Adolescent Development Explained: Becoming an Adult

Adolescent Development Explained: Becoming an Adult


[Dr. Foley] Good afternoon and welcome to the “Adolescent Development Explained” webinar number one, “Becoming An Adult.” Hello I’m
Dr. Diane Foley the deputy assistant secretary for population affairs in the
Health and Human Services Office of the Assistant Secretary for Health. I’d like
to welcome you to today’s webinar. This webinar is the first in a series of
three webinars that reviews changes that are normal and necessary in adolescence,
different ways that adolescents experience these changes, and how caring
adults can support healthy development. This first webinar focuses on physical
and cognitive changes that occur during adolescence. OPA has worked collaboratively with doctors
Phillip Lief and Beth Marshall from the Center for Adolescent Health at the
Johns Hopkins Bloomberg School of Public Health to develop the “Adolescent
Development Explained” as a website content based on updates to the seminal
1999 report called the “Teen Years Explained.” This updated content is
available on the OPA web site as web content and also as a downloadable PDF
file. We’re very pleased to now bring some of that content as a webinar series
that you can watch and share with your colleagues. Please note that these
webinars are not exhaustive- there’s much more rich content on the website. Let’s
get started with a question for all of you: what questions do you have about the
changes in the bodies and minds of adolescents? On this slide we see some of
the topics that were sent in before today’s webinar- thank you for sharing
with us. Our speakers are going to address some of these issues during the
webinar- please continue to ask these questions using the question box or the
chat function so that we can try to answer them at the end of the
presentation. Now I’d like to welcome our first expert presenter Dr. Beth Marshall.
She is the associate director of The Center For Adolescent Health and the assistant
scientist in the Department of Population, Family and Reproductive
Health at the John Hopkins University Bloomberg School of Public Health
Dr. Marshall is going to speak about adolescence as a time of transition to
adulthood and a period of great potential. Dr. Marshall, you are on.
[Dr. Marshall] Thank you so much Dr. Foley. And so adolescence is a fascinating developmental stage
that spans from about 10 years to 24 years of age when children transition to
adolescent in several adolescence to adulthood in several different
developmental areas. The time span starts a little earlier and ends much
later than folks traditionally thought of the teen years, but the work of so many
practitioners researchers and neuroscientists have shifted how we
understand this time of transition and much of what we traditionally saw
written about adolescence, unlike the guy that Dr. Foley just
talked about, was really about the problems and how the adults could fix
them. And then a decade ago there was a movement that pushed to redefine the way
we thought about young people and how we design programs and contexts for them.
Instead of talking about young people as walking negative risk behaviors we
talked about and built programming around and started measuring their
assets. So we focus on the potential of adolescence instead of the peril. Then
the past two decades of neuroscience back that up by showing that adolescence
is really a time of rapid growth of brain cells and that in adolescence the
brain has more plasticity than the periods just before or after adolescence.
And while we still see portrayals of negative sides of adolescents, in truth
most young people are succeeding in school and attached to their families
and they emerge on the other side of adolescence without serious problems of
substance abuse or interpersonal violence. But young people do
experience intense emotions during adolescence, which I think is where some
of the portrayal of angst comes from and that’s really a consequence of brain
development but the adolescent years are about development and not angst and
confusion. Young people are growing physically and their worlds are
expanding, both in their spheres of influence, in the context they’re
developing within, and in their abilities to absorb and process all of those
contexts and then eventually to thrive in them. So we’ll talk today about young
people’s development but it is really important to remember that young people
develop positive attributes through learning and experience, and that parents
and larger community play a fundamental and essential role in
helping young people move successfully into adulthood. Positive youth
development is a research and practice based framework that allows us to
understand that development is best promoted by creating opportunities to
develop a core set of assets which are often terms of five C’s: confidence
confidence connection caring and character. And adolescents develop these
assets when they experience them in their own lives. So a young person learns
that they’re good at something when they’re given the opportunity to try new
things and practice those things and they learn to be caring by being cared
for themselves. Can we go to the next slide? So today we’re going to focus on
physical and cognitive development but these five areas of adolescent
development physical cognitive emotional social and morals and values, they
overlap and they influence each other. For example, changes in the brain and the
way it functions support changes and how a young person interacts socially with
their parents, with their peers, and even with romantic interests. Normal, healthy
adolescent development is uneven and when we look across these five areas it
can often be really out of sync so during this time of growth what you see
may not be what you get. That’s because adolescent development is happening on
all these different tracks at the same time but at different rates. So some of
what’s happening is visible and some of it is invisible and not in sync with
what you see physically. So for instance a teen who physically looks like an
adult might still be struggling with adult-like thinking. Or a teen who looks
very young might be very mature cognitively. It would be difficult for
most people to distinguish based on physical traits my 14 year old daughter
and my 20 year old niece but they’re in very different places with their
cognitive and their social and emotional development which is why we have age-based restriction in place. Could my fourteen-year-old
physically operate a motor vehicle? Probably. Would that be safe? Probably not. So young people in their brains are basically under construction throughout
adolescence but that’s not meant to stereotype or belittle young people in
any way. Part of the reasons that teenagers don’t act or think like adults
is because their physical structures including their brains are different and
they function differently and they don’t have defective adult brains, they have
adolescent brains that are really well adapted to transition them from
childhood to adulthood. I’m going to turn it back to Dr. Foley so she can
introduce Dr. Ammerman.
[Dr. Foley] Thank you so much Dr. Marshall. I’d like to welcome our
second speaker now, Dr. Seth Ammerman. Dr. Ammerman is the adolescent
medicine and addiction medicine specialist at the Alliance Medical
Center in Helzberg, California, retired clinical professor at Stanford
University and the founder of the mobile Adolescent Health Services team health
van program at the Lucile Packard Children’s Hospital Stanford. Dr. Ammerman is going to speak to us about physical changes in adolescence. Dr. Ammerman?
[Dr. Ammerman] Hello it’s a pleasure to be part of this webinar series. As noted I will be
focusing on pubertal changes and first I’d like to let
you all know that there’s a range of timing of normal pubertal development.
About 20% of youth start puberty earlier than their peers, as young as ages eight
to nine in females and ten to eleven in males. About 60% start puberty around the
age of 10 in females and age 11 in males and about 20% start later, around the age
of eleven in females and twelve in males. Females typically start puberty sooner
than males and also end their pubertal development sooner than males. For most
females the first sign of puberty is breast development. Less commonly the
developing of pubic hair comes first. For most males the first sign of puberty
is testicular enlargement, not penile enlargement. Less commonly, too, is the
developing of pubic hair first. As healthcare providers we assess pubertal
development based on breast and pubic hair growth in females and testicle,
penis, and pubic hair growth in males. Usually a female will start her period
about two years after the onset of breast development. This is a sign of
reproductive maturity. And it is common for periods to be irregular for the
first couple of years after the onset of
menstruation. The sign of reproductive maturity in males is having what are
called “nocturnal emissions” or in lay terminology “wet dreams” and that
usually starts mid puberty during male development. Both males and females have significant height and weight increases during
puberty. About 25% of final height is put on during puberty and on average about
50% of final weight, though there are many factors that can lead to an
adolescent being underweight, normal weight or overweight. For females the
height growth spurt occurs early in puberty, and in males late in puberty. So if you go into a sixth grade class, many females are taller than the males, but by
eighth grade this is reversed. Note that early developing females and late
developing males are more likely to engage in risk taking behaviors. This is
in part due to the fact that others treat them by how old they look, rather
than their actual age. So an early developing female who was 12 but looks
15 will be treated differently by peers. Similarly a late developing male who was 15
but looks 13 will also be treated differently by peers, so it’s important
to be sure during the time of pubertal development that the stage of
development is the primary focus, rather than age. Another important point is that most
males and females have a similar amount of body fat pre-puberty. During puberty
on average females double their % body fat from about 12 to 24 percent whereas
males will decrease their percent body fat by one or two percent. This can be a
big issue for females, who may feel like they are getting “fat.” It’s
important to let females know that this is normal and expected and has nothing
to do with being “fat.” Additionally, adolescents often have
questions during this time of, “am I normal?” They may feel embarrassed or
ashamed about their bodies and their development, so it’s important to
reassure them that they’re developing normally. As you can see on the slide, the
different factors that may affect the timing of pubertal development. Genetics
is important in terms of early, usual or late development. Exercise, physical
activity and nutrition play a role. Females who are overweight or obese are
more likely to develop early and experience early menstruation, as an
example. Chronic illnesses may delay pubertal development. Substance use
mainly affects brain development but use of steroids and other hormones may stunt
the physical development. And the development in other areas you will hear
more about in the next webinar. I’ll now turn the back to Beth. [Dr. Marshall] Thank you and so I’m going to focus a little bit on brain functions and
cognitive development. If we were sitting in a classroom together I would ask you
to rank impulse control, creating a plan, foreseeing and weighing possible outcomes
of behavior, risk calculations, simultaneously considering multiple
streams of information, and problem solving in terms of what you think is
most important for adolescents. And you would be very frustrated because they
are all important cognitive functions and they all develop during adolescence.
Young people don’t just wake up one day with a fully functioning adult brain,
there is this period of rapid growth of brain cells in early adolescence and
then throughout adolescence we see that this overgrowth is pruned back, which
enables the brain to work more efficiently and strengthens the
connections and pathways that are more frequently used. And again the process of
brain development is uneven with different parts of the brain coming
online or maturing at different rates and we can think about we often think
about brain development moving from the back of the brain to the front of the
brain in terms of time and in the middle of the brain is the limbic system which
is associated with long-term memory and behavior and motivation but what’s
really important for adolescents is it is a part of the brain that processes
rewards and it’s associated with feeling pleasure. And the last part of the brain
to fully develop is the front- the prefrontal cortex part of the frontal
lobe which is responsible for all the tasks that I wanted you to rank. This is
sometimes called the CEO of the brain and it’s the part that helps us
understand the difference between appropriate and inappropriate behavior
and adjust our own behavior accordingly. And it’s also the part that allows us to
have more empathy for others and insights into our own behavior. So these
structural changes that are happening in the brain itself are termed “brain
development” and then the changes then open the door for changes in the way we
think and how the brain is used which we term “cognitive development.” And while
this process and can be uneven and can have
resulting frustrations for adults, and sometimes doesn’t make sense, it’s
very well-suited for helping adolescents make that transition again to adulthood.
So during the process of maturation, adolescent cognitive development occurs
along these four dimensions that you see on the slide so advanced reasoning
skills… unlike younger children, adolescents
begin to think about multiple options and possibilities and they can consider
questions that are not concrete and not right in front of them, so they start to
think about all of the hypothetical “what if,” and if you have parented an
adolescent, in the early stages of this development, those hypothetical “what
ifs” can be frustrating. Abstract thinking is another skill that, similar
to the “what ifs,” it means that they’re able to think about things that aren’t
right in front of them. They can’t be heard or seen or touched. Concepts like
faith and love and trust and you can see where this would interact with the other
pieces of development like social development and development of
your moral and value systems. Meta-cognition is another cognitive skill
and that’s sort of your ability to think about thinking, or a young person’s
self-awareness. This is another place where we often think about adolescence
as potentially having too much self-awareness
and that’s as these skills come online, we tend to sort of be hyper conscious of
ourselves as young people. And then enhanced learning: the rapid growth in
the brain and all these new synapses make the adolescent brain a learning
machine. So it can absorb facts and ideas and skills like we haven’t been able to
before, and probably don’t in the future once we have left the stage of
adolescence. Can we stretch to the next slide? So young people are unique and
while they’re developing the same cognitive skills, those skills might be
expressed differently as we can see sometimes with different learning styles
and abilities. Adolescence is also where we see more mental health
diagnosis which is based in part on brain development as well as hormones. But it’s also where we see the most promise for treatment, largely due to the
plasticity in our brains. Both sleep and experiences of trauma as well can impact
both brain development and cognitive development and through that, of course,
risk taking. Risks what we’re often interested in for adolescents and the
unevenness of that brain development is what sort of drive some of our
risk-taking behavior. The limbic system , where we process rewards, is developed
before the prefrontal cortex which is responsible for thinking
through the consequence. And this imbalance favors behaviors that are
driven by emotion, and responds to incentives rather than rational
decision-making. Adolescents and adults are similarly responsive to
potential rewards but they, adolescents have less control
over the urge to seek them. But that gap closes over time which is why you would
often do things in adolescence that you might not ever consider doing as adults.
And even though we focus on risk reduction for adolescents, risk-taking in
adolescents serves a purpose and it’s really
important for young people to be able to take risks because we want them to try
new things and we want them to try new schools and head off into the world, and
without the ability to take risks that would be very difficult for them to do.
I’m going to turn it back over to Dr. Ammerman. [Dr. Ammerman] So there are many ways to help adolescents go through this process. One of the most important is to be a
good role model. What you do is much more important than
what you say, and by role modeling healthy behaviors and healthy approaches
to your own life has a huge impact on adolescents doing well. On this slide here, well let me first
say that some other good dues are to spend time with your adolescent on a
regular basis and without distractions. A great time to do this is at family
dinner, at least weekly is recommended. No cell phones TV computers etc just each
of you talking about your day. Also include one-on-one fun activities with
your adolescent. They really appreciate the time and attention you give them and
having fun together is great bonding. Let them know you’re always willing to talk
with them about what’s on their mind even if it’s difficult or hard. And do
admit when you don’t know an answer but let them know you’ll check it out and
get back to them. there are different types of parenting,
and some of the best outcomes for and some of the best outcomes for adolescents are those who have parents that do set reasonable limits but also allow reasonable choices. Being overly
restrictive or too permissive is generally not as helpful. And let them
know you love them on a regular basis. A couple of don’ts would be to don’t
criticize body shape or size. Rather focus on healthy habits and behaviors
and don’t yell or scream or hit your adolescent for messing up. You’re still
in charge as a parent and none of us would want whoever is our boss to yell
or scream or hit us – it’s best to stay calm, explore the situation, and make
plans so it won’t happen again. Back to the slides-let them
know what they’re going through is normal, encourage them to have a positive view of their bodies, encourage healthy habits.
We know that drug use can alter normal brain development and that the younger
an adolescent starts using, or the more heavily they use, the more likely they
will have problems with cognition and other brain development issues. Help them
eat well, again role modeling their behaviors. Next slide. And asking open-ended questions and these complex issues. Help them consider the
consequences of their actions. Seek out opportunities for them to
engage as learners. Adolescents can often do well in community service or
volunteering for something they enjoy and like – it’s a great learning model. And
adolescents with learning disabilities can do very well. And of course the
promoting injury prevention. I’ll turn it back over. [Dr. Foley] Thank you Dr. Ammerman and Dr. Marshall for this and now we have some questions that have come in from the
audience as well as some other questions that we would like you to discuss in the
time that we have left here. First of all Dr. Ammerman- what environmental
stressors affect physical development? [Dr. Ammerman] There are a number of environmental
stressors that can affect physical development- certainly nutrition is
important. Healthy nutrition helps promote normal development. Poor
nutrition can adversely affect development. Same with physical activity-
regular and healthy physical activity helps promote normal development. A big
issue with sleep. A lot of adolescents we have seen don’t get enough sleep, and
this can actually affect normal development. Chronic illnesses I already
mentioned can delay development. And chronic stress can also alter normal
development so that trying to help adolescents minimize stress or deal with
with stressful situations in a healthy way is very important. And of course
there a variety of social determinants of health that can affect development,
and the more secure an adolescent can feel at home and in their their
community, the more normal their development will be. Thanks for that
question. [Dr. Foley] So what you’re saying then is if my teenager wants to sleep in till 10
o’clock on the weekends it doesn’t mean they’re lazy? Correct. Necessarily, right?
[Dr. Ammerman] Correct, most adolescents actually need around 8 or 9 hours of sleep a night and
they often don’t get that amount of sleep and there’s actually an effort
going on now to try to get later starts in school in the mornings so that
adolescents can actually sleep in a little more. [Dr. Foley] Thank you so much. Dr. Marshall, question for you: there’s been a lot of information recently and even a recent
surgeon general update about this but what are your thoughts as far as how
marijuana use actually can affect adolescent brain development?
[Dr. Marshall] Yeah there’s definitely a lot of interest in that question especially as we move to
seeing more states legalize marijuana. And you know it’s not
necessarily a cut and dry answer, which I feel like is what most researchers say
about anything, but there are certainly studies that have shown both
structural and functional changes particularly in adolescents who are
heavy users of marijuana. They have had damage to the white matter in their
brain which really helps for the efficiency in the brain, so for us to be
able to make more rapid decisions, that tends to be more difficult for those
particularly who began smoking at younger ages. But then there are also
studies that have not shown any functional or structural changes in the
brains and have suggested that potentially other studies haven’t
controlled for the impact of alcohol so it’s not necessarily cut and dry but
like we said we’re talking about brain development, adolescence is a critical
period of brain development so the way that we highlight the 0 to 3 years in
terms of brain development and how we want an enriching atmosphere for a young
person’s brain develop to develop in that time is what we want for
adolescents as well because we’re seeing the same level of growth and development
and pruning and so it is very possible that what we will find in the end is
that you know marijuana during this developmental time period is detrimental.
And do you think that there are different, all of the different
substances that can be used have an effect, or do you think that there are
some that show worse effect than others? [Dr. Marshall] I think that certainly like
substance use during this critical time period is going to impact young
people. It’s hard to tease out because substances do tend to cluster the
impact of individual substances. And earlier studies also you know, folks
looked at sort of trajectories of young people and when they began smoking, and
whether their trajectory towards success in life sort of was altered
because of substance use behavior. And again it’s hard to point out which
substance that might be, because those folks who are smoking marijuana often
engaging in other substances as well. [Dr. Foley] Right that makes it difficult too and
then it also just the difference of the earlier that the adolescent is exposed
to these the increased likelihood of addiction, particularly later on as well.
So not only different difficulty with the brain development but also the
likelihood for addiction is that right?
[Dr. Marshall] Yes so the earlier that a young
person begins to use substances, whether we’re talking about marijuana
alcohol or even nicotine, you have a higher propensity towards addiction
later in life.
[Dr. Foley] Okay, Dr. Ammerman, are there any effects on the physical
development of puberty from these substances that we know of?
[Dr. Ammerman] By and large, no, the vast majority of this physical development is going to
be between the ages of ten and thirteen or fourteen and substance use
fortunately is uncommon in those ages. Again the main issue
is going to be a brain development being affected. Now there is a
use of steroids and other similar medications that sometimes middle school
adolescents may use because they think it’s going to be good for their bodies
or make them stronger, fitter, and so on and there is some evidence actually that use
of those substances can’t stunt physical development. But in general with the
substances we’ve been talking about, there’s not much evidence that it
would affect normal physical development. [Dr. Foley] Okay thank you. We had someone write in
and ask whether we know, do we have any studies looking at vaping and how that
might affect adolescent development or is that practice too new for us to
really get a handle on those kinds of studies? This can be for either one of
you.
[Dr. Marshall] So I think, oh I’m sorry I’ll say my two cents and then I’ll pass
it over to you. It’s a great question and like I said I have a 14 year old and
we just had a very long conversation about vaping over the weekend,
particularly making this point that it’s a new phenomenon, we don’t
necessarily have all the information that we need in terms of determining
long-term effects. We’re clearly seeing in the news right now that there are
some serious health consequences and that may be due to other chemicals that
are mixed in with the vaping. And we’ve also seen that it’s become very
attractive to young people so we’re seeing a larger proportion and I work
here in Baltimore City, we generally have lower rates of tobacco use among
adolescents, but we’re seeing much higher rates of e-cigarette use because the
flavor combination, they’re sort of targeted towards young
people and so while research wise the jury is still out, I will tell you that
the conversation I had with my adolescent is the jury may still be out
from a research perspective but this is something that we can clearly see is
causing harm to young people immediately. [Dr. Ammerman] I would agree completely and the
content of nicotine in certain vape products is actually higher than
traditional cigarettes and again for adolescents who are using during this
developmental period they’re much more likely to become addicted to
nicotine using at this point and it’s such a new phenomenon we just don’t
really have any long-term studies to look at the potential adverse
consequences, but it’s likely to be a major problem and it’s best to mention the
recent publicity with over 450 patients developing severe lung disease tied to
vaping, some of them were vaping nicotine, some marijuana, and some both and there have been at least five deaths, and so this is a real serious problem.
[Dr. Foley] Thank you, both of you. This one is directed to Dr. Ammerman:
sometimes teen behavior seems irrational to adults. It can be difficult for adults
to know how to best support them. What advice do you have for parents and
caretakers? How should they respond when they’re seeing this seemingly irrational
behavior from their teens?
[Dr. Ammerman] I think there are a few ways to respond. One would be
to point out the possible consequences of this irrational behavior and to let your team know that you don’t want him or her to suffer a potential
negative consequence which could be serious.
When I talk with teens I like to contextualize the behavior as
much as possible so that, because a lot of teens when they engage in these
irrational behaviors they may not suffer any negative consequences and
their concrete thinkers and may not understand about long-term consequences,
but most of my patients know someone appear who has done something irrational
and it had some negative consequences and so I like to
contextualize it, say “well great that you haven’t had any problems, but you know
what about your friend Johnny?” – you know just a common example -“he got drunk
and got sick, now that isn’t so good right?” And I can start a conversation
about the pros and cons of engaging in these behaviors. I would also add that
discussing scenarios with adolescents can be very useful so if they’re going
to parties or if they’re going to be driving or just being with peers and
potentially things may come up, in advance discussing scenarios and how to
handle these in a way that makes sense – and it’s going to be more than one
conversation for sure- but I think these can all be useful in helping adolescents
understand how to be more rational than their behaviors. But again yelling or
screaming doesn’t usually accomplish much at them. It’s more having a rational
discussion with them. Thanks for the question.
[Dr. Marshall] Can I just add one thing on to that, that we know that adolescents actually are pretty good at
calculating risk, and so I think it’s also important and like Dr. Ammerman
suggested, to be very honest and clear with
adolescence and because when we over exaggerate the risks, they tend to
see through us and then not take us for being open and honest with them. [Dr. Foley] That’s a good point, thank you. You know I think it’s interesting because when you’re talking about not yelling and
screaming back at them that would be probably classified under adult
irrational behavior as well right? So we’re responding with what we’re not
wanting them to do. I think another thing that I have noticed is that there are a
lot of day-to-day examples, even on sometimes on commercials that come up
when you’re watching television together or in some of the sitcom types of things
that come up that can be really amazing teaching moments to have
conversations about this. I remember my kids when they were teenagers would
sometimes refuse to watch something with me because we could never get all the
way through it without having these teaching moments that seemed to always
come up, but I think that those types of things are also very very
important. Dr. Marshall, some members of our audience work with teen parents
and so when you have a teenager themselves going through development and then becoming a parent how does adolescent development in
different stages affect their parenting skills?
[Dr. Marshall] That’s a great question and I sort of want to like jump back to being really clear that you know, as young
people’s brains are developing and their cognitive skills and their social and
emotional skills are coming online, that’s not to their detriment. That’s a positive transition that they’re going
through but they need support and particularly if the young person is
parenting they’ll need additional support. So
they, as most parents will recognize, they will have periods of extreme stress
because parenting is a stressful endeavor, and stress tends to inhibit our
ability to make good rational decisions. So a really strong support system
for teen parents is really important. And helping them sort of practice those
newly formed skills – practicing those cognitive skills by doing behavioral rehearsal, practicing those social and emotional skills by helping young people
sort of name the emotions that their feeling. Parenting of young
children is frustrating and teen parents need to know that it can be
frustrating and that’s not something that they’re experiencing alone. So a really strong support system for young people who are parenting is crucial to
supporting both their own adolescent development and their ability to foster
the development of their own young person.
[Dr. Foley]: It’s great, thank you. Dr. Ammerman a question came in about the pubertal development as far as
growth and physical development and the effect that energy drinks might have on
that, are you aware of any studies yet or thoughts about energy drinks affecting
physical development?
[Dr. Ammerman] As far as actually affecting physical development, there’s not a lot of evidence that it has an impact. Definitely of course
the energy drinks typically have a lot of caffeine, and caffeine can
particularly again in younger adolescents who are going through this
developmental process, it can affect their cognitive functions somewhat
and sometimes cause them to get hyper and overexcited which isn’t
necessarily good of course. But in terms of actually affecting the physical
development, I’m not aware of any particular studies that have
demonstrated that.
[Dr. Foley] Thank you. Dr. Marshall do you have anything to add to that from
the cognitive brain development side?
[Dr. Marshall] Not from the brain development side but the
energy drinks also include typically a ton of sugar, beyond the amount of sugar
that we want for young people for ideal growth and development, so that’s
important to keep in mind as well.
[Dr. Foley] Okay thank you. Dr. Ammerman, you had mentioned it – I mean you both had mentioned it a little bit- the effects of the social determinants of health on development and I wonder- we’ve had a
couple of questions that are asking for a little bit more clarity on where you
see the social developments of health affecting the physical development
during adolescence, and then also the cognitive development. So maybe Dr. Ammerman you could start with that?
[Dr. Ammerman] Sure so for example I’ve worked a lot
with underserved youth, those with low income or poverty and certainly that is
just in and of itself can be chronically stressful. If you have food
insecurity or in terms of nutrition you’re basically just eating a lot of
junk food and high sugar high fat food that’s not going to be healthy for
physical development. If there’s chronic stress, again, that can cause problems.
So in these ways focusing on, you know, social determinants of health is
important because the more positive the environment, the more positive the
developmental outcome, including physical and pubertal development will be.
I’ll turn it over to Beth. [Dr. Marshall] I think in terms of the social
determinants of health, we know that growing up in poverty
tends to have an impact both on health and educational outcomes. I
think that you know from my work the place where we really focus is
on the impact of trauma and how trauma tends to impact both the brain
development to the actual structures. Young people who are subject to
childhood trauma tend to have smaller brain size overall. And then we
also see changes in cognitive functions right so we see deficits in terms of
attention and focus and that’s where we then start to see some impacts on
educational success. And so I think you know social determinants are hard to
tease out individually but certainly you know have an impact on young
people’s growth and development.
[Dr. Foley] Great thank you. Well that’s all the time we have for today with questions I want to
especially thank Docters Ammerman and Marshall for sharing your expert insight
and answers to questions and thank you to all of you for joining us and a
reminder again this is one of three webinars that we’ll be developing and
you will receive information before the next one. So thank you again and have a
great afternoon.

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