5. The Amazing Adolescent Brain
The adolescent brain is a work in progress
Linda Chamberlain PhD MPH

6. What We’re Talking About
Changes occurring in adolescent brain
Implications of stress and trauma
Communicating effectively with teens
Why risk-taking looks different to an adolescent brain
The Adolescent Brain and Substance Use

7. Brain Teasers
By age 6, a child’s brain is nearly the size of an adult brain. True (1) or False (2)
The human brain weighs about the same as an average grapefruit (1) or cabbage (2) .
The cortex is one of the first (1)/last (2) areas of the brain to develop.
Left hemisphere deficit, Teicher et al, 2001
90-95% of adult brain SIZE; AN INFANT’S BRAIN IS 8% OF THEIR BODY WEIGHT---ANYONE WANT TO GUESS WHAT PERCENTAGE OF YOUR TOTAL BODY WEIGHT YOUR BRAIN IS?
2.8 lbs.
Human brain is 78% water; 12% fat so fat isn’t all bad!!!!!!!!! The rest is salt and carbohydrates
77% of your brain is CORTEX (a rat is 31%), SO REMEMBER THIS WHEN WE TALK ABOUT THE ADOLESCENT BRAIN
1998 FRED GAGE AT SALK INSTITUTES PUBLISHES THE PIVOTAL RESEARCH DEMONSTRATING THE ABILITY OF ADULT BRAIN NEURONS TO REGENERATE

8. The Adolescent Brain is a Work in Progress
Adolescent brain science is in its infancy!

9. UPGRADING THE HARD DRIVE
GRAY MATTER PEAKS AROUND PUBERTY
SYNAPTIC PRUNING→ EFFICIENCY & SPECIALIZATION
MYELINATION: INSULATION →
SPEED & INTEGRATION
Gray matter peaks around 11 years in girls and 12 in boys
USE IT OR LOSE IT!
INFORMATION SUPER HIGHWAY

10. THE BRAIN’S CEO Frontal Cortex Impulse control Judgment
Problem solving
Emotional processing & self-control
Language
Organization & planning
Motivation
Goal setting behaviors

11. Executive Function (EF)
Cognitive skills needed for goal-directed behavior including planning, response inhibition (impulse control), working memory & attention (Johnson, Blum & Giedd et al, 2009)
Deficits in working memory & response inhibition (EF) increase risk of substance abuse during adolescence (Squeglia & Gray, 2016)
Unaddressed childhood trauma can lead to EF deficits
SUBSTANCE USE VS. ABUSE SEE Squeglia et al, 2014)

12. What can a maturing frontal cortex look like in terms of behaviors?
More rigid thinking-harder to see all the options can led to decisions that seem irrational to us
Good decision-making comes from experience
Teen brain has to work harder until it gets all of its connections
Teen brain gets stressed out more easily

13. We need to feel safe to think and learn,
but stress can push us DOWNSTAIRS in our brain…
SPEAKER NOTES
Dr. Dan Siegel introduced the concept of the “Upstairs” and “Downstairs” brain as a way to talk about how the brain works. The “Downstairs” brain is the more primitive area of our brain which focuses on survival. This is the part of our brain that regulates breathing, heart rate and other basic functions. The “Downstairs” brain also houses the emotional core of our brain and our survival reaction to stress (“Fight, Flight or Freeze” response).
The “Upstairs” area of the brain is where all of our higher functioning happens so we’re talking about decision-making, setting priorities, understanding the difference between right and wrong, building relationships and much more. The “Upstairs” brain, which is not mature until around 25 years old, helps us regulate the more impulsive, reactive “Downstairs” brain so that we think first versus just acting on our emotions.
EXERCISE
INSTRUCTIONS: Read the instructions below to the group and give everyone a few minutes to think about the question and then ask if anyone wants to share how they felt. You could even ask if anyone felt like they went “Downstairs” in their brain when they were stressed. Let participants know that they do not have to share any specifics about the stressful situation he/she was thinking about.
SCRIPT: Each of us responds differently to stress. Our personal stress response is influenced by what skills we have to manage stress and our life experiences. All stress is not bad. Mild levels of stress can help us learn how to cope with stressful situations. Higher levels of stress such as an illness or losing a job may, depending on what else is happening in our lives and the relationships we have to support us, lead to a stronger stress response. Take a minute to think of a situation that was moderately, but not overwhelmingly, stressful for you. Think about how you felt at that time—was it hard to “get your bearings” or “think straight” at first? How did you feel? What helped you?

14. Multi-Tasking is a Myth
Adolescents spend more hours a day with technology than a full time job
2/3’s of teens are doing something else while doing their homework
8.5 in Kaiser foundation U.S. survey in 2010; 1/3 is more than one device so 11.5 hours daily
See Digital Revolution and Adolescent Brain Evolution by Jay Giedd, J. Adolescent Health, 2012

15. Can you think of any mixed messages we send to teens?

16. Impact of Stress on Adolescent Brain
Poor EF Function may occur because youth are more attuned to danger, making
it more difficult to process verbal information, follow directions & remember what is being said (McCrory et al, 2011; Steele, 2002)
Adolescents who experienced childhood maltreatment have lower performance on executive function (EF) tasks including working memory, verbal fluency and inhibition
Smith, Henry & Messner, 2014
Adolescents 11-18; maltreatment any age before that—all forms of child abuse &
Romeo, 2016

17. Stress, Trauma and the Adolescent Brain
Key areas of brain involved in human stress reactivity —hippocampus, amygdala & prefrontal cortex—are undergoing major changes during adolescence
Structural changes in these areas of the brain in response to stress during adolescence(Eiland & Romeo, 2013)
Romeo et al, decreased hippocampal volume (children with PTSD, Carrion & Wong, 2012)
DECREASED DENDRITIC BRANCHING IN PFC (Romeo et al, 2016) and decreased spine density
INCREASE IN DENDTRITIC COMPLEXITY IN AMYGDALA; INCREASED LENGTH BUT DECREASED SPINE DENSITY IN THESE NEURONS…Romeo et al, 2016
Adolescents (13-17 y.o.) have higher levels of cortisol in response to stress than children (7-12 y.o.) Stroud et al, 2009

18. What Do Teen Brains Need?
1. Lots of hands-on, skill-based learning
2. Opportunities to discover and pursue new interests
3. Opportunities to practice personal control, decision making and leadership
4. Tools to build brain connectivity and manage stress
To be honored for their creative and
innovative thinking

19. Cross-lateral Exercise: Switching

20. Acupressure Points Crisis, Panic, Dizziness Stress
Beneath nose on upper lip
Stress
On top of shoulder -

21. Changes in Other Regions of the Brain During Adolescence
Frontal Lobe
Parietal Lobe
Occipital Lobe
Temporal Lobe
LOBES OF THE CEREBRUM

22. Corpus Callosum Thick cord connecting right and left hemispheres
Creativity and higher type of thinking
Continues to grow into 20’s
Corpus callosum

23. Cerebellum: Use It or Lose It!
Muscle movements, balance, and complex cognitive processes
Changes most during teen years and continues to grow into early 20’s
Physical exercise boosts brain function & learning
LAST STRUCTURE OF BRAIN TO DEVELOP (Giedd, pg. 43 in Primal Teens)---connected to brain-stem
Identical twins’ cerebellum are no more alike than non-identical twins---highly influenced by environment (Jay Giedd)
The Cerebellum—called the LITTLE BRAIN, is attached to the REAR of the BRAINSTEM— has TRIPLED in SIZE in the last million years (“The Amazing Brain” by Ornstein and Thompson)
The more complicated an activity, the more we call on the cerebellum
Physical activity sparks biological changes that encourage brain cells to bind to one another
Naperville School District 203
Zero Hour PE: Fitness focus
#1 in the world on science section of TIMSS (Trends in International Math and Science Study)
$ spent per student notably lower than other top-tier ILL schools
Animal research shows that the # of brain cells in the hippocampus of mice who exercised was nearly TWICE that of the inactive mice
Naperville School District 203

24. EMOTIONAL CORE OF THE BRAIN
LIMBIC SYSTEM:
EMOTIONAL CORE OF THE BRAIN
Hippocampus
Amygdala

25. What emotion do you see?
MRI Study by Yurgelun-Todd et al., 2000
YOUNGER TEENS OFTEN INTERPRETED FEAR AS ANGER, OTHER TEENS SAW SHOCK, SADNESS, ONE-HALF INTERPRETED INCORRECTLY COMPARED TO ADULTS
Also see Hare, Tottenham, Galvan, Voss et al, Biol Pyschiatry, 2008
Permission to use photo from Dr. Yurgelun-Todd

26. Teens Use Less of the Prefrontal Region compared to Adults
Emotional brain dominates
Prefrontal cortex is not ready to take charge
Emotional brain seeks pleasure, in the form of novelty, excitement, and risk
Adult
Adolescent
Yurgelun-Todd, D. Frontline Interview; permission to use graphics from Dr. Yurgelin-Todd

27. Communication Gap The teen brain:
More likely to misinterpret facial expressions of emotion
Uses less of the prefrontal cortex to interpret facial expressions
Processes more in amygdala
Reacts more quickly
Sees anger when it isn’t intended
See Frontline Interview with Dr. Yurgelin-Todd

28. What are some of possible effects when an adult does not express anger constructively with an adolescent?
Becomes angry/emotional
Doesn’t focus on behavior that needs to change
Weakens relationship
Less likely to ask for advice for other problems

29. “What were you feeling?” vs. “What were you thinking?”
#1 Recommendation for effective adult-teen communication?

30. Expressing Anger Constructively
Tell the person how you feel: “I’m…”
Identify the specific event that led to how you are feeling: “I’m feeling __ because…”
Explain what the event produced that feeling (how it effected you): “The reason I feel __ is that….
Explore what the options are to address the problem and make a plan: “What can we do to solve this…?”
EXAMPLE:
I feel angry because you did not call me after school as you promised. The reason I feel angry is that I had a lot of work to do for my meeting tomorrow and I couldn’t get anything done until I knew where you were and that you were OK.
What are some ways we could solve this problem?
Pre-set text message reminding him/her to call after school….
GENERAL STATEMENTS such as You always do that, you never listen to me, you’re lazy usually lead to arguments, not change.
Guiding Good Choices

31. Essential Communication Tools
Less is more---use fewer words!
Use “I” statements to talk about feelings
Be aware of your body language and expressions
Use open-ended questions to ask teens what they are feeling
Validate their feelings without judgment
Time-out is for teens and adults too!
Practice active listening
Timing is everything

32. Fingerhold Practice
Simple technique that combines breathing and holding each finger
Practicing fingerholds can help with emotional literacy to manage emotions and stress
Used with adults and children
Done by yourself or with another person
National Center on Domestic Violence, Trauma and Mental Health

33. How many hours of sleep per night do adolescents need?6
7.5 8
9.5

34. Adolescent Brains Need More Sleep
Brain sleep centers are in transition during adolescence
Melatonin is secreted up to 2 hours later at night
Teens needs 9 to 9 ½ hours of sleep
AVERAGE US HIGH SCHOOL STUDENT: HOURS per night
Sleep is important to brain maturation
50 brain chemicals that induce drowsiness, many of which also have a role in building synapses
Prefrontal cortex is particularly sensitive to sleep deprivation
DURING ADOLESCENCE, SLOW WAVE SLEEP—THE DEEPEST SLEEP—DECREASES BY UP TO 40% (THIS IS WHY YOUNG SLEEP WALKERS NOT A WORRY—HAPPENS DURING SLOW WAVE SLEEP WHICH DECREASES WITH AGE)

35. Adolescent Sleep Deprivation
[Insert Lecture Name Here]
Adolescent Sleep Deprivation
Compromises REM sleep and learning
Mimics symptoms of ADHD
Increases symptoms of depression
Decreases ability to control emotions
Increases aggressive behaviors
Increases risk of obesity
Slide 35

36. Proactive Strategies
Start the day with interactive activities and movement
Assess sleep patterns with teens who are struggling in school, having behavioral problems, or other mental health issues
Schedule more challenging activities later in the day
Limit technology in bedroom!

37. RISK-TAKING AND THE ADOLESCENT BRAIN
Federal Interagency Forum on Child and Family Health Statistics, 2009
#1 struck by or against an object or person and #2 MVAs, #3 falls
“Hot cognition”-conditions of high emotions or conflict are often the riskiest for adolescents Johnson, Blum & Giedd, 2009

38. NEURODEVELOPMENTAL TUG-OF-WAR
Frontal Cortex:” Let’s
Think It Through First…”
LIMBIC: “Let’s Just Do It!”
DOPAMINE
Not mature yet
Peers
In 2008, Mismatch model emerged as DIFFERENTIAL DEVELOPMENT OF TWO BRAIN SYSTEMS---puberty-driven maturation of sub-cortical aregions supporting emotional and reward processing and LATER MATURURATION OF CORTEX SUPPORTING SELF-REGULATION & SOCIAL COGNITION
While overly simplistic, there’s scientific support of this theory---MILLS et al, 2014
BLAKEMORE & ROBBINS, 2012 talk about the RELATIVELY SLOW LINEAR DEVELOPMENT OF IMPULSE CONTROL IN PFC VERSUS NONLINEAR DEVELOPMENT OF REWARD SYSTEM THAT IS HYPER-RESPONSIVE TO REWARD
 cross talk
High emotions
“Mismatch Model”
Dumontheil, 2016; Mills et al, 2014
Vorobyev et al, 2015
Blakemore & Robbins, 2012

39. Three Most Consistent Adolescent Behavioral Changes Across Cultures
Increased novelty seeking
Increased risk taking
Social affiliation shift toward peer-based interactions
Development & acquisition of survival skills
Johnson et al, 2009

40. Teens Weigh Risks Differently
Dopamine has major role in creating drive for reward
Increased activity of neural circuits utilizing dopamine→enhanced dopamine release
↑impulsiveness without reflection
Hyper-responsive to rewards during adolescence— think in concrete terms, less likely to see big picture
Place more weight on positive outcome vs. possible negative results—PROS outweigh the CONS
DTeens usually have awareness of the risks of potentially dangerous behaviors—their
The area of the brain that generates stress and emotions develops early but the part responsible for judgment and self-control continues to develop into early adulthood
Hot cognition note—Johnson et al, 2009

41. What can this look like in terms of behavior?
Thinking one thing and feeling another
Act from impulses that differ from thoughts or feelings
Misread or misinterpret social cues
Engage in risky or inappropriate behavior

42. Depression and Risk Behaviors
Half of lifetime mental health disorders start by age 14
30% of teen report depressive symptoms at any given time
Depression is linked to adolescent risk behaviors
Kessler et al, 2005; Rushton et al, 2002;
Brown et al, 1996;Lehrer et al, 2006; YRBS
MOVING PARTS GET BROKEN…--increasing incidence of p

43. Moving parts get broken…
The emergence of psychiatric illnesses during adolescence including anxiety & mood disorders, psychosis, eating disorders, personality disorders and substance abuse is increasingly understood as arising from aberrations of the maturational changes occurring during adolescence.
Example—many psychiatric disorders emerging during adolescence show FRONT WHITE MATTER ANOMALIES (Iroise Dumontheil, 2016)
Paus, Keshavan & Giedd, 2008;
Dumontheil, 2016

44. Adverse Childhood Experiences (ACEs) and Adolescent Mental Health
Among adolescents, childhood adversities account for:
15.7% of fear disorders
32.2% of distress disorders
34.4% of substance use orders
40.7% of behavior disorders
44 % of low income youth with 5 or more ACEs have a mental health problem compared to 11% of youth with no ACES
WA state, Lucenko et al, 2012
Population attributable risk proportions (PARPs) were predictive
across DSM-IV disorder classes in this national sample ( n= 6483)
LUCENKO—Medicaid (low income youth) ages yrs in WA state
McLaughlin et al, 2012

45. ACEs and Adolescent Violence Perpetration
For boys and girls, each ACE is significantly associated with violence perpetration (bullying, physical fighting, weapon carrying, self-mutilation, suicide attempts)
Risk increased dramatically with each additional ACE→Dose Response Relationship
Population-based data from 6th, 9th and 12th graders in Minnesota
Duke et al, 2009

46. “Neuroscience suggests that mediating the impact of adverse childhood experiences involves not only education and emotional and practical support but also the introduction and application of neurological repair methods such as mindfulness training.”
Bryck et al, 2012
Bryck RL et al. Am Psychol, 2012;67(2):87-100

49. Getting Grounded and Centered
Stand tall, raise your arms up to the sky and imagine
your feet are
are planted firmly
and growing
roots into the Earth

50. Learning to Breathe (L2B)
Integrates SEL with components of Mindfulness-Based Stress Reduction (MBSR) for adolescents
Emotional regulation skills adapted from therapeutic interventions
6 core lessons that address body awareness, working with feelings, reducing harmful judgments and integrating mindful awareness into daily life
High school students who completed L2B had lower levels of stress and improved emotional regulation skills (Metz et al, )
Journal: Research in Human Development;2013: 10(3):
Curriculum is $50 and workbooks are $10

51. Proactive Strategies
Opportunities for positive risk-taking and leadership with adult guidance
Give teens active role in discussing rules, curfews, and consequences for their behaviors
Teach teens how their brains work

52. How important is it for children and youth to understand how their brain works?
Growth mindset (belief that intelligence/brain is not fixed and can be developed) buffers the negative effects of poverty on academic achievement
Massive study in Chile—first of its kind—included all students
Claro, Dweck, Paunesku, 2016

53. The Adolescent Brain and Alcohol and Substances: Implications and Prevention
BINGE DRINKING 4 or more for females and 5 or more for males
In the U.S., 30% of youth have used alcohol by the 8th grade. 69% have used alcohol by the time they graduate high school and 24% of 12th graders were binge drinking in the past two weeks . (Johnson et al, 2013)

54. True or False Whip Around
At the same blood alcohol levels, adolescents are more likely to show the effects of intoxication on muscle coordination compared to adults.
At the same blood alcohol levels, adolescents are more likely to black-out than pass-out compared to adults.
The earlier a person starts drinking, the more likely they are to become dependent on alcohol.
4. The impact of marijuana on the brain suggests that some of the same areas of the brain that are affected by alcohol are also affected by marijuana.
Marijuana use associated with poorer verbal learning verbal working memory---implicates hippocampus and prefrontal cortex ..
5. A trail mix party is mixing together and taking a handful of prescription drugs that are from other persons’ prescriptions.
Pair up (or 3 if needed). Stand back to back when I ask you to, T for True, X for false---now whip around and show one another and if you’re right, both hands up in air and YEAH!! --TOTAL SO KEEP SCORE—HOW MANY GOT 5 OR MORE, 4 OR MORE CORRECT? I will talk about each answer for a bit so be PREPARED TO STAY STANDING!
Correct answer is false. Developing teen brains are delayed in getting this warning sign of intoxication and this increases the risk of alcohol poisoning.
Correct answer is true. The teen brain is geared for rapid learning and is very vulnerable to setting patterns including addiction.
Correct answer is false. This is another surprising aspect of the developing teen brain and alcohol. Adolescents are more likely to black-out (awake but no memories) and this means they can continue drinking (another risk for alcohol poisoning), drive, have sex and have no recollection of what they did.
Correct answer is true. This form of drug use/abuse has increased more than any other type of substance abuse among teens in the past decade.
T for True, X for False

55. Adolescents are affected differently by repeated, heavy drinking
Increased vulnerability to black-outs
Higher levels of alcohol-impaired memory and executive function (EF)
Reduced sensitivity to the sedative effects of alcohol
Reduced sensitivity to the effects of alcohol on motor coordination
Winward et al, 2014
Among year olsd with HEAVY EPISODIC DRINKING =50 or more lifetime drinking episodes more than 1 month past month heavy drinking and 1 or more withdrawal symptoms in prior two weeks; monitored for 4 weeks of abstinence and compared to teens with less than 10 drinking experiences
DRINKERS HAD DEFICITS in EXECUTIVE FUNCTION—PROSPECTIVE MEMORY, COGNITION SWITCHING, AND INHIBTION TASK ACCURACY---ALL NECESSARY FOR GOAL-ORIENTED BEHAVIOR AND FLEXBILITY TO STAY ON TASK, QUICKLY SHIFT MENTAL MODES AND RESPOND ACCURATELY
Brown et al, 2000; Brown et al, 2001; Hanson et al, 2011;
Swartzwelder et al, 1995; White AM, 2002; Winters, 2013; Winward, Hanson et al, 2014; Wuethrich B, 2001

56. Hippocampus
“Switchboard” between short- and long-term memory = gateway to learning
Smaller hippocampus in alcohol-using adolescents
(compared to nondrinking teens—University of Pittsburgh)
Located in middle of brain—one in each hemisphere
Small left hippocampal volumes and greater right to left asymmetry suggest alcohol-related neuronal death or atrophy vs. normal pruning
De Bellis et al, 2000; Nagel et al, 2005
Medinea et al, 2007 Neurtoxicology & Teratology
RESEARCH BY Mark Prendergast at University of Kentucky shows high levels of calcium going into the cells when the alcohol is withdrawn---DRAMATIC CELL DEATHIN in the hippocampus

57. Teens Need to Understand How Substances
Affect Their Brains Differently

58. Adult Alcohol Addiction, Brain Changes, & Intervention
“Sleeper
Effect”
PFC starts
To reengage
Brain starts returning
to pre-drug state
Activity
PFC
1 year
Addiction
Treatment*
90 Days
Analytical skills, decision-making
AMYDGDALA—more basal region that has key role in PRIMING THE DOPAMINE REWARD SYSTEM WHEN CUES SUGGEST PLEASURE—seeing drinking buddies---or white powder that reminds you of cocaine—these learning associations unleash cravings that must be unlearned/dissassociated (Time, 2009)
SLEEP EFFECT---gradual re-engaging of PROPER DECISION-MAKING AND ANALYTICAL FUNCTIONS IN THE PFC AFTER 90 DAYS ABSTINENCE
In a recent study by Dr. MARTIN PAULUA---UC at Sand Diego—used brain imaging on METH ADDICTS who completed a 4-week intensive VA REHAB program---those who relapsed in one year were less able to complete tasks involving cognitive skills and less able to adjust to new rules quickly (Time, 2009)
BRAIN SCANS SHOWED REDUCED LEVELS OF ACTIVATION IN THE PREFRONTAL CORTEX –where RATIONALE THOUGHT CAN OVERRIDE IMPLUSIVE BHEAVIOR----he was able to predict 80-90% of the time who would relapse by examining the scans
CHANGES in some areas of brain persist longer such as LEANRING—in meth addicts, ability to learn new things still affected after 14 MONTHS of abstinence (NIDA, Dr. Frascella)
Treatment strategy: conditioning to over-ride amygdala
Strengthen PFC (Prefrontal Cortex)

59. ADVERSE CHILHHOOD EXPERIENCES AND TEEN ALCOHOL USE
Teens exposed to ACEs are more likely to:
- to start drinking alcohol by age 14
-binge drink
-say that they drank to cope during their first year of drinking
In this retrospective cohort study of 8417 HMO adult patients (Dube et al, 2006), ACEs were strongly related to ever drinking alcohol and to alcohol initiative in early and mid-adolescence.
Number of ACEs that a child experiences predicts earlier age of drinking initiation (dose-response) Children who experienced 3 ACEs were >2X more likely to start drinking before age 15
Individuals who had ACEs are significantly more likely to say they drank to cope during their 1st year of drinking
Children who were physically abused was > 3X more likely to report drinking to cope compared to children who were not physically abused
Dube et al, 2006

60. Some Considerations for Trauma-Informed Practices and Parenting
Risk of misreading emotions and responding inappropriately
Greater sensitivity to symptoms of trauma and PTSD that are not recognized or are attributed to other problems/diagnoses [ADHD, ODD…]
Symptoms/responses to childhood trauma emerging during adolescence

61. Persisting Effects of Marijuana Use Among Adolescent Users
Poorer verbal learning, verbal working memory and attention accuracy at 3 weeks abstinence (Hanson, Winward, Schweinsburg et al, 2010)
Lower IQ and slower executive function after 18 months of abstinence among adolescents with Cannabis Use Disorder (Camchong, Lim & Kumra, 2016)
HANSON ET AL 2010
Ages 15-19, limited or no alcohol and other drugs
Attention accuracy measured with a visual task where certain numbers embedded among letters and other numbers and must be identified and correct hits and errors recorded over series of trials;
Verbal learning & working memory showed some improvement during abstinence while attention accuracy didn’t
CHAMCHONG 2016
Case (n=43) control (n=22) longitudinal study with healthy controls and cases were treatment seeking adolescents with cannabis use disorder (CUD) who had average of 7 days abstinence at start of study; average age of teens was16-17; average age of USE ONSET was 13 plus/minus 2.2)

62. Prevention Strategy: Refusal Skills
Ask questions.
Name the trouble: “That’s….
Identify the consequences: “If I do that…”
Suggest an alternative: “Instead, why don’t we…”
Move it, sell it, leave, but leave door open: “If you change your mind…”
Refusal skills are taught in the following evidence-based prevention curricula for teens and parents: The 4th R, Life Skills, Guiding Good Choices, Staying Connected with Your Teen

63. Prevention Paradigm Shift
The strategy that was most effective to get teens to avoid smoking tobacco wasn’t frightening images or information about the harmful effects. The strategy that worked was informing them about how adults who owned cigarette companies were brainwashing them to smoke so they could get their money. Why was this so effective?
STRATEGY FOCUSED ON THE POSITIVE VALUE OF BEING STRONG IN THE FACE OF MANIPULATIVE ADULTS OUT TO GET RICH AT TEENS’ EXPENSE—not letting adults brainwash them. (Source: Brainstorm, Dan Siegel, 2013)
Take Home Message:
Use approaches that encourage reflection on values

64. Preventure
Personality-targeted, school-based intervention to prevent alcohol & drug use in high-risk teenagers
Students with high-risk personality profiles identified with screening questionnaire
Sensation-seeking
Impulsivity
Anxiety sensitivity
Negative thinking
Contact: Dr. Patricia Conrod
Department of Psychiatry,
University of Montreal

65. PREVENTURE
Two 90-minute group workshops motivate adolescents to understand how their personality style can lead to certain emotions & behaviors
Facilitated by teacher or mental health practitioner who has attended 2-3 day training & 4 hours of supervised practice
Student and teacher manuals provided

66. Preventure Outcomes Reduced alcohol consumption
40% ↓ risk in intervention group maintained at 6-month follow-up
↓ problem drinking for 24-month follow-up
Less likely to consume alcohol & experience alcohol-related harms in 3-year follow-up
Delayed initiation of alcohol use and binge-drinking
55% reduction in binge drinking at 6-month follow-up among students who reported use at baseline
Less likely to binge drink at 3-year follow-up
There were RCTs, Newton study in Australia; Conrod et al was 24-month follow-up with 13 secondary schools; O’leary study was with 2506 students, mean age 13.7 (18 schools)
O’Leary-Barrett, Mackie et al, 2010;
Conrod, Castellanos-Ryan & Mackie, 2011
Newton, Conrod, Slade et al, 2016

67. Preventure
Reduced likelihood of initiating use of marijuana, cocaine and other illicit drugs sustained over 2-year period
Reduced frequency of illegal drug use
Over 2-year follow-up, there was significant ↑ in number of drugs used as well as frequency of use
“Other drugs that are not marijuana or cocaine..”
Mahu, Doucet, O’Leary & Conrod, 2015

68. The “Fourth R”
Relationship-based approach to prevent adolescent violence & related risk behaviors
Peer and dating violence
Substance use and abuse
Healthy growth and sexuality
21 skill-based lessons; in-school and after-school curricula
At 2 ½ yrs follow-up, significant reductions in physical violence perpetrated by boys and girls