Tuesday, November 4, 2014

From The NYT: This Is Your Brain on Drugs


The gray matter of the nucleus accumbens, the walnut-shaped pleasure center of the brain, was glowing like a flame, showing a notable increase in density. “It could mean that there’s some sort of drug learning taking place,” speculated Jodi Gilman, at her computer screen at the Massachusetts General Hospital-Harvard Center for Addiction Medicine. Was the brain adapting to marijuana exposure, rewiring the reward system to demand the drug?

Dr. Gilman was reviewing a composite scan of the brains of 20 pot smokers, ages 18 to 25. What she and fellow researchers at Harvard and Northwestern University found within those scans surprised them. Even in the seven participants who smoked only once or twice a week, there was evidence of structural differences in two significant regions of the brain. The more the subjects smoked, the greater the differences.

Moderate marijuana use by healthy adults seems to pose little risk, and there are potential medical benefits, including easing nausea and pain. But it has long been known that, with the brain developing into the mid-20s, young people who smoke early and often are more likely to have learning and mental health problems. Now researchers suggest existing studies are no longer sufficient. Much of what’s known is based on studies conducted years ago with much less powerful pot.

Marijuana samples seized by the federal Drug Enforcement Agency show the concentration of THC, the drug’s psychoactive compound, rising from a mean of 3.75 percent in 1995 to 13 percent in 2013. Potency seesaws depending on the strain and form. Fresh Baked, which sells recreational marijuana in Boulder, Colo., offers “Green Crack,” with a THC content of about 21 percent, and “Phnom Penh,” with about 8 percent. The level in a concentrate called “Bubble Hash” is about 70 percent; cartridges for vaporizers, much like e-cigarettes, range from 15 to 30 percent THC.

A Harvard-Northwestern study has found differences between the brains of young adult marijuana smokers and those of nonsmokers. In these composite scans, colors represent the differences — in the shape of the amygdala, top, and nucleus accumbens. Yellow indicates areas that are most different, red the least.
High-THC marijuana is associated with paranoia and psychosis, according to aJune article in The New England Journal of Medicine. “We have seen very, very significant increases in emergency room admissions associated with marijuana use that can’t be accounted for solely on basis of changes in prevalence rates,” said Nora D. Volkow, director of the National Institute on Drug Abuse and a co-author of the THC study. “It can only be explained by the fact that current marijuana has higher potency associated with much greater risk for adverse effects.” Emergency room visits related to marijuana have nearly doubled, from 66,000 in 2004 to 129,000 in 2011, according to the Substance Abuse and Mental Health ServicesAdministration.

Higher potency may also accelerate addiction. “You don’t have to work so hard to get high,” said Alan J. Budney, a researcher and professor at Dartmouth’s medical school. “As you make it easier to get high, it makes a person more vulnerable to addiction.” Among adults, the rate is one of 11; for teenagers, one of six.

Concerns over increasing potency, and rising usage among the young, is giving new urgency to research.

For the Harvard-Northwestern study, published in the April issue of The Journal of Neuroscience, the team scanned the brains of 40 young adults, most from Boston-area colleges. Half were nonusers; half reported smoking for one to six years and showed no signs of dependence. Besides the seven light smokers, nine used three to five days a week and four used, on average, daily. All smokers showed abnormalities in the shape, density and volume of the nucleus accumbens, which “is at the core of motivation, the core of pleasure and pain, and every decision that you make,” explained Dr. Hans Breiter, a co-author of the study and professor of psychiatry and behavioral sciences at Northwestern’s medical school.
Similar changes affected the amygdala, which is fundamental in processing emotions, memories and fear responses.

What is already known is that in casual users, THC can disrupt focus, working memory, decision making and motivation for about 24 hours. “The fact that we can see these structural effects in the brain could indicate that the effects of THC are longer lasting than we previously thought,” said Dr. Gilman, an instructor in psychology at Harvard’s medical school.

The study was preliminary and small, and attempts to replicate it are underway. Meanwhile, Dr. Gilman is trying to figure out how the findings relate to brain function and behavior.
One day in September, she was assessing Emma, a student who said her smoking — almost every day — didn’t interfere with school, work or other obligations. For $100 to go toward study-abroad plans, Emma politely plowed through nearly three hours of tests on cognitive functions that are or might be affected by THC, like the ability to delay gratification (would it be better to have $30 tonight or $45 in 15 days?) and motivation (a choice between computer games, the harder one offering a bigger payoff). For memory, Emma listened to lists of words, repeating back those she recalled. Next came risk. Would she bungee jump? Eat high-cholesterolfood? (“These kids tend to be risk takers, particularly with their own health and safety,” Dr. Gilman said.)

A final test: Did Emma crave a joint? Her response: somewhat.

Dr. Gilman is concerned about pot’s impact on the college population. “This is when they are making some major life decisions,” she said, “choosing a major, making long-lasting friendships.”

Dr. Volkow noted another problem: Partying on a Saturday night may hinder studying for a test or writing a paper due on Monday. “Maybe you won’t have the motivation to study, because there’s no reward, no incentive,” she said.

Evidence of long-term effects is also building. A study released in 2012 showed that teenagers who were found to be dependent on pot before age 18 and who continued using it into adulthood lost an average of eight I.Q. points by age 38. And last year at Northwestern, Dr. Breiter and colleagues also saw changes in the nucleus accumbens among adults in their early 20s who had smoked daily for three years but had stopped for at least two years.
They had impaired working memories as well. “Working memory is key for learning,” Dr. Breiter said. “If I were to design a substance that is bad for college students, it would be marijuana.”

Thursday, August 28, 2014

To Sip or Not to Sip: New Pitt Study Looks at Ramifications of Allowing Kids to Taste Alcohol

A parent enjoying an alcoholic drink might find his or her young child to be curious about what’s in that bottle or glass. It raises the question: Should the parent offer the child just a taste? Will it remove the temptation or encourage use or even abuse?
University of Pittsburgh researcher John E. Donovan said previous research findings prompt his recommendation against parents’ offering children a taste of alcohol. Even if research, so far, shows no harm from only a taste, it also has shown no benefit. So why encourage alcohol consumption?
His current study published online in the journal Alcoholism: Clinical & Experimental Research sought to identify factors that prompt children to taste or sip alcohol at ages as young as 8 or 10.
Research already has identified two factors predicting whether a 12-year-old child has tasted alcohol — the child’s attitude toward giving it a try and a family environment supportive of alcohol use.
But the study led by Mr. Donovan, a Ph.D. and associate professor of psychiatry and epidemiology at Pitt, and co-written by Brooke S.G. Molina of Pitt’s departments of psychiatry and psychology, found that parental approval more so than the child’s psychological proneness is key to whether children 8 or 10 years old already have tasted alcohol.
“Children who sipped alcohol before age 12 reported that their parents were more approving of a child sipping or tasting alcohol and more likely to be current drinkers“ than those yet to have a sip,” he said. Parents’ comments confirmed that conclusion.
The study involving 452 children (238 girls and 214 boys 8 or 10 years old), and their families from Allegheny County, sought to identify factors that predict whether a child will start to sip or taste alcohol before age 12. One key finding is “that sipping during childhood is not itself a problem behavior, like delinquent behavior or drug use,” Mr. Donovan said.
A previous study he conducted determined that nearly two-thirds (66 percent) of 12-year-olds have at least tasted alcohol. Children often have their first taste of alcohol during family gatherings or celebrations, he said. Parents in the study, even those regularly drinking in the presence of their children, did not roundly approve of offering their children a taste. But some were less opposed to it.
“We don’t really know yet whether childhood sipping or tasting [of alcohol] has any future negative consequences,” he said. “But our previous research found that sipping or tasting alcohol by age 10 was significantly related to early-onset drinking — that is, having more than a sip or a taste before age 15.”
Previous research also found early-onset drinking, as opposed to just tasting, to be associated with numerous negative outcomes for adolescents and young adults, including alcohol abuse and dependence, illicit drug use, prescription drug misuse, delinquent behavior, risky sexual behavior, motor vehicle crashes and job problems, among others. But it’s not yet known whether just a taste or sip can lead to early consumption of alcohol and later negative outcomes.
But that information could eventually be drawn from already gathered information from Mr. Donovan’s ongoing longitudinal study, which is one that follows the same participants through time. “I don’t know whether sipping or offering a sip or taste can have any consequences later on,” he said. “So we shouldn’t assume there is no problem. You have to make your own decision, but it suggests that it may be a problem, and they shouldn’t have a taste.”
In a published reaction to the study, Robert A. Zucker, of the University of Michigan Addiction Research Center, said it would be “a significant mistake to misinterpret the study” as encouragement that early introduction of alcohol can prevent future problems.
“The fact that the majority of early sippers are not problem children, and that the majority of them do not go on to early regular use, is not evidence supporting the early introduction of drinking with the family as protective. It’s long-term effects remain still to be charted.”

Read more: http://www.post-gazette.com/news/health/2014/08/27/University-of-Pittsburgh-study-childhood-alcohol-sipping/stories/201408270238#ixzz3BhAMXA8L

Monday, August 25, 2014

Want to keep your new middle-schooler out of trouble? Then let them take risks.

From the Washington Posts On Parenting feature

 August 20

Middle school gets a bad rap.

Ask parents of graduating elementary-schoolers how they feel about their kids moving up, and you’ll be surprised how many of their responses fall into the “totally dreading it” end of the anticipation spectrum.

What’s so scary about middle school anyway? I mean, besides hormones, attitudes, peer pressure, emerging sexuality, defiance, exposure to drugs and alcohol… Um, okay. I get it. Middle school can be scary. But there is a lot to love about middle school, too. One of my favorites is that middle school can offer a buffet of new experiences, and kids should try them all. (Scratch that: No drugs and sex. But they should try a lot. )

Parents worry too much when their kids start listening to hard-core rap, or dyeing their hair strange colors, or making unlikely new friends. Instead, middle school should be seen as an important time to let kids begin to develop their identities apart from their parents. Who a child will become is not a foregone conclusion, and without trying a lot of new things, how can a young person truly know who she is? She has to test some limits. While it can be strange to see this happening, know that it’s happening for good reason.

Your kid doesn’t just want to take risks. She needs to take risks.

At around the age of 11, kids’ brains start undergoing some amazing, albeit messy, reorganization. The prefrontal cortex, responsible for impulse control, critical thinking and evaluating other people’s emotions (to name just a few of its important jobs) goes on vacation during the teen years. That’s when the amygdala, or emotional center of the brain, kindly takes over the decision-making department. This makes perfect sense when you consider how impulsive, reactive and dramatic middle-schoolers can be.

It’s not a fluke that kids become more impulsive in middle school. As tweens prepare to take their first big steps on the path toward independent thoughts and behavior, the adolescent brain can’t be dedicated to worrying about risk. Becoming an independent adult, after all, requires a lot of bravery, something impulse control tends to squelch. Put plainly, if your kid’s prefrontal cortex were highly functioning throughout adolescence, she would never consider leaving the comfort of home for college. Why should she take that risk when everything she needs to survive is at her fingertips under your roof?

Let them check the risk box

Understanding why middle-schoolers are driven toward risk-taking is helpful, but knowing how to keep them safe is even better. While a middle-schooler’s brain can’t tell the difference between a good risk and a bad risk, the good news is that it’s equally satisfied by both. You’ve probably heard that kids who play sports are less likely to engage in negative risky behavior. That is not because they’re too busy to find time to misbehave. (Note: This is not a call to sign your child up for every after school activity you can find. Being busy doesn’t satisfy the adolescent need to take risks. ) Instead, that’s because athletes are already taking risks on the field, so they’ve checked that box. And don’t fret if your kid isn’t a jock. Auditioning for a play, joining a new club, starting a baby-sitting business, or doing anything else that takes a kid out of his comfort zone will fulfill that risk-taking drive.

Often, parents think middle school is the time to clamp down and impose lots of limits, because they are fearful of their child making dangerous and impulsive decisions. Certainly, limits are appropriate, but they should be balanced with lots of encouragement to try new things. Yes, this will get messy. Switching friends, changing activities, dressing in all black, and hopping from obsession to obsession will make waves, leaving people, time and money in the wake. With any risk, good or bad, there are challenges. But consider the alternative. Kids who don’t belly up to the buffet and try new things, new friends, new styles and new behaviors may be compelled to try something worse. Or at the very least, they may get left behind by their peers, or miss getting a foothold in a fun new activity.

You can’t always protect them, but you can comfort them.

When my daughter was in fifth grade she auditioned for the school talent show. Though she had been an adorable performer during her early elementary years, this time I was nervous. By fifth grade, she had hit her awkward phase pretty hard. Her singing voice, on which she prided herself for years, had changed from cute and clear to a strangled, nasally something. “If she sings,” I thought, “she will mortify herself and people will tease her relentlessly.”

I so badly wanted to protect her from taking a risk that might get her ostracized, and I debated with myself for days over whether I should discourage her in order to protect her. And then it occurred to me, “Either way, she’ll be hurt. Don’t let it be by me.” Kids would tease, for this or for something else later on, and I wanted to always be her champion. Turns out, she did audition, she made the cut and both her nerves and the terrible cafeteria acoustics kindly muffled her voice enough that the performance was pretty unmemorable – in a good way. She has only happy memories of this event. I am so glad I kept my mouth shut.

So, if you and your tween are staring down the reality of life in middle school, start welcoming the changes coming your way, and not dreading them. Let them sing. Let them go Goth. Let them wear shorts all winter long. They’re just trying to figure out who they are, and that’s hard work. They’ll be grateful you’re by their side when all that work is done.

Michelle Icard is the author of Middle School Makeover: Improving the Way You and Your Child Experience the Middle School Years. Her web site is  www.MichelleintheMiddle.com.


Monday, August 18, 2014

From the NYT: When Sports and Family Time Conflict, Speak Up

Try saying this out loud: “Family and academics are more important than sports, until sports conflict, then sports win.”
I don’t personally like the way that sounds — but yes, I’ve had children skip school, and left my parents to be driven to the bus by a friend after a holiday visit, for hockey tournaments. I love my children, and they love hockey, and that sometimes leaves me making choices that are hard to square with what I say are my priorities.
In “There’s No Off in This Season,” my colleague Bruce Feiler describes how “Friday Night Lights” have become Every Night Lights, with team sports the behemoth that’s consuming American childhood. The quote above paraphrases James Emery White, the pastor of Mecklenburg Community Church in Charlotte, N.C., who has spoken out widely on the dangers of sports eclipsing family life. “Parents are so insecure,” he is quoted as saying, “they feel like whatever other parents are doing, they have to do. If it’s soccer, then my kid has to play soccer. We have elevated sports into a cultural religion. The fact that it clashes with family life is not surprising.”
Those clashes are often infuriating (read the article for more on missed vacations and the near-complete loss of August as part of summer), yet, Bruce writes, few parents are willing to stand up to coaches and reclaim lost weekends and break time if it means risking their child’s place on the team.
It will take more than a few parents to change the culture that allows coaches to make Augusts and Saturdays mandatory. Even for less intense towns, schools and sports, the creep of practice, tournament and game time is hard to resist. The tournaments I’ve allowed my children to miss school for weren’t “mandatory” in any sense of the word. There would have been no individual repercussions for them had they missed them — but because of the size of their teams, their absence could mean the team can’t play, or loses, in part, because they just didn’t have the numbers to keep up. I might have sent the league a message about the importance of academics over sports, but I would also be sending my children a message about letting down a team I’d allowed them to commit to. Suddenly, that simple-seeming dichotomy — academics or sports — isn’t so simple.
Just the fact that games, tournaments, tryouts or practices can be, and are, regularly scheduled during time that is traditionally family time or indisputably school time forces choices parents and students shouldn’t have to make. If you would like to see changes in the sports your family participates in, now, as things are getting organized for the school year, may be the time to speak up at introductory meetings or even attend early meetings of league boards or town recreational programs; for fall sports, now is the time to figure out when and how you can work for changes next year.
Commonly, the people who volunteer to organize leagues and teams are those for whom a sport is a passion and therefore a priority. That may feel as if it makes conflict inevitable, but any change starts with taking the time and making the effort to speak up before the coach who’s genuinely excited to spend spring break taking the team to a tournament has circled the dates on the calendar, and with appreciating that enthusiasm even while looking for a happy medium.
No practice or game time will work for every child, but that shouldn’t mean families should have to make any time work.

Wednesday, July 23, 2014

Kathy Radigan's Open Letter to her Teenager about Drinking

As hard as it is for me to believe this, I'm the mother of a teenager. In fact, Tom will be entering 10th grade this September.
The years have gone so fast that I really feel as if one day I was taking pictures of him graduating from our Mommy and Me class, the next day I couldn't believe he was in the fourth grade, and then bang, he was in high school.
Playdates at friends' houses have been replaced by going out for sushi, a movie, or walking around town with his buddies. Alone. No adults watching over them.
Instead of chatting with his friends' parents over coffee at kitchen tables, we wave to them out of car windows.
The times they are a-changin'.
Whenever my family or friends ask about Tom and marvel at the fact that he is now a teenager, the subject of alcohol and drugs always seems to come up. As in, how will I handle it when he comes home drunk for the first time? Or what will I do if I find out that he's been using drugs?
I always find the questions a bit baffling, because it's just assumed that Tom will try these things. In fact, the common answer I get from most of my friends and family is that of course he will.
Truth be told, I find this mindset maddening. And if I were a kid today, I would find it really confusing.
From the time Tom was in kindergarten, he has been learning in school that drinking and drugs are dangerous choices. He has read books and been shown movies about how alcohol can affect your judgment and make it easier to engage in other risky behaviors like unprotected sex or driving under the influence.
In eighth grade, his health teacher made the whole class write letters addressed to themselves making the promise that they wouldn't smoke, drink or have unprotected sex in high school.
Yet so many parents take it as a foregone conclusion that their kids will engage in any manner of risky behavior.
I've been accused of living in "La La Land" if I think otherwise. "Kids will be kids," some say. Others will chime in with, "after all, we did it."
Really? Are these the criteria we are going to base our parenting on?
I get it. My son is growing up, and he's going to have to make choices for himself.
I want him to spread his wings and discover who he is. And as much as some people think I'm living under a rock, I do know that he is going to make mistakes along the way.
But, I want him to know where I stand on engaging in behaviors that are at best risky and at worst illegal or life-threatening.
I never want my son to say that I wasn't clear about my feelings -- so I'm writing them out here, for all to see.
Dear Tom,
The legal drinking age in this country is 21. Please know that dad and I will never allow you to have alcohol in our house or in our presence until you reach that age. Please also know that no good has ever come from a group of teenagers drinking. It's a recipe for all kinds of disasters.
If you should choose to drink, you'll not only be breaking the rules of our house, you'll be breaking the law.
If you get stopped for driving under the influence, or the police get called to a party where you have been drinking, you may be in a position where we can't protect you.
Always call me and your dad. ALWAYS. No matter what you have done.
Don't ever follow up a bad choice with one that's worse just because you're afraid of disappointing us or making us angry.
Will we be happy? Of course not. But we would much rather get you and any friend who wants to come with you home safely, than get a call saying you are NEVER coming home.
Let me be clear that the fact that we love you and will stand by you does not in any way mean we will stand by while you do things that you know aren't good for you.
There are those who will tell you that your parents are being unreasonable and totally unrealistic. Some may tell you that you are a teenager and it's a rite of passage to get drunk. They may even regale you with stories of their own youthful mistakes.
Listen to your own heart and trust your gut. Also know there is nothing cool about waking up in your own vomit, or having a DUI before you are 18.
Your father and I are so proud of the man you are becoming. We love you so much that we don't care if you hate us. That's our gift to you -- we are your parents, not your friends.

from: http://www.huffingtonpost.com/kathy-radigan/an-open-letter-to-my-teenage-son-about-drinking_b_5609429.html?utm_hp_ref=email_share  

Tuesday, July 1, 2014

Is Risky Behavior in Teens "Hard-Wired" into their Brains?

From the New York Times:

Why Teenagers Act Crazy

ADOLESCENCE is practically synonymous in our culture with risk taking,
emotional drama and all forms of outlandish behavior. Until very recently,
the widely accepted explanation for adolescent angst has been
psychological. Developmentally, teenagers face a number of social and
emotional challenges, like starting to separate from their parents, getting
accepted into a peer group and figuring out who they really are. It doesn’t
take a psychoanalyst to realize that these are anxiety-provoking

But there is a darker side to adolescence that, until now, was poorly
understood: a surge during teenage years in anxiety and fearfulness.
Largely because of a quirk of brain development, adolescents, on average,
experience more anxiety and fear and have a harder time learning how not
to be afraid than either children or adults.

Different regions and circuits of the brain mature at very different
rates. It turns out that the brain circuit for processing fear — the amygdala
— is precocious and develops way ahead of the prefrontal cortex, the seat
of reasoning and executive control. This means that adolescents have a
brain that is wired with an enhanced capacity for fear and anxiety, but is
relatively underdeveloped when it comes to calm reasoning.

You may wonder why, if adolescents have such enhanced capacity for
anxiety, they are such novelty seekers and risk takers. It would seem that
the two traits are at odds. The answer, in part, is that the brain’s reward
center, just like its fear circuit, matures earlier than the prefrontal cortex.

That reward center drives much of teenagers’ risky behavior. This
behavioral paradox also helps explain why adolescents are particularly
prone to injury and trauma. The top three killers of teenagers are
accidents, homicide and suicide.

The brain-development lag has huge implications for how we think
about anxiety and how we treat it. It suggests that anxious adolescents
may not be very responsive to psychotherapy that attempts to teach them
to be unafraid, like cognitive behavior therapy, which is zealously
prescribed for teenagers.

What we have learned should also make us think twice — and then
some — about the ever rising use of stimulants in young people, because
these drugs may worsen anxiety and make it harder for teenagers to do
what they are developmentally supposed to do: learn to be unafraid when
it is appropriate to do so.

As a psychiatrist, I’ve treated many adults with various anxiety
disorders, nearly all of whom trace the origin of the problem to their
teenage years. They typically report an uneventful childhood rudely
interrupted by adolescent anxiety. For many, the anxiety was inexplicable
and came out of nowhere.

Of course, most adolescents do not develop anxiety disorders, but
acquire the skill to modulate their fear as their prefrontal cortex matures
in young adulthood, at around age 25. But up to 20 percent of adolescents
in the United States experience a diagnosable anxiety disorder, like
generalized anxiety or panic attacks, probably resulting from a mix of
genetic factors and environmental influences. The prevalence of anxiety
disorders and risky behavior (both of which reflect this developmental
disjunction in the brain) have been relatively steady, which suggests to me
that the biological contribution is very significant.

One of my patients, a 32-year-old man, recalled feeling anxious in
social gatherings as a teenager. “It was viscerally unpleasant and I felt as if
I couldn’t even speak the same language as other people in the room,” he
said. It wasn’t that he disliked human company; rather, socializing in
groups felt dangerous, even though intellectually he knew that wasn’t the
case. He developed a strategy early on to deal with his discomfort: alcohol.
When he drank, he felt relaxed and able to engage. Now treated and sober
for several years, he still has a trace of social anxiety and still wishes for a
drink in anticipation of socializing.

Of course, we all experience anxiety. Among other things, it’s a
normal emotional response to threatening situations. The hallmark of an
anxiety disorder is the persistence of anxiety that causes intense distress
and interferes with functioning even in safe settings, long after any threat
has receded.
We’ve recently learned that adolescents show heightened fear
responses and have difficulty learning how not to be afraid. In one study
using brain M.R.I., researchers at Weill Cornell Medical College and
Stanford University found that when adolescents were shown fearful faces,
they had exaggerated responses in the amygdala compared with children
and adults.

The amygdala is a region buried deep beneath the cortex that is
critical in evaluating and responding to fear. It sends and receives
connections to our prefrontal cortex alerting us to danger even before we
have had time to really think about it. Think of that split-second
adrenaline surge when you see what appears to be a snake out on a hike in
the woods. That instantaneous fear is your amygdala in action. Then you
circle back, take another look and this time your prefrontal cortex tells you
it was just a harmless stick.

Thus, the fear circuit is a two-way street. While we have limited
control over the fear alarm from our amygdala, our prefrontal cortex can
effectively exert top-down control, giving us the ability to more accurately
assess the risk in our environment. Because the prefrontal cortex is one of
the last brain regions to mature, adolescents have far less ability to
modulate emotions.

Fear learning lies at the heart of anxiety and anxiety disorders. This
primitive form of learning allows us to form associations between events
and specific cues and environments that may predict danger. Way back on
the savanna, for example, we would have learned that the rustle in the
grass or the sudden flight of birds might signal a predator — and taken the
cue and run to safety. Without the ability to identify such danger signals,
we would have been lunch long ago.

But once previously threatening cues or situations become safe, we
have to be able to re-evaluate them and suppress our learned fear
associations. People with anxiety disorders have trouble doing this and
experience persistent fear in the absence of threat — better known as

Another patient I saw in consultation recently, a 23-year-old woman,
described how she became anxious when she was younger after seeing a
commercial about asthma. “It made me incredibly worried for no reason,
and I had a panic attack soon after seeing it,” she said. As an older
teenager, she became worried about getting too close to homeless people
and would hold her breath when near them, knowing that “this was crazy
and made no sense.”

B. J. Casey, a professor of psychology and the director of the Sackler
Institute at Weill Cornell Medical College, has studied fear learning in a
group of children, adolescents and adults. Subjects were shown a colored
square at the same time that they were exposed to an aversive noise. The
colored square, previously a neutral stimulus, became associated with an
unpleasant sound and elicited a fear response similar to that elicited by the
sound. What Dr. Casey and her colleagues found was that there were no
differences between the subjects in the acquisition of fear conditioning.

But when Dr. Casey trained the subjects to essentially unlearn the
association between the colored square and the noise — a process called
fear extinction — something very different happened. With fear extinction,
subjects are repeatedly shown the colored square in the absence of the
noise. Now the square, also known as the conditioned stimulus, loses its
ability to elicit a fear response. Dr. Casey discovered that adolescents had a
much harder time “unlearning” the link between the colored square and
the noise than children or adults did.

In effect, adolescents had trouble learning that a cue that was
previously linked to something aversive was now neutral and “safe.” If you
consider that adolescence is a time of exploration when young people
develop greater autonomy, an enhanced capacity for fear and a more
tenacious memory for threatening situations are adaptive and would
confer survival advantage. In fact, the developmental gap between the
amygdala and the prefrontal cortex that is described in humans has been
found across mammalian species, suggesting that this is an evolutionary
advantage. This new understanding about the neurodevelopmental basis
of adolescent anxiety has important implications, too, in how we should
treat anxiety disorders.

One of the most widely used and empirically
supported treatments for anxiety disorders is cognitive behavior therapy, a
form of extinction learning in which a stimulus that is experienced as
frightening is repeatedly presented in a nonthreatening environment. If,
for example, you had a fear of spiders, you would be gradually exposed to
them in a setting where there were no dire consequences and you would
slowly lose your arachnophobia. The paradox is that adolescents are at
increased risk of anxiety disorders in part because of their impaired ability
to successfully extinguish fear associations, yet they may be the least
responsive to desensitization treatments like cognitive behavior therapy
precisely because of this impairment.

This presents a huge clinical challenge since young people are
generally risk takers who are more prone to exposure to trauma as a direct
result of their behavior, to say nothing of those who were exposed to the
horrors of the wars in Iraq and Afghanistan or the mass shootings like
those in Newtown and Aurora. Many of them will go on to develop posttraumatic
stress disorder, which is essentially a form of fear learning. Now
we have good reason to think that exposure therapy alone may not be the
best treatment for them. A recent study of children and adolescents with
anxiety disorders found that only 55 to 60 percent of subjects responded to
either cognitive behavior therapy or an antidepressant alone, but 81
percent responded to a combination of these treatments. And in another
study, there was preliminary evidence that adolescents responded less well
to cognitive behavior therapy than children or adults.

This isn’t to say that cognitive therapy is ineffective for teenagers, but
that because of their relative difficulty in learning to be unafraid, it may
not be the most effective treatment when used on its own.
And there is potentially something else to worry about with our
anxious adolescents: the meteoric rise in their use of psychostimulants like
Ritalin and Adderall. In theory, stimulants could have a negative impact
on the normal developmental trajectory of anxious teenagers.

According to the health care data company IMS Health, prescription
sales for stimulants increased more than fivefold between 2002 and 2012.
This is of potential concern because it is well known from both human and
animal studies that stimulants enhance learning and, in particular, fear
conditioning. Stimulants, just like emotionally charged experiences, cause
the release of norepinephrine — a close relative of adrenaline — in the
brain and facilitate memory formation. That’s the reason we can easily
forget where we put our keys but will never forget the details of being

Might our promiscuous use of stimulants impair the ability of
adolescents to suppress learned fear — something that is a normal part of
development — and make them more fearful adults? And could stimulants
unwittingly increase the risk of PTSD in adolescents exposed to trauma? In
truth, we haven’t a clue.

But we do know this: Adolescents are not just carefree novelty seekers
and risk takers; they are uniquely vulnerable to anxiety and have a hard
time learning to be unafraid of passing dangers. Parents have to realize
that adolescent anxiety is to be expected, and to comfort their teenagers —
and themselves — by reminding them that they will grow up and out of it
soon enough.

Richard A. Friedman is a professor of clinical psychiatry and the director of the psychopharmacology
clinic at the Weill Cornell Medical College.
7/1/2014 Why Teenagers Act Crazy - NYTimes.com
http://www.nytimes.com/2014/06/29/opinion/sunday/why-teenagers-act-crazy.html?emc=eta1&_r=0 7/7
A version of this op-ed appears in print on June 29, 2014, on page SR1 of the New York edition
with the headline: Why Teenagers Act Crazy.
© 2014 The New York Times Company

Thursday, May 8, 2014

From our friends at the Aliquippa Council of Men and Fathers: A Student Athlete Symposium

Dear Community Stakeholder:
On behalf of the Aliquippa Council of Men and Fathers, an initiative of the Franklin Center of Beaver County, we invite you to join us for “How to Succeed in Professional Athletics and Other Alternative Paths to Success,” a symposium on the student-athlete. This free event will take place on May 17, 2014 from 8am-4pm at the Aliquippa Jr/Sr High Black Box Theatre.

As someone who is actively engaged in the lives of our student-athletes, we believe that you possess valuable insights into the questions and issues that they confront now, and may encounter after graduation from high school. These questions and issues include the following: How important is it to obtain the academic skills necessary for post-secondary success and beyond? Is athletic success valued over academic achievement in our homes and schools? The importance of exposing our kids to opportunities in the marketplace such as: law enforcement, public transportation, military careers; local, state and federal government etc.

Former athletes, career specialists and professionals will present alternative/additional career choices and advice on how to navigate the peaks, valleys and pitfalls of the student-athletes journey.

We need you! Come join us for a great, informative and fun day. If you need more information contact Shon Owens or Lispert Dowdell by phone or email. Phone: 724-378-2882 or email: sowens@franklincenter.org or ldowdell@franklincenter.org. RSVP by Friday May 9, 2014.

See you at the Black Box!


Wednesday, May 7, 2014

School Safety

Letter from Dr. Clapper, Superintendent 
of Quaker Valley School District

Dear Quaker Valley Families:

As you know, school safety is paramount at Quaker Valley. We depend upon partnerships between our parents, students, staff members, law enforcement officials and others within our community to maintain a safe and nurturing environment for all. Open communication is crucial and we are extraordinarily appreciative of our parents' willingness to call us when there is a concern or issue.

Yesterday afternoon, Osborne elementary students discovered a closed pocketknife on the school bus. A parent immediately contacted the school and the pocketknife was subsequently delivered to the school principal, Dr. Barbara Mellett. As a precaution, the Sewickley Police Department was called to investigate.

School buses are used for multiple bus runs each day. The school district is closely examining the rosters of those who rode that bus yesterday. However innocent the possession of a pocket or Swiss army knife may be, please remind your child that it is against district policy to take such an item to school - possession of which would result in expulsion.

Each of us must do everything we can to keep our schools safe. We are extremely grateful to those who called Osborne Elementary yesterday. It is vital that parents talk with their children about what they would do in a similar situation and the importance of reporting such a finding to an adult as soon as possible.

We urge students and parents to share concerns and information with our teachers, counselors, principals or any school or law enforcement official with whom they feel comfortable. If you or your child are not comfortable talking with a teacher or other staff member, reports may be made anonymously on the district's tip-line 412-749-3633 or from our district website (look for QV Tipline under the Quick Links drop down menu). I assure you that each report is taken seriously, investigated fully, and remains private.

Thank you for helping to keep our schools and community safe. School safety is everyone's business.

Sincerely yours,

Dr. Joseph H. Clapper

Thursday, April 24, 2014

Prescription Drug Abuse the Focus for May 10th Panel Discussion

On Saturday, May 10th, Youth Connect will convene a panel of experts to discuss the high rate of prescription drug abuse among teens, and how parents can proactively deal with the issue. Entitled, “When Child-Proof Caps Aren’t Enough: The Prescription Drug Abuse Epidemic and What Parents Can Do,” the panel discussion will close out Youth Connect’s 2013-2014 calendar of events.  The presentation begins at 10 am, is free and open to the public, and takes place at the Sewickley Y’s Walter Brennan Community Activity Center, located near the paddle tennis courts off Blackburn Road.
The centerpiece of the event is the screening of a short but effective video by The Partnership at Drugfree.org. The Alliance Against Drugs, represented by executive director Debbie Kehoe, will be on-hand to talk about the film and the real-life issues the Alliance helps parents deal with when it comes to prescription drug abuse.  The film features a number of families who lived through having a child abuse prescription medications. Also on the panel are Officer Frank Lesniak with the Sewickley Police Department; members of QV Voice, a student-run organization that helps teens make smart decisions; and health care professionals who witness the effects of prescription drug abuse.

The Sewickley Police will also be collecting prescription drugs for disposal, so attendees are encouraged to bring any medications they wish to safely dispose of to the event.