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I mplications of the new research for adolescent public health. Dr Bruce Dick Independent Consultant (Adolescent Health) Senior Associate Johns Hopkins Bloomberg School of Public Health. Overview of the Presentation.
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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
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
The early years of developing programmes for adolescent health
Child Survival and Development: the brain in early childhood
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
Brain Development in adolescence: what’s going on? Acknowledgement: The Mentor Foundation www.mentorfoundation.org
Brain Development: what it looks like Acknowledgement: The Mentor Foundation www.mentorfoundation.org
240 Volume in 220 200 4 6 8 10 12 14 16 18 20 22 Age in years Frontal Grey Matter 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 Acknowledgements: Linda Spears and Marc Potenza
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 oldsare 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
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
Common Determinants for different behaviours (risk and protective factors) Risk & Protective factors for adolescents Early Sex Substance Use Depression A positive relationship with parents Conflict in the family A positive school environment Friends who are negative role models A positive relationship with adults in the community Having spiritual beliefs Engaging in other risky behaviours *”Broadening the Horizon” Evidence from 52 countries: http://www.who.int/child_adolescent_health/documents/en/
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
The early childhood brain Carnegie Corporation (1994): Starting Points – meeting the needs of our youngest children • 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. • Brain development is much more vulnerable to environmental influence than we ever suspected. • The influence of early environment on brain development is long lasting. • The environment affects not only the number of brain cells and number of connections among them, but also the way these connections are "wired.” • We have new scientific evidence for the negative impact of early stress on brain function. Nearly 20 years later, we can now say much the same about the adolescent brain!