Risks and rewards in adolescent decision-making

A cognitive-computational account of mood swings in adolescence

Teenagers have a reputation for being fickle, in both their choices and their moods. This variability may help adolescents as they begin to independently navigate novel environments. Recently, however, adolescent moodiness has also been linked to psychopathology. Here, we consider adolescents' mood swings from a novel computational perspective, grounded in reinforcement learning (RL). This model proposes that mood is determined by surprises about outcomes in the environment, and how much we learn from these surprises. It additionally suggests that mood biases learning and choice in a bidirectional manner. Integrating independent lines of research, we sketch a cognitive-computational account of how adolescents' mood, learning, and choice dynamics influence each other, with implications for normative and psychopathological development.

Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury

PURPOSE

This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2).

METHODS

At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level.

RESULTS

By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04).

CONCLUSION

Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Goal-directed learning in adolescence: neurocognitive development and contextual influences

Adolescence is a time during which we transition to independence, explore new activities and begin pursuit of major life goals. Goal-directed learning, in which we learn to perform actions that enable us to obtain desired outcomes, is central to many of these processes. Currently, our understanding of goal-directed learning in adolescence is itself in a state of transition, with the scientific community grappling with inconsistent results. When we examine metrics of goal-directed learning through the second decade of life, we find that many studies agree there are steady gains in performance in the teenage years, but others report that adolescent goal-directed learning is already adult-like, and some find adolescents can outperform adults. To explain the current variability in results, sophisticated experimental designs are being applied to test learning in different contexts. There is also increasing recognition that individuals of different ages and in different states will draw on different neurocognitive systems to support goal-directed learning. Through adoption of more nuanced approaches, we can be better prepared to recognize and harness adolescent strengths and to decipher the purpose (or goals) of adolescence itself.

Lessons Learned From COVID-19 Lockdown: An ASPED/MENA Study on Lifestyle Changes and Quality of Life During Ramadan Fasting in Children and Adolescents Living With Type 1 Diabetes

Background

Lockdown was a unique experience that affected many aspects of life, particularly during the challenge of Ramadan fasting (RF). Studying this can increase understanding of the effects of lifestyle changes on quality of life (QoL) for children with type 1 diabetes (T1D) during RF.

Methods

A cross-sectional study that assessed the effect of lockdown on lifestyle and QoL on fasting children living with T1D during Ramadan in the Middle East and North Africa region (2020-2021). We compared the child (self) and parent (proxy) reports using PEDQoL v3.0 disease specific questionnaire during lockdown and non-lockdown periods, and assessed correlations with lifestyle changes using regression and gap analyses.

Results

A total of 998 reports from 499 children with T1D aged 8 to 18 years (study = 276, control = 223), and their parents during RF in lockdown and non-lockdown periods. Fathers were more involved in their children's care during lockdown (P = .019). Patients had better compliance with treatment (P = .002), a reversed sleep pattern (P = .033), increased food intake (P ⩽ .001), and less exercise (P < .001). Children and parents perceived better QoL during lockdown (P ⩽.001) with no differences between their reports in "Diabetes Symptoms", "Treatment Adherence," and "Communication" domains. Self and proxy reports were different in all domains during non-lockdown (P = <.001-.009). In gap analysis, although not statistically significant, the gap was approximated between children's and parents' perceptions in all domains during lockdown.

Conclusion

COVID-19 lockdown had a positive impact on QoL of children living with T1D during RF, possibly due to lifestyle changes and superior psychosocial family dynamics.

Consequences of adolescent drug use

Substance use in adolescence is a known risk factor for the development of neuropsychiatric and substance use disorders in adulthood. This is in part due to the fact that critical aspects of brain development occur during adolescence, which can be altered by drug use. Despite concerted efforts to educate youth about the potential negative consequences of substance use, initiation remains common amongst adolescents world-wide. Additionally, though there has been substantial research on the topic, many questions remain about the predictors and the consequences of adolescent drug use. In the following review, we will highlight some of the most recent literature on the neurobiological and behavioral effects of adolescent drug use in rodents, non-human primates, and humans, with a specific focus on alcohol, cannabis, nicotine, and the interactions between these substances. Overall, consumption of these substances during adolescence can produce long-lasting changes across a variety of structures and networks which can have enduring effects on behavior, emotion, and cognition.