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.

A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well‐being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services

“…Transition usually occurs during adolescence, a time of important change in an individual's physiology, psychology and for societal expectations 2, 3. These changes and pressures are associated with potentially detrimental effects on health behaviours such as service engagement, and on biological markers of disease control.…”

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…This definition is consistent with the theories of Arnett and the recent discoveries in the field of neurophysiology, which point out that prefrontal cortex continues to mature until the age of 25. 7,8 There have been several attempts to improve the transition process by increasing education and support, adjusting clinic visits, and creating teams to target the transition-age population and transfer of care. Some programs have provided both clinic-based and online support groups with access to medical providers as well as peers that focused on providing information and support to improve the transition process.…”

What does quality healthcare look like to adolescents and young adults? Ask the experts!

“…The distress and frustration from this prompted one group member to write her own self-help booklet, Wired up -a young person's manual , 14 so that other young people did not experience this. We were very supportive of the DH recommendations for preparation for transition, 7,13 and would have found these helpful. It was very scary that we did not know our doctor or how to find our way around the adult clinic and ward settings.…”

“…4,6 In addition, YAAs with chronic health conditions are reported as having low levels of educational achievement and social participation. 7 The developmental goals of this phase, and consequent changing roles and responsibilities are played out against the upheaval of a move to adult health, education and social-care systems, which places new and often greater demands on young people. Evidence also suggests that health behaviours established in adolescence persist into adult life, highlighting the importance of engaging young people in their healthcare throughout this developmental phase 8 and ensuring that services effectively meet their needs.…”