Nine experts at a November symposium spoke on what's driving some young people to abuse substances, court legal trouble, bully peers and attempt suicide.
The meeting, "What's killing our kids? Behavioral misadventures," was the fourth in an annual public lecture series at Brown University endowed in perpetuity by Brown professor emeritus and former APA Executive Director for Science Lewis P. Lipsitt, PhD, and his wife, Edna Duchin Lipsitt, to foster interest in child and adolescent psychology.
Teen deaths and disabilities are largely the result of behavioral actions, making the area ripe for social science study and intervention, said Lipsitt, who hosted the conference.
Even though just 3 to 20 percent of America's youth are chronically destructive, "More young people under age 35 die of accidents, suicides, homicides and the effects of smoking, drinking and drugs than from all the major diseases in the world," Lipsitt said. "And all of these things are preventable."
Indeed, many factors--high emotional intelligence, mentors, parents and the right interventions, to name a few--can buffer the storms of adolescence, he and the other presenters agreed.
One of those storms involves hormones. New brain research provides ever stronger evidence that the biology of youth serves to "ignite passions"--sexual, romantic, physical and cognitive, said University of Pittsburgh pediatrician Ronald Dahl, MD. While these changes serve the adaptive role of preparing youngsters to eventually take on adult roles, they also increase the odds that even the most sanguine of teens will sometimes act out, Dahl said.
A review of 140 studies in the June 2003 American Journal of Psychiatry (Vol. 160, No. 6), for example, shows that various aspects of adolescent brain development make young people highly susceptible to addictions: Pubertal maturation, for example, is associated with a biologically based increase in the tendency toward some types of sensation-seeking and risk-taking behaviors, he said. Other studies find that teens make riskier choices while driving or gambling in the presence of friends than while alone, for example, and that their brains operate differently than adults' brains when performing some tasks, suggesting they have to work harder to achieve the same goals.
Puberty is starting at younger and younger ages, added Dahl, increasing the time span during which these changes occur. Twenty-six percent of African-American girls, for example, now begin some aspects of pubertal development as early as age 7, and other groups are reaching it earlier as well. Developmentally, this means a wider gap between the igniting of passions and the cognitive skills necessary to rein them in. In essence, "It's like starting the engines without a skilled driver," Dahl said.
Some of the choices teens make while they're figuratively learning to drive--smoking, drinking and bullying, for example--can have lifelong negative consequences if started early enough and left untreated, other presenters said. They summarized data in each area and provided ideas on interventions as well.
Problem: Large-scale public health statistics show that young people who begin drinking before age 15 are twice as likely to become alcohol-addicted as those who begin drinking at age 21, said presenter David Lewis, MD, founding director of Brown's Center for Alcohol and Addiction Studies. Those who drink heavily often have co-occurring problems as well, including drug abuse and such mental health problems as attention-deficit disorder and conduct disorder, he said.
Regardless of whether young people become addicted to alcohol over the long term, Lewis added, underage drinking is strongly related to the major cause of death and disability among young people: motor-vehicle accidents. 2002 data from the National Highway Traffic Safety Administration show that a quarter of drivers under age 21 killed in vehicle crashes were intoxicated. Excessive drinking is also strongly linked to suicidal thoughts and attempts among teens, new data find (see Another link).
Solutions: Researchers should include young people when designing alcohol-intervention programs, Lewis said, because they're more tuned in to their own psychology than adults are, and many drink anyway, despite legal prohibitions.
"Zero tolerance does not account for what kids see around them," he said. "You can tell them there will be disastrous consequences and they won't believe you."
College students he's surveyed suggest options that differ significantly from those offered by "experts," Lewis added. These include focusing on individuals, not drugs; taking a health-and-safety rather than a punitive perspective; listening to real students rather than student leaders; educating students on how to deal with friends who drink too much; and promoting open dialogue between students and administrators, he said, adding that interventions would vary for other age groups.
Interventions for one of those age groups--teens--need more attention as well, said psychologist Eric Goplerud, PhD, whose work was cited at the conference and who directs a Pew Foundation-funded program at George Washington University's Medical Center called Ensuring Solutions to Alcohol Problems (www.ensuringsolutions.org). Analyses by Goplerud of the 2000 and 2001 National Household Survey on Drug Abuse found that 8.1 percent of young people ages 12 to 20 meet the criteria for alcohol dependence or abuse in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, but only about 17 percent of them report getting treatment, signifying an enormous need for more outreach, he noted. To highlight the problem, Ensuring Solutions just launched the Kid's Calculator, a Web-based tool to help parents, school personnel, community leaders and others understand teen alcohol abuse and to access resources and treatment options.
Problem: Smoking presents an even thornier problem, despite strong antismoking efforts, said health psychologist David Abrams, PhD, who directs Brown Medical School's Centers for Behavioral and Preventive Medicine at Miriam Hospital. While it's not the most high-profile of youthful transgressions, it's by far the most dangerous: Eighty percent of adult smokers begin smoking before age 18, and 440,000 people die of tobacco-related illnesses each year, making it the country's No. 1 preventable cause of death, he said.
Research shows good reasons to pay attention to youth smoking, Abrams added. For the biological reasons noted by Dahl, teens are especially susceptible to the effects of addictive substances, he said. They're also more vulnerable to advertising: As-yet unpublished research by psychologist Scott Novak, PhD, of Brown, and colleagues, for instance, shows a strong relationship between the density of tobacco ads in Chicago neighborhoods and teen smoking rates. This fact is not lost on the tobacco industry, which has shifted two-thirds of its annual $9 billion advertising budget to target youth, Abrams said.
While smoking has declined slightly among teens in the past few years, Abrams added, it has risen among college students, from about 22 percent in 1993 to 28 percent in 1998. To him, such figures demonstrate the tenacity of the habit: "Smoking is like having an IV drug going directly into your brain's pleasure center," he said, "and the tobacco industry capitalizes on this fact for profit and with flagrant disregard for human life."
Solutions: It's important to keep tobacco on center stage at a time when it would be easy to dismiss the problem because of strong antismoking breakthroughs, Abrams asserted. Indeed, funding in the area is already declining as other problems such as obesity grab public attention, he said.
Abrams confessed he'd like to see tobacco outlawed. But aside from that, the most important focus should be prevention and early intervention, he maintained. "The biggest bang for the buck," he said, "is in keeping kids from tasting this chocolate cake in the first place."
Problem: As with smoking and drinking, youthful bullying can have serious long-term effects, said psychologist Susan Limber, PhD, associate director of Clemson University's Institute on Family and Neighborhood Life. Norwegian psychologist Dan Olweus, PhD, for example, reported in "Bullying at School: What We Know and What We Can Do" (Blackwell, 1993) that 60 percent of boys who bully had at least one conviction by age 24, and 40 percent had three or more convictions.
Limber and others' research finds that about 20 percent of American middle school children say they bully others sometimes. Such youngsters tend to have multiple problems: They're more likely to fight, steal, drink, smoke, carry weapons and drop out of school than non-bullies.
That said, recent research has exploded some common myths about bullies: in particular, that they're loners and misfits with low self-esteem, Limber said. In fact, many bullies are reasonably popular and tend to have "henchmen" who aid their bullying activity, she said.
Solutions: Many antibullying interventions don't use research knowledge and are hence prone to failure, said Limber. Those that adopt the myth that the root of bullying is low self-esteem, for example, "may produce more confident bullies," she said, "but they probably won't have a significant effect on their bullying behavior."
Likewise, the common approach of grouping bullies together for treatment tends to escalate their behavior, while conflict resolutions or mediation--which assumes equal power between children who bully and their victims--may actually revictimize those who have been bullied, she said. Fad treatments tend to fail because they focus on only one aspect of the problem, she explained.
Instead, said Limber, successful programs take a holistic approach to bullying, working to change school norms for acceptable behavior and involving all of those at the school--children, parents and school personnel, she said. A range of effective programs already do that, she noted, including variations on the Olweus Bullying Prevention Program, which she and others have tailored to American school settings and are now evaluating and disseminating.
Indeed, key to the success of any intervention is appropriate adult guidance and support, presenters agreed. Adults supervise their children about 40 percent less than they did 30 years ago, statistics show, and this and related phenomena have been correlated with problem behaviors. The trend, they added, occurs at a time when teens report wanting more parental attention and family time.
Research shows that parents can be effective interventionists, added discussant Theodore Bosack, PhD, chair of the psychology department at Providence College. In a 2001 article in Psychology of Addictive Behaviors (Vol. 15, No. 4), for example, psychologist Rob Turrisi, PhD, of Boise State University and colleagues showed that when parents learned to effectively communicate information on binge drinking to their precollege teens, the young people returned from their first semester of college significantly less likely to drink than a control group, Bosack said.
Relatedly, Peter Salovey, PhD, the Yale University psychologist who pioneered the concept of emotional intelligence (EI)--in essence, the ability to manage one's emotions--noted new findings in press in Personality and Individual Differences by his former student Marc Brackett, PhD, now associate director of Yale's Health, Emotions and Behavior Laboratory, and colleagues, that suggest links between EI and good nurturance.
College students who appear more securely attached, as measured by the number of photos of family and friends displayed in their dorm rooms, have higher EI scores, the team found. Conversely, college-age males who reported illicit drug use and frequent fights had lower scores, Brackett found in earlier unpublished research.
Such findings square with Dahl's observations that the biggest challenge for teens is to develop the self-regulatory abilities implied by high EI, and that adults can aid in that process.
"We need to think about who is influencing adolescents' passions," Dahl said. "The same things that create unique vulnerabilities in youth," he noted, "also create opportunities for artistic, scientific and academic expression."Tori DeAngelis is a writer in Syracuse, N.Y.
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