New understanding of adolescent brain development: relevance to transitional healthcare for young people with long term conditions

Abstract

Whether or not adolescence should be treated as a special period, there is now no doubt that the brain changes much during adolescence. From an evolutionary perspective, the idea of an under developed brain which is not fit for purpose until adulthood is illogical. Rather, the adolescent brain is likely to support the challenges specific to that period of life. New imaging techniques show striking changes in white and grey matter between 11 and 25 years of age, with increased connectivity between brain regions, and increased dopaminergic activity in the pre-frontal cortices, striatum and limbic system and the pathways linking them. The brain is dynamic, with some areas developing faster and becoming more dominant until other areas catch up. Plausible mechanisms link these changes to cognitive and behavioural features of adolescence. The changing brain may lead to abrupt behavioural change with attendant risks, but such a brain is flexible and can respond quickly and imaginatively. Society allows adolescent exuberance and creativity to be bounded and explored in relative safety. In healthcare settings these changes are especially relevant to young people with long term conditions as they move to young adult life; such young people need to learn to manage their health conditions with the support of their healthcare providers.

Keywords: Adolescent Health; Neurodevelopment; Transition.

Figure 1. Right lateral and top views of the dynamic sequence of gray matter maturation over the cortical surface.

The side bar shows a colour representation in units of gray matter volume. Fifty-two scans from 13 subjects each scanned 4 times at approximately 2-year intervals.

Figure 2. Page from booklet written by Jessica Platt, A level student.

Figure 3. Example of tract reconstruction from Diffusion Tensor Imaging data.

The red tract connects a frontal region (Broca’s area) to a temporal region (Wernike’s area) and is important for language processing. The yellow tract connects a parietal region to a temporal region.