giedd, M.D. , National Institute of Mental Health.

Maturation of the Prefrontal Cortex

• The prefrontal cortex is often referred to as the “CEO of the brain.” • This brain region is responsible for

cognitive analysis and abstract thought, and the moderation of “correct” behavior in social situations.

“Executive functions” of the human prefrontal cortex include:

• Focusing attention• Organizing thoughts and problem solving• Foreseeing and weighing possible

consequences of behavior• Considering the future and making

predictions• Forming strategies and planning• Ability to balance short-term rewards with

long term goals

• Shifting/adjusting behavior when situations change

• Impulse control and delaying gratification• Modulation of intense emotions• Inhibiting inappropriate behavior and initiating

appropriate behavior• Simultaneously considering multiple streams

of information when faced with complex and challenging information

U.S. Department of Health & Human Services

FRONTAL LOBE

• Seat of personality, judgment, reasoning, problem solving, and rational decision making

• Provides for logic, understanding of consequences, and emotional/behavioral regulation

• Governs impulsivity, aggression, ability to organize thoughts, and plan for the future

• Controls capacity for abstraction, attention, cognitive flexibility, and goal persistence

• Undergoes significant changes during adolescence — not fully developed until mid 20’s (Giedd, 2002)

COMPONENTS OF EXECUTIVE FUNCTIONS AND SAMPLE BEHAVIORS

COMPONENTS BEHAVIORS

Goal Directedness Establishing and maintaining goals; evaluating progress, using strategies

Initiation/Inhibition Initiating behavior independently, self-cueing, inhibiting inappropriate behaviors

Flexibility/Perseverance Generating novel possibilities, flexibility, performing contingency based revisions, strategizing

COMPONENTS BEHAVIORS

Abstract Reasoning Using rule-guided thinking, forming concepts, using hierarchical and temporal relationships

Reward Appraisal Evaluating reward likelihood, using reward appraisal to guide behavior

Social Appraisal Understanding social norms and cues, incorporating social information into decision making

Brown et al., 2008

The Amygdala• Responsible for:– arousal, – regulation of emotion,

and – the initial emotional

response to sensory information.

• Plays important role in –mediating anxiety and

depression.– emotional memory.

ADOLESCENCE

• Adolescence is much broader and longer than the teenage years alone (has changed significantly over the past 150 years)

• Adolescence now stretches across more than a decade, with pubertal onset often beginning by age 9-12 and adult roles delayed until mid twenties

(Worthman, 1995)

• Adolescence is a TRANSITIONAL period during which a child is becoming, but is not yet, an adult• Adolescent brains are far less

developed than we previously believed• Normal adolescent development

includes conflict, risk taking, facing insecurities, creating an identity, mood swings, self-absorption, etc.

ADOLESCENCE

• Most elements of cognitive development show a trajectory that follows age and experience rather than the timing of puberty (Dahl, 2004)

• Research (eg, Martin, 2003) demonstrates a significant positive correlation between pubertal maturation and sensation seeking

PUBERTY Romantic motivationSexual interestEmotional intensitySleep cycle changesAppetiteRisk for affective

disorders (girls)Increase in risk taking,

sensation seeking, and novelty seeking

AGE/EXPERIENCEPlanningLogic, reasoningInhibitory controlProblem solvingUnderstanding

consequencesAffect regulationGoal setting and pursuitJudgment and abstract

thinking

Dahl, 2004

ADOLESCENCE VS. ADULTS

• Being a responsible adult requires developing self-control over behavior and emotions– must be able to appropriately inhibit behaviors despite STRONG FEELINGS

• The ability to integrate these multiple components of behavior, cognition, and affect in the service of long term goals involves neurobehavioral systems that are among the last regions of the brain to fully mature (Dahl, 2004)

• The most widely implicated factor associated with maladaption vs. resilience in adolescence is REGULATORY CAPACITY (RC) [Kupfer & Woodward, 2004]

• Behavioral control (RC) requires tremendous effort; adolescents need practice being consistent and integrating RC

• White matter development is needed for regulatory capacity

In the heat of the moment, teen decision-making can be overly influenced by emotions, because their brains rely more on the limbic system (the emotional seat of the brain) than the more rational prefrontal cortex

– Sheryl Feinstein, author of Inside the Teenage Brain: Parenting a Work in Progress (Rowman and Littlefield, 2009.)

Critical Differences Between Adult and Adolescent Thinking

• Jay Giedd and his colleagues have given us a new window into understanding how the pre-adolescent brain develops. It confirms what other neuroscientists have outlined over the past 25 years -- that different parts of the brain mature at different times.

• In particular, it corroborates the work of neuroscientists like Peter Huttenlocher who have shown that the frontal cortex of human beings matures relatively late in a child's life.

• http://www.pbs.org/wgbh/pages/frontline/shows/teenbrain/work/adolescent.html

Why is it that a young person is not able to drive a car until 16, vote until 18, drink alcohol until 21, rent a car

from a commercial agency until 25, but in some states,

can stand trial for murder at age 12 or 13?

(Dahl, 2004)

• Underdevelopment of the frontal lobe/prefrontal cortex and the limbic system make adolescents more prone to “behave emotionally or with ‘gut’

reactions” (Yurgelun-Todd, 1999)• Adolescents tend to use an

alternative part of the brain– the AMYGDALA (emotions & aggression)

rather than the prefrontal cortex (reasoning) to process information

Illustration by Lydia Kibiuk, 2003

• Amygdala and nucleus acumbens (limbic system within the temporal lobes) tend to dominate the prefrontal cortex functions– this results in a decrease in reasoned thinking and an increase in impulsiveness• Because of immature brains, adolescents do

not handle social pressure, instinctual urges, and other stresses the way adults do• A major part of adolescence is learning how to

assess risk and consequences — adolescents are not yet skilled at these tasks (Dahl, 2004)

Hot/Cold Cognition• Hot cognition is a relatively new

psychological term describing the mental processes that occur when emotions and personal goals influence judgment.

• Unlike cold cognition that is purely intellectual, it often relies on biases, hunches, feelings, intuition, “gut feelings,” and heuristics.

• People are especially likely to rely on this type of processing when making decisions that involve powerful emotions and self-interest.

HOT AND COLD COGNITION• Thoughts and emotions are intertwined –

teens need to develop a balance between cognitive and affective systems of the brain

• “COLD” cognition refers to thinking under conditions of low emotions and/or arousal

• “HOT” cognition refers to thinking under conditions of strong feelings or arousal

• Decisions made under conditions of strong affect are difficult to influence by cool rational thought alone

• Decision making in teens cannot be fully understood without considering the role of emotions and the interaction between thinking and feeling (Dahl, 2003)

• Teen decisions are unlikely to emerge from a logical evaluation of the risk/benefits of a situation – rather decisions are the result of a complex set of competing feelings – desire to look cool, fear of being rejected, anxiety about being caught, excitement of risk, etc.

• Adolescent brain is a “vulnerable” system that could fail under “hot” high demanding situations – where the circuitry is not sufficiently established to sustain adult level cognitive control of behavior in the face of heightened states of emotion, motivation, distracting stimuli, or competing tasks

• (Luna & Sweeny, 2003)

Researchers know that the integrity of the brain's white matter is compromised in adult alcoholics, but it is unclear when during the course of drinking white matter abnormalities become apparent. A study of adolescent binge drinkers has found that even relatively infrequent exposure to large doses of alcohol during youth may compromise white matter fiber coherence.

Susan F. Tapert

• PFC is linked to the ability to inhibit impulses, weigh consequences, prioritize, and strategize – this area is still “under construction” until late 20’s (Giedd, 1999)

• Wernicke’s area (reception of speech) and Broca’s area (production of speech) undergo substantial changes during the teen years – impacts ability to listen and express oneself

• Adolescents are not very skilled at distinguishing the subtlety of facial expression (excitement, anger, fear, sadness, etc.)—results in a lot of miscues—leads to lack of communication and inappropriate behavior

• Differences in processing, organization, and responding to information/events leads to misperceptions and misunderstanding verbal and non-verbal cues

• To appreciate consequences of risky behavior, one has to have the ability to think through potential outcomes and understand the permanence of consequences,

• due to an immature prefrontal cortex, teens are not skilled at doing this

• Teens do not take information, organize it, and understand it in the same way that adults do—they have to learn how to do this

ADOLESCENT BRAIN DEVELOPMENT

• Important to understand that teens often fail to heed common sense or adult warnings because they simply may not be able to understand and/or accept reasons that seem logical and reasonable to adults (difference in evaluating positive & negative consequences {Fromme et al., 1997})

• Adolescents may know “right from wrong”, but they may not be able to prioritize when stressed with social/peer pressure

• NEVER assume that you and a teen are having the same understanding of a conversation

Phineas Gage

• Gage was a railroad construction foreman

• An 1848 explosion forced a steel tamping rod through his head

• Others said he was “…no longer Gage…”

• Lost his job, worked as a sideshow exhibit

Phineas Gage………….

• Damage to orbitofrontal area—• Impaired sensitivity to risk,

reward, and punishment• Impulsivity and insight• Lash out in response to

perceived slights

A Model of Gage’s Injury Computer simulatedreconstruction of Gage’s skull by Damasio and her colleagues (1994) suggests that Gage’s left and right frontal lobes were both damaged.

Frontal Lobe Injury

• Phineas Gage• http://www.youtube.com/watch?v=5B2pQkq

M6nc&feature=related

The Prefrontal Cortex in Close-Up• Phineas Gage: His accident led to major personality

changes• Prefrontal cortex: brain region particularly concerned with

social phenomena (e.g., following norms). Patients with injury to this region often have profound disturbances in their ability to get along with others

• Lobotomy: deliberate damaging of the prefrontal cortex; used in the late 1940s early 1950s

• Left patients lethargic and emotionally flat, and much easier to manage in mental hospitals, but it also left them disconnected from their social surroundings

• As the “prefrontal cortex” area of the frontal lobe matures, through experience and practice, teens can reason better, develop more impulse control, and make better judgments

• Prefrontal cortex is one of the last areas of the brain to fully develop (Sowell, 2001)

• Increased need for structure, mentoring, guidance

Anderson RN, Smith BL (2005) Deaths: leading causes for 2002. Hyattsville, Maryland: National Center for Health Statistics. Spear LP (2000) The adolescent brain and age-related behavioral manifestations. Neurosci Biobehav Rev 24: 417–463. Arnett J (1993) Reckless behavior in adolescence: a developmental perspective. Developmental Review 12: 339–373

Adolescent Engagement in Dangerous Behaviors Is Associated with Increased White Matter Maturity of Frontal Cortex. Berns, Moore &I Capra