Anxiety Disorder in Teens

What Is Anxiety?

Liam had always looked out for his younger brother Sam. But whenever Sam took the late bus after soccer practice, Liam worried about him so much he couldn't concentrate on his homework. Liam watched the clock, worrying and imagining the worst — picturing bus accidents and fearing, for no particular reason, that Sam might be injured or dead. Only when Sam arrived home safe could Liam finally relax.

It's completely normal to worry when things get hectic and complicated. But if worries become overwhelming, you may feel that they're running your life. If you spend an excessive amount of time feeling worried or nervous, or you have difficulty sleeping because of your anxiety, pay attention to your thoughts and feelings. They may be symptoms of an anxiety problem or disorder.

Anxiety is a natural human reaction that involves mind and body. It serves an important basic survival function: Anxiety is an alarm system that is activated whenever a person perceives danger or threat.

When the body and mind react to danger or threat, a person feels physical sensations of anxiety — things like a faster heartbeat and breathing, tense muscles, sweaty palms, a queasy stomach, and trembling hands or legs. These sensations are part of the body's fight-flight response. They are caused by a rush of adrenaline and other chemicals that prepare the body to make a quick getaway from danger. They can be mild or extreme.

The fight-flight response happens instantly when a person senses a threat. It takes a few seconds longer for the thinking part of the brain (the cortex) to process the situation and evaluate whether the threat is real, and if so, how to handle it. If the cortex sends the all-clear signal, the fight-flight response is deactivated and the nervous system can relax.

If the mind reasons that a threat might last, feelings of anxiety might linger, keeping the person alert. Physical sensations such as rapid, shallow breathing; a pounding heart; tense muscles; and sweaty palms might continue, too.

Normal Anxiety

Everyone experiences feelings of anxiety from time to time. Anxiety can be described as a sense of uneasiness, nervousness, worry, fear, or dread of what's about to happen or what might happen. While fear is the emotion we feel in the presence of threat, anxiety is a sense of anticipated danger, trouble, or threat.

Feelings of anxiety can be mild or intense (or anywhere in between), depending on the person and the situation. Mild anxiety can feel like a sense of uneasiness or nervousness. More intense anxiety can feel like fear, dread, or panic. Worrying and feelings of tension and stress are forms of anxiety. So are stage fright and the shyness that can come with meeting new people.

It's natural for new, unfamiliar, or challenging situations to prompt feelings of anxiety or nervousness. Facing an important test, a big date, or a major class presentation can trigger normal anxiety. Although these situations don't actually threaten a person's safety, they can cause someone to feel "threatened" by potential embarrassment, worry about making a mistake, fitting in, stumbling over words, being accepted or rejected, or losing pride. Physical sensations — such as a pounding heart, sweaty hands, or a nervous stomach — can be part of normal anxiety, too.

Because anxiety makes a person alert, focused, and ready to head off potential problems, a little anxiety can help us do our best in situations that involve performance. But anxiety that's too strong can interfere with doing our best. Too much anxiety can cause people to feel overwhelmed, tongue-tied, or unable to do what they need to do.

Anxiety Disorders

Anxiety disorders are mental health conditions that involve excessive amounts of anxiety, fear, nervousness, worry, or dread. Anxiety that is too constant or too intense can cause a person to feel preoccupied, distracted, tense, and always on alert.

Anxiety disorders are among the most common mental health conditions. They affect people of all ages — including adults, children, and people in their teens. There are many different types of anxiety disorders, with different symptoms. They all have one thing in common, though: Anxiety occurs too often, is too strong, is out of proportion to the present situation, and affects a person's daily life and happiness.

Symptoms of an anxiety disorder can come on suddenly, or they can build gradually and linger until a person begins to realize that something is wrong. Sometimes anxiety creates a sense of doom and foreboding that seems to come out of nowhere. It's common for those with an anxiety disorder to not know what's causing the emotions, worries, and sensations they have.

Different anxiety disorders are named to reflect their specific symptoms.

• Generalized anxiety. With this common anxiety disorder, a person worries excessively about many things. Someone with generalized anxiety may worry excessively about school, the health or safety of family members, and the future. They may always think of the worst that could happen.
  
  Along with the worry and dread, people with generalized anxiety have physical symptoms, such as chest pain, headache, tiredness, tight muscles, stomachaches, or vomiting. Generalized anxiety can lead a person to miss school or avoid social activities. With generalized anxiety, worries can feel like a burden, making life feel overwhelming or out of control.
• Obsessive compulsive disorder (OCD). For a person with OCD, anxiety takes the form of obsessions (bad thoughts) and compulsions (actions that try to relieve anxiety).
• Phobias. These are intense fears of specific situations or things that are not actually dangerous, such as heights, dogs, or flying in an airplane. Phobias usually cause people to avoid the things they are afraid of.
• Social phobia (social anxiety). This intense anxiety is triggered by social situations or speaking in front of others. An extreme form called selective mutism causes some kids and teens to be too fearful to talk at all in certain situations.
• Panic attacks. These episodes of anxiety can occur for no apparent reason. With a panic attack, a person has sudden and intense physical symptoms that can include a pounding heart, shortness of breath, dizziness, numbness, or tingling feelings causes by overactivity of the body's normal fear response.Agoraphobia is an intense fear of panic attacks that causes a person to avoid going anywhere a panic attack could possibly occur.
• Posttraumatic stress disorder (PTSD). This type of anxiety disorder results from a traumatic or terrifying past experience. Symptoms include flashbacks, nightmares, or constant fear after the fact.

How Anxiety Disorders Affect People

For people dealing with anxiety disorders, symptoms can feel strange and confusing at first. For some, the physical sensations can be strong and upsetting. For others, feelings of doom or fear that can happen for no apparent reason can make them feel scared, unprotected, and on guard. Constant worries can make a person feel overwhelmed by every little thing. All this can affect someone's concentration, confidence, sleep, appetite, and outlook.

People with anxiety disorders might avoid talking about their worries, thinking that others might not understand. They may fear being unfairly judged, or considered weak or scared. Although anxiety disorders are common, people who have them may feel misunderstood or alone.

Some people with anxiety disorders might blame themselves. They may feel embarrassed or ashamed, or mistakenly think that anxiety is a weakness or a personal failing. Anxiety can keep people from going places or doing things they enjoy.

The good news is, doctors today understand anxiety disorders better than ever before and, with treatment, a person can feel better.

What Causes Anxiety Disorders?

Experts don't know exactly what causes anxiety disorders. Several things seem to play a role, including genetics, brain biochemistry, an overactive fight-flight response, stressful life circumstances, and learned behavior.

Someone with a family member who has an anxiety disorder has a greater chance of developing one, too. This may be related to genesthat can affect brain chemistry and the regulation of chemicals called neurotransmitters. But not everyone with a family member who has an anxiety disorder will develop problems with anxiety.

Things that happen in a person's life can also set the stage for anxiety disorders. Frightening traumatic events that can lead to PTSD are a good example.

Growing up in a family where others are fearful or anxious can "teach" a child to view the world as a dangerous place. Likewise, someone who grows up in an environment that is actually dangerous (if there is violence in the family or community, for example) may learn to be fearful or expect the worst.

Although everyone experiences normal anxiety in certain situations, most people — even those who experience traumatic situations — don't develop anxiety disorders. And people who develop anxiety disorders can get relief with proper treatment and care. They can learn ways to manage anxiety and to feel more relaxed and at peace.

How Are Anxiety Disorders Treated?

Anxiety disorders can be treated by mental health professionals, or therapists. A therapist can look at the symptoms someone is dealing with, diagnose the specific anxiety disorder, and create a plan to help the person get relief.

A particular type of talk therapy called cognitive-behavior therapy (CBT) is often used. In CBT, a person learns new ways to think and act in situations that can cause anxiety, and to manage and deal with stress. The therapist provides support and guidance and teaches new coping skills, such as relaxation techniques or breathing exercises. Sometimes, but not always, medication is used as part of the treatment for anxiety.

What to Do

Getting the problem treated can help a person feel like himself or herself again — relaxed and ready for the good things in life. Someone who might be dealing with an anxiety disorder should:

• Tell a parent or other adult about physical sensations, worries, or fears. Because anxiety disorders don't go away unless they are treated, it's important to tell someone who can help. If a parent doesn't seem to understand right away, talk to a school counselor, religious leader, or other trusted adult.
• Get a checkup. See a doctor to make sure there are no physical conditions that could be causing symptoms.
• Work with a mental health professional. Ask a doctor, nurse, or school counselor for a referral to someone who treats anxiety problems. Finding out what's causing the symptoms can be a great relief.
• Get regular exercise, good nutrition, and sleep. These provide your body and brain with the right fuel and time to recharge.

Try to stay patient and positive. It can take time to feel better, and courage to face fears. But letting go of worry allows space for more happiness and fun.

Reviewed by: D'Arcy Lyness, PhD

Paradigm Malibu is devoted to the provision of state of the art Teen Drug Treatment, Adolescent Behavioral Health, Mental Health and Emotional Health Treatment. To learn more about our services, please visit our web site at: www.paradigmmalibu.com

Teen survey reveals dangerous behavior during holidays

Contact: Jennifer Choi
jennifer.choi@med.nyu.edu
NYU Langone Medical Center / New York University School of Medicine 

Holiday season promotes dangerous and risky behaviors by teens

NEW YORK, NY  Results of a survey by the New York University Child Study Center show that there is an extraordinary crisis of untreated depression and anxiety among American adolescents, particularly adolescent girls. Among depressed girls, 54% report feeling more depressed and sad during the holiday season, while only 19% of depressed boys indicate that the holiday season negatively affects their mood.

More than 400 teens between the ages of 13 and 19 participated in Internet interviews between December 3 and 6th. This survey, conducted by Penn, Schoen & Berland Associates, Inc., and led by the NYU Child Study Center, is the first ever National Holiday Teen Mood Survey. Results of the national survey reveal that many teens experience feelings of depression and sadness that often go untreated. 9 out of 10 adolescents reported they have experienced feelings of depression or sadness; 43% of adolescent girls, and 28% of adolescent boys have experienced periods of depression that last at least two weeks. More than 80% of these depressed teens have never received treatment for their symptoms. This data reconfirms the 1999 Mental Health Report from the Surgeon General which stated that only 1 out of 5 children with a psychiatric illness receive treatment.

Furthermore, the holiday season seems to promote dangerous and risky behaviors among a significant number of depressed adolescents. Depressed adolescents are more likely to drink alcohol, take non-prescription drugs and have sex, compared to their peers who have not experienced bouts of depression. This is particularly true among depressed girls with nearly four out of ten reporting that they are more likely to drink alcohol during the holidays. In addition they are more likely to engage in other at-risk behaviors such as taking drugs and having sex than girls who are not depressed:

• 70% of depressed girls drink vs. 58% of girls who are not depressed
• 55% of depressed girls take non-prescription drugs vs. 39% of girls who are not depressed
• 35% of depressed girls are sexually active vs. 23% of girls who are not depressed

"We know that teens that suffer from depression and do not receive treatment are at higher risk for abusing substances and engaging in risky behavior," said Harold S. Koplewicz, M.D., Director of the New York University Child Study Center and author of More Than Moody: Recognizing and Treating Adolescent Depression, "This survey shows that not only are depressed teens more at risk throughout the year, but that this risk increases during the holiday season. Depressed teenagers are more sensitive to the environment than depressed adults therefore parents must be more alert during the holiday season for signs and symptoms of depression in their adolescents. "

Nearly half of adolescents (49%) report feelings of anxiety and worry that they perceive to be worse than those of their peers.

• 46% of boys and 51% of girls have felt these feelings of anxiety or worry
• 100% of girls who admit to these feelings also say they have experienced depression
• 35% of all girls have experienced prolonged feelings of anxiety for two weeks or longer, compared to just 14% of boys who have felt this way

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National Holiday Teen Mood Survey Reference Information
Led by the NYU Child Study Center, the National Holiday Teen Mood Survey was conducted by Penn, Schoen and Berland. 429 Internet interviews were conducted with 193 adolescent boys and 236 adolescent girls. The margin of error among the entire sample is +/- 4.7%. For boys the margin of error is +/-7% and for girls it is 6.4%. Margin of error is larger among subgroups.

Warning Signs of Depression in Teens

• Irritable or depressed mood
• Change in sleeping habits
• Change in appetite
• Difficulty concentrating
• Social isolation
• Deterioration in academic performance

More Than Moody: Recognizing and Treating Adolescent Depression
Dr. Harold S. Koplewicz, Director of the NYU Child Study Center and one of the nation's premier child and adolescent psychiatrists, explores and illuminates an under-recognized but growing problem in America today: depression among teenagers. Through his first-hand experience as a clinician and researcher, Koplewicz helps parents distinguish between normal teenage angst and true depression, a serious psychological illness with important long-term consequences. Dr. Koplewicz combines prescriptive advice and compelling anecdotes-based on some of his most compelling cases and the stories of real teenagers-to show parents the warning signs, risk factors, and key behaviors to look for in their teenage sons and daughters. Furthermore he illustrates for parents, teachers, health-care professionals, and young adults the options for treatment, which have broadened dramatically in recent years with the approved use of SSRI anti-depressants for young people and advances in such non-pharmaceutical approaches as cognitive behavior therapy.

Paper Ornaments--Anorexia, a personal journey

By Anonymous, Tarrytown, NY
Reprinted from Teen Ink

It's Christmas day, and the tree is adorned with paper cutouts of ornaments tied to branches with string. Glass, wire, and implements with even the slightest edge are deemed hazardous and confiscated by the staff, or hidden between couch cushions by desperate patients. The ornaments bear sayings like “Keep on keepin' on” and “You are loved.” The room is drafty, but Donna and I are curled under a fuzzy green blanket on the couch, pretending that the red and orange tissue paper fire in the fireplace is actually emanating warmth. It's not her first Christmas away from home, but it's mine.

Across from us is Marina, clad in a Led Zeppelin shirt and bright pink velour sweat pants. Her black hair is piled atop her head in a giant Amy Winehouse inspired beehive. She is molding a lump of flesh-colored Silly Putty into obscene shapes, and Cara, my roommate, is laughing hysterically. Thumbing through photos of her blue-eyed young son is Gina, a small-framed, exquisitely pretty English teacher. She serves as my makeshift mother here. We sit together in the day room around a makeshift fire, next to a tree with makeshift ornaments. My makeshift family celebrating a makeshift Christmas.

In the far corner are the shivering, skeletal figures of the women holding onto their dear lives with blistered, skinny, sweaty fingers. They are emaciated and their conversations move slowly, heavily, as though each word is dressed in denim and forced to swim against a rip tide. Some are 40 and look 80, some are 20 and look 12. They reek of decay as their bodies waste away. It is their twelfth or thirteenth time in treatment. Their families long ago gave up on them, and I almost can't blame them. Anorexia has won.

Donna and I head upstairs for a Christmas day nap. My floppy, tattered Liam and her plushy, gray Pursely are perched on our beds, waiting for us. It's important to stay in touch with your inner child while in recovery. I put The Velvet Underground on the stereo, and Lou Reed plucks at his guitar strings and gently sings to us, “Candy says, ‘I've come to hate my body and all that it requires in this world.'” We know very well how Candy feels. But I look at Donna, and her sea-green eyes are swimming with life. Her once gray-tinged skin is supple and glowing again. We can think again, speak again, laugh again, and as long as our mirror access is limited, we are happy again. Our saggy, shapeless pants are beginning to fill out a bit. We're getting healthy together.

She wears a bright yellow jacket and a black bandana to tie up a spiky mane of bleach-blonde hair. Every part of the human face that can be pierced is, and the holes in her ears are stretched to the size of quarters. On her shoulder is a tattoo she designed – a scrawny man with butterfly wings. And black, gothic lettering across her chest reads “This Is Just The Beginning.” She smells like lavender linen spray and cigarette smoke.

“My psychiatrist asked if I dress offensively to scare people,” she told me once, laughing. He had a point. You could see how the more fearful girls shied away at the sight of her provocative attire, and I think that's exactly how she wanted it. The silver bullring through her nose and her heavily black-lined eyes seem to warn, “If you're shallow enough to judge me by my looks, then you're certainly not worth talking to.” She smiles with pierced pink lips. I think she is so beautiful. I'm happy to be spending Christmas with her.

That morning we had Belgian waffles for breakfast, a seemingly harmless confection, but sometimes seemingly harmless things are actually the most powerful. A seemingly harmless wave to a friend once caused an Italian captain to capsize his cruise ship. A seemingly harmless rainstorm once flooded the city of New Orleans. A seemingly harmless pebble slung by a seemingly harmless David brought the seemingly invincible Goliath to his downfall.

“How,” I asked the waffles silently, “did you become so powerful? Why am I so afraid of you? Why do you hate me so much?”

“You fat, ugly girl,” they replied. “You fat, ugly, gluttonous girl.”

I thought about my friends at home and the relationships my eating disorder had damaged. I thought about my family, whose Christmas would be spent in the crowded visiting room of a treatment center with fake ornaments on fake trees. I thought about how I had nothing to give them except a few lousy string bracelets, and about all the abusive obscenities I had hurled at them when all they were trying to do was help.

I thought about how waffles are my little brother's favorite breakfast food.

I felt a delicate hand on my knee under the table. It was Gina's. I told her about how waffles were Henry's favorite. She squeezed my knee and said sweetly, “The best gift you could give him is a better you. Enjoy them for him.”

So I did. Never had a cold, soggy Belgian waffle tasted sweeter.

Teen Dating Violence Linked to Substance Abuse

By Denise Mann

Teens in abusive relationships may be more likely to develop emotional problems and substance abuse issues as they age, a new study suggests.

The study included more than 5,600 12- to 18-year-olds who had been in one or more relationships with someone of the opposite sex back in 1996. Of these, about a third said they had experienced teen dating violence, including emotional and physical abuse.

Participants were asked if they had ever been called names, insulted, or treated disrespectfully by their partner. They were also asked if they had been threatened with violence, pushed, shoved, or had something thrown at them.

Five years later, those who answered yes to any of these questions were more likely to engage in unhealthy behaviors. Specifically, girls who reported experiencing dating violence as teens were more likely to binge drink, have  symptoms of depression, smoke, and think about killing themselves as young adults, compared with girls who were in healthier relationships.

By contrast, boys who reported dating violence during their teen years were more likely to be antisocial, think about suicide, and use marijuana as young adults than boys who did not report any dating violence or abuse.

Males and females who were in physically abusive relationships as teens were also two to three times more likely to be in violent relationships at ages 18 to 25, the study shows.

The findings appear in Pediatrics.

What Is a Healthy Teen Dating Relationship?

“Children and teens need to know what it means to be in a healthy dating relationship,” says researcher Deinera Exner-Cortens of Cornell University in Ithaca, N.Y. “Parents, teachers, and health care providers all have a role to play in encouraging healthy relationships and modeling respect, trust, and open communication.”

In other words, it’s "do as I say and do as I do" when teaching kids what a healthy relationship looks like, she says.

It’s not just dating violence that sets children up for health and emotional problems, says Metee Comkornruecha, MD, an adolescent medicine specialist at Miami Children's Hospital in Florida. “When children are exposed to any sort of violence or insult, unfortunately it does affect their psyche,” he says. “The study shows how important it is for pediatricians to screen for teen dating violence and prevent and/or treat these negative health outcomes.”

What do these kids look like?

“They may be isolated from their parents or peers and may not do the things they used to enjoy because their partner is keeping them from going out with friends,” he says. “When it comes time to go out on dates, they don't seem as happy as they used to be.”

Parents get the raw truth on teen drug use: Town hall focuses on alcohol, marijuana and prescription drugs

By Shanna McCord

PTOS -- Parents who filled the Aptos High School theater on Thursday for a town hall meeting with law enforcement officers got the raw truth when it comes to drug and alcohol use by teens.

"It's out there, it's in the schools," sheriff's deputy Nick Baldrige told the crowd of more than 100. "Too many parents say 'that can't be my kid'."

Baldrige, a narcotics expert with the Santa Cruz County Sheriff's Office, led a discussion designed to alert parents about the latest trends surrounding marijuana, alcohol and prescription drug use among young people.

Baldrige showed the audience pictures of drug paraphernalia and candy and soda products containing marijuana, such as "Stoney Ranchers." He detailed the ill effects of marijuana use, despite popularity statewide as a so-called medicine.

"They have problems focusing, their grades drop, they have memory problems. They can't retain any information given in school," Baldrige said. "We see it with marijuana use, not necessarily just the hard street drugs. These things have a direct link to marijuana use."

Baldrige also focused on the rising use of prescription drugs by teens, particularly teens from affluent communities. Specifically, the painkiller Oxycontin has seen widespread abuse, he said.

A video was played that included first-hand accounts of Oxycontin abuse from Jay, a teen in San Diego County, who said the drug was used by all sorts, including jocks and student government officers.  officers.

Jay was in and out of rehabs and prison for crimes related to stealing to feed his addiction. He was found dead in Tijuana.

"He's the kid of a cop," Baldrige said, letting the message sink in with parents.

Migdalia DeNike, a mother of two high school students, said she's heard plenty of stories from her kids about students drinking and smoking pot on campus. She said she's even smelled pot herself while visiting the high school last year.

"Marijuana is basically an accepted thing," DeNike said. "That's the norm. Being absent from those things is abnormal."

Aptos High junior Hannah Holm, 17, said it's common to hear about her peers drinking or trying drugs.

However, for Holm, a member of the school dance team, staying away is easy.

"It all depends on who you're friends with," she said. "You can choose not to by hanging out with the right people."

Dominique Barnes, 16, agreed that not trying drugs was an easy choice for her.

"Just seeing the road that doing drugs can take you down, it's not a pretty road," Barnes said. "I don't like the possible outcome."

Representatives from Pajaro Valley Prevention and Student Assistance, a nonprofit that partners with South County schools to provide drug and alcohol counseling for students, spoke about services available to teens struggling with addiction.

Aptos High Principal Casey O'Brien told parents about the efforts under way at the school to deal with the ongoing issues of experimentation and abuse.

He cited counseling, referrals to outside services, a hotline to report problems, having a sheriff's deputy on campus and a discipline policy that involves suspension on the first offense.

"We can do more," O'Brien said. "We need more staff training on how to spot a student under the influence and more parent opportunities like tonight."

Overeating as a Child is Red Flag for Future Drug Use

Researchers studying overeating in children and teens have found what they call a strong link to drug use.

The Boston Children's Hospital study looked at girls and boys between the ages of 9 and 15, and followed up with them every year until they were young adults 18 to 24. They found a connection between binge eating as a child and using marijuana and other drugs as a young adult.

Researchers say their findings suggest that lack of control is an important indicator of the severity of overeating episodes -- regardless of whether the children said they felt "in control" or "out of control" during their eating.

Nutritionists say it's another good reason to screen children and teens for eating problems, because intervention, such as behavioral therapy, can prevent health problems later in life.

The study did not find a correlation between binge eating and binge drinking.

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Teenage drug abuse skyrockets

LOS ANGELES - At a music rave in Los Angeles, thousands of teenagers were drunk and high, reports CBS News correspondent Ben Tracy.

15-year-old Sasha Rodriguez drank water laced with ecstasy. She later overdosed and died.

It may seem shocking, but in the last three years ecstasy use among teenagers has jumped 67 percent. One in 10 teens now use it. Marijuana use is up 22 percent, with four in 10 teens smoking pot, according to The Partnership at Drugfree.org.

Teen drug abuse rising: Why?

One group of high school students we spoke with said marijuana is not taboo.

"People look down upon someone who smokes cigarettes more than they look down upon weed," said high school senior Samantha Gerson.

"I'm kind of surprised that people don't think it's such a big deal," said high school junior Madeleine McSweeney.

As for alcohol, 71 percent of teens have a drink before they leave high school. On average they start at just 14 years old. Twenty-five percent of them have had a drink by age 12.

The group says they first saw alcohol when they were in 7th grade.

Experts say after years of declines in teen alcohol and drug use, parents and the government became complacent.

"Over this last decade there has been less of a message getting out if you will," said Steve Pasierb, president of The Partnership at Drugfree.org. "A lot of the programs that used to exist have been cut, through successive rounds of budget cuts."

The teens we talked to say drinking and smoking pot isn't something that just happens on the weekends at parties -- they say it happens all week long.

"There's people who do it after school, during school, on the weekends," said high school senior Rafe Aksad.

"You come and relax after the party by getting high and drinking," said Gerson. "It's never ending."

A non-stop party that can turn deadly.

The Teen Brain: It's Just Not Grown Up Yet

by RICHARD KNOX

EnlargeRichard Knox/NPR

Neurologist Francis Jensen examining a teenage patient. Jensen decided to study the teenage brain when her own sons became teenagers. Now Jensen lectures to teens and parents about how teenagers' brains are different.

When adolescence hit Frances Jensen's sons, she often found herself wondering, like all parents of teenagers, "What were you thinking?"

"It's a resounding mantra of parents and teachers," says Jensen, who's a pediatric neurologist at Children's Hospital in Boston.

Like when son number one, Andrew, turned 16, dyed his hair black with red stripes and went off to school wearing studded leather and platform shoes. And his grades went south.

"I watched my child morph into another being, and yet I knew deep down inside it was the same Andrew," Jensen says. Suddenly her own children seemed like an alien species.

Jensen is a Harvard expert on epilepsy, not adolescent brain development. As she coped with her boys' sour moods and their exasperating assumption that somebody else will pick up their dirty clothes, she decided to investigate what neuroscientists are discovering about teenagers' brains that makes them behave that way.

EnlargeRichard Knox/NPR

Jensen's older son Andrew Murphy, now a physics major at Wesleyan, is the reason his mother first started studying the teenage brain. She wanted to find out what was causing his maddening teenage behavior.

Teenage Brains Are Different

She learned that that it's not so much whatteens are thinking — it's how.

Jensen says scientists used to think human brain development was pretty complete by age 10. Or as she puts it, that "a teenage brain is just an adult brain with fewer miles on it."

But it's not. To begin with, she says, a crucial part of the brain — the frontal lobes — are not fully connected. Really.

"It's the part of the brain that says: 'Is this a good idea? What is the consequence of this action?' " Jensen says. "It's not that they don't have a frontal lobe. And they can use it. But they're going to access it more slowly."

That's because the nerve cells that connect teenagers' frontal lobes with the rest of their brains are sluggish. Teenagers don't have as much of the fatty coating called myelin, or "white matter," that adults have in this area.

Think of it as insulation on an electrical wire. Nerves need myelin for nerve signals to flow freely. Spotty or thin myelin leads to inefficient communication between one part of the brain and another.

EnlargeKathryn C Reed

Jensen's younger son Will Murphy is now a Harvard student. He says he learned a lot about his teenage brain from his mother.

A Partially Connected Frontal Lobe

Jensen thinks this explains what was going on inside the brain of her younger son, Will, when he turned 16. Like Andrew, he'd been a good student, a straight arrow, with good grades and high SAT scores. But one morning on the way to school, he turned left in front of an oncoming vehicle. He and the other driver were OK, but there was serious damage to the car.

"It was, uh, totaled," Will says. "Down and out. And it was about 10 minutes before morning assembly. So most of the school passed by my wrecked car with me standing next to it."

"And lo and behold," his mother adds, "who was the other driver? It was a 21-year-old — also probably not with a completely connected frontal lobe." Recent studies show that neural insulation isn't complete until the mid-20s.

This also may explain why teenagers often seem so maddeningly self-centered. "You think of them as these surly, rude, selfish people," Jensen says. "Well, actually, that's the developmental stage they're at. They aren't yet at that place where they're thinking about — or capable, necessarily, of thinking about the effects of their behavior on other people. That requires insight."

And insight requires — that's right — a fully connected frontal lobe.

Mask making--an innovation in substance abuse therapy

by Cathy Malchiodi

Masks are worn for performance, entertainment, disguise, concealment, or protection. They have been around since ancient times and have been used in ceremony, storytelling, and dramatic enactment. Making a mask invites you to explore the persona you reveal or conceal from the world. 

Mask making always reminds me of an experience of working with a teenage boy in an inpatient mental health clinic. The boy had a long history of physical and sexual assault and tortuous life with a drug-addicted parent; not surprisingly, he had attachment, emotional, and cognitive challenges as a result of abuse and neglect. After several sessions with him, I learned that the story of the extraterrestrial character "Alien" was an obsession; he always carried a worn-out paperback version of the movie and was delighted to read his favorite sections to me whenever possible.

s a creative therapist, I try to reach my clients at a place of metaphor and imagination; for this adolescent, that place was his fixation on Alien and this metaphor led to my intervention. I suggested that we work on a life-size mask of the character out of paper, paste and chicken wire, a process that unfolded over several sessions. A set of food tongs became a moveable part that emerged from Alien's mouth to "capture" his victims. The boy wore the mask while he enacted his favorite scenes for me and I often impersonated the various characters that Alien encountered or destroyed. To make a long story short, this intervention led this adolescent to verbalize traumatic events and confront his feelings toward his neglectful parent for the first time in his life.

To me, masks are all about communication through the wearable image of a face. In art and drama, they are used for their expressive potential in enactment and ritual. Masks are a universal art form that generally evokes power, magic, and mystery for both those who wear them and their audience.
In art therapy, creating a mask from scratch or decorating a pre-made mask often leads to exploring one's persona. Persona actually is a word that derives from the Latin for "mask," but often refers to the practical and successful personality that we use most of the time in the workplace and social relationships. It's a bit like a facade that we start to develop inchildhood when we get approval for behaving in certain ways. At the same time, we also learn to disguise and repress those features and traits that not approved- negative characteristics such as anger, greed,envy, and jealousy. We also may repress any other aspects such ascreativity or self-confidence if these qualities are not appreciated or affirmed.

Carl Gustav Jung wrote extensively about the concept of persona and the various ways it manifests itself. He also proposed that there is a dark side to the personality, well-know to the field of psychology as theshadow. It includes both repressed, instinctual feelings and untapped potential. To me, the shadow is not just the "evil" opponent of persona, but is also imagination and creativity left behind or forgotten because of sensible or good behavior.

Mask making is a popular art therapy intervention because it touches on many of Jung's concepts, including persona and shadow. Masks can bring to consciousness how we both see ourselves or what we fantasizewe would like to be. Because a mask has an outside and an inside, I often ask clients to consider portraying "how others see you" on the outside of the mask and "how you really feel inside" on the reverse side of the mask. For individuals with addictions or history of physical or sexual abuse, working with a therapist to explore persona and shadow in this way is a profound, revealing, and often personally liberating experience.

Finally, mask making is a good example of an art therapy intervention that invites the use of expressive therapies-- the continuum of the arts [visual art, theater, dance, and music] in healing. Facilitated by a skilled therapist, it helps to initiate an imagination-driven exploration of the self through role play, dramatic enactment, movement, or storytelling. Best of all, it is an approach that allows all the arts to meet in one place, making it both a very cool and powerful intervention.