This document discusses how to understand teenage behavior and effectively communicate with teenagers. It explains that teenage behavior is influenced by genetics, brain development, environment, sleep, nutrition, and mood. The author recommends that parents model appropriate expression of emotions, provide structure and accountability, and engage local resources and specialists to assist with parenting teenagers.

1. “How To Talk to Your Teenager”
The Psychiatry Behind What Makes Teens Act Out
Desiderio Pina, MD, MPH
Chief, Medical Staff
Chief, Psychiatry
Adjunct Associate Clinical Professor,
University of Notre Dame
Associate Clinical Professor,
Indiana University, School of Medicine
September 16, 2010
6:00 pm - 7:30 pm

2. What is Madison Center?
With its original roots established in 1949 --
Madison Center is a not for-profit organization that
provides specialty behavioral medicine services in
St. Joseph and surrounding counties in northern
Indiana and southwestern Michigan.

3. Who am I?
 I am a son (and was once a teenager - the wife might say I still am)
 I am a dad and a step-dad (raised/raising 6 kids)
 I am a husband
 I am a veteran (Operations Enduring & Iraqi Freedom)
 I am a public health specialist
 I am a physician/medical doctor
 I am a physician-executive
– a medical doctor who has experience & training in administration
 I am a psychiatrist
– a physician whose medical specialty is the study of the brain & behavior
– and illnesses that affect & change the brain & behavior
 I am a teacher/lecturer at the medical school (IU-SOM-SB) and the
university (ND) and have been a researcher
 I am the new chief doc at here at Madison Center

4. What are we here to ‘talk’ about
 The Good... The Bad… & The Ugly
 So, What’s “normal” anyway?
 Teens… Can’t live with ‘em….
 So, what’s a “teen” anyway?
 Vat two doo?
4  What should you NOT do

5. Hey...Check this out...
“Your heart, lungs, kidneys and digestive tract
keep you alive.
But your brain is where YOU live.”
- Michael C. Miller, MD
Editor in Chief,
Harvard Mental Health Letter

6. A sign of the…. TIME
THE GOOD
THE BAD
THE UGLY

7. How about this...
“All mental processes, even the most
complex psychological processes, derive
from operations of the brain”
Eric Kandel,
Nobel-Prize winning
Psychiatrist/Neuroscientist
(got the prize for discovering
how long term memory works)

8. Normal?
8

9.  But my kid is SPECIAL/DIFFERENT doc!
9

10. Some Kids are just REALLY different
10

11. Ever see this guy’s movie?
 “There is only one cardinal rule:
One must always listen to the
patient. “
— Oliver Sacks
Neurologist/Neuroscientist/Author/Screenwriter
(Author of ‘Awakenings’ -later turned into a movie)
Quoted by Walter Clemons, 'Listening to the Lost',
Newsweek (20 Aug 1984).
11

12. “Uhhh...huh-hu-huh. he said.. ‘Oh - mee - bahh’... That sounds cool, huh-hu-huh”
“The mind arises from an array of
mindlessness, billions of linked cells, each
one alone no smarter than an amoeba.”
- Michael C. Miller, MD
Editor in Chief,
Harvard Mental Health Letter

13.  Amoeba?… Teenagers...Ah…..
I SEE WHERE YOUR GOING NOW!
13

14. Teenagers:
(mounds of gelatinous flesh, moving, eating, pooping, resting and trying to replicate)
14

15. but...These are Teenagers Too
15

16. How do we get ‘Here’ from ‘There’
16

17. How do we get...
HERE
Complex behavior,
choreographed, purposeful
movement that some would
consider culture, beautiful, ugly,
obscene, modern, art,
embarrassing, dance, expression,
communication
17

18. From ‘There’:
FIGURE 16
CEREBRAL HEMISPHERES VI - MEDIAL VIEW
~ 3 lbs of gelatinous/
fatty flesh
(remember- with
cells individually no
smarter than an
amoeba)
18

19. 19

20. Current theories
are that WE get HERE from THERE do we
get ‘Here’ from ‘There’
?
20

21. The Good, The Bad & The Ugly
 How to understand it all:
– Genetics
– Mom, Dad and both (ie empathy vs morality)
– Anatomy/Physiology
– (Neuro)Development
(why don't babies hold their head up @ birth?)
 Pregnancy, birth (what went right & what didn't)
 Milestones
 What is age-appropriate and what isn't
– Environment
 Home, bed, school, position on the Socioeconomic
scale and birth order?
(1st, 2nd, 3rd), adopted? (or not), immigrant? (or not),
brain injuries? Our cultural beliefs?
– Nutrition
 maternal (prior to conception), fetal, infant, current
21

22. 22

23. LAPSE OF ATTENTION - by the way...
What do...
 ‘Strong Women’
 An American Psychologist
 The polygraph test
 And Comic Books
Have in common?
23 (YELL IT OUT IT IF YOU KNOW THE ANSWER)

24. 24

25. NOW THAT I HAVE YOUR ATTENTION AGAIN...AND THE SOME ARE MORE AWAKE...
SOME common problems
 Sleep
 Nutrition
 Moodiness/
– Mood Instability/Poor Impulse Control
 Drama
25

26. Sleep
During Sleep our brains engage in:
– Data analysis
– Consolidation of the day’s events/stimuli (DATA)
– Strengthening of memories
– SOLVING PROBLEMS

27. Hey did you now…
In 1865 Dr Friedrich Kekulé had a strange dream:
– He imagined a Ouroboros or Uroborus (a snake biting its
own tail

28. The Ouroboros or Uroborus[1] is an ancient symbol depicting a
serpent or dragon swallowing its own tail and forming a
circle.The Ouroboros often represents self-reflexivity or
cyclicality, especially in the sense of something constantly re-
creating itself, the eternal return, and other things perceived as
cycles that begin anew as soon as they end.

29. 29

30. Eating Habits
Skipping Meals!?
No gas in tank ...aint gonna go far
(especially in a fast revving ferrari)
What the heck is that your eating!?
(Salami, peanutbutter, marshmello, cheezit milkshake?!)
Did your mom make that for you? Can I have some?
What do you mean your hungry...it’s 330 in
the morning!? Why are you making another milkshake?
Can I have some? Don’t tell your mother.
What do you mean your NOT hungry...you
have to eat dinner with the family!?

31. Moodiness
Moodiness ≠ Depression
Moodiness ≠ Psychosis
Moodiness ≠ Drugs
Moodiness ≠ Menarche
(about to start her monthly visitor? NO! DAD?!
Yuck...MOM, dad is talking crazy talk again)
Moodiness ≠ ADD/ADHD
Moodiness ≠ Bad/evil/possessed
Moodiness = need for investigation/discussion
(by supervising adult)

32. DRAMA
 Genetics (apple..falling...tree?)
 Neurobiology and anatomical development
 Group/Social Dynamics
 ALL = MATURITY
– Give choices
– ENABLE responsibility
– HOLD accountable for actions
– Recognize individuality, resiliance, self-reliance &
confidence
32 – BE CONSISTANT

33. The Frontal Lobes...ooh... scary
33

34. Do’s & Dont’s: GIRLS
 Model and promote expression of feelings in appropriate
ways (all or nothing; Cliques) and relationships
 MOMS (& dads): your daughters are NOT your
girlfriends...avoid ruminating about worries and excessive
sharing...keep your boundaries
 Avoid sending messages that imply boys can be more
trusted with independence than girls
 Try and understand the dynamics of arguments/fights
between moms/daughters as a teen’s attempt to gain
validation “I am not you mom...I am different”
 Nurturing time from fathers is paramount - not just activity
time (in-spite of awkwardness, reluctance)
34  Provide appropriate outlets (JOB, sports)

35. Do’s & Dont’s: BOYS
 Model and promote expression of feelings in
appropriate ways - including relationships
 Limit images (games, movies) of violence,
aggression, and degrading portrayals of women
 Don’t criticize or make fun for crying or showing
emotion or being vulnerable
 Nurturing time from fathers is paramount (ALSO)-
not just activity time
 Accept rambunctiousness but discourage hyper-
masculinity and encourage the development of
empathy and therefore (hopefully) later morality
35  Provide appropriate outlets (JOB, sports)

36. Summary
 Genetics + Environment = NOT destiny
 Just DO IT (DO SOMETHING) --->
– U R the PARENT… NIKE! (“just do it”)
 Take advantage of your (local) resources
– Enlist the whole family (friends/clergy/teachers etc)
– Embrace individuality but with DEMAND/REQUIRE
accountability
– Look to specialists and don’t let old stigmas stop you
from seeking professional help/an opinion when
36 needed