What were they thinking? An expert on teenage brains explains

From school to friends to home, being a teenager is tough. Also tough? Raising one! 

On this episode of In It, hosts Gretchen Vierstra and Rachel Bozek welcome Karen Wilson. Karen is a clinical neuropsychologist in Los Angeles and a professor at UCLA. She also supervises the assessment of children and adults with learning, thinking, and social-emotional differences.

Tune in to get Karen’s expert advice about supporting your child through the teen years.

We love hearing from our listeners. Email us at init@understood.org.

Related resources

• How to help high schoolers gain self-control

• Developmental milestones for teenagers

• What to do when your teen or tween is lonely

• Listen: When kids and teens have tantrums: how to help

• Listen: Unpacking the teen mental health crisis: How we got here and what to do about it

Timestamps 

(1:35) What’s going on in teens’ brains

(6:10) When teens want more independence

(16:56) Sexual and gender identities

(21:48) The awesome side of teens

Episode transcript

Gretchen: Hello and welcome to "In It," a podcast for families with kids who learn and think differently.

Rachel: Here you'll find advice, camaraderie, stories of successes and, yes, sometimes failures from experts and from parents and caregivers like you.

Gretchen: I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.org.

Rachel: And I'm Rachel Bozek, a writer, editor, and mom who has definitely been "in it." Today we're talking about raising kids who learn and think differently and have the added challenge of being teenagers.

Gretchen: Uff, this can be an exciting stage of life, but it can come with lots of big feelings, new demands, and a brain that's not always the best fit for all of that.

Rachel: So, how do you support your teen through these years while also giving them the space they need to grow more independent? We've got Dr. Karen Wilson here to help us figure that out.

Gretchen: Karen is a clinical neuropsychologist in Los Angeles.

Rachel: She's also a professor at UCLA and supervises assessment of children and adults with learning, thinking, and social-emotional difficulties. We've had her on the show before, and we're delighted to have her back.

Rachel: So, Karen, welcome back to "In It."

Karen: Thank you so much for having me.

Rachel: As you know, we're talking about adolescence as it relates to kids with learning and thinking differences. We've all heard the warnings. Look out for the teenage years. They'll shorten your lifespan. And while that is certainly not the case for all teens, it can be the case for some.

(1:35) What's going on in teens’ brains?

Can you help us understand what's happening to teens' brains in these years that can make them challenging?

Karen: I absolutely can. It really is this volatile period because the adolescent brain undergoes significant changes, particularly in that front area, the brain, the prefrontal cortex, and that prefrontal cortex is responsible for all of our executive functions. So, if you think about planning an organization, decision-making, judgment, you know, impulse control, all of those things are kind of controlled by that front part of the brain, which is still under construction and developing during this time.

And what we know about adolescents and the prefrontal cortex is that the prefrontal cortex is the last part of the brain to develop and doesn't fully mature until the mid-twenties. So, all of those areas that I just discussed are still in development.

Rachel: And that's for any kid, right?

Karen: Right.

Rachel: So, am I correct that that would mean that a kid with learning and thinking differences who may already kind of struggle in some of those areas, it's just sort of like exacerbated?

Karen: Absolutely. Because if you're already struggling with those executive functions and that's more often the case for individuals with learning differences, then you are going to have even more difficulties with decision-making, planning, prioritizing, than your peers.

Rachel: So, we talk a lot about changes that happen during puberty and what you're describing, is that different or is this all kind of the same thing?

Karen: It's it really happens around that period of adolescence, right? So, it's around the same time that their hormones are changing as well. And so, it's almost like the perfect storm. And there's this disconnect in the development of the emotional centers of the brain and then in the rational, logical centers of the brain.

So, what you'll see is that you've got these adolescents who have these big emotions, you know, it's ruled by their limbic system, but they don't have a way of analyzing the information to help them make decisions logically. So, they rely on that emotional center to make decisions, so they make decisions based on how they feel, whether that's anxious or stressed or angry or sad, rather than using, you know, rational, you know, decision making to make, you know, choices.

Gretchen: I feel like I'm in the thick of that right now. And the fact that you said that it doesn't fully develop until you said mid-twenties, how am I supposed to make it till then?

Karen: I know, I know. And especially if you've got these neurodiverse students, because students with learning and thinking differences, like we're saying, those areas of the brain are slower to mature. And there's actually some research that shows there can be as much as a three-year delay in the development of the frontal cortex for students with ADHD and other learning and thinking differences.

Gretchen: Wow.

Karen: Yeah.

Gretchen: So, can you maybe talk us through a concrete example about how a teen and their teen brain might approach a decision compared to the more developed brain of an adult?

Karen: Right. And so, think about a teen making a decision to go to a party, right? Where there might be no parental oversight. They don't know who's going. They don't know the people. They just know that they want to be included. So, that feeling of wanting to be part of something, wanting to be included. So, they're making the decision to go based on how they feel.

An, you know, an adult, a college student might think, "Who's there? Is it appropriate for me to go? Am I going to be safe?" You know, "Will I have an exit plan if it's not safe?" But an early adolescent would not be thinking about those things. They'll be making that decision based on how they feel, not wanting to be left out. And we know that that's a common, you know, need for adolescents at the stages to be connected, to be part of something, to be accepted. And so, they'll make decisions based on that feeling.

Gretchen: Yeah. So, for teens, a lot of those feelings are related to social things, right? Social pressures.

Karen: Absolutely.

Gretchen: I see a lot of that.

Karen: Yes. And then as parents, we look at some of the things they do and think, I wouldn't have made that choice.

Gretchen: Right.

Karen: Right? But you are an adult with an adult, fully developed frontal lobe. And you have to have some compassion, some empathy for teens where they don't have that level of development of their judgment centers and their decision-making centers. So, they need some support around that.

Rachel: So, around this time in life, kids crave more independence.

Karen: Yes.

(6:10) When teens want more independence

Gretchen: And we know this is totally normal and healthy. But what are some good strategies that parents and caregivers can use to help them make good decisions while we're also giving them a chance to be more independent?

Karen: Right. And I think that wanting them to be more independent is so important because we absolutely want them to get ready for all of those transitions, those important transitions. And that transition to adulthood is one of them. And at the same time, we want to encourage decision-making opportunities. Even though they're not ready to make the best decisions yet, we still want to encourage the process, but ensure safety nets for that.

And that may involve, you know, scaffolding, providing some insight, some feedback. You know, that's an interesting choice. Are there other things that you might consider or other things to think about if you decide to do X, Y, and Z and help them with that decision-making process? So, for example, we talked about, you know, "I really want to go to this party because, you know, everybody's going to be there and they're going to be posting about it and I want to be part of it." And then they may not be thinking about these other risk factors.

And so, if you ask them those questions, even just, "Well, who's going to be there?" If they say, "I don't know," "Is there a way for you to find out? You know, it's there a way for you to find out. Is it just going to be kids in your class? Is it going to be other people? Where is it going to be?" If they're like, "I don't know, I just heard there's going to be a party." I mean, it helps them to think, just asking the question.

And then you can even say "When you find out, let's talk about this again so I can help you figure out if this is something you want to do, if it's something I'm going to allow you to do, depending on the age of the student." But it helps them engage in the decision-making. Then they can go and ask "Who's going to be there? What time is it going to be? Is it open to anybody? You know, are adults going to be around? Is it going to be supervision?"

They can start asking those questions and then if something is awry, then you can start kind of guiding them, "Well, if you know there are no parents there, you know what would happen if people were drinking and you're only 13 years old. What would you do?" Right? And so, you help them to make decisions.

Rachel: That's also scary. Some of it is like, like especially when it's like the first time they go do something with their friends without a parent.

Karen: Without a parent. Absolutely. It's like even if they're going to the mall and they, first time, you're sending them to the mall by themselves. What do you do if someone approaches you? If someone says, "Hey, you know, your mom's in the parking lot looking for you, she sent me in to get you." What should you do? Right?

Rachel: Yeah.

Karen: If older boys try to join your group and ask you questions and you're by yourselves, what should you do? And so, helping them to think about what could happen and help them with the strategies and problem solving that would be beneficial might be like, "OK, so you go to the girls' restroom, you go to the restroom, and then you call me or you call an adult and you tell us where you are," right?

Rachel: Right.

Karen: So, those kinds of things.

Rachel: Yeah. I've actually told my kids that if they need like a sort of, like, escape, you know, strategy, that they can call me or text me and say that it's about that camping trip because that's not a thing that I would ever actually do. So, then I'll know that there's an emergency.

Gretchen: Oh my God.

Like if you're just like, "I need to talk to you about that camping trip we're taking," I'm like, I'm on my way.

Gretchen: Oh my God. I love that's a camping trip.

It's totally a camping trip. So, during these years, as we're talking about, our kids are reaching milestones that might feel really scary for us as parents. So, a good example of this, I think, for so many people is driving. How do we prepare them, especially if they have learning and thinking differences for the responsibility that comes with something like driving?

And what are some good ways to talk with them about the risks of being impulsive or distracted and sort of walking that line of not scaring them about it or making them feel like you're not confident in them, but also like, this is real and it's serious?

Karen: Yes, absolutely. You know, driving is such a significant milestone for so many young people. I mean, my daughter's talking about "I can't wait till I can drive," and she's 12, right?

Gretchen: Oh my God.

Karen: And so, she's already anticipating how wonderful this thing is going to be to be able to do this, right? The ultimate independence, to get in the car and drive and go where you want to go. And so, it is a significant milestone, but it's also a potential concern, you know, for students who think and learn differently, who may have attention issues, may have motor coordination difficulties. And actually, the research shows is that adolescents, for example, with ADHD, are 36% more likely to be involved in motor vehicle accidents than their peers who do not have learning and thinking differences.

And so, I know we said we don't want to scare them, but that's the reality.

Gretchen: Right.

Karen: So, we want to be able to be open about ADHD, how it impacts attention, focus, reaction time, distractibility, and how that impacts driving. Consider delaying getting a driver's license. You know, just because you're 16 doesn't mean you have to get a driver's license. Are there other ways we can help you become more independent without putting you behind the wheel? Right? So, that you can introduce, you know, driving privileges and stages where you can drive around your neighborhood, but you're not going to get on the freeway, right?

So, there are different things that you can do to kind of start the process. But it's really important to educate teens on how impulse control, attention, and distractibility can impact driving, particularly when you've got phones and notifications and you have to put some hard rules around where that phone is, when the notifications go off. All of those things are really important, particularly if they're going to use their phones for navigating because they're going to be looking at that phone while they're driving and that's going to put them at increased risk.

Rachel: So many layers. And then there's the layer of like the friends driving.

Karen: Yes.

Rachel: It isn't just about them driving.

Karen: Right. Right. Absolutely.

Gretchen: Yeah. Like getting in a car with a friend and do you trust their driving?

Karen: Exactly. Exactly.

Gretchen: Adolescence can also be a time when kids start to experience severe anxiety or even depression. And I know that some amount of anxiety is normal and to be expected. But how do we know when they're experiencing something that's not typical, something that we should be worried about?

Karen: Right. And I think that, you know, your first point about this period being a time when kids experience more anxiety is so important to recognize and to see it for what it is. Because, again, there's this disconnect between their emotional centers and the executive functioning system. And the demands on them require a lot of executive functioning, particularly during those transition periods. So, there's a higher demand for organization and planning and prioritizing and managing your emotions.

And that creates a lot of anxiety when those demands increase, particularly when you're transitioning from elementary to middle school or middle school to high school, and you're trying to manage all of these changes, it can create a lot of stress and a lot of anxiety. And so, when you're trying to determine whether this is like normal worry, which it's normal to be a little nervous about, you know, a new phase in your life, but it's when the anxiety becomes intense and it's out of proportion to what you would typically expect and it keeps you from doing things that you would normally do.

So, kids who do not want to get out of the car, they don't want to leave their room. They're having, you know, heart palpitations, sweaty palms. They're maybe even experiencing what we would consider like a panic attack. And they may not want to do things because they're afraid of something bad might happen to them or they'll be embarrassed or, you know, they'll be, you know, an outcast if something terrible were to happen.

And so, it's when it becomes very intense and it impacts their daily life, that's when you really need to look for support, look for professional help for your child, for your teen, and also maybe even some guidance as a parent for how to manage the anxiety.

Gretchen: Yeah. And I feel like I understand how to look for some real severe anxiety. But sometimes with depression, like a lot of kids are sullen and sulky and they just want to be in their room and they don't really want to talk to people. So, how do you know when it's just like typical teen kind of "I'm a sullen teen" versus like "I'm a depressed teen"?

Karen: Right. And I think the same rules apply. It's when maybe they're acting out of, you know, teens it's a time when they all want to go to their rooms. They all want to shut their door. But if you're seeing that there's a change in behavior, that there's more sadness, there might be more tearfulness, there might be a lack of interest in doing things that they used to enjoy. They used to be involved in sports and involved in clubs and organizations. And all of a sudden they don't have that same interest anymore. They're spending more time online, but they don't want to see friends in person.

So, those can all be indications that it's not just being a teen, that it's really crossing the threshold of something more significant, whether it be depression or anxiety.

Gretchen: OK. And so, when you notice that and you're worried about really severe anxiety or depression, what's the first thing you should do as a parent?

Karen: Yeah, I think you always want to connect with your teen about how they're feeling. But then keep in mind that a lot of teens "I'm good. I'm fine. Nothing's wrong," right? But the more opportunities you can have to have conversations or to notice you know, say, "You know, I've noticed that you're spending a lot more time in your room. I notice that you're not hanging out with, you know, Sarah anymore. I notice that you're, you don't seem interested in that club that you were really excited about at the beginning of the year," and see what the response is.

I think that's really important to open that dialog. And sometimes you need to do it at a time where it's not, you know, where it feels very relaxed.

Gretchen: Right.

Karen: So, it's not like knocking at the door of their bedroom and saying, "Hey, we need to talk." It's like maybe you're doing it on the drive home from school or you're going to head out to get some ice cream or, you know, let's go for a walk. And so, again, in a more relaxed state is often helpful.

Gretchen: Yeah.

Karen: The other thing is to know that a lot of these concerns that we might have about their social-emotional well-being, whether it be depression, anxiety, there are effective treatments for those things. And so, even if you as a parent are noticing significant anxiety or depression, know that there is help available and treatments available that are very effective at reducing some of those symptoms.

(16:56) Sexual and gender identities

Gretchen: Is this the time where we should also be asking them if they need support around their developing sexual identities or gender identities as well?

Karen: I think you definitely, it's definitely the right time because again, it's all part of their development, their social-emotional development, their frontal lobe development, executive functioning system development, which we've talked about. And so, again, it's all about opening that conversation being open, validating their experiences. Noticing when topics bother them. And, you know, being inquisitive about, you know, "It seemed like that really bothered you. Can you tell me, you know, what's what's going on there?" And opening up the conversation.

You don't want to assume anything, but you want to be that person who they feel safe with, who they feel comfortable sharing information with and know that there's no judgment. And if a teen is not comfortable sharing that information with you, you can ask them, you know, "Is this something that you'd be interested in talking to a counselor about or a therapist about or a teen coach about?"

Rachel: So, real question, is there a like non-cringey way to bring that up?

Karen: I don't think so, because it really depends. It's really an individual kid in terms of what you're noticing, what they're experiencing, what they're saying. Sometimes it's just a matter of, you know, kind of wanting them to expand on something that they've said to you.

Rachel: Yes.

Karen: Right? And so, it's really going to be an individual, you know, thing for each child, each teen.

Rachel: Yeah, I feel like the only non-cringey way is if they bring it up, which is like 99% of kids are not going to.

Karen: Right. Absolutely. Or if you make assumptions, I think that's cringey.

Rachel: Yeah.

Karen: "I'm thinking that," you know, whatever that might be, right?

Rachel: Or, "You know what I heard about some other kid?"

Karen: Yes.

Rachel: They do not buy that at all.

Karen: Right.

Gretchen: Well, thank you for being real and telling us that we have to be cringey.

Rachel: Won't be the first time.

Gretchen: Yeah, exactly. It won't be the first time.

Karen: I think that's a rite of passage for all parents.

Rachel: So, let's talk for a minute specifically about teens who have ADHD. Do symptoms of ADHD change during the teen years? And should parents expect to see new behaviors from a child with ADHD during this time?

Karen: They change a little bit in the sense that some of the hyperactivity is not as prominent, right? So kids, when they're younger, there might be a lot of activity. They're running around. They can't sit still. You might see less of that, but it may manifest as talkativeness, right? In the teen years. So, it may look different. They can sit still but they're very talkative. They can, you'll still see the distractibility and the inattention.

And I think one of the big changes that you see is really the struggle with executive functioning. The struggle has always been there, but we haven't expected them to do the things that we're now expecting them to do. Right? They didn't have to prioritize on their own when they were younger. They didn't have to, you know, think about organizing, you know, all of their classes and the tests and quizzes that they had to do.

So, now the demand for executive functioning has increased considerably. And now you're seeing that again, that disconnect where those areas of the brain are not fully developed and are actually delayed in development in individuals with ADHD. But the demands for those executive functioning skills have increased significantly.

Gretchen: Yeah.

Rachel: So, then what about teenagers who take medication for ADHD. As their brains are evolving in these years, will they find that they need to make changes in their prescriptions?

Karen: Yeah, it really depends on the teen. Some students go off their medication because you've got ADHD that is mild, moderate, severe. You have ADHD that co-occurs with anxiety which can exacerbate the symptoms. So, it really, it can differ depending on the person in terms of what the needs are.

A lot of times what you'll see is that the ADHD medication helps with focus and attention and helps to reduce the distractibility, but it doesn't help you become better at organizing. And so, you still need support for help with those skills because the medication isn't going to teach you how to organize and plan and prioritize.

Rachel: Right. So, that's kind of a conversation to have with like your specialist, your therapist.

Karen: Yes.

Gretchen: OK. So, we've been talking about a lot of challenges and we've been scared into realizing these challenges last for a long time.

Karen: Yeah.

Gretchen: So, how about a little pep talk?

Karen: Yes.

Gretchen: Are there some awesome things about kids at this age that we should know about?

(21:48) The awesome side of being a teen

Karen: I mean, there's so many awesome things.

Gretchen: Good. Phew.

Karen: One is that they're motivated, they've got the energy, they've got the interest. They're interested often in so many different things, and we should encourage them to try different things, right? They want to do well, right? There's a need to want to engage with their peers to do well in school. And so, oftentimes they're open to support and strategies. And so, offering support, if you go into it with a collaborative approach, right? It's not "I'm telling you this is what you need to do," but together let's figure out some strategies that will help you.

And I think the good news is that when students get support and have the tools and strategies that they need to help them address some of these executive functioning challenges and social-emotional challenges, they can absolutely thrive.

And the other good thing is that once they get support and they get it over and over again, they internalize a lot of those strategies and tools and then they don't need that external support. They don't need that parent waking up in the morning, checking their calendar, making sure that their backpack is packed. They can do those things on their own. And that's really an exciting time. That's the goal.

Gretchen: That is the goal.

Karen: Just to help with that independence.

Karen: Yes.

Gretchen: Yes. Well, thank you, Dr. Wilson. This has been a great conversation.

Rachel: Yes. Thank you so much.

Karen: Thank you so much for having me.

Rachel: Thanks so much for listening today. If you have any thoughts about the episode, we'd love to hear from you. You can email us at init@understood.org.

Gretchen: And check out the show notes for this episode, where we have more resources and links to anything we mentioned.

Rachel: This show is brought to you by Understood.org. Understood is a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. If you'd like to help us continue this work, donate at Understood.org.give.

Gretchen: "In It" is produced and edited by Julie Subrin, with additional production support from Cody Nelson and Ash Beecher. Justin D. Wright mixes the show and Mike Errico wrote our theme music. Briana Berry is our production director. Neil Drumming is our editorial director.

Rachel: From Understood.org, our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. Thanks for listening.

Gretchen: And thanks for always being "in it" with us.