# data[].attributes.body
Adolescents are vulnerable today because they are not prepared to make the jump from parental dependency to self sufficiency.

# data[].attributes.attachment_link.readable_text
Adolescence, the period of life between childhood and adulthood, is defined by the transition from parental dependence to relative autonomy. During this time, important changes take place in the structure and workings of the brain, and in the mental abilities which underlie some of the most sophisticated human behaviours.

One of the central events of adolescence is puberty, the transition to reproductive maturity. We now know that puberty impacts not just the production of gametes, but is also associated with changes in the brain and in behaviour. Of course, adolescence is also a socio-cultural phenomenon. Across time and place, its duration varies widely, as do its "typical" behaviours. Yet studies conducted with humans and with non-human animals suggest there may be some biological commonalities of adolescence reflecting changes in brain and behaviour. By all accounts, adolescence happens for a reason.

In humans, adolescence is often characterised as a risk factor in itself, something to be managed or controlled. However, current scientific thinking highlights a series of carefully orchestrated, exquisitely sensitive neurodevelopmental changes that make adolescence a period of both vulnerability and opportunity.

This piece will discuss some of the very real risks of adolescence, such as vulnerability to mental illness, alongside the unique plasticity that allows the adolescent to flexibly adapt to changing socio-cultural demands. Finally, we will consider what can be done to support optimal adolescent development and experience.

Adolescent brain development

The human brain continues to mature throughout childhood and adolescence. In many regions of the brain, the number of connections increases sharply in the first few months and years of life, and then gradually decreases to adult levels during puberty and adolescence.1 Myelin, the fatty substance that insulates the brain's axonal conduction fibres and speeds their electrical impulses, increases with age throughout childhood and adolescence.2These changes in synapse density and myelin are thought to correspond to changes across age in the amount of grey and white matter observed using magnetic resonance imaging.

Across different regions of the brain, changes in grey and white matter take place at different rates.3,4Parts of the brain involved in basic sensory processing tend to mature early in life - prior to adolescence. Brain regions involved in higher-level mental abilities, such as language, decision-making, and high-level social understanding, continue to mature during adolescence.

Early maturation of certain brain regions responsive to reward (e.g. subcortical brain regions) and later maturation of brain regions involved in thoughtful, effortful control of behaviour (e.g. prefrontal cortex) is thought to underlie enhanced adolescent reward seeking, exploration and risk-taking.5,6 These same mechanisms may also result in adolescence being a period of enhanced flexibility in learning and adapting to new environments.7

Mental health risk and the impact of the environment

During adolescence, individuals are at their physical peak. However, relative to during childhood, individuals in adolescence are at increased risk of death and disability. This is largely due to theoretically preventable causes such as reckless behaviour and car accidents, in addition to mental illness.8 Indeed, large-scale epidemiology studies have reported that the median age of onset for a range of mental health problems is during adolescence.9,10 According to the World Health Organisation, suicide is the second leading cause of deaths in 15-29 year olds.11

Evidently, the adolescent years play a crucial role in shaping outcomes that have wide-ranging and long-lasting impacts. Importantly, a number of external and intrinsic factors act to shape the course of adolescent development, whether that development is typical or atypical. As discussed below, the developing brain is exquisitely sensitive to its environment.

Abuse and neglect

Abuse and neglect during development are associated with alterations in brain structure.12 This may increase the risk of psychiatric illnesses such as depression and borderline personality disorder in adulthood. Due to the distinct time-course of development across different regions of the brain, the impact of adversity may differ depending on its age of occurrence. In one study, childhood sexual abuse was associated with alterations in subcortical and white matter structures, whereas sexual abuse during adolescence was associated with abnormalities in late-maturing prefrontal cortex.13

Gender

Brain development shows subtle differences across gender. At puberty, some of these gender differences accentuate, and are attributed to the effects of puberty hormones on neural tissue.14 Understanding puberty-linked gender differences in brain maturation may help us to understand the gender imbalance in depression and anxiety, which first arises during adolescence.15

Cannabis
The short and long term impacts of recreational and addictive substances may differ in adolescence compared to adulthood.16 Exposure to high strength cannabis (e.g. skunk) during adolescence may be more detrimental than exposure during adulthood. In a recent study,17patients in South London presenting with first onset psychosis were more likely to have started cannabis during adolescence (<15 years) than were healthy controls.

Another finding from the above study was that, in adults, daily or weekly exposure to high strength cannabis was associated with increased risk of psychotic illness, relative to no cannabis, and relative to weaker forms of cannabis (e.g. hash). It could be beneficial for young people to be made aware of the increased risk of psychotic illness associated with the use of high strength cannabis particularly.

Puberty and nutrition

There is evidence that the age of puberty onset is dependent on both foetal and childhood nutritional intake.18Population-wide changes in nutritional status may therefore impact brain development via mechanisms related to pubertal timing. We do not yet understand the implications of early or late pubertal timing on adolescent brain development, behaviour and mental health risk. Potentially, poor nutrition in utero and during childhood could have mental health consequences many years later.

Culture and ethnicity

Intriguingly, there is evidence that aspects of brain structure may vary across culture. Such differences could potentially reflect the impact of differing linguistic and social environments on the developing brain, although the direction of causality is difficult to determine. For example, one study documented differences between Asian and Caucasian adults in late-maturing regions of the brain, such as the frontal cortex.19

Optimising adolescent development and experience

How can we make use of recent research findings to mitigate the risks of adolescence and promote well-being?

Dietary supplementation

Diet can have a profound impact on the brain and mental health, and represents one means for policy makers to effect positive change. Maternal dietary supplementation with omega-3 fatty acids during pregnancy can improve cognitive indicators of infant brain development shortly after birth.20 Studies are being conducted to evaluate whether omega-3 supplementation during adolescence may alleviate symptoms of emotional disorders.21 More generally, studies have documented a positive relationship between healthy dietary habits and mental health in adolescence, as well as the reverse, above and beyond potential confounding factors such as socioeconomic status and family conflict.22,23

Cultural inclusion

The presentation and recovery rates of many mental health problems vary widely across cultures.24 There are a number of mechanisms that might underlie this disparity, including culturally insensitive diagnostic criteria, variations in social expectations for "normal" behaviour, difficulties in access to mental health facilities, and societal stigma.25 It is important to consider variations in cultural norms when providing support to child and adolescent refugees, who have often experienced trauma and may suffer from mental health disorders.26

More research needs to be conducted outside the typical Western, white, middle class community, to obtain a more accurate picture of global mental health and to develop more inclusive provision of support and treatment worldwide.27

Positive impact of adolescent peer relationships

The impact of peer influence on adolescent risk perception and risky behaviour has been highlighted.28-30 However, peers also have an important and positive role to play for adolescents. Evidence from studies on immigration, refugee status and mental health in adolescence have converged in identifying strong social, including peer, support as a protective factor against adverse outcomes.31-33

Conclusion

Research has shed light on changes occurring during adolescence in the brain, with potential implications for understanding adolescent behaviour and mental health risk. It is our hope that this research will feed into debate on steps that can be taken to optimise adolescent development and well-being worldwide. Across borders and cultures, the provision of accessible mental health services is crucial for society's young people. As the cornerstone of our future, the world needs to provide adolescents with a solid framework of support, within which they can explore, grow and flourish.

References

Huttenlocher, P. R., De Courten, C., Garey, L. J. & Van der Loos, H. Synaptic development in human cerebral cortex. Int. J. Neurol. 16-17, 144-154 (1982).

Yakovlev, P. & Lecours, A. in Regional Development of the Brain in Early Life (ed. Minkowski, A.) 3-70. (Blackwell Scientific, 1967).

Houston, S. M., Herting, M. M. & Sowell, E. R. in The Neurobiology of Childhood (eds. Andersen, S. L. & Pine, D. S.) 3-17 (Springer Berlin Heidelberg, 2013). at <http://link.springer.com/chapter/10.1007/7854_2013_265>

Brain development during childhood and adolescence: a longitudinal MRI study. Nat. Neurosci. 2, 861-862 (1999).

Steinberg, L. A Social Neuroscience Perspective on Adolescent Risk-Taking. Dev. Rev. DR 28, 78-106 (2008).

Casey, B. J., Jones, R. M. & Hare, T. A. The adolescent brain. Ann. N. Y. Acad. Sci. 1124, 111-126 (2008).

Crone, E. A. & Dahl, R. E. Understanding adolescence as a period of social-affective engagement and goal flexibility. Nat. Rev. Neurosci. 13, 636-650 (2012).

L. Kann & et al. Youth Risk Behavior Surveillance - United States, 2013. Surveill. Summ. June 13, 2014 / 63(SS04);1-168, (2014).

Ormel, J. et al. Mental health in Dutch adolescents: a TRAILS report on prevalence, severity, age of onset, continuity and co-morbidity of DSM disorders. Psychol. Med. 1-16 (2014). doi:10.1017/S0033291714001469

Gregory, A. M. et al. Juvenile mental health histories of adults with anxiety disorders. Am. J. Psychiatry 164, 301-308 (2007).

WHO | Preventing suicide: A global imperative. WHO at <http://www.who.int/mental_health/suicide-prevention/world_report_2014/en/>

The neurobiological consequences of early stress and childhood maltreatment. Neurosci. Biobehav. Rev. 27, 33-44 (2003).

Andersen, S. L. et al. Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development. J. Neuropsychiatry Clin. Neurosci. 20, 292-301 (2008).

Blakemore, S.-J., Burnett, S. & Dahl, R. E. The role of puberty in the developing adolescent brain. Hum. Brain Mapp. 31, 926-933 (2010).

Satterthwaite, T. D. et al. Impact of puberty on the evolution of cerebral perfusion during adolescence. Proc. Natl. Acad. Sci. 111, 8643-8648 (2014).

(W. W. Norton, 2010).

Proportion of patients in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psychiatry 2, 233-238 (2015).

Gluckman, P. D. & Hanson, M. A. Changing times: the evolution of puberty. Mol. Cell. Endocrinol. 254-255, 26-31 (2006).

Tang, Y. et al. The Construction of a Chinese MRI Brain Atlas: A Morphometric Comparison Study between Chinese and Caucasian Cohorts. NeuroImage 51, 33-41 (2010).

Innis, S. M. Dietary omega 3 fatty acids and the developing brain. Brain Res. 1237, 35-43 (2008).

Clayton, E. H. et al. Reduced mania and depression in juvenile bipolar disorder associated with long-chain ω-3 polyunsaturated fatty acid supplementation. Eur. J. Clin. Nutr. 63, 1037-1040 (2009).

Jacka, F. N., Sacks, G., Berk, M. & Allender, S. Food policies for physical and mental health. BMC Psychiatry 14, 132 (2014).

Jacka, F. N. et al. Associations between diet quality and depressed mood in adolescents: results from the Australian Healthy Neighbourhoods Study. Aust. N. Z. J. Psychiatry 44, 435-442 (2010).

Demyttenaere, K. et al. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291, 2581-2590 (2004).

Fernando, S. Mental Health, Race and Culture. (Palgrave Macmillan, 2010).

Fazel, M., Reed, R. V., Panter-Brick, C. & Stein, A. Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. The Lancet 379, 266-282 (2012).

Norbury, C. F. & Sparks, A. Difference or disorder? Cultural issues in understanding neurodevelopmental disorders. Dev. Psychol. 49, 45-58 (2013).

Gifford-Smith, M., Dodge, K. A., Dishion, T. J. & McCord, J. Peer Influence in Children and Adolescents: Crossing the Bridge from Developmental to Intervention Science. J. Abnorm. Child Psychol. 33, 255-265 (2005).

Gardner, M. & Steinberg, L. Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: an experimental study. Dev. Psychol. 41, 625-635 (2005).

Knoll, L. J., Magis-Weinberg, L., Speekenbrink, M. & Blakemore, S.-J. Social Influence on Risk Perception During Adolescence. Psychol. Sci. 0956797615569578 (2015). doi:10.1177/0956797615569578

C. A. Vaughan, Foshee, V. A. & Ennett, S. T. Protective Effects of Maternal and Peer Support on Depressive Symptoms during Adolescence - Springer. J. Abnorm. Child Psychol. (2009). doi:10.1007/s10802-009-9362-9

Sujoldzić, A., Peternel, L., Kulenović, T. & Terzić, R. Social determinants of health--a comparative study of Bosnian adolescents in different cultural contexts. Coll. Antropol. 30, 703-711 (2006).

Young, J. F., Berenson, K., Cohen, P. & Garcia, J. The Role of Parent and Peer Support in Predicting Adolescent Depression: A Longitudinal Community Study. J. Res. Adolesc. 15, 407-423 (2005).

# data[].attributes.attachment_link.title
The adolescent brain: vulnerability and opportunity

# data[].attributes.attachment_link.description
Adolescence, the period of life between childhood and adulthood, is defined by the transition from parental dependence to relative autonomy. During this time, important changes take place in the structure and workings of the brain, and in the mental abilities which underlie some of the most sophisticated human behaviours.

# data[].attributes.body
"The final lines are barely audible.
'Here your dreams are sweet and tomorrow brings the true
Here is the place where I love you.'" (Collins 235).

Katniss refuses to leave Prim alone to die. This scene triggers her irritability with the Capitol. She promised to finish the song for Rue, so she can go peacefully. And as she hears her cannon fire, she becomes defiant in following the Capitol's rules and becoming a pawn in their games.

# data[].attributes.body
"I can almost hear Haymitch groaning as I team up with this wispy child. But I want her. Because she's a survivor, and I trust her, and why not admit it? She reminds me of Prim." (Collins 201).

The comparison from Katniss about Rue and Prim brings her peace. She has something to keep her going. She chooses not to underestimate Rue and realizes she's fast and quiet. She was her first real ally, and friend, when in the Games. They taught each other things and it helped Katniss stay alive.

# data[].attributes.body
"Almost all of the boys and at least half of the girls are bigger than I am, even though many of the tributes have never been fed properly. You can see it in their bones, their skin, the hollow look in their eyes." (Collins 94).

This begs the question of how people can even have a fair chance at all. If the Capitol wants the games to be somewhat interesting, everyone should start on the same level. This relates to how our society today has lived through many tough things, some on line on poverty. The government continues to make things difficult which only worsens their situations.

# data[].attributes.body
"I want to do something, right here, right now, to shame them, to make them accountable, to show the Capitol that whatever they do or force us to do there is a part of every tribute they can't own.The Rue was more than a piece in their Games. And so am I. A few steps into the woods grows a bank of wildflowers. Perhaps they are really weeds of some sort, but they have blossoms in beautiful shades of violet and yellow and white. I gather up an armful and come back to Rue's side. Slowly, One stem at a time, I decorate her body in the flowers. Covering the ugly wound. Wreathing her face. Weaving her hair with bright colors."
(Collins 236- 237)
This quote helps show the importance of humanity within the book, The Hunger Games. It shows how Katniss responded to Rue's death and how she starts to show her rebellion towards the Capitol. She creates a "service" in a way to show her love/ friendship with Rue and how much she cared for her, knowing that the Capitol would show it and warm the hearts of many citizens in the districts and the Capitol.

# data[].attributes.body
"I loosen the top of the pouch and pour a few spoonfuls of berries in to his palm. Then I fill my own. "On the count of three?" Peeta leans down and kisses me once, very gently. "The count of three," he says. We stand, our back pressed together, our empty hands locked tight. "Hold them out. I want everyone to see," he says. I spread out my fingers, and the dark berries glisten in the sun. I give Peeta's hand one last squeeze as a signal, as a good-bye, and we begin counting. "One." Maybe I'm wrong. "Two." Maybe they don't care if we both die. "Three!" It's too late to change my mind. I lift my hand to my mouth, taking one last look at the world. The berries have just passed my lips when the trumpets begin to blare. The frantic voice of Claudius Templesmith shouts above them. "Stop! Stop! Ladies and gentlemen, I am pleased to present the victors of the Seventy- fourth Hunger Games, Katniss Everdeen and Peeta Mellark! I give you -- the tributes of District Twelve!"" (Collins 344- 345)
This quote help shows rebellion because Katniss thinks that if her and Peeta can't be victors together then they can't have a victor at all. Katniss shows her rebellion toward The Capitol by making them change the rules of the Hunger Games, from having one victor to two. She saved her and Peeta's life and I don't think she is going to stop there.

# data[].attributes.body
The connection between poverty and the districts

# data[].attributes.attachment_link.title
Analysis | How rising inequality hurts everyone, even the rich

# data[].attributes.attachment_link.description
Over the past 40 or so years, the American economy has been funneling wealth and income, reverse Robin Hood-style, from the pockets of the bottom 99 percent to the coffers of the top 1 percent. The total transfer, to the richest from everyone else, amounts to 10 percent of national income and 15 percent of national wealth.

# data[].attributes.body
""Why don't we just kill him now and get it over with?" "Let him tag along. Whats the harm? And he's handy with that knife." Is he? That's news. What a lot of interesting things I'm learning about my friend Peeta today. "Besides, he's our best chance of finding her." It takes me a moment to register that the "her" they're referring to is me.

The career tributes are only using Peeta. Right now, they are going to use him to find Katniss and when they do and kill her, they will kill him too. They only want to win but are playing nice for now.

# data[].attributes.body
'"They call it hot chocolate," says Peeta. "It's good.'" (Collins 55).

Katniss and Peeta get invited to big breakfasts, some foods including things they've never heard of or tried before. This shows how little the people in the outer branches of the Capitol get to eat. This relates to society today because many people struggle to put food on the table and sometimes go days without being able to eat. Others have lavish meals and never go to bed hungry.

# data[].attributes.body
"They do surgery in the Capitol, to make people appear younger and thinner. In District 12, looking old is something of an achievement since so many people die early. You see an elderly person, you want to congratulate them on their longevity, ask the secret of survival. A plump person is envied because they aren't scraping by like the majority of us. But here it is  different. Wrinkles aren't desirable. A round belly isn't a sign of success." (Collins 124-125)

Today we think that if we are fat then we aren't desirable. We look up to people that aren't us and can't make ourselves into them. If we try to make ourselves into them it can be detrimental to us. In the end making us think less of ourselves and our body image.

# data[].attributes.body
"He tells the history of Panem, the country that rose up out of ashes of a place that was once called North America. He lists the disasters, the droughts, the storms, the fires, the encroaching seas that swallowed up so much of the land, the brutal war for what little sustenance remained" (Collins 18).

This is related to how our world was created. People from Britain came over and fought with people who were already here: Native Americans, French, and Spaniards. They experienced different areas of the country, some hotter or colder than others. They battled for their independence from their government just as the 13 colonies do from the Capitol.

# data[].attributes.body
""Prim!" The strangled cry come out of my throat, and my muscles begin to move again. "Prim!" I don't need to shove through the crowd. The other kids make way immediately allowing me a straight path to the stage. I reach her just as she is about to mount the steps. With one sweep of my arm, I push her behind me. "I volunteer!" I gasp. "I volunteer as tribute!" (Collins 22)
This quote help shows how much Katniss cares and is willing to risk for her sister, Prim. At the reaping the pick the girl tribute first, when Katniss hears her sisters name called she goes a little crazy. She runs to catch her and in doing so, she takes her spot as tribute. Katniss is putting her life on the line so that her sister can stay alive  and help her mother.