The teen brain: insights from neuroimaging

Mechanisms involved in the neurotoxic, cognitive, and neurobehavioral effects of alcohol consumption during adolescence

Studies over the last decade demonstrate that adolescence is a brain maturation period from childhood to adulthood. Plastic and dynamic processes drive adolescent brain development, creating flexibility that allows the brain to refine itself, specialize, and sharpen its functions for specific demands. Maturing connections enable increased communication among brain regions, allowing greater integration and complexity. Compelling evidence has shown that the developing brain is vulnerable to the damaging effects of ethanol. It is possible to infer, therefore, that alcohol exposure during the critical adolescent developmental stages could disrupt the brain plasticity and maturation processes, resulting in behavioral and cognitive deficits. Recent neuroimaging studies have provided evidence of the impact of human adolescent drinking in brain structure and functions. Findings in experimental animals have also given new insight into the potential mechanisms of the toxic effects of ethanol on both adolescent brain maturation and the short- and long-term cognitive consequences of adolescent drinking. Adolescence is also characterized by the rapid maturation of brain systems mediating reward and by changes in the secretion of stress-related hormones, events that might participate in the increasing in anxiety and the initiation pattern of alcohol and drug consumption. Studies in human adolescents demonstrate that drinking at early ages can enhance the likelihood of developing alcohol-related problems. Experimental evidence suggests that early exposure to alcohol sensitizes the neurocircuitry of addiction and affects chromatin remodeling, events that could induce abnormal plasticity in reward-related learning processes that contribute to adolescents' vulnerability to drug addiction. In this article, we review the potential mechanisms by which ethanol impacts brain development and lead to brain impairments and cognitive and behavioral dysfunctions as well as the neurobiological and neurochemical processes underlying the adolescent-specific vulnerability to drug addiction.

Heritability of risk-taking in adolescence: a longitudinal twin study

Adolescents are prone to risk-taking behaviors leading to adverse consequences such as substance abuse, accidents, violence, and victimization. However, little is known about the contribution of genetic and environmental factors to individual differences in the propensity for risk-taking. This study investigated developmental changes, longitudinal stability, and heritability of risk-taking using data from 752 adolescent twins including 169 MZ and 203 DZ pairs. The Balloon Analogue Risk Task (BART), an experimental behavioral measure of risk taking, was administered to the twins at age 12 and then re-administered to a part of this sample at age 14. Risk-taking increased with age, but individual differences showed a significant longitudinal stability. Genetic model fitting showed that at age 12, heritability of risk-taking was modest but significant in both sexes, whereas at age 14, heritability increased to 55% in males and became nonsignificant in females. The findings suggest that propensity for risk-taking as measured by BART can be a useful endophenotype for genetic studies of adolescent externalizing psychopathology, however, the utility of this measure may be limited by sex differences in heritability.

Alterations of resting state functional connectivity in the default network in adolescents with autism spectrum disorders

Autism spectrum disorders (ASD) are associated with disturbances of neural connectivity. Functional connectivity between neural structures is typically examined within the context of a cognitive task, but also exists in the absence of a task (i.e., "rest"). Connectivity during rest is particularly active in a set of structures called the default network, which includes the posterior cingulate cortex (PCC), retrosplenial cortex, lateral parietal cortex/angular gyrus, medial prefrontal cortex, superior frontal gyrus, temporal lobe, and parahippocampal gyrus. We previously reported that adults with ASD relative to controls show areas of stronger and weaker connectivity within the default network. The objective of the present study was to examine the default network in adolescents with ASD. Sixteen adolescents with ASD and 15 controls participated in a functional MRI study. Functional connectivity was examined between a PCC seed and other areas of the default network. Both groups showed connectivity in the default network. Relative to controls, adolescents with ASD showed widespread weaker connectivity in nine of the eleven areas of the default network. Moreover, an analysis of symptom severity indicated that poorer social skills and increases in restricted and repetitive behaviors and interests correlated with weaker connectivity, whereas poorer verbal and non-verbal communication correlated with stronger connectivity in multiple areas of the default network. These findings indicate that adolescents with ASD show weaker connectivity in the default network than previously reported in adults with ASD. The findings also show that weaker connectivity within the default network is associated with specific impairments in ASD.

Progressive temporal lobe grey matter loss in adolescents with schizotypal traits and mild intellectual impairment

Adolescents with mild intellectual impairment are known to have an increased risk of schizophrenia compared to the general population. However, little is known regarding the association between potential risk markers for later schizophrenia within this population. We therefore set out to examine the association between schizotypal traits and progressive grey matter loss in adolescents with mild intellectual impairment. Ninety-eight adolescents receiving educational assistance were divided into two groups based on their degree of schizotypal features, measured using the Structured Interview for Schizotypy (SIS). Each participant received two structural magnetic resonance imaging scans approximately 16 months apart. Changes over time in the voxel-wise presentation of tissue were evaluated using tensor based morphometry. Those with marked schizotypal features exhibited significantly greater grey matter losses in the left medial temporal lobe than those without. Three focal locations were identified, two within the left amygdala and one in the left parahippocampal gyrus. Thus, adolescents with cognitive impairment and schizotypal features show changes in brain structure over time, changes that are consistent with those identified in other high risk populations. Medial temporal grey matter loss may therefore represent a common neuroanatomical substrate of risk for schizophrenia, common to familial, prodromal and cognitive high risk groups.

Neuromaturation and Adolescent Risk Taking: Why Development Is Not Determinism

In the January 2009 issue of this journal, Males argues that adolescent brain science perpetuates the “myth of adolescent risk taking.” He contends that those who study adolescent neuromaturation are biological determinists who ignore the profound social and environmental forces that influence adolescent behavior to further their own agendas. Males mischaracterizes developmental research and misinterprets public health data. This article analyzes his argument and provides a response based on the evidence. There is significant cross-species evidence that adolescence serves an important developmental function on the road to full maturation and is not merely an oppressive social construction. Research on neuromaturation can help elucidate both the vulnerabilities and tremendous potential of the adolescent brain. It also provides the opportunity to examine the role of social environments in shaping developmental processes and to explore how reasoned understandings of adolescent brain and biological development are being used to inform interventions that scaffold adolescent vulnerabilities.

Invited commentary: understanding brain mechanisms of pain processing in adolescents' non-suicidal self-injury

Whereas non-suicidal self injury (NSSI) is reported in 13-23% of adolescents and is an increasingly studied topic, there has been little investigation into the pathophysiology behind self-injury. This commentary examines recent research into pain and emotional distress to discuss implications for the manner we should understand, research, and treat NSSI in the future. Research indicates that adolescents may be particularly vulnerable to NSSI behaviors due to neurodevelopmental changes in the processing of distress and pain. Additionally, emotional distress and physical pain neural pathways may have been altered in these individuals, leading to the development of NSSI behaviors during adolescence when changes in ongoing brain development may lead to further emotional dysregulation and poor impulse control. Further studies that directly characterize the relationship between emotional distress and physical pain in adolescence, as well as the neural differences between self-injurers and non-self-injurers, are needed.

Heterogeneity in subcortical brain development: A structural magnetic resonance imaging study of brain maturation from 8 to 30 years

Brain development during late childhood and adolescence is characterized by decreases in gray matter (GM) and increases in white matter (WM) and ventricular volume. The dynamic nature of development across different structures is, however, not well understood, and the present magnetic resonance imaging study took advantage of a whole-brain segmentation approach to describe the developmental trajectories of 16 neuroanatomical volumes in the same sample of children, adolescents, and young adults (n = 171; range, 8-30 years). The cerebral cortex, cerebral WM, caudate, putamen, pallidum, accumbens area, hippocampus, amygdala, thalamus, brainstem, cerebellar GM, cerebellar WM, lateral ventricles, inferior lateral ventricles, third ventricle, and fourth ventricle were studied. The cerebral cortex was further analyzed in terms of lobar thickness and surface area. The results revealed substantial heterogeneity in developmental trajectories. GM decreased nonlinearly in the cerebral cortex and linearly in the caudate, putamen, pallidum, accumbens, and cerebellar GM, whereas the amygdala and hippocampus showed slight, nonlinear increases in GM volume. WM increased nonlinearly in both the cerebrum and cerebellum, with an earlier maturation in cerebellar WM. In addition to similarities in developmental trajectories within subcortical regions, our results also point to differences between structures within the same regions: among the basal ganglia, the caudate showed a weaker relationship with age than the putamen and pallidum, and in the cerebellum, differences were found between GM and WM development. These results emphasize the importance of studying a wide range of structural variables in the same sample, for a broader understanding of brain developmental principles.

Is activity regulation of late myelination a plastic mechanism in the human nervous system?

Studies on various animal models have established that neuronal activity can influence the myelination process. Are such mechanisms present in humans, and do they mediate experience-driven white matter plasticity not only during early development but also in adolescents and adults? While there is as yet no direct evidence for this, a number of findings - reviewed here - are consistent with this idea. First, postmortem and neuroimaging studies show that the human white matter development is a protracted process that continues well into adulthood. Second, developmental changes and individual differences in white matter structure are related to differences in neural activity and behavior. Finally, studies on effects of long-term training, in particular in musicians, show strong relations between training and white matter structure. I conclude by briefly discussing possible types of white matter plasticity that could underlie these findings, emphasizing a distinction between indirect myelination plasticity, where the myelin sheath grows in parallel with the axon itself, and direct myelination plasticity, where the myelin sheath thickness is modulated independently of axonal diameter.

Developmental effects of aggressive behavior in male adolescents assessed with structural and functional brain imaging

Aggressive behavior is common during adolescence. Although aggression-related functional changes in the ventromedial prefrontal cortex (vmPFC) and frontopolar cortex (FPC) have been reported in adults, the neural correlates of aggressive behavior in adolescents, particularly in the context of structural neurodevelopment, are obscure. We used functional and structural magnetic resonance imaging (MRI) to measure the blood oxygenation level-depended signal and cortical thickness. In a block-designed experiment, 14-17-year old adolescents imagined aggressive and non-aggressive interactions with a peer. We show reduced vmPFC activation associated with imagined aggressive behavior as well as enhanced aggression-related activation and cortical thinning in the FPC with increasing age. Changes in FPC activation were also associated with judgments of the severity of aggressive acts. Reduced vmPFC activation was associated with greater aggression indicating its normal function is to exert inhibitory control over aggressive impulses. Concurrent FPC activation likely reflects foresight of harmful consequences that result from aggressive acts. The correlation of age-dependent activation changes and cortical thinning demonstrates ongoing maturation of the FPC during adolescence towards a refinement of social and cognitive information processing that can potentially facilitate mature social behavior in aggressive contexts.

Adolescent maturity and the brain: the promise and pitfalls of neuroscience research in adolescent health policy

Longitudinal neuroimaging studies demonstrate that the adolescent brain continues to mature well into the 20s. This has prompted intense interest in linking neuromaturation to maturity of judgment. Public policy is struggling to keep up with burgeoning interest in cognitive neuroscience and neuroimaging. However, empirical evidence linking neurodevelopmental processes and adolescent real-world behavior remains sparse. Nonetheless, adolescent brain development research is already shaping public policy debates about when individuals should be considered mature for policy purposes. With this in mind, in this article we summarize what is known about adolescent brain development and what remains unknown, as well as what neuroscience can and cannot tell us about the adolescent brain and behavior. We suggest that a conceptual framework that situates brain science in the broader context of adolescent developmental research would help to facilitate research-to-policy translation. Furthermore, although contemporary discussions of adolescent maturity and the brain often use a deficit-based approach, there is enormous opportunity for brain science to illuminate the great strengths and potentialities of the adolescent brain. So, too, can this information inform policies that promote adolescent health and well-being.

Interactive food and beverage marketing: targeting adolescents in the digital age

Because of their avid use of new media and their increased spending power, adolescents have become primary targets of a new "Media and Marketing Ecosystem." Digital media resonate particularly well with many of the fundamental developmental tasks of adolescence by enabling instantaneous and constant contact with peers, providing opportunities for self-expression, identity exploration, and social interaction, and facilitating mobility and independence. Six key features of interactive media--ubiquitous connectivity, personalization, peer-to-peer networking, engagement, immersion, and content creation--are emblematic of the ways in which young people are both shaping and being shaped by this new digital culture. The advertising industry, in many instances led by food and beverage marketers, is purposefully exploiting the special relationship that teenagers have with new media, with online marketing campaigns that create unprecedented intimacies between adolescents and the brands and products that now literally surround them. Major food and beverage companies, including Coca-Cola, McDonald's, Burger King, and Kentucky Fried Chicken (KFC), have incorporated these elements into their interactive marketing strategies, posing particular risks to adolescents, who are not being addressed in the current U.S. policy and self-regulatory regimens. However, recent and emerging neuroscience and psychological research on adolescents suggests a need to revisit the traditional approach to regulation of advertising. Despite the growth of interactive marketing, academic research on the impact of digital advertising on children and youth remains underdeveloped. Additional research and policy initiatives are needed to address the growing health threat facing youth in the digital marketplace.

Adolescent engagement in dangerous behaviors is associated with increased white matter maturity of frontal cortex

BACKGROUND

Myelination of white matter in the brain continues throughout adolescence and early adulthood. This cortical immaturity has been suggested as a potential cause of dangerous and impulsive behaviors in adolescence.

METHODOLOGY/PRINCIPAL FINDINGS

We tested this hypothesis in a group of healthy adolescents, age 12-18 (N = 91), who underwent diffusion tensor imaging (DTI) to delineate cortical white matter tracts. As a measure of real-world risk taking, participants completed the Adolescent Risk Questionnaire (ARQ) which measures engagement in dangerous activities. After adjusting for age-related changes in both DTI and ARQ, engagement in dangerous behaviors was found to be positively correlated with fractional anisotropy and negatively correlated with transverse diffusivity in frontal white matter tracts, indicative of increased myelination and/or density of fibers (ages 14-18, N = 60).

CONCLUSIONS/SIGNIFICANCE

The direction of correlation suggests that rather than having immature cortices, adolescents who engage in dangerous activities have frontal white matter tracts that are more adult in form than their more conservative peers.

Pubertal timing, friend smoking, and substance use in adolescent girls

The influence of friend substance use on the association between pubertal timing and substance use has received little consideration in the literature. With a sample of 264 female adolescents (11-17 years), this study examined (a) the relationship between pubertal timing and substance use, (b) the impact of number of friends that smoke cigarettes on adolescents' use of three substances (cigarettes, alcohol, and marijuana), and (c) the interactions between pubertal timing and friends' smoking in predicting individual substance use. Results showed a significant relationship between pubertal timing and alcohol use; later timing was related to more alcohol use. This association between late timing and alcohol use is contrary to previous literature and may be due to the broad age range of this sample. Pubertal timing may have less of an effect in late adolescence when drinking becomes more normative and less deviant; the rationale for this association is discussed. Second, this study found females who reported that more of their friends smoke regularly (at least once a week) used significantly more cigarettes, alcohol, and marijuana than those who reported no friends who smoke. Finally, the interaction between pubertal timing and number of friends who were regular smokers was not significantly related to adolescent substance use. However, friend smoking explained more of the variation in substance use than pubertal timing. This indicates that having friends who smoke is more influential in predicting substance use than pubertal timing. These findings are important when considering the development of interventions to target adolescent substance use.

Gender differences in factors influencing alcohol use and drinking progression among adolescents

While prevalence rates for alcohol use and related disorders differ widely between adult men and women, male and female adolescents do not exhibit the same disparity in alcohol consumption. Previous research and reviews do not address the emergence of differences in drinking patterns that occur during late adolescence. Therefore, a developmental perspective is presented for understanding how various risk and protective factors associated with problematic drinking affect diverging alcohol trajectories as youth move into young adulthood. This review examines factors associated with risk for developing an alcohol use disorder in adolescent girls and boys separately. Findings indicate that certain biological (i.e., genetic risk, neurological abnormalities associated with P300 amplitudes) and psychosocial (i.e., impact of positive drinking expectancies, personality characteristics, and deviance proneness) factors appear to impact boys and girls similarly. In contrast, physiological and social changes particular to adolescence appear to differentially affect boys and girls as they transition into adulthood. Specifically, boys begin to manifest a constellation of factors that place them at greater risk for disruptive drinking: low response to alcohol, later maturation in brain structures and executive function, greater estimates of perceived peer alcohol use, and socialization into traditional gender roles. On an individual level, interventions which challenge media-driven stereotypes of gender roles while simultaneously reinforcing personal values are suggested as a way to strengthen adolescent autonomy in terms of healthy drinking decisions. Moreover, parents and schools must improve consistency in rules and consequences regarding teen drinking across gender to avoid mixed messages about acceptable alcohol use for boys and girls.

Development of large-scale functional brain networks in children

Large-scale rewiring of brain circuits in children leads to emergence of hierarchical organization in the mature adult brain.

The ontogeny of large-scale functional organization of the human brain is not well understood. Here we use network analysis of intrinsic functional connectivity to characterize the organization of brain networks in 23 children (ages 7–9 y) and 22 young-adults (ages 19–22 y). Comparison of network properties, including path-length, clustering-coefficient, hierarchy, and regional connectivity, revealed that although children and young-adults' brains have similar “small-world” organization at the global level, they differ significantly in hierarchical organization and interregional connectivity. We found that subcortical areas were more strongly connected with primary sensory, association, and paralimbic areas in children, whereas young-adults showed stronger cortico-cortical connectivity between paralimbic, limbic, and association areas. Further, combined analysis of functional connectivity with wiring distance measures derived from white-matter fiber tracking revealed that the development of large-scale brain networks is characterized by weakening of short-range functional connectivity and strengthening of long-range functional connectivity. Importantly, our findings show that the dynamic process of over-connectivity followed by pruning, which rewires connectivity at the neuronal level, also operates at the systems level, helping to reconfigure and rebalance subcortical and paralimbic connectivity in the developing brain. Our study demonstrates the usefulness of network analysis of brain connectivity to elucidate key principles underlying functional brain maturation, paving the way for novel studies of disrupted brain connectivity in neurodevelopmental disorders such as autism.

The disruption of normal brain organization in humans is believed to underlie a number of behavioral conditions, such as autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD). To gain insight into how normal brain organization develops, we mapped functional brain connectivity in children and young adults, and used a network analysis to characterize and compare the organization of brain networks. Comparison of network properties revealed that while children and young adults' brains have similar organization at the global level, there were several key differences in connectivity. For example, children's brains had less of a hierarchical organization than young-adults. Most importantly, we show that the dynamic process of over-connectivity followed by pruning, which rewires connectivity at the neuronal level, also operates at the systems level, reconfiguring and rebalancing subcortical and paralimbic connectivity in the developing brain. Our findings demonstrate the utility of using network analyses of multimodal brain connectivity to study maturation of brain circuits, and suggest new avenues for future research on neurodevelopmental disorders such as ASD and ADHD.

Increased apoptosis and reduced neuronal and glial densities in the hippocampus due to nicotine and ethanol exposure in adolescent mice

It has been recently shown that nicotine and ethanol interact during adolescence affecting memory/learning and anxiety levels. Considering the role of the hippocampus in both anxiety and memory/learning, we investigated whether adolescent nicotine and/or ethanol administration elicit apoptotic cell death and whether this results in neuronal and/or glial density alterations in the following regions of the hippocampus: granular layer of the dentate gyrus (GrDG), molecular layer (Mol), CA1, CA2 and CA3. From the 30th to the 45th postnatal day, C57BL/6 male and female mice were exposed to nicotine free base (NIC) and/or ethanol (ETOH). Four groups were analyzed: (1) concomitant NIC (50mug/ml in 2% saccharin to drink) and ETOH (25%, 2g/kg i.p. injected every other day) exposure; (2) NIC exposure; (3) ETOH exposure; (4) vehicle. We evaluated cell degeneration (TUNEL assay), neuronal and glial densities (optical disector) and region thicknesses at the end of the period of exposure. Our results demonstrate that ETOH elicited an increase in TUNEL-positive cells relative to the vehicle group in all hippocampal regions. NIC elicited less severe region-dependent effects: the number of TUNEL-positive cells was significantly increased in the Mol and CA1 when compared to the vehicle group. These results were paralleled by reductions in neuronal and glial cells densities, which indicate that both cell types are sensitive to the neurotoxic effects of these drugs. There were no effects on region thicknesses. On the other hand, concomitant NIC and ETOH reduced the adverse effects of the drugs when administered separately. This ability of nicotine and ethanol co-exposure to lessen the adverse effects of nicotine and ethanol may contribute to adolescents co-use and co-abuse of tobacco and alcoholic beverages.

Peculiar response to methylphenidate in adolescent compared to adult rats: a phMRI study

RATIONALE

Adolescent rodents differ markedly from adults in several neuro-behavioural parameters. Moreover, 'paradoxical' responses to psychostimulants have been reported at this age.

OBJECTIVES

Thus, we investigated the responses of adolescent (post-natal day, PND, 34 to 43) and adult (PND >60) Sprague-Dawley male rats to the psychostimulant drug methylphenidate (MPH). We used pharmacological magnetic resonance imaging (phMRI) performed at 4.7 T under isoflurane anaesthesia. Following anatomical MRI, axial gradient echo images were collected continuously. After baseline recording (32 min), animals received MPH (0 or 4 mg/kg i.p.) and were recorded for further 32 min.

RESULTS

Region-specific changes in the blood-oxygenation level dependent (BOLD) signal were evident as a function of age. As expected, among adults MPH induced an increase of BOLD signal in nucleus accumbens (NAcc) and prefrontal cortex (PFC), with no effects in the hippocampus (Hip). Notably, among adolescents, MPH induced a marked and generalised decrease of BOLD signal, which occurred earlier in NAcc and PFC whilst being delayed in the Hip. Any bias in BOLD responses was excluded by the measurement of physiological parameters.

CONCLUSIONS

The present findings highlight the utility of phMRI in animal models. The peculiar negative BOLD effect found in adolescent rats may be suggestive of a reduced cerebro-vascular feedback and/or an increased MPH-induced neuronal activation. Data are relevant for a better understanding of brain/behavioural regulation during adolescent development. Moreover, a greater understanding of the differences between adult and adolescent drug responses will aid in the development of a more appropriate age-specific treatment strategy.

Hitting a moving target: Basic mechanisms of recovery from acquired developmental brain injury

Acquired brain injuries represent a major cause of disability in the pediatric population. Understanding responses to developmental acquired brain injuries requires knowledge of the neurobiology of normal development, age-at-injury effects and experience-dependent neuroplasticity. In the developing brain, full recovery cannot be considered as a return to the premorbid baseline, since ongoing maturation means that cerebral functioning in normal individuals will continue to advance. Thus, the recovering immature brain has to 'hit a moving target' to achieve full functional recovery, defined as parity with age-matched uninjured peers. This review will discuss the consequences of developmental injuries such as focal lesions, diffuse hypoxia and traumatic brain injury (TBI). Underlying cellular and physiological mechanisms relevant to age-at-injury effects will be described in considerable detail, including but not limited to alterations in neurotransmission, connectivity/network functioning, the extracellular matrix, response to oxidative stress and changes in cerebral metabolism. Finally, mechanisms of experience-dependent plasticity will be reviewed in conjunction with their effects on neural repair and recovery.

Repeated alcohol administration during adolescence causes changes in the mesolimbic dopaminergic and glutamatergic systems and promotes alcohol intake in the adult rat

Adolescence is a developmental period which the risk of drug and alcohol abuse increases. Since mesolimbic dopaminergic system undergoes developmental changes during adolescence, and this system is involved in rewarding effects of drugs of abuse, we addressed the hypothesis that ethanol exposure during juvenile/adolescent period over-activates mesolimbic dopaminergic system inducing adaptations which can trigger long-term enduring behavioural effects of alcohol abuse. We treated juvenile/adolescent or adult rats with ethanol (3 g/kg) for two-consecutive days at 48-h intervals over 14-day period. Here we show that intermittent ethanol treatment during the juvenile/adolescence period alters subsequent ethanol intake. In vivo microdialysis demonstrates that ethanol elicits a similar prolonged dopamine response in the nucleus accumbens of both adolescent and adult animals pre-treated with multiple doses of ethanol, although the basal dopamine levels were higher in ethanol-treated adolescents than in adult-treated animals. Repeated ethanol administration also down-regulates the expression of DRD2 and NMDAR2B phosphorylation in prefrontal cortex of adolescent animals, but not of adult rats. Finally, ethanol treatment during adolescence changes the acetylation of histones H3 and H4 in frontal cortex, nucleus accumbens and striatum, suggesting chromatin remodelling changes. In summary, our findings demonstrate the sensitivity of adolescent brain to ethanol effects on dopaminergic and glutamatergic neurotransmission, and suggest that abnormal plasticity in reward-related processes and epigenetic mechanisms could contribute to the vulnerability of adolescents to alcohol addiction.

Adolescent Transition to Adult Care in Solid Organ Transplantation: a consensus conference report

Transition of care from pediatric to adult-oriented health care providers is difficult for children with special health care needs. Children who have received solid organ transplants and their providers experience the same difficulties and frustrations as children with other major illnesses. A consensus conference was organized by several transplant organizations to identify major issues in this area and recommend possible approaches to easing the process of transition for solid organ transplant recipients. This report summarizes the discussions and recommendations.

Evaluating the negative or valuing the positive? Neural mechanisms supporting feedback-based learning across development

How children learn from positive and negative performance feedback lies at the foundation of successful learning and is therefore of great importance for educational practice. In this study, we used functional magnetic resonance imaging (fMRI) to examine the neural developmental changes related to feedback-based learning when performing a rule search and application task. Behavioral results from three age groups (8-9, 11-13, and 18-25 years of age) demonstrated that, compared with adults, 8- to 9-year-old children performed disproportionally more inaccurately after receiving negative feedback relative to positive feedback. Additionally, imaging data pointed toward a qualitative difference in how children and adults use performance feedback. That is, dorsolateral prefrontal cortex and superior parietal cortex were more active after negative feedback for adults, but after positive feedback for children (8-9 years of age). For 11- to 13-year-olds, these regions did not show differential feedback sensitivity, suggesting that the transition occurs around this age. Pre-supplementary motor area/anterior cingulate cortex, in contrast, was more active after negative feedback in both 11- to 13-year-olds and adults, but not 8- to 9-year-olds. Together, the current data show that cognitive control areas are differentially engaged during feedback-based learning across development. Adults engage these regions after signals of response adjustment (i.e., negative feedback). Young children engage these regions after signals of response continuation (i.e., positive feedback). The neural activation patterns found in 11- to 13-year-olds indicate a transition around this age toward an increased influence of negative feedback on performance adjustment. This is the first developmental fMRI study to compare qualitative changes in brain activation during feedback learning across distinct stages of development.