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Scott Webb (Host): Those of us with teenagers know they can be emotional and confusing at times. And a lot of that has to do with their brains not being fully developed and here today to help us understand our teens' brains and how we can support them during this time is Dr. Aileen Puno, a pediatrician with the Franciscan physician network.

Scott Webb (Host): This is the Franciscan Health Doc Pod. I'm Scott Webb. So, Doctor, thanks so much for your time today. I have two teens, myself, you know, we were talking off the air. You've got a couple of teens. I've got a couple of teens. So, this is a bit of a loaded question, but we'll start here. What is going on with teen brains?

Aileen Puno, MD: Oh, we all know that teens are going through rapid growth spurts. I think the biggest thing you're going to see is more of the physical changes. Them getting taller and, you know, sizing up and all that. But what we're probably seeing is that their brains are also growing, it's maturing. Their brains will grow at different rates for girls and usually will reach the biggest size around 11 years old. And then for boys, they're closer to 14. So, even if their brains may be done growing in terms of size, their actual development or maturity are not done until their mid to late twenties actually into adulthood, if you think about it,

Host: That's really interesting. You know, you think of maybe teens as being fully developed by the time maybe they finish high school, but as you're saying, it's really more into their twenties. So, let's talk about that. What are the critical periods of development for teens?

Dr. Puno: There are two critical areas of development. And those are on two different parts of the brain. You've probably heard of the prefrontal cortex and that's the area of the brain that sits right behind the eyes or kind of more of the front part of your brain. And scientists believe that this is the area of the brain that plays a very crucial part in regulating mood, attention, impulse control, and just the ability to think in a more abstractly way of thinking what consequences will happen with this behavior that I portrayed. And this part of the brain is actually not fully mature until about, they say 24 years old. And this is based on brain scans of typical teens. And then another part of the brain is called the amygdala, which is a kind of a small walnut shaped structure that sits deeper in our, in the teen's brain. And it's that part of the brain that is thought to play a part in controlling emotions sometimes there's aggression and responses based on just pure instinct.

Host: You mentioned about abstract thinking skills. So, do teens have new thinking skills? Do they have the ability to think in the abstract the way you're mentioning?

Dr. Puno: During the teens, they said they are transitioning. So, from a child who is thinking in more of a concrete way, and with this type of reasoning, based on what a person can see, can hear or feel to transitioning during the teen years to more abstract thinking. And this abstract thinking is kind of more the ability to be able to plan ahead or, you know, check my behavior and see if it affects other people or does it have any consequences? So the teen period is really a transition from like the concrete thinking to more abstract thinking. And again, these are things that are still developing during the teen years. They're not fully developed until adulthood.

Host: Yeah, and you and I were talking before we got started here, and I was mentioning my 17 year old. It's something I'm working on with him is getting him to understand that his actions cause reactions and beginning to maybe understand how the dominoes fall. If I do this, then that kind of thing and he's any starting to get it at 17, which is great. But as you say, there's still a ways to go and parents need to be understanding of that. And something I'm sure that all parents of teens have dealt with is tantrums. I have a 13 year old daughter. Uh, so I am familiar with this, how are teen tantrums just like toddler tantrums, Doctor?

Dr. Puno: Yeah, I think that the biggest similarity is that they're at the moment. They're an impulse. They're really not thinking of the consequences. It's more about feeling the moment. And there's a disconnect between the teen's decision making center, which is like I mentioned our prefrontal cortex versus that part of our emotions. So, the disconnect between the thinking skills and the emotional part of the brain is usually what leads to tantrums or I guess, just having these emotional outbursts and having maybe some aggression. So, they're really not thinking at the moment. And actually, if you ask them once they're done with this tantrum, if you're asking them, like, what were you thinking? And they certainly were not thinking there was this more feeling that moment or feeling that experience.

Host: Doctor, this leads to a natural question, uh, right in this area here. Why are teens so emotional and why are they so focused on themselves?

Dr. Puno: Teens are, you know, daily they have a lot of challenges and pressures and stress and temptations, especially with nowadays their social media. So they have these challenges, but they don't have the fully mature brain to deal with it. And that's why they end up having these tantrums or there's this kind of more - just very emotional.

Host: Yeah, they are very emotional, as you say, there are a lot of challenges for all of us, but especially for teens right now, whether it's, you know, virtual learning and, uh, sort of being isolated from their friends and kind of dealing with things through social media. There's a lot going on there and all of us parents, we're just trying to be understanding and help them through this period as best we can. And one of the concerns I think that all parents have is it seems like teens are more likely to take risks than adults. And if that's true doctor, why is that?

Dr. Puno: That is definitely true. They are more likely to take risks and a big part of that is because of their prefrontal cortex. Again, it's not fully developed. That's an area of the brain that is responsible for being able to plan, being able to control impulses, being able to prioritize like which one's more important, which ones can I do later? So that's part of the brain is still developing. So they're more likely to take risks again, not really thinking through their behavior, they are just kind of feeling the moment and responding to the moment.

Host: I think the difficulty for all of us parents is how do we react to the decisions that teens make, to their tantrums, to the changes going on in their brains and their bodies as difficult as it is for them to deal with all these changes, it's equally difficult for us. So, how do we deal? How do we react to all these changes going on with our kiddos?

Dr. Puno: I think the first thing is for us parents or guardians is to provide a nurturing home, a nurturing environment. A lot of these things really not their fault or they're wanting to do, but it's just a consequence of their brain developing. So, I think that's the big thing is making sure that we provide them with a home that is nurturing, which means there is, you know, there's love, there's support in the home.

And then the second thing that we can do is taking the time to understand their brains, kind of what we're doing right now. Learning how their brains develop and at what stage do we expect it to be fully developed Being able to understand how their brains develop helps us understand their behavior as well. And then the other thing we can do is when our teen is having these tantrums or is just, you know, having these outbursts, we can help them slow down. They do have a functioning brain, maybe it's not fully developed, but if it's functioning, it can definitely acquire skills. So, our role as parents is to just help them slow down and help them think through something that they may have done that, you know, made they've had some negative consequences.

So kind of going, okay, this is a behavior that we did or that you did. Like what steps can we do to either change it or what steps can we do to correct it. So, just helping them build those skills are definitely going to be helpful. And then another thing that we can also help is helping teens focus on a future. I think having a plan like after high school, having a dream, having something to work for it definitely a good thing it's helps them be able to one before it does something and then two, kind of think through more of their behavior at this present time as it relates to their future. And then other things that we can also help them with is just reminding them to have like good nutrition, good sleep and you know, finding ways to relax themselves. If they're there a lot of challenges in that I think providing that environment is very helpful as well. And then I think the very last one is be alert for any warning signs, if there are any red flags that you're seeing, then definitely call for help if need be, but just be on the lookout for that as well.

Host: Yeah, that's all such great advice. And I think all of us parents can relate to it. And the thing that I try to do, try to remind myself is to really listen to my teens, to my kids, really listen to them, put my phone down, stop looking at my laptop, you know? Yeah, I have my work to do, but when they do want to talk to me is just making time for that and really listening to them and not judging, and not always trying to fix everything. Sometimes as, you know, Doctor, they just want someone to listen to them. Right?

Dr. Puno: That's true. That's true. I'm going to helping them as you're listening kind of they're seeing if they're looking for advice or they're just looking for support kind of, and then providing that to them in whatever way they feel more supported.

Host: Yeah, that's great. Just being a good parent just doing whatever we can to help our kids, which is awesome. You know, Doctor, as we get close to wrapping up here. Let's talk about teens and sleep.   I mentioned my son earlier. My son sleeps more than any other human being I've ever seen in my life. I don't know how he does it. I don't know how he can stay in bed as long as he does. Yeah. He gets up for school and he works out and he does all of that, but the kid loves to sleep. So, is there something to that about teens and sleep? Do they need more sleep than adults do? Are they just capable of sleeping more? Because I can't sleep that much. I'm good, you know, maybe six, seven hours at the most. He's getting a good 10, 11, 12 hours a night and I'm hoping that's good for him. So, I guess my question is, is it?

Dr. Puno: Yeah, so that is definitely a good for him. So, teens typically should get about nine to 10 hours of sleep. So, your teen is definitely right on that, that requirement if you will. If you think about it, they are growing pretty rapidly, part of them sleeping longer is also kind of part of helping with growth. And then the other thing that is important with sleep is that the more rest or sleep that they have, when they wake up in the morning, feeling a little bit more refreshed, it's easier to pay attention. It's easier to be less impulsive and just kind of feel ready for the new challenges for the day. So, yeah, they definitely need good sleep. It definitely helps with that.

Host: Well, uh, if, if there's any benefits to sleep, my son is going to be a superstar in life because he's getting plenty. And you're so right though, like all of us, but especially with our kids, when they're well rested, they're better in school. They're better at sports. They're just better citizens around the house. You know, they're nicer to be around, which is great. Doctor, it's been so great talking to you today. We've covered a lot of ground and I think we can all identify and great to have the advice of an expert. As we wrap up here, anything else you want to tell parents about teens, their brains, their emotions. What are the takeaways for parents today?

Dr. Puno: I think the biggest takeaway is probably to understand that they are developing at their own pace. And our role as parents is to support them and to nurture them.

Host: That sounds great way to finish. Thank you so much for your time today, Doctor, your expertise, your compassion, your insight, all great. I hope this really helps parents. It definitely helped me and thank you so much and you stay well.

Dr. Puno: Thank you. I appreciate your time as well.

Host: Visit Franciscandocs.org to schedule an appointment with Dr. Puno or any other Franciscan Health Pediatrician. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.