Young Adults and Adolescents

The biggest neurobiological difference between a young adult or adolescent and a fully matured adult is in the development of the prefrontal cortex. Let’s look at what the prefrontal cortex does, and you will see why it is so important.

How different is a young adult from an adolescent?

Young Adults

Comparing the two pictures makes it look like the answer is “very different”!  But what about the differences in their brains? How different are the young adult and adolescent?  Not much!

What these two look like on the outside is very different, but their brain maturity level is amazingly the same when it comes to two very important areas of the brain: the prefrontal cortex and the amygdala.

Comparing these two young people to a fully mature adult, what are the differences in neurobiology?

The difference is very significant! And has huge implications in treatment / therapy.

The prefrontal cortex is the brain’s center of executive function – the captain of the ship, if you will. Its functions include the following:

“Decision making, moderating social interaction, orchestrating thoughts and actions based on internal goals, the ability to differentiate between conflicting thoughts and determine the difference between good and bad – better and best, future consequences of current activities, and social control – the ability to suppress certain urges that if not suppressed could lead to socially unacceptable outcomes.”

The prefrontal cortex is not fully developed until the mid- to late 20s. Many parents ask me if we are just now discovering this fact because of new technology, or if it is something new compared to past generations. The answer is that probably since the Depression, every generation has experienced an increasingly delayed development of the prefrontal cortex. The neurobiological technology that exploded in the 1990s just helps scientists to see it.  The prefrontal cortex is part of the frontal lobe:

“The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgment, impulse control, and social and sexual behavior.” View article

“The frontal lobe is the part of the brain that controls important cognitive skills in humans, such as emotional expression, problem solving, memory, language, judgment, and sexual behaviors. It is, in essence, the “control panel” of our personality and our ability to communicate.” View article

This paragraph is worth repeating from an earlier page. My friend and mentor Andrea Barthwell, MD, says that there is occasionally a young person whose prefrontal cortex is fully developed by around the age of 19–20, which would seem to be an anomaly compared to a late 20s norm. This person is almost always a female who is the oldest child with several younger siblings for whom she has been the primary caretaker since she was very young. Because of absent and neglectful parents, she has been responsible for her younger siblings’ food, shelter, clothing and safety. Assuming these responsibilities has caused her prefrontal cortex to develop in a similar way to physical exercise building muscles.

Most young adults and adolescents have not experienced anything close to this challenging. When you are looking at a typical 21- to 22-year-old and thinking that they should be seeing and navigating life the way you did a generation ago at the same age, you are mistaken. Take your estimate down a few years, and you will be more accurate in your expectations and successful in your communications.

The second significant aspect of young adult and adolescent brain development concerns the amygdala. Children, adolescents and young adults often function like a big ball of emotions, which is a normal part of their brain development and maturing process. Much, perhaps most, of their experience of life is through their “emotional brain,” the limbic system or mid-brain. At the heart of the limbic system is the amygdala. It is the center of our emotional responses and functions as our alarm system to danger. Our survival response, the “fight–flight–freeze” response, is orchestrated by the amygdala.

The amygdala is fully developed at birth. When we feel threatened, the amygdala signals us to act – “fight–flight–freeze” – without consulting the prefrontal cortex for factual data or wise counsel. Here’s the challenge for young adults and adolescents: they must navigate survival situations involving danger, sadness, fear, etc., with a still-developing prefrontal cortex that governs rational responses and a fully developed amygdala that governs instinctive responses.

What does this have to do with you helping your son? Remember the phrase “How you see it is how you treat it”? Because of the stark difference between young adults and adolescents compared to fully mature adults, treatment approaches designed for fully matured adults just don’t fit the needs of the younger group.

According to the typical treatment approaches for adults, to be successful the person needing help must:

  1. Hit bottom Because they’re stuck in a model that doesn’t fit this age group.
  2. Must want help and ask for help to get help – but young adults and adolescents rarely think they need help, so why would they ask for it? I always tell parents that if they have a young adult or adolescent child who is asking for help, they should make it happen immediately, because asking for help is rare, and it means that the situation is urgent!The majority of young men admitted to Capstone since 2001 did not want to be admitted and spend 90–96 days of their lives in a residential program. Of course not! And that is the norm! I’ve had several parents so engrained in the adult model that they delayed admitting their sons – waiting on them to hit bottom and ask for help – because they thought it was vital to getting help. That’s often risky. The goal in working with the 13–26+ age group is to take them through a process in which they come to see that they need help in making some changes, help them to begin those changes, and watch them eventually be glad they got the help.
  3. Admit that they are powerless – but adolescent/young adult males are unlikely to feel powerless with an underdeveloped prefrontal cortex, an undeveloped ability to connect choices to consequences, an inability to orchestrate thoughts and actions based on internal goals, a high level of testosterone which by itself makes them feel invincible, and a growing-up experience in a culture of affluence with very few consequences.

Young adults and adolescents hate being labeled and, in my opinion, most often don’t deserve it. Labels like addict, disorder, mental illness and more tend to become self-fulfilling prophecies. For example, ADHD is considered a disorder. Once assigned this label, it is difficult for a young person to ever “not be labeled” – i.e., not expected to behave like someone with ADHD. But research shows that up to half of these diagnoses are misdiagnoses. Bessel van der Kolk, MD, says that many of the behaviors labeled as ADHD and other disorders are actually the result of trauma. Also, many Fortune 500 CEOs have ADHD. From their perspective, they might label their condition not as a disorder but instead as a gift. It’s about harnessing a spirited horse and training it to use its strength productively, instead of vilifying it and castrating its potential.

I was at a luncheon at the annual NAATP (National Association of Addiction Treatment Providers) Conference in 2009 at which there was a panel of five people, each representing their treatment program. These were top-notch people, respected and knowledgeable, each representing top-notch programs. Collectively they had worked with thousands of teens and young adults over many years. The leader of the group would pull out a card, read the question, let the panel discuss it, and then open it up to the audience. One question was particularly significant to me: “Can we as an industry tell an adolescent or young adult that they are an addict?” I was expecting a yes from each person but got the opposite.

Every single member of the panel said no, all five. Their consensus was that we cannot accurately determine if any young adult or adolescent has an addiction. Why? Well, all of us have seen that teen or young adult, male or female, who was using so many drugs and/or so much alcohol that if they were older we would say they were severe addicts. Based on consumption levels alone, we’d call that full-blown addiction (what I call the “body-rot” phase of addiction) or Jelinek’s chronic phase. However, they abuse like this for a few years, and then something changes – they heal their trauma, get into a safe and supportive group of friends and family, finish high school or college, move to a new location or are removed from an overwhelming situation of distress – and they stop abusing. Instead, they now control their use in a healthy way: a glass of wine at night or a beer at the barbecue on Saturday. (Not that I am for either; I’m not. I’m a teetotaler by choice.)

Caution! Not only can we not accurately determine who has an addiction, we also cannot determine who doesn’t have one, so trying to control-use after being a compulsive abuser of chemicals or behaviors is like playing Russian roulette. Abstinence is always the best plan once a person has had an abuse problem that might be an addiction or might become an addiction, simply because it could.

What does all this mean for your loved one?

You don’t fit a square peg into a round hole. You don’t measure your height with a bathroom scale. And you don’t take a therapy approach that was designed for one age group and apply it to a very different age group where it doesn’t work the same way. This is why Capstone’s Core-Systems Model is specifically designed to meet the needs of young adults and adolescents and their families.