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Brain:
A Work in Progress
Daniel R. Weinberger, M.D.
Brita Elvevåg, Ph.D
Jay N. Giedd, M.D.
June 2005
THE NATIONAL CAMPAIGN TO PREVENT TEEN PREGNANCY BOARD OF DIRECTORS
Chairman President Director and Treasurer
THOMAS H. KEAN ISABEL V. SAWHILL, PH.D. SARAH S. BROWN
President, Drew University Vice President and
Former Governor of New Jersey Director of Economic Studies,
The Brookings Institution
June 2005
Foreword
When the National Campaign first set up shop From all these sources and more, the National
in the mid-1990s, a serious commitment was made Campaign and others have developed a list of back-
to basing the entire enterprise on science and ground and contextual factors that help to explain
research. We strongly believed then, and still do, teen pregnancy in the United States. What is strik-
that when an organizations deals with a compli- ing about this list—in addition to its sheer length—
cated and controversial issue such as teen preg- is that it is almost entirely confined to psychological
nancy, a solid grounding in the facts significantly and social factors as attitudes, feelings, beliefs, cou-
strengthens the overall enterprise. In that spirit, one ple relationships and communication, family and
of the very first advisory groups established by the peer influence, community and school attributes,
National Campaign was the Task Force on Effective poverty and ethnicity, the characteristics of medical
Programs and Research. To this day, this Task Force services and clinics, health insurance status and
remains a critical part of the National Campaign’s more. Aside from age of puberty, physiological fac-
work, and it was under its auspices that the paper tors are virtually absent. It is as though there were
presented here was developed. not one biological factor or insight that might
deepen our understanding of teen sexual behavior
Two of the most important tasks that the and pregnancy, or that might help us craft effective
Research Task Force and the National Campaign interventions.
have addressed are (1) trying to understand the
factors within teens themselves and their broader In truth, this inclination to see teen pregnancy
environment that help to determine teen sexual only in psychosocial and contextual terms charac-
behavior and pregnancy, and then, based on such terizes much of the field generally. For example, the
insights, (2) outlining approaches to teen preg- vast majority of conferences about teen pregnancy
nancy prevention that are likely to be most effec- that occur around the nation rarely include even
tive. This basic line of inquiry has brought us into one session on biological issues that help in under-
contact with countless teens and parents, advocates standing adolescent sexual behavior. By contrast,
and experts in the field, and people who fund, run, the field of early child development—the so-called
and study intervention programs. "zero to three" community—now combines intense
Introduction ...............................................................................................................................................5
References ..................................................................................................................................................23
Neuroscience, the scientific study of the biol- The brain produces a large number of neural
ogy of the brain, has made great strides over the connections just before puberty—connections that
past decade in revealing that remarkable changes diminish in number throughout adolescence
occur in the brain during the second decade of life. through a "use-it-or-lose-it" pruning. Through this
Contrary to long-held ideas that the brain was process, the brain becomes leaner and more effi-
mostly grown-up—"fully cooked"—by the end of cient. Like a sophisticated computer, the maturing
childhood, it is now clear that adolescence is a time brain also grows circuits that can perform several
of profound brain growth and change. In fact, the tasks simultaneously and with ever-greater effi-
ciency. As circuits mature, they become coated with
brain of an early adolescent in comparison to that
a layer of a white fatty substance, myelin, which
of a late adolescent differs measurably in anatomy,
speeds communication, much like the insulation on
biochemistry, and physiology.
electric wire.
Between childhood and adulthood, the brain’s
In addition, cells that use the chemical messen-
"wiring diagram" becomes richer, more complex
ger dopamine—a neurotransmitter that, among
and more efficient, especially in the brain’s frontal
other things, increases one’s capacity to learn in
lobe, or front outer mantle, which is the seat of
response to reward—increase the density of their
such higher order functions as learning and social-
connections with the prefrontal cortex. Dopamine
ization. An important part of the frontal lobes is inputs to the prefrontal cortex grow dramatically
the prefrontal cortex (PFC), which is often referred during adolescence, probably representing one of
to as the "CEO" or executive of the brain and is the neuronal mechanisms that increase the capacity
responsible for such skills as setting priorities, orga- for more mature judgment and impulse control.
nizing plans and ideas, forming strategies, control- Indeed, beginning in adolescence, the dopamine
ling impulses, and allocating attention. New reward signal becomes especially important in the
research suggests that the PFC is one of the last prefrontal cortex as ideas, per se, become increas-
areas of the brain to fully mature. ingly reinforced and valued.
The plasticity of the child’s brain is reflected in Precisely where a synapse sprouts up on this
the fact that damage to it—for example, through a dentritic tree also varies, depending on exactly what
stroke or head injury—can often be compensated information it is meant to convey. All synapses do
for, since so many extra synapses are available to not transfer the same signals, since each is con-
help out and take over for the damaged cells structed to recognize a specific neurotransmitter.
(Kennard, 1936). Later in childhood, after the For example, some synapses transmit excitatory
period of exuberant overproduction of connec- information and use a neurotransmitter called glu-
tions, recovery is much more difficult, because the tamate, which appears to increase the probability
potential for a cell to find an alternative wiring dia- that the receiving neuron will fire and send an
gram is more limited. For example, if a child’s left impulse to another neuron (excessive excitation of
Another indication of the maturation of con- Certain neurons that provide more general
nections among areas of the cortex that takes place alerting and orienting signals—signals that help
during adolescence has come from studies of a pro- focus the activity of information processing net-
cess that protects nerve fibers and makes them works within the cortex—also become more
more efficient. The long extensions that allow neu- robust. One set of cells that shows this pattern in
rons to span many centimeters from one brain the prefrontal cortex is the set that carries the mes-
region to another are called axons. These fibers senger chemical dopamine. This chemical has been
connect the body of the cell—the nucleus with it found to be critical for focusing attention on envi-
DNA and the protein synthesis machinery—to the ronmental stimuli when it is necessary to chose
distant terminals where chemical signals are sent between conflicting options, especially when the
via synapses to the dendrites of other cells. Since
goal may not be obvious and choices based on
axons must conduct electrical impulses over rela-
memory, not impulse, are required. Dopamine
tively long distances, they are wrapped in a fatty
inputs to the prefrontal cortex grow dramatically
chemical coat called myelin, which makes them
during adolescence, probably representing one of
more efficient conductors, just like the insulation
the neuronal mechanisms that increase the capacity
on electrical wires.
for more mature judgment and impulse control
Myelin greatly increases the speed at which sig- (Lambe, Krimer, & Goldman-Rakic, 2000). Indeed,
nals between brain cells can travel—up to 100-fold beginning in adolescence, the dopamine reward sig-
compared to axons lacking myelin. During child- nal becomes especially important in the frontal lobe
hood and adolescence, the amount of myelin as ideas, per se, become increasingly reinforced and
increases throughout the brain. So, during the teen valued. Since learning is based on reward, the ado-
years, not only does the number of connections lescent begins to have the ability to follow an idea
change, but the connections themselves also in pursuit of a goal, rather than to simply act on
become faster. instinct.
Different regions of the brain produce these The role of dopamine neuron growth during
myelin coats at different stages of brain develop- adolescence may be important not just for increas-
ment after birth. It has been known since early in ing the capacity of the brain to learn in response to
the 20th century, for example, that the age at which reward, but it also may have implications for the
brain circuits become covered with myelin corre- vulnerability of the brain to certain drugs of abuse.
sponds, more or less, to the time at which they Drugs such as cocaine and amphetamine target
become functionally mature and achieve their adult dopamine neurons, and damage to these very neu-
role. Areas of the brain that process complex rons caused by such drugs might affect adolescent
abstract information—e.g., learning and memory brain development, especially the brain’s ability to
in the service of goal directed behavior—develop experience reward and learn from it throughout
these coats relatively late. Parts of the brain adult life.
Although the intrinsic neuronal architecture of Few parents of a teen would be surprised to
the hippocampus and amygdala appear to mature hear that there are measurable anatomical differ-
relatively early in life, the manner in which this cir- ences between teen and adult brains, yet actually
cuitry processes environmental stimuli changes in characterizing these differences in living people has
adolescence. The changes reflect, in part, the fact long eluded science. This is because nature has gone
that the prefrontal cortex controls the responses of to a great deal of trouble to protect the brain dur-
these lower centers. Changes intrinsic to these ing life. It is wrapped in a tough leathery mem-
structures might also independently contribute to brane, surrounded by a protective moat of fluid,
differential responses or influence prefrontal cortex and completely encased in bone. This has shielded
development and adult function. As the prefrontal the brain from falls or attacks from predators, but it
cortex matures, a stimulus that might earlier have has also made it hard to study.
initiated an automatic behavioral routine or a
simple emotional arousal comes to be treated Old ways of looking at the living brain, such as
with a more reasoned or deliberate response. The X-rays or CAT scans, use harmful radiation, pre-
prefrontal cortex’s control of more automatic venting their use for the study of healthy children.
response patterns is another manifestation of the Now, magnetic resonance imaging—MRI—safely
reorganization of brain activity that emerges during provides exquisitely accurate pictures of the living,
adolescence. growing human brain and has helped launch a new
era of adolescent neuroscience. The most striking
In sum, many types and levels scientific inquiry finding from a recent series of MRI studies of teens
have demonstrated the changing organization of is the enormous plasticity, or capacity for change,
the brain during adolescence. At the most basic that can be observed in the living brain during this
level, as noted in this section, these changes involve time of life.
molecular rearrangements that affect how the brain
processes information from one cell to another. As summarized in the previous section, studies
Around the third decade of life, the profile of cell- had revealed the over-production and selective
to-cell contacts reaches an adult pattern. The net elimination of cells occurring in the womb—
change in the number of synapses tends to level off processes that are followed by a winnowing of
■ Making decisions
Temporal lobe
■ Empathy
220
200
4 6 8 10 12 14 16 18 20 22
Age in years
The reorganization and refinement of the cor- are used will survive and flourish; those that are not
tex, following a period of apparent growth and used will whither and die.
anatomical exuberance, appears to be the underly-
ing biology of the behavioral adaptability and plas- These concepts suggest that teens may be able
ticity seen at this time of life. But the brain’s to shape some aspects of their own neurological
circuitry, particular those parts involved in assess- development. Unlike their time in the womb or
during the first few months of life, teens can, to
ing risk, making long-range plans, and controlling
varying degrees, exert some control over how they
impulses, are not yet fully developed and refined.
spend their time and can therefore influence the
These parts of the brain are, in a sense, still “under
sculpting of their brains for the adult years to
construction”—a process that appears to continue
come. Consistent with this view, neuroanatomical
into the early 20’s.
evidence suggests that learning and positive experi-
Scientists do not yet understand all of the ence build complex, adaptive brains by increasing
the potential for forming and sustaining neuronal
forces that guide the building up or pruning down
connections—a perspective that echoes sociological
of connections between cells. Both are likely influ-
and psychological tenets, as well.
enced by genetic and environmental factors. The
roles of bacteria, viruses, nutrition, education, par- Periods of exuberant growth or restructuring
enting, school, peers, drugs, video games and many of the brain may also be sensitive periods when the
other factors are hotly debated. At present, the sci- environment can have enhanced effects. The notion
entific jury is still out regarding how much of this of sensitive, critical periods is well understood for
process is automatic versus how much is susceptible some fundamental processes, such as the visual sys-
to manipulation and intervention. The best tem. For example, if a baby has cataracts (a cloud-
hypothesis at present is that learning and the for- ing of the eyes’ lenses), the condition must be
mation of memories guide the building-up of con- corrected within the first two years of life if the
nections. The best current hypothesis at present to child is to have a chance at normal vision. Similarly,
explain the pruning phase is the “use it or lose it” songbirds must hear the singing of their species
principle; that is, those cells and connections that during critical periods in order to acquire their own
Figure 4: Developmental decline in perseverative errors on the Wisconsin Card Sorting Test
(source: Heaton et al., 1993).
20
18
16
% Perseverative Errors
14
12
10
8
6
4
2
0
12 13 14 15 16 17 18 & 19 20-29 30-39
Age in years
1 "The gambler’s fallacy is a belief that the next event in a series of events will compensate for a prior sequence in which an
outcome occurred with greater-than-expected frequency. For example, after a coin toss yields heads 15 times in a row, the
gambler’s fallacy would result in a belief that there is a greater than 50-50 chance that the next toss will yield tails, despite
the fact that each coin toss is independent and the probability of either outcomes is .50" (p.148, Jacobs & Klaczynski,
2002).
Dr. Daniel Weinberger, M.D. research focuses primarily on examining the bio-
logical basis of cognitive, emotional, and behavioral
Dr. Daniel Weinberger is nationally recognized disorders in children and adolescents and his mag-
for his work in psychiatry and neurology. His cur- netic resonance imaging studies have contributed
rent research focuses on neuropsychiatric disorders,
greatly to our understanding of adolescent brain
especially schizophrenia. He has published over 400
development. He has authored over 100 scientific
scientific articles and has authored or edited six
books. He is a member of the Institute of Medicine publications and has received numerous honors,
of the National Academy of Sciences and has won including the National Institute of Health Fellows
numerous awards, including the Research Prize of Award for Research Excellence. He received his
the World Federation of Societies of Biological undergraduate and medical degrees from the
Psychiatry and the Foundation’s Fund Prize form University of North Dakota, did his residency in at
the American Psychiatric Association. He received the Menninger School of Psychiatry and Duke
his BA from Johns Hopkins University and MD University Medical Center.
from the University of Pennsylvania. After medical
internship at UCLA-Harbor General Hospital, Dr.
Weinberger did residencies in psychiatry at Harvard Brita Elvevåg, Ph.D
Medical School and in neurology at George
Washington University. He is board certified in Dr.Brita Elvevåg worked for eight years in the
both specialties. Clinical Disorders Branch at the National Institute
of Menal Health. She received her PhD in cognitive
Dr. Jay Giedd, M.D. psychology at Oxford University in the UK, and
while at the NIH, she studed the functional mecha-
Dr. Jay Giedd is a brain imaging scientist and is nisms of basic cogntive processing in the human
widely quoted expert on adolescent brain develop- brain.
ment. He is board certified in General, Child and
Adolescent, and Geriatric Psychiatry. Dr. Geidd’s
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