Knowing what’s 'normal'


The first peeks into the puzzling adolescent mind are revealing an organ in the
midst of a near complete overhaul. The startling changes are partially
responsible for teenagers' often erratic and risky behavior and may also harbor
the seeds of mental illness.

The research has broad implications not just for parents and their teens but
also for everyone who shares a part of their world - at school, in the
workplace, on the highways and the Internet. Policymakers will have to decide
what to make of these findings as they ponder issues such as crime and
punishment, educational testing programs, drug use and even video games.

To date, much of the discussion around teenagers has focused on why so many
change from adorable children into sometimes moody pre-adults. But the latest
research has focused on defining normal and tracking the changes that may
trigger mental illnesses or strip the defenses of a mind already vulnerable to
psychiatric disease. Knowing what's "normal" may lead to a tool that can
predict which adolescent is likely to fall prey to depression, bipolar
disorder, schizophrenia or a variety of other brain disorders. The key is to
figure out who is vulnerable in time to change the course of brain development
and head off the disease or reduce the devastation caused by mental illnesses.

The technology to predict who will get a mental illness is still years away,
said Dr. Deborah Yurgelun-Todd, director of cognitive neuroimaging at the Brain
Imaging Center at McLean Hospital and Harvard Medical School in Boston. And
researchers are still struggling to pin down normal brain development. That's
not an easy task, because the brain grows in fits and starts, and everyone
develops a bit differently. So what may look like the warning sign of disease
may be only delayed development, she said.

"For parents worried about their children getting labeled too young, I can sort
of see that, because the indicators aren't hard and fast yet," Yurgelun-Todd
said. "We have hints. We have suggestions of trends that seem to be more
typical," but no definitive diagnostic test yet.

Brain changes rapidly

Teenagers' often inscrutable and erratic behavior has been dismissed as a
product of a bath of sex hormones unleashed during puberty. That is about where
research halted for a long time. Now scientists are learning that changes in
the brain may play a bigger role in that behavior.

There is no question that the brains of people with schizophrenia and bipolar
disorder look and work differently from those of their healthy peers,
Yurgelun-Todd said. And those changes probably start earlier than most people
suspect.

Her research into adults with schizophrenia and bipolar disorder showed
significant brain changes. Those alterations were already present when
schizophrenics had their first episode, and she began tracing the illness to
its earliest appearance.

It now seems that "some people may be genetically ready to develop illness,"
but the defect does not become apparent until the brain matures, she said.

Dr. Judith L. Rapoport and her colleagues at the National Institute of Mental
Health also have been searching for the roots of schizophrenia. For a decade
and a half, they have repeatedly scanned the brains of people ranging from
toddlers to adults. Along the way, they began to discover how normal brains
mature.

Only last year, the group published its first analysis of the maturing human
brain in living people. The general layout of the brain doesn't change as
people mature, Rapoport said. But the brain grows and shrinks, gets rewired and
refined, parts are encased in protective coatings, brain cells die, and sex
hormones and neurotransmitters flood in. This all happens under the influence
of genetic and environmental blueprints designed to shape the organ into a
brain ready for the responsibilities of adulthood.

The timing of the hormonal surges and brain changes with the onset of mental
illnesses probably aren't coincidental, researchers say. One theory holds that
because brain structures involved in emotion are developing in the teenage
years, the brain is more susceptible to emotional disturbance at that time.

Neurochemical systems are also developing during adolescence. Dopamine, a brain
chemical that governs pleasure, motivation and interpreting perception, reaches
peak production in early to mid-adolescence.

It is also one of the brain chemical systems most affected by schizophrenia.
Drug and alcohol abuse or other experiences that affect dopamine may contribute
to mental illness during certain sensitive times in the brain maturation
process, research suggests.

Understanding normal brain development is crucial to understanding mental
illnesses because some of the areas most changed during adolescence are also
implicated in schizophrenia, bipolar disorder and other psychiatric disorders.

Looking for changes

The details of normal brain development are still just sketches. What goes
wrong in the brain during mental illness is even more unclear. The portrait
that is emerging is drawn in gray and white. Gray matter and white matter, that
is.

Take a slice of the brain and the outer layer appears gray, while most of the
middle is a mass of white. The layers look as though they are separate
entities, like the skin and flesh of fruit. But gray and white matter are
composed of the same stuff - brain cells.

The gray matter is the cell bodies of neurons, the brain cells responsible for
processing information. Long projections, called axons, extend out from the
cell body of the neuron and connect it to other brain cells, like the cables
that link computers in an office. The axons are wrapped in fatty protective
coating called myelin. The myelin coating helps the neurons transmit
information more quickly, much the way insulation keeps electrical impulses
traveling along a wire. The axons with their myelin sheaths make up the white
matter.

During brain development, the gray and white matter increase in volume,
Rapoport said.

White matter growth accelerates in the teen years and continues into adulthood.
The "growth" is actually the result of myelin encasing the brain's connecting
wires.

The earliest parts of the brain to get wrapped in myelin are the parts that
control movement and language - skills young children need, said Dr. Henry
Nasrallah of the University of Cincinnati College of Medicine. But some parts
of the brain don't really come online until the teen years, he said.

Among the last areas to become fully wired are the frontal lobes and temporal
lobes. Those parts of the brain are significant because they control abstract
thinking, impulsiveness and emotion.

The fact that teenagers' brains aren't mature has led many people to ask
whether teens can be held fully accountable for their actions, Yurgelun-Todd
said last month in an address at the annual meeting of the Society for
Neuroscience in Washington. The research could influence debates about whether
the death penalty should be imposed for crimes committed by teens, whether kids
are responsible enough to drive at 16 and whether 18-year-olds are ready to
vote on who should lead the country.

Differences are emerging

The research into the development of the brain during adolescence is beginning
to show how the brains of mentally ill people are different.

Dr. Melissa P. DelBello, co-director of the Bipolar Disorders Research Program
at the University of Cincinnati, and her colleagues have been peering into the
white matter of the brain. In teenagers with bipolar disorder, the white matter
is disorganized, particularly in the frontal regions, the researchers found.

Since those regions govern impulse control and attention, and help regulate
emotion, disruptions there can produce erratic behavior.

While the white matter is being wrapped in its protective coating, the gray
matter of the brain is undergoing its own changes. Inefficient or confusing
connections between neurons, called synapses, are pruned and some cells die.

From the ages of about 14 through 16, people lose about 20 percent of the
synapses in the brain, Nasrallah said.

This loss of gray matter, he said, is "like a company laying off 10 percent of
its workers and still being profitable and efficient."

The pruning may actually help the brain work better, not harder.

Children have more overall brain activity than adults, probably because they
use their brains less efficiently than adults do, said Dr. Deanna M. Barch, an
associate professor in the Department of Psychology at Washington University.

"It's almost like they need more brain than an adult to perform the same task,"
Barch said.

In schizophrenia, the pruning process doesn't work the way it should and
doesn't allow for specialization, Barch said.

Some areas of the brains of people with schizophrenia are less active than in
healthy adults, but overall, their brains are more active, she said.

Working memory - the type of memory that lets you hold a phone number in your
head for a few minutes and contributes to long-term memory - is defective in
people with schizophrenia, Yurgelun-Todd said.

"If this is missing, it's going to put people at a disadvantage for being able
to read their world and respond," she said.

That can be particularly crippling during adolescence when skills for social
interaction, intuition and nuance are emerging, she said.

Rapoport's studies showed that children with early-onset schizophrenia rapidly
lose gray matter from the frontal and temporal lobes, and they lose more gray
matter than their healthy peers.

The pattern looks like a great exaggeration of normal maturation, Rapoport said.

"It's way out of whack and happens much too fast," she said.

But the way to slow the process is unclear. It could involve medicating
children who display warning signs of schizophrenia but don't yet have the
illness.

Yurgelun-Todd said, "We have no problems taking aspirin to prevent heart
disease or vitamins to prevent colds, so if you know you're going to get a
devastating brain disease, maybe it's not so bad to take a drug."

And drugs may not even be necessary to head off mental illness, she said.
Simple changes in the way children are raised could be as effective.

"The human brain is very susceptible to its environment, both positive and
negative," she said.

Some people think censoring movies, TV and video games could help promote
mental health in youngsters. But it may be more important that families provide
stimulating activities, good role models and a supportive environment for their
children, Yurgelun-Todd said.

Researchers hope that learning to control the rush of neurochemicals and
hormones and shape brain development could help cure mental illness.
Yurgelun-Todd said she is optimistic that science will soon be able to diagnose
mental illness at its earliest stages, but she doesn't have confidence that
society will embrace the changes necessary to minimize the ravaging effects the
brain disorders can have on young minds.

thesman@post-dispatch.com 314-340-8325

*NOTE The TeenScreen program was developed by Columbia University in 1991. Its
creator said it was based on studies of teens who had committed suicide.


SOURCE: By Tina Hesman ST. LOUIS POST-DISPATCH
Sunday, Dec. 11 2005

Thats a very interesting article. Like a lot of other people my depression and anxiety got much worse beginning at about 13 years old. That was when my crying fits and general sadness turned into being suicidal and anti-social. These have been pretty consistent things for me for the last 7 years.

I have always suspected that my brain was wired differently than most everyone else simply because I have never reacted to things in the way that others do. I have always taken cruelty much more personally than the people around me, even though most of it was not directed towards me. And for the most part, I have never liked any competition under any circumstance. Even when making moral judgements, I usually come up with drastically different results than what the average opinion is, seeing evil everywhere.

But, just as significant as the biological changes that occur in teens, I think the cultural part of things is at least as significant. The sudden shift from loving and accepting you for who you are, regardless of your independance, popularity, competitiveness, and working skills, to judging you as a level of drain on society as you approach adulthood, has been at least for me, traumatic. I believe that is why as a child I was viewed as "sensitive," and as an adult a "failure."

You add all of these things together with a culture of constant prejudice, (high school) and it is plainly obvious that there will be those like me that fail at what society and evolution wants them to do.

But even with all my "strange" chemicals and failures, I have learned to respect myself as an individual and keep living with them no matter how many people tell me that they are not O.K. They are me, and mine, out of balance with the rest of the population or not.

This post has been edited by chaku: Dec 16 2005, 11:34 AM

I started to feel the worst in my pre-teens (11, 12 years old). Then it just went on from there. It also explains why my symptoms are so different from the symptoms of the 20-somethings and up here, my brain could still be developing a mental illness. I'm 17. My therapist says she knows something is wrong with me but she can't figure out what it is. Argh, why can't mental health techonology be more advanced!! If it were, they would be able to predict it in me now and treat it before it gets to the really bad point.

Well I am sitting here eating dirt off my hands... is that normal?

One could say that theres such a thing a "normal". it would be defined as what can be accepted by others as socially acceptable behavior. your statement is alittle invalidating. but being a part of society, one can partially decide what gets chosen as the requisites for normal. its a complicated topic i suppose.

and as an interesting note, my cousin rubs ranch dip on his hands as a substitute to cleaning them. i'm not sure why. but people love and accept him anyway. so don't worry, its not that strange.

This is probably off topic but I'm just curious. Does depression cause procrastination or the other way around? I'm trying to fix my procrastination right now hoping that that would fix my depression problems.

Hmm...that is tricky I think. I'm a procrastinator...always have been. I notice that depression worsens my procrastination to the point of not doing things. But I'm not sure if it would be the same for everyone. But I think trying to reduce procrastination is a small step in a positive direction.

oh I see, thanks. I've always procrastinated but I guess the workload got much heavier in university, so I just broke down.

Very interesting. This article reminds me of a tv show which focused on teenagers taking risks that sometimes lead to injury and death. An area in the front of the brain (not sure which part) which is used to understand consequence of action is said to stop working temporarily before a "newer version is installed". So, meanwhile, the parents' senses are very much needed to help the teenager to make good, safe choices.

Your not alone, I am this way as well. But the more I procrastinate, then the worse I feel, and then Everything feels so overwhelming. It really is a discouraging situation.

For me, as a teenager... I feel like I was all of a sudden, out of nowhere, hit with a load of perspective, responsibility, and general mental well-being, about two or three months ago. Clouds went away, sky cleared, the birds are singing, all my old fallacies and concerns are no longer... concerning. Crippling depression and anxiety struck me at age 12, I had found my way out be age 12, but I'd been dealing with recovering (from starvation and grief for a lost childhood and social anxiety and isolation and such) and recurring depression and agitation ever since then.

Even before then, though, when I was in elementary school, I had terrible shyness and anxiety, phobias, and hallucinations, so I can't say much for the teenage years bringing about a great change for the worse. (I was always on a different wavelength--didn't socialize, cared more about the pattern of the answers on a test than getting the right answer, played by lying on my stomach staring at my toys, responded very strongly to adult's expressed and implied opinions.) I just hope that growing up has brought about a PERMANENT change for the better.