Talking To Teens: Expert Tips for Parenting Teenagers

Andy:
I've just read this book Born to Be Wild: Why Teens Take Risks, and How We Can Help Keep Them Safe. And I'm super excited about it. It speaks to us here because I love kind of using science to help people think about things in a new way. And this topic especially of why teens just kind of go crazy for a few years is something that a lot of our listeners are very interested and keen to solve. So can you talk a little about how you got interested in this topic yourself and got to the point where you're writing this 250 page well-researched book on it?

Dr. Jess:
Sure, sure. Thanks for first of all having me on your show and happy to talk with you. I got interested in teenagers, I think, as a teenager myself. I always had an understanding, maybe because I'm the youngest of five kids, maybe because of the family I grew up in our constitution. I don't know what, but in some way I was always interested in the change that I was going through. I knew that the feelings that I had were not how I'd felt before and I imagined that one day I wouldn't quite feel this way or this intensely. And I understood that as a teenager as I watched people around me struggle with things, as I watched myself struggle with things. We have a name for that in psychiatry, we call it pseudo maturity. This idea that you're kind of a little beyond your years, but you're not really because you're still a kid.

Dr. Jess:
And I think it's a defense and I think I had a little bit of that defense. I think partly because as a youngest of five I had seen my siblings have some struggles, whether it was the drugs or sex or breaking rules. And so I was connected to that. I also saw some of my peers having major struggles so it was always just in my mind. And as I aged, I went to medical school late. I was 29 when I started med school, but I was very interested in adolescents from the beginning. And the field is either going to be pediatrics or child adolescent psychiatry and I chose the latter because you get more time with people. Because fewer people do it, the need is greater because the problems are so profound and so deep.

Dr. Jess:
And as I got into that, I found that amongst the population of people I like working with it's really about 10 to 30 years of age that there's so many changes that happen during those two decades, which are greater than those that came before and those that come after. That I just thought this is an area that I really want to understand more deeply. And that's, I guess, the genesis of the background for me.

Andy:
Yeah, the possibilities for change are so huge during that time. It's really exciting.

Dr. Jess:
Yeah. And so then my work has led in one way or another towards that direction. I developed a program at the college at NYU that teaches about mental health studies and that's become a big part of what I do. I've taken on mostly adolescent patients in my ... and by adolescent, I really mean say 12, 13, 10 to 30 years of age, but young adults adolescents. I have developed programs in that area, trained doctors to work with those people. So writing the book was really an outgrowth of all that I'd been learning.

Dr. Jess:
And as I learned more to prepare myself better clinically and as a teacher, I thought there's a lot here that I wasn't taught in my training that I'm learning now as I go and there's a way to share this. And it's not that things that I said in the book haven't been said elsewhere, but I tried to ... and some of them haven't been shared elsewhere, honestly, in terms of research. But I tried to make the focus on risk because risk is such an area that we all struggle with as teens and as parents and teachers managing teens. So I felt like that needed a really fine point on it. And so I wanted to take all that. research that had been done and look at it through that lens.

Andy:
I read everything about teenagers that I can find and have read tons of books on it. We've had all these people on the podcast and there's stuff in here that I didn't know and you go into all these specific changes that are happening in the teenage brain. Whereas a lot of people kind of hand wave at like, "Oh, there's these big changes happening in the teenage brain which caused these things to happen." But you really spell it out and go into specific neurotransmitters and hormones and what they do and how it's changing in the teenage brain and how it's different from both childhood and adulthood. But you do it in a way that's not academic-y boring. You've got stories and it's engaging and it's fun and it challenges kind of the way that most people think about adolescents and about how this period work. And one of the big things early on in the book is this idea of invincibility, this theory that the reason teenagers engage in all of this crazy risk taking is because they think they're invincible. And so why do they think they're invincible and how does that work?

Dr. Jess:
So the invincibility thing is a lesson that most of us who are over the age of 35 or 40 and who trained in mental health got about adolescents. We got the message in our training for 50 years, 60 years now that adolescents must think that they're invincible. Otherwise who would drive drunk? Who would have sex without a condom? Who would whatever? Jump off a bridge into the river? I mean, who would think to do something like that? They must be not only impulsive, but they must think that they're not going to get harmed. And so what the research in this area shows is around 20 years ago when people actually sat down and said, "Hey, what do you really think about risk as a 15 year old or a 17 year old?" Instead of assuming what adults think.

Dr. Jess:
Do you think you're invincible? What adolescents said was not that they think they're invincible, but in fact that they think that they're really vulnerable even more vulnerable than at other times of life. So when you talk to adolescents about the risk of pregnancy from one time unprotected sex or the risk of transmission of HIV or the risk of dying from cancer or the risk of whatever, what you find is that they have numbers that are really, really high. Hundreds of percent higher than they actually are. The young people believe the risk of pregnancy is 90, 95% from one time unprotected sex, but it's nothing near that level. Young people think that the risk of HIV transmission is 75, 80, 90%, but it is nowhere near that level. So the reason I bring that up early in the book is to make the point that it's not because they think they're invincible that they engage in risk.

Dr. Jess:
And I think that if you think that they think they're invincible, then the strategies that you come up with to address risk are teaching them again and again that they are vulnerable. That, "The risk of this is really high. The risk of that is really high. Don't you see? Don't you understand?" And we start addressing these things cognitively, but in fact all the strategies that we have developed where we teach people again and again about risk, there's a certain saturation. It's good to know that a condom protects you from pregnancy and STDs, but there's only a certain point at which that that lesson is valuable. After that it's just noise in the air and so it stops being a helpful message and we put all of our efforts into an area that isn't effective.

Dr. Jess:
Now, I want to give a caveat here and I want to say that some people do think they're invincible and some people do have what we call an optimistic bias. They think, "Well bad things will happen, but they won't happen to me." But the issue here at play is that when you talk to adults about these very same risks, "What's the likelihood of you getting hurt? Or, "What's the likelihood of you getting a divorce as an adult?" Or you dying at a certain age, what have you. Adults actually are just as fanciful in their impressions. They think they are just as invincible as adolescents in other words. And in fact in many studies adults think they're more invincible and maybe that's a product of living longer and being successful.

Dr. Jess:
But the lesson from that is that it's not invincibility that causes adolescents to take risks. And so I start the book with that chapter because what I really want to emphasize is that adolescents aren't doing this because they think they're all that. They're not jumping off of a bridge into the water below or having unprotected sex because they're thumbing their nose at the parents and the teachers and society. It's for other reasons, and those other reasons come later in the book, but it's not because they think they're invincible.

Andy:
And yeah you have this great story of asking your daughter these questions and being like, "So just quick quiz. What do you think if you were to have unprotected sex, what would the likelihood be that you get pregnant?" She's like, "Oh, maybe 90%. And you're like, "Well, do I tell her that the true number is less than that?" And you have this kind of moment of conflict because as a parent it's like, "Well, thinking that it's higher than it really is. Maybe that's not a bad thing." But so I think that's based on kind of this way of thinking about why teenagers engage in risk that you kind of dismantled through this book that's really interesting. But so then the question of course that leaves us with is if they really believe that 90% chance of getting pregnant every time they have unprotected sex, then why would they ever engage in that activity?

Dr. Jess:
Exactly. I think I mentioned this in the book. A student says to me that the risk of getting pregnant from one time unprotected intercourse is 95%, but for me it's a 100% because I have bad luck.

Andy:
Yeah, I actually highlighted that in the book. I thought that was so great.

Dr. Jess:
So I think that's really common. And I think that it begs the question just as you're saying Andy. So if they really think it's 90%, 95%, 100%, why would you ever have unprotected sex? What are you thinking? And again this brings up then the next handful of chapters in the book which are really articulating the reasons as to what we understand now. So they take risks in spite of the fact, not because of the fact, but in spite of the fact that they believe that they're highly vulnerable.

Andy:
And so one part of the explanation lies in dopamine and the idea of prediction error, which kind of you explain by thinking about M&M's. And the idea that when you eat an M&M, for the very first time you ever eat an M&M it just blows your mind how delicious it is and there's this huge mismatch that occurs between your expectations of looking at this little round thing and then putting it in your mouth and realizing how good it really is. That when those things occur, and especially it can note some sort of a survival value, there's a high caloric content here. There's high energy and that is like, "Ding, ding, ding, ding," in your dopamine system. And so I think that's such a perfect example, but also so many of those things are happening during the teenage years where it's their first time doing so much stuff. And then you also kind of point out it's then the perfect storm so.

Dr. Jess:
That's a great thing to talk about for a second. So remember what's happening in adolescence developmentally, people are going from child to adult. And evolutionarily speaking it happens quite quickly, there's puberty and within a couple of years of hitting puberty you are reproductively viable. And historically, evolutionarily, our species was having babies at 14, 15, 16 and that's what our bodies are still designed to do. It's only 10,000 years ago that we're sort of living that way. So physical evolution takes longer than that so we're essentially still living in a modern day with a body that is designed to be on the Savannah with a lot of people dying at a young age, a lot of people dying of childbirth. We better have babies quickly so we're driven for that.

Dr. Jess:
And dopamine, many people think of dopamine as a neurochemical of pleasure. What it really is is a neurochemical of potential pleasure. The idea that this may feel good and feeling good matters. I say it's a neurochemical of potential pleasure, but really what its neurochemical job is is to help us stay alive. It's to teach us things. So if it tastes good, if it feels good, if it might feel good, do it and do it a lot. And if it doesn't protect you, don't do it. And that's what dopamine is there for. So certain foods tastes good, certain foods or non-food items taste really bad. We don't eat poop. Why? It tastes really bad. If poop tasted good people would eat it. What is it about our evolutionary mechanism that has taught us that? Well, it's dangerous to eat poop, people get sick when they eat poop, so you don't eat poop so it tastes bad. Other things tastes good.

Dr. Jess:
Sex feels good. If sex didn't feel good, there's no way anyone would ever think about putting a penis in a vagina. It's just totally like, "What are you thinking? I mean, that's insane." Except for that it feels good and so then we started to do it and then by God, babies are made and so these things drive us. And dopamine is in higher amounts in our brains during adolescence than any other time of life. So things don't just feel good, they feel outrageously good.

Andy:
Whoa. They're great!

Dr. Jess:
There you go. It's like, "Ding, ding, ding, ding," as you said.

Dr. Jess:
So they're driven to do behaviors in part neurochemically by the huge amounts of dopamine they have. Think about the roller coaster rides that kids like, think about the horror movies that teenagers like. These things that really stimulate you, they're into at that age because dopamine is begging the question. And they're learning from all these things so in the event that you have an M&M or you snort a line of cocaine and you get this really high level of dopamine, your body is a little tricked thinking like, "Oh, there's something really valuable here. I have to get into this more. I got to eat more chocolate. I got to do more cocaine. I got to have more sex." So there's an element of dopamine that is at play in why people take risk.

Andy:
You write on page 49 that things will never feel this good again. Likewise, bad experiences may never again feel this bad. As adults dopamine is shared better between our emotional centers and our prefrontal cortex and these parts of the brain are much better connected, which allows the CEO to have a much bigger impact on the emotional brain. All of which allows adults to take more time, act less impulsively, and be more thoughtful when making decisions that present an element of risk. So it's kind of like these freeways open up a little more that just allow it to communicate. It's like it gets upgraded from the dial up internet to the fiber optic or is in way better control of what's going on down there a little bit or ability to respond as emotional.

Dr. Jess:
Yeah, and the learning during these years is really profound. So if you're traumatized during your teenage years or you have an experience that's bad, just like if you have an experience that's good, you're really likely to remember it during this time. So you find people really having long lasting trauma that sometimes happens during these years or also just setting up life patterns. If you saw the tiger and the tiger scared you or you almost got eaten by the tiger, you may really stay away from that place forever. And that happens to some degree in childhood, but even more and more as you age into adolescence and so people develop these patterns.

Andy:
And then kind of incorporate that into your sense of identity and those flashbulb incidents into your personal narrative of even like, "Oh, well I was pretty cocky as a kid. But then I had this incident with a tiger and I really realized that you have to be prepared before you go out on any, whatever you have to be prepared." And so now I always do this, this, and this.

Dr. Jess:
That's right. Those things are harder to unlearn as you get older. So I give the example of being on my bicycle at 14 and getting hit by a motorcycle. And I still have in my mind as I say it right now that flashbulb memory, like you said. I have the picture, I see myself sitting on the fender of that motorcycle and I hear the girl scream and I feel the glass breaking against my leg. And it's just like, "Boom, that will," and then the next picture is me rolling over 20 feet away on the ... rolling over many times on the railroad tracks that were right there. That flashbulb memory taught me, even though I thought I had looked, I guess I hadn't. And so the looking left, looking left right left, that's in my head now and that has stayed with me. It's harder to unlearn those things once you've had some sort of a big traumatic reaction or negative event as well in those years.

Andy:
So the reason is because we, I guess, have this kind of perfect storm of things going on in the brain. And there's a really increased level of plasticity during that time where we can kind of learn those profound things that really changed how we see who we are in the world and how we want to be. And something interesting that you brought up in the book is the idea that this period of adolescence is kind of extending. People keep talking about how there's this emerging adulthood now and it kind of actually doesn't end at 18 anymore, it ends in the 20s and well maybe early 30s.

Andy:
You kind of point out actually that there's some real benefit to that because it gives us a much longer period of being in that plasticity and being able to kind of experiment and try things out. Obviously it's like anything, there's a cost to it in terms of that we're not just jumping right into the workforce. So there's a delay in producing and contributing to the economy maybe, but at the same time there's such a value to that period of additional growth. So I don't know. Yeah. I thought that was really interesting. It's something for parents to think about when you're kind of thinking like, "Man, I wish my kid would just hurry up and grow up a little bit."

Dr. Jess:
Yeah. I think it's mixed. I think that there's a real value for people to find their path at a pace that makes sense for them. That doesn't mean that people should go to college and move home and do nothing and sit in the basement and work part time at Starbucks and smoke a lot of weed. That's not what I'm advocating for, but I am advocating for an understanding that the average age of medical students who start medical school in this country is 25 not 22. And that there's a range and that the average age of law students, I don't know what it is, but it's not 22 either. The idea that it's good to take some time and it's good to have a little bit of an opportunity to figure out what you really want to do because a lot of people are unhappy when they enter and are regimented from the beginning.

Dr. Jess:
Some people aren't unhappy with that and some people do very well with that and they know exactly what they've wanted since they were five years of age and it works out beautifully for them. And other people, similarly, can get derailed by having too much lack of structure. So I think that it varies for different people, but the reality is what we've learned is that the brain is mostly set up by 23, but really as late as 26 even 30 years of age there are still brain changes going on that are significant of growth towards a more adult kind of mindset. So there's an opportunity during those years to not have to shut everything down, but to continue our growth, continue our learning, pick up new hobbies, pick up new interests, explore things, do some travel. And it's gotten easier to do some of that in the world so I think it's a real opportunity for people. And I think it's a way that we're going to ultimately solve some problems by people having more exposures as opposed to fewer.