This lecture is given at the Weekend Course on Pediatric Endocrinology & Adolescent Medicine Seminar in Auditorium Nuclear, HUSM. It highlights the fact that adolescents’ brain generally complete myelination of the frontal lobe and prefrontal areas at 18-20 years. Essentially, neurons undergo huge spurt of growth and connectivity around the age of 7-11. Then selective pruning takes place (at 11 years and above) sculpting away excess neurons and connectivity, maintaining the frequently used cells. The fact that myelination process completes at the frontal lobe around the age of 18-20 explains why adolescents (age: 15-18) are generally poor at planning, reasoning, organizing, setting goal and priority, engaging in multitasking and problem solving (these are basically the function of the frontal lobe).

Metaforically, adolescents will only function like a newly bought Toyota when generalize myelination of the brain occur, thus allow more efficient operation to happen.

Their mindset start to move from concrete to abstract and hypothetical thinking. They become more idealistic, develop more empathy and concern for others. This changes happen because the completeness of myelination process moves from temporo-parietal to the frontal cortex. As temporo-parietal areas are more concern with movement, sense, speech and concrete thinking whereas frontal lobe are dealing with abstract thinking.

What we see in term of emotional control is the predominant of amydala (which serve for fight-flight reaction) over cerebral prefrontal cortex. As a result, they are fast to act before reflect.

Generally, the main concern in adolescence years are (i) failure to organize and taking rational action, (ii) taking risky and high reward behavior and (iii) tendency to stay late night and morning lay-in.

You need to study the role of ventral striatum (reward center) in addictive behavior and peneal body in the secretion of melatonin late at night in adolescents to understand this phenomena. This lead to a behavior known as invincible fable that is a myth that nothing would happen to him/her and if it does happen, his/her experience is just unique to him/her alone.

I would argue that the solution to adolescents’ dilemma is to equip them with 6C namely Competence, Confidence, Connections, Character, Caring and Compassion through a comprehensive training that built the brain capacity according to their developmental level, capitalize their skills and minimize the risk taking behavior.

Till we meet again, have a nice day.

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