the psychiatry of why teens act out

“How To Talk to Your Teenager”The Psychiatry Behind What Makes Teens Act Out

September 16, 2010 6:00 pm - 7:30 pm

Desiderio Pina, MD, MPH Chief, Medical Staff Chief, Psychiatry

Adjunct Associate Clinical Professor, University of Notre Dame

Associate Clinical Professor,Indiana University, School of Medicine

What is Madison Center?

With its original roots established in 1949 --

Madison Center is a not for-profit organization that

provides specialty behavioral medicine services in

St. Joseph and surrounding counties in northern

Indiana and southwestern Michigan.

Who am I? I am a son (and was once a teenager - the wife might say I still am) I am a dad and a step-dad (raised/raising 6 kids) I am a husband I am a veteran (Operations Enduring & Iraqi Freedom) I am a public health specialist I am a physician/medical doctor I am a physician-executive

– a medical doctor who has experience & training in administration I am a psychiatrist

– a physician whose medical specialty is the study of the brain & behavior– and illnesses that affect & change the brain & behavior

I am a teacher/lecturer at the medical school (IU-SOM-SB) and the university (ND) and have been a researcher

I am the new chief doc at here at Madison Center

What are we here to ‘talk’ about

The Good... The Bad… & The Ugly

So, What’s “normal” anyway?

Teens… Can’t live with ‘em….

So, what’s a “teen” anyway?

Vat two doo?

What should you NOT do4

Hey...Check this out...

“Your heart, lungs, kidneys and digestive tract keep you alive.

But your brain is where YOU live.”

- Michael C. Miller, MDEditor in Chief,

Harvard Mental Health Letter

A sign of the…. TIME

THE GOOD

THE BAD

THE UGLY

How about this...

“All mental processes, even the most complex psychological processes, derive from operations of the brain”

Eric Kandel, Nobel-Prize winning

Psychiatrist/Neuroscientist(got the prize for discovering

how long term memory works)

Normal?

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But my kid is SPECIAL/DIFFERENT doc!

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Some Kids are just REALLY different

Ever see this guy’s movie?

“There is only one cardinal rule: One must always listen to the patient. “

— Oliver SacksNeurologist/Neuroscientist/Author/Screenwriter

(Author of ‘Awakenings’ -later turned into a movie)Quoted by Walter Clemons, 'Listening to the Lost',

Newsweek (20 Aug 1984). 11

“Uhhh...huh-hu-huh. he said.. ‘Oh - mee - bahh’... That sounds cool, huh-hu-huh”

“The mind arises from an array of mindlessness, billions of linked cells, each one alone no smarter than an amoeba.”

- Michael C. Miller, MDEditor in Chief,

Harvard Mental Health Letter

Amoeba?… Teenagers...Ah…..

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I SEE WHERE YOUR GOING NOW!

Teenagers:(mounds of gelatinous flesh, moving, eating, pooping, resting and trying to replicate)

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but...These are Teenagers Too

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How do we get ‘Here’ from ‘There’

How do we get...

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HERE

Complex behavior, choreographed, purposeful movement that some would

consider culture, beautiful, ugly, obscene, modern, art,

embarrassing, dance, expression, communication

FIGURE 16 CEREBRAL HEMISPHERES VI - MEDIAL VIEW

Separation of the brain in the midline (along the interhemispheric fissure) reveals the medial surface of the hemispheres, the brainstem divided, and medial view of the vermis (midline) of the cerebellum. This view of the brain and brainstem is most important for understanding the structural anatomy of the CNS.

The focus here is on the fissures, sulci and gyri which are found on the medial surface of the cerebral cortex, in the interhemispheric fissure. It should be noted that the cerebral ventricle is below (i.e. inferior to) the corpus callosum.

15 17 59

From ‘There’:

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~ 3 lbs of gelatinous/fatty flesh

(remember- with cells individually no

smarter than an amoeba)

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Current theoriesare that WE get HERE from THERE do we

get ‘Here’ from ‘There’

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?

The Good, The Bad & The Ugly

How to understand it all:– Genetics

– Mom, Dad and both (ie empathy vs morality)– Anatomy/Physiology– (Neuro)Development

(why don't babies hold their head up @ birth?) Pregnancy, birth (what went right & what didn't) Milestones What is age-appropriate and what isn't

– Environment Home, bed, school, position on the Socioeconomic

scale and birth order?(1st, 2nd, 3rd), adopted? (or not), immigrant? (or not), brain injuries? Our cultural beliefs?

– Nutrition maternal (prior to conception), fetal, infant, current

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LAPSE OF ATTENTION - by the way...

What do... ‘Strong Women’

An American Psychologist

The polygraph test

And Comic BooksHave in common?

(YELL IT OUT IT IF YOU KNOW THE ANSWER)23

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SOME common problems

Sleep

Nutrition

Moodiness/

– Mood Instability/Poor Impulse Control

Drama

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NOW THAT I HAVE YOUR ATTENTION AGAIN...AND THE SOME ARE MORE AWAKE...

Sleep

During Sleep our brains engage in:

– Data analysis

– Consolidation of the day’s events/stimuli (DATA)

– Strengthening of memories

– SOLVING PROBLEMS

Hey did you now…

In 1865 Dr Friedrich Kekulé had a strange dream:– He imagined a Ouroboros or Uroborus (a snake biting its

own tail

The Ouroboros or Uroborus[1] is an ancient symbol depicting a

serpent or dragon swallowing its own tail and forming a

circle.The Ouroboros often represents self-reflexivity or

cyclicality, especially in the sense of something constantly re-

creating itself, the eternal return, and other things perceived as

cycles that begin anew as soon as they end.

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Eating Habits

Skipping Meals!?No gas in tank ...aint gonna go far

(especially in a fast revving ferrari)

What the heck is that your eating!?(Salami, peanutbutter, marshmello, cheezit milkshake?!)Did your mom make that for you? Can I have some?

What do you mean your hungry...it’s 330 in the morning!? Why are you making another milkshake? Can I have some? Don’t tell your mother.

What do you mean your NOT hungry...you have to eat dinner with the family!?

Moodiness

Moodiness ≠ DepressionMoodiness ≠ PsychosisMoodiness ≠ DrugsMoodiness ≠ Menarche

(about to start her monthly visitor? NO! DAD?! Yuck...MOM, dad is talking crazy talk again)

Moodiness ≠ ADD/ADHD Moodiness ≠ Bad/evil/possessed Moodiness = need for investigation/discussion

(by supervising adult)

DRAMA

Genetics (apple..falling...tree?) Neurobiology and anatomical development Group/Social Dynamics

ALL = MATURITY– Give choices– ENABLE responsibility– HOLD accountable for actions– Recognize individuality, resiliance, self-reliance &

confidence– BE CONSISTANT32

The Frontal Lobes...ooh... scary

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Do’s & Dont’s: GIRLS

Model and promote expression of feelings in appropriate ways (all or nothing; Cliques) and relationships

MOMS (& dads): your daughters are NOT your girlfriends...avoid ruminating about worries and excessive sharing...keep your boundaries

Avoid sending messages that imply boys can be more trusted with independence than girls

Try and understand the dynamics of arguments/fights between moms/daughters as a teen’s attempt to gain validation “I am not you mom...I am different”

Nurturing time from fathers is paramount - not just activity time (in-spite of awkwardness, reluctance)

Provide appropriate outlets (JOB, sports)34

Do’s & Dont’s: BOYS

Model and promote expression of feelings in appropriate ways - including relationships

Limit images (games, movies) of violence, aggression, and degrading portrayals of women

Don’t criticize or make fun for crying or showing emotion or being vulnerable

Nurturing time from fathers is paramount (ALSO)- not just activity time

Accept rambunctiousness but discourage hyper-masculinity and encourage the development of empathy and therefore (hopefully) later morality

Provide appropriate outlets (JOB, sports)35

Summary

Genetics + Environment = NOT destiny Just DO IT (DO SOMETHING) --->

– U R the PARENT… NIKE! (“just do it”)

Take advantage of your (local) resources– Enlist the whole family (friends/clergy/teachers etc)

– Embrace individuality but with DEMAND/REQUIRE accountability

– Look to specialists and don’t let old stigmas stop you from seeking professional help/an opinion when needed36