 We have just a few more minutes until the start of the fourth annual Clarity Con. So make sure to grab your drinks, your breakfast, get settled because we'll be starting momentarily. Test, test, that's fine. Okay. I think we're ready to begin. Can I get everyone's attention a moment? All right. Okay. Good morning. I'm Dr. Wayne Erisman, Chief Psychologist of Clarity Child Guidance Center. It's my special privilege to represent our President and CEO Fred Hines and welcome all of you to Clarity 2016, the Summit on Children's Mental Health. We've planned a full day and a half of wonderful and interactive presentations on a number of topics connected to children's mental health. Look through your syllabus and you'll see we offer over 20 breakouts, keynote, and luncheon presentations. I trust we'll provide you with insight to apply to your own particular area. It all begins in just a few minutes with our special keynote speaker, Dr. Lauren Steinberg, right over there, who has traveled from Temple University in Pennsylvania to lead off with his presentation, Age of Opportunity, Lessons from the New Science of Adolescents. We will hear from Dr. Steinberg shortly. We're also pleased to welcome our special luncheon speaker today, the multi-talented woman, Randy Silverman, who will share her work on a recently released movie and present her talk, Recovery, The Importance of Family Engagement. We are so grateful that Randy has joined us here today from New York City since Judge Susan Hawk was unable to speak today due to unforeseen circumstances. Tomorrow, we will welcome one of the leading authorities and the diagnosis of treatment and treatment of impulsive aggression in children and teens, Dr. Dan Matthews who will present Understanding Disruptive Mood Disregulation Disorder, a primer for mental health professionals. There will also be a choice of five more breakout sessions for you to attend Friday morning following the keynote address. This is going to be a special day and a half of learning opportunities for all of us. This is our fourth year to present ClarityCon and altogether that adds up to over 80 unique speakers we've hosted to provide insight on children's mental health. As many of you know, we continue to offer speakers on our campus in the South Texas Medical Center that provides CEUs. These speakers are leading authorities in mental health. We host these events because we believe it's important as a non-profit provider to actively share knowledge in order to serve the children of our community and their mental health care needs. Our community CEUs held on the Clarity campus are offered free of charge. And today, because of generous and caring sponsors that we'll thank in a moment, some of you are attending on scholarship. Now, please show our appreciation for the over 20 speakers and presenters who will be joining us today. For some of the business, there will be surveys following each session for you to complete and to provide your feedback. Please note, we'll provide CEU certificates after each session, including our keynote presentations like this morning. If you're seeking CEU hours, please complete the white evaluations at your seat. For those of you who need continuing education for doctoral level licensures, please complete a green evaluation form instead of the white one. Please take the completed form with you as you exit the ballroom to exchange for your certificate. I became involved with Clarity. At that time, it was called the San Antonio Children's Center. Went through a number of name changes I won't go through. But we've been the same organization since that time. I came here in 1970 while doing my psychology residency in the Department of Psychiatry at the University of Texas Health Science Center. And Clarity was a major training site there, and that's how I got connected to this organization and came to love it. I joined the faculty of the Department of Psychiatry the following year. Divided my time between San Antonio Children's Center and the Community Guidance Center, both of which are now integrated into Clarity, Child Guidance Center, both inpatient and outpatient. I was fortunate to be a very early participant in the conversations with the University of Texas, the Texas Health Science Center in the creation of a program that was providing teaching, training, and service partnership in a community mental health setting. That was the key word, community mental health. The relationship became full circle this past April with the opening of our main campus of the Clarity Child Guidance Center. Our patient services facility and the new home for the University of Texas Health Science Center Division of Child and Adolescent Psychiatry. So it's like a complete merger of those two organizations at this point. That grand opening was in fact the third we hosted at Clarity, main campus since Clarity 2015. In September, we opened our six bed crisis assessment center and living unit number four with 14 additional beds, bringing our bed total to 66. In February of this year, we opened the New Maze Gymnasium with our expanded therapeutic recreation and day treatment facilities. The 22 million expansion was made possible through the support of local funding agencies and donors. Thanks to this support and expansion, we anticipate serving nearly 9,000 children this year. However, even with our expanded services, we all know we're still very limited in resources available throughout our community to provide care for children with mental, emotional, and behavioral disorders. We're so thankful to many of you here representing the systems of care that we often cross refer to who are out there to provide these services to support this effort. We all know it's still not enough and there's still a hesitation for many families to seek help. We continue to create awareness of the importance of children's mental health through our one in five minds advocacy campaign. Many of you may have seen the coverage of our recent pinwheels for change at the San Antonio Central Library to commemorate mental health. Mental health awareness month in May. 17 artists each painted four foot pinwheels to represent mental health and healing. The pinwheels have been on display at organizations throughout San Antonio, and many were auctioned to support children's mental health. Visit the one in five minds website and the Facebook page for more information about that. On behalf of the staff at Clarity, I would also like to thank all of you for the work you do for the one in five kids who are contending with mental, emotional, or behavioral problems. We hope this next day and a half will be beneficial for you. Now, before I introduce one of our special sponsors, there are a few important things to know about the conference beginning with this room. This is Red Oak Ballroom B. This is where you'll hear the keynote speakers and later today enjoy lunch and the discussion with filmmaker and mental health advocate Randy Silverman. You likely noticed as you walked in that there are exhibitors throughout the lobby and hallway. We encourage you to visit them on your way to the breakout sessions. And please thank them for being here to support Clarity 2016. This year, exhibitors will be initiating your exhibitor passport, which is this little piece of paper here, you all should have one. There's more out there, I'm sure, but I think there's in your packets. As you visit each booth, please write your name on the front of the card and place it in the box in the check-in tables. We will draw from them to award free entries to Clarity Count 2017. The Wi-Fi password is in your syllabus. And many of today's presentations are available on website for easy viewing, downloading, and printing. Third, breakout room names are outside the doors. There's also a map of the venue inside your syllabus. While you have time in your schedule to visit exhibitors, we also ask that you arrive at the breakout sessions promptly because we'll try to make them all start on time. And finally, this conference would not be possible without the caring support of our sponsors. If full listing is in our syllabus, but we'd like to highlight our presenting and luncheon sponsors. Today's special luncheon and presentation from Randy Silverman is made possible by the generous support of the Community Bible Church and HEB. The table's right here, I think. And thank you to our keynote sponsors, Methodist Healthcare Ministries of South Texas, and New Star Energy and the Griehe Family Foundation. Because of these sponsors, we are able to provide scholarships to attend this summit at no cost. We would also like to thank Nowcast SA for their support in live streaming and recording of our keynote and luncheon speakers. Thank you all. I would like now to welcome my colleague, Dr. Jeff Gentry, Psychologist and Senior Vice President of Clinical Services for Clarity Child Guidance Center to the podium to introduce our keynote speaker. Jeff. Thank you, Wayne. And thank you to Methodist Healthcare Ministries of South Texas for your continued support of this conference. As well as your focus on mental health care access and the social service investments you've made throughout our region. It really makes a big difference. It's now my pleasure to introduce our keynote speaker, Dr. Lawrence Steinberg. Lawrence Steinberg, PhD, one of the world's leading experts on adolescence, is a distinguished university professor of psychology at Temple University. He was educated at Vassar College where he received his AB in psychology and a Cornell University where he received his PhD in developmental psychology. Dr. Steinberg is a fellow of the American Psychological Association, the Association for Psychological Science and the American Academy of Arts and Sciences. He's the author of approximately 400 articles and essays on development during the teenage years. And the author or editor of 17 books, including You and Your Adolescent, The Essential Guide for Ages 10 to 25. The 10 Basic Principles of Good Parenting and Adolescence, which is the leading college textbook on the subject, now in its 11th edition. I wish I had it when I was teaching undergraduate adolescent development. Dr. Steinberg has also served on editorial boards of many major psychology journals, including developmental psychology and child development. His research has focused on a range of topics, including adolescent brain development, risk taking and decision making, family and peer relationships, school achievement, and juvenile justice. He's also been a consultant to federal and state agencies and lawmakers. And his research was cited frequently by the Supreme Court in landmark cases that abolished adolescent death penalties and life sentences for adolescents. Dr. Steinberg has been a featured guest on numerous television programs, including the CBS Morning News Today, Good Morning America, 2020, Dateline, the PBS News Hour, and the Oprah Winfrey Show. He's a frequent consultant on adolescents for print and electronic media, including the New York Times and National Public Radio. He's also written for The New York Times, The Wall Street Journal, The Washington Post, USA Today, and Psychology Today. Dr. Steinberg's latest book is Age of Opportunity, Lessons from the New Science of Adolescents. I happen to read Age of Opportunity soon after it came out and immediately thereafter obtained a copy and read You and Your Adolescent. I was very impressed with the amount of useful information these books contain. I recommend them frequently and I usually take one or both of them with me if I give a presentation or participate in some kind of event that involves adolescents in some way. And I brought mine with me today hoping maybe I can get it signed. I like to point to these books as very useful resources for both parents and professionals. And I've also used several ideas from these books as starting points for conversations with my own 15 year old son. With all that said, I think it's safe to say that we're extremely fortunate to have such a well qualified expert to share with us recent advances in the study of adolescent development. Including important changes in the way we think about adolescents as a developmental period, such as when it starts and how long it lasts. And also to talk to us about the implications of our current knowledge of adolescent development for how we treat, educate and raise young people. Now please join me in welcoming to the podium Dr. Lawrence Steinberg. Thank you so much. I'm very honored to be here and happy to see all of you this morning. I want to tell you a little bit about myself before I begin. I'm an adolescent psychologist. I've been studying people this age for 40 years. I've done research involving thousands of young people from all over the United States, all ethnic groups in the United States, all social classes in the United States. I've worked with kids who are from our most disadvantaged destitute communities because some of our work, a lot of our work recently has been on young people involved in the justice system and that's where they come from primarily. But I've also done studies in some of our most privileged and affluent communities in private schools. I've recently completed a study of about 5,500 people between the ages of 10 and 30 in 11 different countries, including some of the world's most wealthy like Sweden and some of the world's poorest like Kenya or Jordan. I served on many national commissions and panels on adolescent development and chaired the panel on the science of adolescents for the national academies. I think I have a pretty good sense of what the science of adolescents says about this period of time. And I'm always struck by the disconnect between what science tells us about adolescent development and what the popular press leads us to believe. And what parents and some educators and practitioners believe about kids. One of the things I want to do this morning is to change the way that you think about adolescents. And if I have done that, I will consider this a big success. Because I think that we really do need to change how we view this period and that by doing so will help improve the quality of care that we provide, the quality of parenting that kids are exposed to at home, the quality of instruction and teaching that they're exposed to at school. Many times when I speak to large audiences like this one, people wonder whether I've had personal experience in raising an adolescent. And I have, I have one son, he's now in his early 30s, but we went through adolescence just like everybody else does. And I appreciate what a humbling experience it is to do that. Even if you purportedly know something about the period of time. Tell you a story which will then allow me to tell you other stories. So you'll just have to listen for a sec. When I was working one day in my office at home, Ben at the time was about 14 years old, I guess around eighth grade or ninth grade, and he came storming into my office, obviously angry about something that afternoon holding a rolled up copy of a weekly news magazine, something like Time or Newsweek in his hand. It turns out that in that issue there had been a story about parent-adolescent relationships and I had been quoted in that story. I've been quoted as saying that many parents and teenagers go through a rough patch and that we had also. But that now my son and I were best friends. So he did not like this. And he said, you do not have the right to talk to journalists about me without asking my permission, which is a legitimate point. And I apologized for that. And then he said, and I think it's pathetic that you think that I'm your best friend. I am not your best friend. And let me just suggest that you go out and find a best friend your own age. But that conversation led to a larger one about what I could say and could not say about his life and our relationship because. And I know this for those of you in the audience who are our parents. We learn a lot by going through life with our own kids. Even if our kids aren't necessarily troubled kids, we still learn a lot by watching them grow up and seeing how things change in our homes and in their relationships with other people and at school and so forth. And there's no question that some of the ideas that I've had over the years were sparked by observations I made as a parent. And a lot of those observations informed what I wrote in the kinds of books that you have talked about, like you and your adolescent or age of opportunity or principles of parenting. This sometimes led to problems for me. Because occasionally, Ben and I would get into an argument about something. I would call it a discussion, Ben would call it an argument. And he would go to the bookshelf and take down one of these books and open it up to the right chapter and he would say, you can't even follow your own advice. So knowing something about kids, knowing something about adolescence, doesn't protect you against some of the normal transformations and relationships that take place as we go through this period of time. And one of those, as you know, is that kids seek and often demand a little more distance and privacy from their parents as they get to this age. And this is an issue that we often encounter when we work with families of teenagers. We've had to help them deal with this. I always remember the evening when my wife and my son and I were having dinner. It was around this same age. So this is a time when kids often do pull back a little bit. And having dinner together every night was something very important in our family. And this evening, Ben asked if he could take his dinner up to his bedroom. He wanted to do something on the computer or watch television or talk to a friend or listen to music or whatever. And could he just bring his plate upstairs? And I said, this is the one time of day when we get to catch up with each other. It's when mom and I get to find out how you spent your day. And you get to find out how mom spent her day. And you get to find out how I spent my day. And it's really important to do this. They paused and he looked at me and he said, no offense. But I'm really not all that interested in how you spent your day. He said, if you come into a lot of money or if we're going to move, I'd like to hear about it. But otherwise, you can just assume I'm not all that interested. So I said that I wanted to change the way that you think about adolescence. And that's really the reason that I wrote Age of Opportunity. Because I think that this change in the way we think about adolescence is long overdue, what do I mean by this? If you go to your local bookstore and you go to the section where you find books written for parents of teenagers. And even for teenagers themselves, you're going to find a lot of survival guides. You would be struck, I think, after you get home this evening, go on Amazon or go on Barnes & Noble or go on another online bookseller site. And start looking through the titles of books that are written for parents of teenagers. And you will be amazed at the number that have the word survive or survival in the title. I'm not kidding. And there's actually even a book, and this is not a joke. There is a book called How to Survive Your Dog's Adolescence. So this notion that this is a difficult period that we need to survive is apparently a cross-species phenomenon as well. Now, if you were to do the same thing, but focus on books written for parents of newborns, you won't find a single one that mentions surviving or survival. Now I can tell you as a parent that there never was a single time while our son was a teenager during which I worried about whether I was going to survive it. But during the first three months of his life when we were being sleep deprived, I really did wonder then whether I was going to make it through. And this survivor's mentality that we have about adolescence pervades sort of the cultural narrative about this time period. And it's not doing us very well. It is not working, especially in the United States. You probably are aware when you read about these international achievement comparisons that compared to high school kids from other parts of the world, particularly other developed countries, our high school students are almost always at the bottom of the list in their performance on standardized measures of achievement. But we're at the top of the list when the surveys look at things like STDs, or unintended pregnancy, or obesity, or binge drinking, or illicit drug use, or violence. And in some of the surveys that have just asked directly about mental health, American teenagers turn out to be among the most miserable in the developed world. So there's something to matter, right? I mean, I think when you have a country and your kids are doing the worst when it comes to the things that you want them to do good at, and they're scoring the highest on measures of mental health problems, that we really need to rethink how we're raising young people. And that's what I want to try to do. And that's what I've been doing going around speaking on this subject for the last couple of years. Now, when we go into experiences in life, in which we think that the best thing we're going to do is to survive, to just get through, we don't invest very much in the experience. Because we think, I'm just going to close my eyes, I'm just going to hold my breath, and I'm going to wait until this is over. And we have turned adolescence into the root canal of parenting, that it is something to be gotten through. It is something to be survived. And I think we don't invest very much as a society in trying to get the best out of this period, because we spend so much of our energies trying to avert disaster. And we view it as a kind of success if we've gotten through and something tragic hasn't happened. But I know and you know that that's not all we want for our kids this age. If I said to you, well, hear your goals for the end of your child's adolescence, that he's not serving life in prison, that she's not having a baby she doesn't want to have, that he's not addicted to drugs, that he's still alive. I mean, that's set in the bar a little too low. We want more than that for our kids. But we're not going to get more than that unless we have a completely different set of goals in mind. And so we need a different vision of adolescence, one that doesn't just say this is something to be survived, but that instead says this is a period during which people can really thrive. And fortunately, I think that the science of adolescence and especially some of what we're learning from brain science can provide the foundation for this view that adolescence is a time when people can thrive. And it's not simply something to be survived. That's what I want to talk to you about. Now it's obviously important to understand adolescence, have a more accurate, more informed view of it if you're the parent of a teenager or a teacher or a practitioner who works with people this age. But I think it's important for all of us, for all of society, because we all have a stake in making sure that the next generation of young people is happy, healthy, and competent. So though my messages in what I write are typically aimed at parents or policymakers or educators or practitioners, I'm trying to hit everybody with this message, even young people themselves, that we need to rethink what adolescence is. Now this has a special urgency right now, I think, because adolescence today is longer than it's ever been in human history. It's been stretched at both ends. It starts earlier because the age at which kids go through puberty has been declining and continues to decline. But it lasts longer because the age at which people make the transition from the conventional roles of adolescence into the conventional roles of adulthood, establishing independence, entering the labor force full-time, establishing your own household. All of these things are occurring at later and later ages. And that's also increasing as well. So where we are now, in my estimate, is looking at adolescence as a period that lasts about 15 years, 15 years. That's from the approximate age of the beginning of puberty to the approximate age at which people have entered into the roles of adulthood. Now to put that in a cultural historical perspective, this 15 years is twice as long as adolescence was in the 1950s. And it's three times as long as adolescence was in the 19th century. So maybe there was a point in time when adolescence was short enough that we could hold our breath and wait for it to be over. That we could look at it simply as something to survive. But we can't do that anymore. You can't hold your breath for 15 years. It's too long a period to have that attitude about. And that is, I think, a special urgency to the need to adopt a new and more accurate view. So why has adolescence become such a long period of development? Well, when you're a scholar of adolescence, as I am, you tend to think of adolescence as beginning with biology and ending in culture. It begins with the biological transition that we call puberty. And it ends not with some obvious biological marker, but when people start playing the roles in society that are reserved for adults. So let's look at what's happened to each of those. At the beginning of the 20th century, the average American girl got her first period when she was about 14 and a half years old. Today, it's about 12. It's a substantial change in a relatively short period of time. There are pediatric clinics around the United States where they see kids for normal health care who are reporting seeing the early signs of puberty in adolescent girls who are five and six years old. And by the way, this is not a trivial number. In some inner-city communities, the number of girls who are showing things like breast development at this young of an age is close to 20%. This is not a small number of kids. You'd think about the kindergarten teachers and the first grade teachers and the training that they have, whether anything in their training has possibly prepared them for working with kids that are starting the biological changes of adolescence at that age. There have been comparable changes in the drop in the age of puberty among boys. They're a little harder to document because in male pubertal development, we don't have such an obvious marker as menarchy. Even though menarchy, first period, is not the beginning of puberty by any means, it's a relatively late development in puberty. But in boys, it's sort of harder to get reliable information. But there have been a couple of clever studies done that have looked at this. One that I like very much, looked at the age at which voices break in boys who sing in children's choirs. You wouldn't think this would be important to the kind of work we do, but it turns out that if you run a children's church choir, you care about when the boys start to break their voices because they can't sing those parts anymore. And there actually have been studies done that have tracked this age through surveys of choir masters. And the drop in the age of puberty among boys in the developed world has been comparable to the drop in puberty among girls. So it's happening for both sexes. Why is puberty starting so much earlier? There are a number of causes I wanna mention the three most important. The first is obesity. It's well known that puberty begins earlier in children who have more fat on them than in children who are leaner. A lot of this has to do with the impact of the substance leptin on pubertal development. I go through that in the book and I won't bore you with the technical details here. But as the obesity epidemic in the United States has continued, we see more and more kids going through puberty earlier and earlier. So that's probably the most important cause of the drop. A second one is man-made. And that's the exposure of our young people to chemicals in the environment that disrupt their endocrine system. In fact, these chemicals are called endocrine disruptors. A lot of people think that these are in food. That's not where they are primarily. A lot of them are in cosmetics. A lot of them are in pesticides. A lot of them are in plastics. And not just plastics in water bottles but plastics in common everyday things like chairs that we sit on. So the exposure of kids to endocrine disrupting chemicals is ubiquitous in American society and these have been shown to hasten the onset of puberty. And then a third one that very few people know about but there is growing evidence for this is that exposure of kids to light, particularly the kind of light that's emitted from smartphones and tablets, computer monitors is also playing a role here. You probably are aware that exposure to that light affects your melatonin system, which is why it's recommended that if you're reading before you go to sleep at night, you don't read from one of these devices because doing so makes it harder to fall asleep. But melatonin, although we think of it as a brain hormone that plays a role in sleep regulation, also plays a role in the regulation of puberty. And through the same process that these lights affect our ability to fall asleep, they also affect the timing of the onset of puberty. And so things like obesity, endocrine disruptors, exposure to artificial light, all of these have worked together to gradually lower the age at which kids begin puberty. As I'll explain in a little bit, that's important for a number of reasons that might not have occurred to you. We think of puberty as something that changes the external appearance of the young person, the sex drive, the reproductive organs. But we now know that the same hormones that do those things have a profound effect on the brain. They change the way the brain develops. And so if puberty is happening when kids are five, six, seven years old, then those brain changes are beginning to happen then as well. And in a little bit I'll explain what those brain changes are and you'll see why it's so important to understand and be concerned about the fact that they're happening earlier and earlier. So puberty is making adolescence start earlier. At the other end of it, I said before it's lasting longer. Again, just to put some numbers on it. Today, the average 25 year old is twice as likely to still be in school than her parents were when they were 25. And she's only half as likely to be married. And she's 50% more likely to still be receiving money from her parents at the age of 25 than they were from their parents when they were that age. By any measure that we can find, it is taking people longer to become adults. It's taking people longer to become adults. Why is this happening? Well, I think there are different theories out there for this, some of which seem to make a lot of sense to me and some of which I think are just baloney. The ones that make the most sense view this as a rational response to a changing labor force. We know that in order to get a good job today, you need a college education. In order to get a college education, you need to stay in school much longer. Whoever stay in school much longer, you need to be dependent economically on your parents much longer. And if you're going to be economically dependent on your parents and you're going to be in school, you're going to delay things like getting married, starting a family, entering into a full-time job. And so I think that the delayed entrance into adulthood is driven mainly by changes in the labor force, which are demanding that people stay in school longer. There's an alternative theory, which I think is just not true. And that's that there's something to matter with today's millennials. There's something to matter with people in their 20s today and that those of us who raise them are responsible for this, that people in their 20s today are spoiled, and narcissistic, and entitled. And that they're taking longer to become adults because they can. And they're doing this because their mommies and daddies are willing to pay for it, for them to take as long as they want. If you look at the data on this, as my colleagues and I have, you will find absolutely no support for this whatsoever. I know that you probably think that today's young people are more narcissistic and self-centered than you were when you were that age, but you're wrong, you're absolutely wrong. There are a lot of studies out there that have asked the same kinds of personality questions to people for generations and generations. And so we have, my students and I have pulled these data together and we've looked and asked, are people today really more narcissistic than they were in previous generations? And the answer is no. Is there a lot of narcissism at this age? Sure is. There always is. In every generation, people are a little bit narcissistic and self-entitled when they're this age. It's part of what it means to be this age. But it's not any more of an issue today than it was when kids' parents today were themselves growing up. I'll come back to this when we talk later about social media and the impact of social media on kids. But let me just say, as somebody who's been studying adolescence for his entire adult life, and some of his adolescent life really, and I think you probably know this, but I'll say it just in case it hasn't occurred to you. There has never been a generation of adults ever that hasn't criticized the next generation of young people as being self-absorbed, lazy, immoral, and so forth. And as I'll show you in a moment, there has never been a generation of adults that hasn't said that whatever the new form of technology or entertainment kids seem to be interested in is turning society into the devil's playground. They said it about comic books, and that didn't turn out to be true either. But I'll say that for later. So there's no question that adolescence is taking longer. It's one of the reasons why we're willing to think carefully about it. Now I want to have you engage in a little exercise now for a moment, and just close your eyes and think back to your own teenage years. Just take 10 seconds and conjure up some memories, some visions of that. So I know that when I do this, I find that I have richer and more detailed memories from that time of life than of any other period in my development, even though it was quite long ago for me. And this is surprising to me because there was nothing particularly special about my adolescence. I grew up in a middle-class suburban family outside New York City. Nothing terrible happened to my family during that time period. Nothing wonderful happened to my family during that time period. Life was about as exciting as being on the people mover in the San Antonio Airport. Just kind of one day rolled into the next one and into the next one after that. So on the surface, it doesn't seem like there'd be any reason that I would remember adolescence better than any other time of life, but I do. And I can recall things that happened to me in 1967, let's say, when I was 15, better than I can recall things that happened to me last week. And it turns out that I'm not unusual in this respect. Psychologists have done some interesting research on this topic. And what they find is that most people, most of you, remember adolescence better than other periods of your life. You remember adolescence better than other periods of your life. Now it had been thought for a while that this is because of the kinds of things that happened during adolescence. I mean, after all, a lot of very memorable things take place during this era. Your first love, your first job, your first beer, maybe the first time you lived away from your own parents. But it turns out that this is not the explanation because even mundane things from adolescence are remembered better than mundane things from other periods of life. So not only do we remember the people and the places and the events that we were exposed to during that time, but we remember them with a level of richness and detail that is very different than our recollections from other periods of time. And it's not just personal events that are recalled better from adolescence. The books that we read during adolescence are remembered better than books that we read during other periods of time. The movies that we see during adolescence are remembered better than movies we see during other periods of time. The music that we hear during adolescence is remembered better than music that we hear during other periods of time. Even the current events that take place during adolescence are recalled better than current events that take place during other periods of time. And that's a surprise because we don't typically think of teenagers as paying a great deal of attention to things going on outside their own little world. Psychologists have studied this so many times now and have documented it so many times that we've given it a name. It's called the reminiscence of bump, because if you graph out people's recollections as a function of what age they were when the event happened and you plot them, you get a little bump during the time characteristic of adolescence from about 12 to 22. So if it's not the nature of the events that makes us remember adolescence better, how can we account for the reminiscence bump? It turns out that the answer is in the adolescent brain. What we now know is that the adolescent brain is remarkably sensitive to experience, remarkably sensitive to experience. It's like the brain's recording device is set at a different level during adolescence than it is during other points in time. We understand a little bit about why this is. It turns out that when things happen to us that are accompanied by strong emotions, we store those events deeper and in a more permanent way than when those same events are not accompanied by strong emotions. And adolescence is a time when emotions are often very strong. So even if the events themselves are not particularly emotional ones, the emotional state of adolescence may make them be stored at a deeper level. So the adolescent brain is very sensitive to experience and stores a lot of things because of that. This is a small part of a bigger story that I wanna tell you about the adolescent brain. You know that the adolescent brain is a very malleable organ, that the brain is a malleable organ, that the brain is affected by experience. It actually changes physically in response to experience. This is a phenomenon that neuroscientists call plasticity. The brain is plastic. Plasticity means the capacity to be affected by experience. Now, although the brain is always somewhat plastic, it's more plastic at some times than at others. And we've heard a lot about the plasticity of the brain during the early years of life, during what we call zero to three. And, excuse me, the discovery that the brain is very plastic then is what led to many calls for improving the quality of childcare and early childhood education and programs for young children because we know how much the brain is affected by early experience. But what has only been revealed in recent years, and I'm talking within the last four or five years, and has not gotten out into the public discussion, is that there's a second period of heightened brain plasticity, and that's adolescence. So adolescence, it turns out, is another zero to three. It's another time when the brain is especially affected by experiences that it has. One of the effects of puberty on the brain is to make the brain more plastic. We now understand this. That the chemical changes that are reduced in the brain by exposing it to testosterone and estrogen and other pubertal hormones, those chemical changes affect processes through which the brain forms and eliminates synapses and grows myelin and changes where the locations of different neuro receptors are. So adolescence is a second period of heightened brain plasticity. There's a burst during adolescence. That heightened period of plasticity ends when adolescence ends. The adult brain is plastic, but not in the way the brain is plastic during adolescence. You've seen those infomercials, right, that tell you that you can change your brain. Yeah, a little, not much. Of course the brain is plastic in adulthood. If it wasn't somewhat plastic, we couldn't learn anything because there'd be no way of storing that knowledge without some underlying neural change in the brain. But there's a big difference between the way the brain is plastic in adulthood and the way it's plastic beforehand. It's really important to understand this difference. Neuroscientists distinguish between two types of brain plasticity, what they call developmental plasticity and what they call adult plasticity. Developmental plasticity refers to the plasticity of the brain while the brain is still being built. Plasticity while the brain is still being built. During infancy in childhood and adolescence, and especially during early infancy and adolescence, the brain is undergoing market transformations. Whole new brain circuits are being developed. Unnecessary brain circuits that get in the way of efficient information processing are being eliminated through a process we call pruning. The brain is being rewired, it's being remodeled as the word that we use to describe it. During adulthood, that is not taking place anymore. What happens during adulthood when the brain changes is that there are tiny little tweaks to existing brain circuits as a result of learning. So no new brain circuits are developed, no brain circuits are eliminated during adulthood, not like we see in adolescence and before. It's like the difference between remodeling your home and redecorating your home. During adolescence and childhood and infancy, your brain's being remodeled. You're adding on rooms. You're getting rid of ones you don't want anymore. You're putting in new wiring and new plumbing. You're transforming the whole organ. During adulthood, you're just redecorating. You're changing the colors of the curtains and the carpets. Now think about this for a moment. This means that adolescence is the last time in human development when the brain will ever be that plastic again. It's the last time in development when the brain will ever be capable of that amount of change in response to experience. That makes adolescence so special, really special, even more special than we always knew it was. It means it's our last best chance to change people because the brain will never be that plastic again. Now, when the brain is plastic, it's not plastic in all regions of the brain at the same time. Different regions are relatively more or less plastic at different ages. I'll give you a couple of examples of this. The brain's visual system, located in the back of your head, the brain's visual system is very plastic during the first year, year and a half of life, and then it's not plastic after that. So we see tremendous improvements in baby's vision during the first year, a little bit into the second year. That's because their visual cortex is still plastic then. But maybe you've noticed this, after you're two years old, your vision doesn't get any better. You don't get to see better after that. There's nothing you can do to make your vision better after that age other than wearing glasses, but your vision doesn't improve. No matter what experiences you give yourself, once you're three, four, five, six, seven, and older than that, you can't make yourself see better. You can't practice yourself into being a better seer. That's because the brain's visual system is done developing at that point. There's no plasticity left in it. Some brain systems stay plastic longer than that, but not forever. A good example of that is language acquisition regions. But we know that it is much easier to acquire a second language before puberty than after. That's because the parts of the brain that are important for language acquisition lose their plasticity after a certain amount of time. It's not impossible to learn a second language as an adult, but it's really, really hard, very, very hard. And you won't have the accent that you would have acquired had you learned it at a young age. I guess living in a bilingual environment like San Antonio gives away very quickly who learned their second language as a child and who learned it as an adult. Certain motor abilities are much easier acquired earlier than later in life. If you haven't learned how to ski, for example, or how to surf before you're an adult, the chances that you're gonna learn it are really slim. It's not impossible, but it's really, really hard. So when we say that the brain is especially plastic during adolescence, we need to ask where? Where is this plasticity? And the most important part of the brain where we see plasticity during adolescence is in the prefrontal cortex. The prefrontal cortex is the area of the brain right behind your forehead. The prefrontal cortex is the part of the brain that takes the longest to mature. It's still undergrowing a lot of change during adolescence and it's still plastic during adolescence. What does the prefrontal cortex do? The prefrontal cortex is the brain's chief executive officer. It is responsible for directing the show. It's responsible for every type of advanced thinking ability that we engage in, like planning and reasoning and thinking ahead. It's also important for self-regulation, self-control. This is critical to understanding adolescence. Self-control is probably the single most important trait a person can have in order to be successful in this world. There have been hundreds and hundreds of studies done showing that kids who score higher on measures of self-regulation do better in school. They have better relationships with other people. They have fewer mental health problems. They're less likely to get into trouble. How many of you have heard of the Marshmallow study? The Marshmallow study is a study that looked at self-control in a small population of young kids. Study was done at Stanford University by a psychologist named Walter Michelle. It was done about 50 years ago. They took a group of preschoolers. They sat each one at a table and they put a marshmallow down on the table and they said, okay, here's the deal. I'm gonna leave the room and leave you alone here with this marshmallow for a while. If you want the marshmallow, you can eat it. But if you wait until I get back in the room, I'll give you two, though you get the setup. By the way, it doesn't have to be a marshmallow. And in some of the studies, it was something else. It needs to be something that you know the child likes. Cookies, whatever. So when they did this study, they had a video camera recording the child while the child was left alone. You can go on YouTube and you can see some pretty funny videos of kids dealing with this. Some of the kids grabbed that marshmallow before the experimenter has even gotten two feet out of the room. Others just sit there patiently and wait. And then there's this group in the middle that has these strategies. They sit on their hands. They close their eyes. They pretend the marshmallow isn't really a marshmallow. But the most important point of the study comes from asking whether this told us anything about how these individuals would develop. So Michelle and his team have been following these people as they've grown up. So they're now middle-aged adults. They've been tracking them through childhood and adolescence and young adulthood and now into middle age. And they classified the preschoolers into the ones who could delay gratification and the ones that couldn't. And it turns out that over the course of life, the delayers did better in school. They did better on standardized tests. They accumulated more years of education. They had better jobs. They made more money. They were less likely to be arrested. They were less likely to develop substance abuse problems. They were less likely to be obese. So having strong self-control is a huge advantage throughout life. And the opposite is true as well. Not having good self-control is a lifelong liability. Economists and sociologists have identified four, let's call them rules, that if you follow, will pretty much guarantee that you'll have at least what one of them called a minimally decent life. What are these rules? Graduate from high school. Don't have a child until you're married. Don't break the law and don't be idle. In other words, if you're looking for a job and you're not in school and somebody offers you a job, take it, no matter what it is. If you have a job and you don't like it, don't quit it until you have something else lined up. Don't be idle. And what study shows is that if you follow those four rules, you will almost never end up in poverty, ever. And this is not a moral judgment. This is just a statistical fact. But when we step back and ask, well, what are the kinds of things that causes people to not follow those rules? Poor self-control is often a part of the explanation. It's associated with dropping out of high school. It's associated with having a child outside of marriage. It's associated with crime. It's associated with storming off of a job because you don't like it when you don't have something else lined up. Jeff mentioned before that some of the work that I do is in the area of juvenile justice. We've been doing longitudinal studies of serious juvenile offenders in different parts of the country where we track them over time. One thing that some of you who work in the justice system probably know is that only a very small percentage of juvenile offenders become adult criminals. We designed a bunch of studies to see if we could predict which kids who had committed serious crimes, they'd been arrested for felonies when they were 15, 16 years old. And we followed them into their 20s. We wanted to see if we could predict which of these kids would still be committing crimes in their 20s and which ones would have desisted from crime as we expect most of them to do. The only reliable psychological predictor of who continued to commit crimes was poor self-control, poor self-control. The kids who developed normal self-control during this time period, during the time period when the prefrontal cortex is supposed to be developing, those kids stopped committing crimes. They weren't committing crimes once they hit their early 20s. The ones that didn't show this, who showed stunted development in this particular psychological trait were the ones who kept committing crimes and kept getting arrested. They'd get arrested, they'd serve time, they'd be released, they'd commit a crime, they'd get arrested, they'd serve time, and so on, over and over and over again. So poor self-control is a huge liability. And one reason that's important to know for us, and the good news here, is that self-control is governed by a part of the brain that's still plastic. It's still plastic during adolescence, so we can do something to help increase kids' self-control. And that will help increase the life chances of all of our children by doing that. And later in my talk, I'm gonna talk about what we know about building stronger self-control. Self-control is also important because it helps protect young people against the most virulent threats to their health and well-being. And here I'm not just talking about kids in the justice system, I'm talking about all of our kids. We have made incredible progress in the developed world, in the prevention and treatment of illness and disease during adolescence. If you look across stages of development, what you will see is that adolescence is one of the healthiest times in life, at least with respect to illness and disease. And yet there is a huge increase in both morbidity and mortality between childhood and adolescence. The mortality rate triples between childhood and adolescence, despite the fact that there isn't an increase in illness and disease. The main threats to the health and well-being and life of young people are not illness and disease anymore, they're behavioral in nature. They're things that kids do to themselves and to each other. And if we could do something from preventing kids engaging in these behaviors, we could really improve the health and well-being of a significant segment of the population. Adolescent brain science is helping us understand why there is so much risky and reckless behavior during adolescence. I'm gonna talk much more about this in my workshop later this morning, but let me just say a few brief words about this now. Every type of risky and reckless behavior increases during adolescence and peaks sometime during the mid or late adolescent years. The most well-documented example of this is crime with both violent and nonviolent crime peak around the age of 18, but that's not the only one. Experimentation with drugs peaks during adolescence. Attempted suicide peaks during adolescence. Even accidental drowning peaks during adolescence, and that's a surprise because I don't know, it doesn't seem like it would be the case that 17-year-olds should drown more than 10-year-olds or more than 40-year-olds, but they do. Be pretty sure, I think, that it's not because they're weak or they run out of stamina, it's because they make bad decisions about where and when to swim. So why is adolescence a time of all of this reckless and risky behavior? We now know what's going on in the brain that might be contributing to this. I mentioned earlier that puberty has a lot of effects on the brain, makes it more plastic for one thing. One of the other things that puberty does is it increases activity involving the neurotransmitter dopamine. Dopamine serves many functions in the brain, but one of the most important functions it serves is the experience of pleasure or reward. So whenever you anticipate something good happening, or when you actually get rewarded for something, or experience pleasure, you get a little dopamine squirt in your brain, and that is what makes you feel good. That's what leads to the good feeling, the dopamine activity. Puberty increases dopamine activity in the brain, especially in the brain's reward centers. In fact, there's more activity in the brain's reward centers involving dopamine during adolescence than at any other time of life. If you graph dopamine activity in the reward centers over age, what you see is it follows a kind of upside-down U-shaped curve. It increases during pre-adolescence. It peaks somewhere in the late teen years and then it decreases after that. Actually, if you look at the size of the area of the reward center that's most important, it's a structure called the nucleus accumbens. The actual size of that part of the brain follows the same upside-down U-shaped curve. It increases in volume, peaks in mid-to-late adolescence, and then decreases after that. Now, what does this mean subjectively? What it means is that during adolescence, because of all this dopamine activity, things that feel good feel even better. Things that feel good feel even better. This is why, and I hate to say this, that nothing will ever feel as good to you for the rest of your life as it did as when you were a teenager. Nothing. That's because you don't have as much dopamine activity going on in your reward centers. One thing that's really interesting about the reward centers of the brain and the role of dopamine in the experience of pleasure is that the same underlying process is at work regardless of what the stimulus is. In other words, we get the dopamine squirt from food, or from sex, from money, from praise. All of this activates the same reward circuitry, and all of those things feel better during adolescence than they do at other points in time. Fascinating study that I came about in doing research for age or opportunity actually had people of different ages rate how sweet something tasted. People in adolescence taste sweetness more strongly than people at other ages do. Everything that we get pleasure from feels more pleasurable when you're a teenager. Now what this does behaviorally is it makes teenagers on the lookout for reward. It increases their sensitivity to reward, and it increases their willingness to go after rewards. Teenagers engage in a lot of what psychologists call sensation seeking behavior. There's the pursuit of exciting and novel and potentially rewarding experiences even in the face of some risk or some danger. And sensation seeking, if we graph it out over time follows the same upside down U pattern that dopamine activity does. It increases throughout adolescence and then peaks and then decreases as we go into adulthood. I can speak personally about this in that a lot of the things that felt really good to me when I was a kid don't feel so good anymore. Remember that feeling of driving like 100 miles an hour when nobody was around? How many of you still like doing that? The feeling of riding a roller coaster? How many of you still like to go out and ride roller coasters? These things stop feeling so good as we get older. And we understand the biology behind this as well. Now, so imagine we've got this brain that is very easily aroused by reward and that leads people to go after these rewards because they feel so good. But at the same time, the part of the brain that helps us regulate our impulses and our drives is still immature. It's still developing. The prefrontal cortex doesn't reach maturation until the early 20s. Now you've got this mismatch between this easily aroused reward seeking system when people are 15, 16, 17 years old and this still maturing self-control system. It's like having the accelerator pressed down to the floor before there's a good braking system in place. And that's what adolescence is. The accelerator is on the floor, the braking system is still developing. We spend a lot of money in the United States trying to get kids not to do the things that we worry about them doing. Surveys show that, you know, between 95 and 100% of American high school students have had classes in sex education and drug education, smoking education. A lot of them have had courses in driver education. What's fascinating about this is that these classes don't do very much. What evaluations of them show, like things like dare, do you have dare in San Antonio? Okay. These evaluations have been very carefully done and there are many of them. Absence education? Nah, that doesn't do anything. The evaluations of these programs show that they're very good at changing what kids know, but they're very bad at changing how kids behave. The reason we now understand is that kids don't do these things because they're ignorant. Kids don't do these things because they have delusions of invulnerability. When we do studies in our research lab and we give people questionnaires, people of different ages, and we ask them to rate, to look at lists of activities and rate, how risky is this activity? How dangerous is it? How much could you be harmed by doing this if something went wrong? Kids don't score worse on this than adults do. If anything, kids overestimate how risky things are. Kids perceive risk comparably to adults' perceptions of risk, but yet they engage in these behaviors anyway. And so as much as I think it's important for kids to know about drugs and sex and driving, these courses don't change their behavior in the ways that we expect them to change. And the reason is that the behaviors are not the result of things that you can fix in a classroom. They're the result of this mismatch between an easily aroused reward system and a still maturing breaking system. In our work at Temple, we've been especially interested in conditions that improve or worsen this situation. And one of the most interesting ones that we've discovered has to do with adolescents and their peers. Come back to a story about my son, one that I have permission to tell. When he was 14, he spent the night at the house of another kid with two other guys. All nice kids knew them well, all went to school together, good kids knew their parents. They decided to sneak out of the house and go visit a girl in the neighborhood. And they sneak out at two o'clock in the morning, Saturday night, and just to illustrate the kinds of kids these boys were. They left a note for the parents saying that they had snuck out of the house and not to worry. Telling them where they had gone, they'd be back. Right, so, you know, good kids. So they go over to this girl's house in the neighborhood, suburban Philadelphia, and Romeo and Juliet style, they throw some pebbles up to her bedroom window to wake her up, and what happens is they set off the house's burglar alarm. A loud siren goes off. What they didn't know was that a silent alarm went to the local police precinct, and a patrol car was dispatched out to the house. So the siren goes off and the four boys run, and they run right into the patrol car that's coming up the street. We don't have a curfew in our neighborhood. So they technically aren't doing anything wrong. So they could have stood there and explained what they were doing, but, you know, instead, what do they do? They run. They go off in four different directions and they run through the neighborhood. And the patrol car follows one of the kids. Didn't happen to be mine, but it could have been. Catches him, brings him home, talks to his parents. The other three kids meet up back at the place where they had sneaked out. You can only imagine the conversation that these 14-year-old boys are having. And I found out about this the next morning. Our phone rang about 7.30 in the morning. Do you know where Ben was last night? Yes, he was sleeping over at Brad's house. Well, not quite. And it was the girl's mother who was explaining to me what had happened. Now, how many of you are parents in here? You don't like to get a call from a parent of another kid your child goes to school with telling you something bad your child has done. Let me just say that when that parent is your wife's gynecologist, it makes it even worse. So it doesn't have the intimate knowledge that she has with your family. So I hang up and I call our son on his cell phone and he's probably only been asleep at the point for two hours. I wake him up, I say, get your things together. I don't know if I use the word things. Get your things together. I'm coming over to Brad's house, I'm picking up, meet me outside, come over again and he gets in the car and I just completely lose it with him. And I said, hey, you were running away from armed police officers in the dark who think that they've just interrupted a burglary. What were you thinking? And he said, that's the problem, I wasn't. So that incident sparked 15 year, now 20 years of research in our lab at Temple about why kids do so many stupid things when they're with their friends that they don't do when they're by themselves. There is no way that our son would have run from the police had he been by himself. So we started doing a series of experiments on what we began calling the pure effect and we found that when you put kids together in a group and you ask them to play risk taking games on a computer they take more risks if their friends are watching them. If you do the same thing with adults it doesn't change their risk taking behavior. If you put them in front of a computer playing a risk taking game and their friends are in another room and can see them on a monitor they take more risks than if they're by themselves without their friends watching them. If you put them in an FMRI scanner and you give them these risk taking tests to take and they know that their friends can see them from another room. Not only do they take more risks if their friends are watching them they show different patterns of brain activity. They show heightened activation of reward centers when they know their friends are watching them. And the more heightened their reward center activation is the more likely they are to engage in risky behavior. And we see no such effect for adults and we see it for boys as well as for girls. You know when we first presented this work everybody said well of course of course kids take more risks when they're with their friends. Their friends are encouraging them to do this. And we said well no they're in the other room we don't let them talk to each other. They can't be encouraging them. They said well it's gotta be because they know what their friends want them to do. So we started thinking about that and thought well maybe we should find a group of adolescents who are incapable of mentalizing who are incapable of imagining what their friends want them to do. Who are these kids? Where can we find them? So we did this study with mice. So all mammals go through puberty just like we do. So here's what we did. We took mice and after they were weaned we put them into groups of three. One mouse from each of three different litters and we let them grow up together in a cage. A little mouse peer group. And then we did an experiment where we tested half of these peer groups when they were juveniles right after puberty which is about 30 days in mice and we tested the other half after we waited until they were fully grown adults like 70 or 80 days old. And just as we did in our human experiments we took the adolescent mice and we randomly assigned them to be tested either by themselves or with their two friends in the cage with them. And the same thing with the adult mice. Half tested by themselves, half with their friends in the cage with them. And here's what the test was. We gave them unlimited access to alcohol to drink. Now this is the species of mouse that is used specifically to study the impact of alcohol on the brain. These mice like to drink. So what we found was really staggering. In the adolescent mice we saw significantly more drinking when they were with their friends than when they were by themselves. In the adult mice we saw no difference between their alcohol consumption when they were with their friends versus by themselves. So this notion that the peer affects the brain during adolescence in ways that makes people seek rewards seems to be something hardwired in us as a species. We think that risk taking during adolescence is hardwired as a species. A minute or so here on evolution just to explain why this is the case. So I mentioned that all mammals go through puberty and so we can study what happens during the juvenile period in other animals to learn something about humans. And what we know is that we, those of us in this room, we humans are the only animals stupid enough to continue to live with our offspring after they've gone through puberty. In every other species, the offspring leave after they've gone through puberty. In some species they don't wanna leave and the parents kick them out. Now, we probably were like this at some point in our evolutionary history as well. When you're a juvenile who's leaving your family environment to go off to become independent in search of a mate, you are taking a big chance because you are going off into a world that is filled with predators and filled with competitors bigger and stronger and older animals. And you've gotta fight them to survive. And that is a big risky thing to do. And so we think that we've been programmed genetically to be more risk seeking and more risk tolerant during adolescence so that we would do this. It's no coincidence that this peak in adolescent recklessness happens at the same time as the peak in fertility that is that's the age at which if you have unprotected sex you're most likely to get pregnant if you're a woman when you're about 17 or 18 years old which is just around the same time that we see this peak in risk-taking behavior. We think that you have something to do with each other. We're programmed to take risks at a time when taking risks was necessary for us to be able to reproduce. Well, so let me turn now to the question of what can we do about this. We can't do anything to interfere with the impact of puberty on reward-seeking behavior. We write, this is a fundamental biological human process. And it's there so that we reproduce. But maybe we can do something to help build the breaking system to help improve self-control. One of the things that's happened over time which has really changed the situation that we now live in is that because the age of puberty has fallen the gap, the time gap between when we go through puberty and when our prefrontal cortex is fully mature has gotten bigger and bigger because the maturation of the prefrontal cortex is not changed by the timing of puberty. And so as puberty has gotten earlier and earlier this gap between the accelerator and the breaking system has gotten wider and wider. We need to ask whether there's something we can do to accelerate the breaking system development to make it more in line with the arousal of the reward system. So I wanna mention a few things that we know help improve self-control, self-regulation, maturation of the prefrontal cortex during adolescence. Some of these things are things that schools can do. Some of them are things that families can do. Some of them are things that US practitioners can encourage your clients and your clients' families to do. Let me start with schools because that's where I think we have a huge deficiency. What helps the prefrontal cortex get stronger? What helps the prefrontal cortex mature? Exposure to novelty and challenge. Exposure to novelty and challenge. Any of you familiar with the term scaffolding from your psychology classes? Scaffolding is the technique of asking somebody to do something that's a little bit harder than what she's been asked to do before but still within her grasp. That's called scaffolding. Good teachers know how to scaffold. They ask their students to do a little bit more than what they've been asked to do in the past but not so much more that they can't do it. Scaffolding helps the prefrontal cortex mature because exposing the prefrontal cortex to novelty and challenge is what helps build that circuitry and that's what's going to help build self-control and self-regulation. Surveys of American high school students are very saddening in terms of what kids tell us about school. With the exception of kids in this country who go to our best selective high schools where they take a lot of AP classes and where they're expected to go to highly competitive universities. With the exception of those schools, our schools in this country are terrible. They are just terrible. And we know this, we mentioned before the achievement test scores. We know this from surveys of students. In these international student comparisons where they've ranked people from different countries on measures of aptitude and achievement, they also from time to time ask some questionnaires. Not that long ago, they asked the kids in this international sample to rate how boring their schools were. We came in second in the world in boring. I don't know why what they're doing in Ireland that make their schools even more boring than ours, but they apparently are. Second in the world in how boring school is. Only one out of every six American high school students says that she's ever taken a single course that was challenging. A single course that was challenging. You know, when I go around speaking on this topic and I hear people talking about how stressed their kids are and how much work their kids are in high school and so forth, and I think, well, maybe in your community, but that's not what the data say nationally. Our kids are bored, they're not challenged, they're not engaged in school, they're not asked to do very much at all. In fact, what studies show is that there is a complicit deal that's made between teachers and students. The deal is, you don't disrupt my class and I won't ask you to do very much. And kids are graduating as a result without knowing what they need to know. And I'll just say a few more words about this and then come back to this topic of what can we do. In during all of President Obama's administration, we have heard calls for getting more and more kids into college and there is a good reason for that because we now know that you can't get a good job without college. In fact, it used to be the case that you could get a good job with just a couple of years of college, that's even gone now. In order to get a good job, you have to have four years of college and a college degree, not just a couple of years of college. So if you go to college and you don't finish, you're no better off than if you just had a high school diploma, except you'll be in debt. So when I hear of these calls to get more and more kids in college, I think, well, that's fine, but, and here's the but. We don't have a college enrollment problem in the United States compared to other countries. We have one of the highest college enrollment rates in the world. That's not our problem. Our problem is getting people to finish college. We have the lowest college completion rate in the developed world. More kids who start college in this country drop out of college than in any other country in the world. And so if we just get more kids to go to college, but we don't give them the skills that they need to finish college, we're not helping anything, what we're doing is burdening people with more debt. And by making our high schools better and more challenging, we're gonna help deal with that problem and we're gonna help stimulate prefrontal cortical development, which is gonna help build self-regulation. So we need to encourage our schools to be better. If our kids are telling us that school was boring at a time in life when people don't find things boring, when it's really easy to get them excited about things, that is just a terrible shame and we need to do something about that. Number two, mindfulness. I know it's become a cliche, but it works. There's now a lot of evidence that mindfulness training helps build prefrontal cortical functioning, it helps improve self-regulation. In schools, and I've seen schools around the country that are now starting to incorporate mindfulness training into their curriculum, in schools that are using mindfulness, they see improvements in kids' behavior, they see declines in behavioral problems, they see improvements in kids' achievement. You can start at a young age, you can build up gradually to more and more minutes per day, it doesn't have to be through meditation, it can be through walking mindfulness, it can be through yoga, it can be through martial arts. There are many routes toward mindfulness, but it's good for children to do, and it's good for you to do too. We know that it is very important for cardiovascular health and for the functioning of your immune system. So this is something you can encourage your clients and your clients' families to do. Number three, aerobic exercise. Aerobic exercise is really important for brain function. I don't know about the schools in San Antonio, but schools around the country have eliminated physical education or severely cut it back because they say they don't have enough time for it. It's really a huge mistake, it is a huge mistake. The benefits of aerobic exercise to brain functioning and intellectual functioning are very, very well documented. We've gotten into this situation now where the only high school kids who get regular aerobic exercise are the star athletes. Everybody needs an hour a day of aerobic exercise when they're a teenager. And if your children or students or clients are not getting it, you need to encourage them to get it. That's number three. Novelty and challenge, meditation, aerobic exercise. Number four, sleep, sleep, sleep. Teenage your needs between eight and nine hours of sleep a night for healthy brain development. This is also well documented, that sleep deprivation during the adolescent years is related to increased rates of depression, of substance use and abuse, of anxiety related problems, of impulse control problems, of lower school achievement. It has been recommended by panel after panel that our high schools should start later in the day than they do. And studies show that when high schools move their start time ahead, by just an hour they see significant improvements in kids' academic achievement and in their behavior and declines in mental health. So there are things we can do to help strengthen the prefrontal cortex and build self control. I wanna leave a few minutes for questions, but let me just, since I said I would say something about it and somebody invariably asks about it, let me just comment on technology and social media. I won't take more than two minutes or so to talk about this. As I said before, adults love to demonize whatever the latest form of entertainment or technology is. And today's use of social media and electronic technology is no exception. The fact of the matter is is that the data are all over the place. We don't have enough research yet to really know. There are studies that show that many kids benefit from engaging with social media and electronic technology. There are studies that show that some kids are harmed by this. My own sense as a psychologist is that the issue is how much time people are spending on them and more importantly, what kids are not doing if they're spending so much time on these electronic devices. Not challenging themselves, not sleeping, not meditating, not getting physical exercise. Many years ago, a very wise person expressed some concerns about a new technology that was going to rot away our kid's ability to remember things. This person was shown to be wrong, was a smart person and we expected good things from this person. It was Socrates. Socrates wrote that he was worried about this new technology called reading and writing. Because if kids learned how to write, they wouldn't have to remember things anymore. And he actually said we should not teach children how to write because it was gonna erode their memories. My point is that every generation of adults has one of these things that they believe is sending kids to hell. In Socrates' time, he was writing, it has been dime store novels, comic books, radio, rock and roll, television, the internet, Facebook, Snapchat, Instagram. Who knows what's next? And I'll tell you, every single time when people like me say, let's not get carried away here, the critics say, oh, this time it's different. They've been saying this time it's different every one of these times. I'm not so sure this time is different, but I wouldn't overreact. So let me conclude before we take some questions by coming back to where I began, which is that what I hope to have accomplished this morning is to give you a new way of thinking about adolescence. About thinking about adolescence as a time when there's tremendous potential for thriving. And where we can't afford any longer to look at adolescence as something just to be survived. Where we really have to look at it as a time where we can promote positive development and positive growth, not just prevent problems. Yes, the malleability of the brain makes adolescence a time of vulnerability. And there's no question that it is. But the same malleability of the brain makes adolescence a time of opportunity. So I want you to leave here today thinking about adolescence that way, that it's not a burden, it's not a problem, it's not a mental illness. It's a time of tremendous opportunity and we just need to start taking advantage of it. Thank you very much. I believe there's a mic set up in the middle of the room. Thank you, Dr. Steinberg for this wonderful presentation. If we ask, if you have a question, if you could please come to this microphone and then we'll ask. Actually, your last comment is what my question's about with adolescence being a mental illness when we're dealing with mental illness and the fact that adolescents are over-diagnosed and even when we consider psychiatry with your presentation, how do we as mental health providers, how do we consider treating our clients with a lot of this research that you're giving us and the impact of psychotropic medication in regards to the brain development, with it impacting how it's developing the natural development that you're talking about and what's needed? I think, first of all, that many kids suffer from mental illnesses that require psychotropic medication to manage. But many kids are misdiagnosed. A very good example of that is ADHD where the United States consumes 75% of the world's ADHD medication and I doubt very much that we have 75% of the world's kids with ADHD. I think that most competent mental health practitioners would look to behavioral interventions before turning to psychotropic interventions. And unless one has made an attempt to try to manage a problem that way first, I wouldn't go to psychotropic medications. That should be the last line, not the first line. It also means that the people who are making the diagnoses need to be trained in adolescent and child mental health and not all of them are. A lot of kids in this country are getting psychotropic medication from general practitioners and I don't really know very much about this. It is easy to confuse normal adolescent behavior with mental health problems. And it takes a very skilled practitioner to understand the difference between them. On the one hand, we don't wanna look at a kid who has a serious mental health problem and say, oh, that's just normal adolescent stuff. Don't worry about it. But on the other hand, we don't wanna look at a kid who's behaving in a way that we know is typical for adolescents and to say, let's give him a drug so he'll stop doing this. I mean, other than training, I'm not sure what we can do. I'm getting a time signal here, but are you serious about that? Yes, I have two minutes here. We'll take one more question, is that good? Yes, you made, when you talked about the breaking system, you gave several examples. Can you share how you can get adolescents to be interested in discipline of yoga, mindfulness, a lot of times they'll say, I tried it, I tried it once, it doesn't work. Sure, I think that the first thing is that you have to start small. You can't expect somebody to be able to meditate for 20 minutes the first time they've meditated. And so you have them do it for a minute and then see how that goes. I think another thing to do is if you're a parent, maybe you can have it be something you do with your kid. Maybe you can work out some kind of schedule that you put on the refrigerator for how many minutes this day, this day, this day, this day. I think kids can kind of understand the idea that an investment now might not have a payoff until a little bit later, but maybe try to approach it that way and explain to them that they're gonna feel better and do better in school as a result of it. All this stuff is easier for me to get up here and say than to do, but I think those are some tips. I would do for a break, yeah? Okay, thank you all. Great. Thank you. Thank you, Dr. Steinberg, for your presentation. On behalf of Clarity Child Guidance Center, I'd like to present you with this pinwheel shadow box to remember us by. Thank you. Yeah. Thanks very much. Thank you very much. Appreciate it. Made by our kids, some of our kids. That's great, thank you. Ladies and gentlemen, Dr. Steinberg will be leading breakout session in the Magnolia Room beginning at 10 o'clock. Along with many other speakers and topics, please complete your survey and as you exit the ballroom through the doors in the back, you'll exchange your survey for a CEU certificate. Please also take a moment to visit our exhibitors, but note that session will begin promptly at 10. There'll be about 30 minutes after lunch to continue visiting the exhibitors and complete your exhibitor card for the drawing for two complimentary entries to ClarityCon 2017. Ballroom doors will reopen at 11.45 for lunch. Thank you and have a great morning.