P. Michiel Westenberg

What Motivates the Adolescent? Brain Regions Mediating Reward Sensitivity across Adolescence

The relation between brain development across adolescence and adolescent risky behavior has attracted increasing interest in recent years. It has been proposed that adolescents are hypersensitive to reward because of an imbalance in the developmental pattern followed by the striatum and prefrontal cortex. To date, it is unclear if adolescents engage in risky behavior because they overestimate potential rewards or respond more to received rewards and whether these effects occur in the absence of decisions. In this study, we used a functional magnetic resonance imaging paradigm that allowed us to dissociate effects of the anticipation, receipt, and omission of reward in 10- to 12-year-old, 14- to 15-year-old, and 18- to 23-year-old participants. We show that in anticipation of uncertain outcomes, the anterior insula is more active in adolescents compared with young adults and that the ventral striatum shows a reward-related peak in middle adolescence, whereas young adults show orbitofrontal cortex activation to omitted reward. These regions show distinct developmental trajectories. This study supports the hypothesis that adolescents are hypersensitive to reward and adds to the current literature in demonstrating that neural activation differs in adolescents even for small rewards in the absence of choice. These findings may have important implications for understanding adolescent risk-taking behavior.

A Developmental Study of Risky Decisions on the Cake Gambling Task: Age and Gender Analyses of Probability Estimation and Reward Evaluation

Decision making, or the process of choosing between competing courses of actions, is highly sensitive to age-related change, showing development throughout adolescence. In this study, we tested whether the development of decision making under risk is related to changes in risk-estimation abilities. Participants (N = 93) between ages 8–30 performed a child friendly gambling task, the Cake Gambling task, which was inspired by the Cambridge Gambling Task (Rogers et al., 1999), which has previously been shown to be sensitive to orbitofrontal cortex (OFC) damage. The task allowed comparisons of the contributions to risk perception of (1) the ability to estimate probabilities and (2) evaluate rewards. Adult performance patterns were highly similar to those found in previous reports, showing increased risk taking with increases in the probability of winning and the magnitude of potential reward. Behavioral patterns in children and adolescents did not differ from adult patterns, showing a similar ability for probability estimation and reward evaluation. These data suggest that participants 8 years and older perform like adults in a gambling task, previously shown to depend on the OFC in which all the information needed to make an advantageous decision is given on each trial and no information needs to be inferred from previous behavior. Interestingly, at all ages, females were more risk-averse than males. These results suggest that the increase in real-life risky behavior that is seen in adolescence is not a consequence of changes in risk perception abilities. The findings are discussed in relation to theories about the protracted development of the prefrontal cortex.

Interpretation bias and social anxiety in adolescents

Interpretation bias, described as the tendency to interpret social situations in a negative or threatening manner, has been widely linked to social anxiety in adult populations. This study aimed to extend research on interpretation bias to an adolescent population. Thirty-seven high socially anxious and a control group of 36 non-socially anxious adolescents rated the likelihood of different interpretations of ambiguous social and non-social situations coming to mind and which interpretation they most believed. Results showed that negative interpretations of social situations were more common in the high anxious than control group. Such negative bias could not be accounted for by high levels of negative affect. The groups did not differ as to their positive interpretations. Furthermore, there was evidence for content specificity of interpretation bias; high anxious adolescents were not more negative than control participants in their interpretations of non-social situations. Findings are discussed in relation to the adult literature and their clinical relevance is considered.

A prepared speech in front of a pre-recorded audience: Subjective, physiological, and neuroendocrine responses to the Leiden Public Speaking Task

This study describes a new public speaking protocol for youth. The main question asked whether a speech prepared at home and given in front of a pre-recorded audience creates a condition of social-evaluative threat. Findings showed that, on average, this task elicits a moderate stress response in a community sample of 83 12- to 15-year-old adolescents. During the speech, participants reported feeling more nervous and having higher heart rate and sweatiness of the hands than at baseline or recovery. Likewise, physiological (heart rate and skin conductance) and neuroendocrine (cortisol) activity were higher during the speech than at baseline or recovery. Additionally, an anticipation effect was observed: baseline levels were higher than recovery levels for most variables. Taking the anticipation and speech response together, a substantial cortisol response was observed for 55% of participants. The findings indicate that the Leiden Public Speaking Task might be particularly suited to investigate individual differences in sensitivity to social-evaluative situations.

Neural mechanisms supporting flexible performance adjustment during development

Feedback processing is crucial for successful performance adjustment following changing task demands. The present event-related fMRI study was aimed at investigating the developmental differences in brain regions associated with different aspects of feedback processing. Children age 8–11, adolescents age 14–15, and adults age 18–24 performed a rule switch task resembling the Wisconsin Card Sorting Task, and analyses focused on different types of negative and positive feedback. All age groups showed more activation in lateral orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC), and superior parietal cortex following negative relative to positive performance feedback, but the regions contributed to different aspects of feedback processing and had separable developmental trajectories. OFC was adultlike by age 8–11, whereas parietal cortex was adultlike by age 14–15. DLPFC and ACC, in contrast, were still developing after age 14–15. These findings demonstrate that changes in separable neural systems underlie developmental differences in flexible performance adjustment. Supplementary data from this study are available online at the Psychonomic Society Archive of Norms, Stimuli, and Data, atwww.psychonomic.org/archive.

Intelligence and maturity: meta-analytic evidence for the incremental and discriminant validity of Loevinger's measure of ego development.

This review examined whether Loevingers measure of personality (ego) development is equivalent to the measurement of intelligence. The authors conducted a meta-analysis of 52 correlations between ego level scores and intelligence test scores (retrieved from 42 studies involving 5,648 participants). The weighted average correlation between ego level and intelligence ranged from.20 to.34, depending on the intellectual ability assessed (e.g., verbal intelligence). Adjusting for measurement unreliability increased these values only minimally. The authors also reviewed 16 studies that examined the association between ego level and various criterion variables (e.g., aggressive behavior) after statistically controlling for the effects of intelligence. Ninety-four percent of the tests revealed significant relations between ego level and criterion variables after controlling for intelligence, indicating that ego development and intelligence are not interchangeable constructs. These findings do not support recent speculations concerning the limited value of stage models of maturity, social development, and moral reasoning.

School refusal and anxiety in adolescence: Non-randomized trial of a developmentally sensitive cognitive behavioral therapy

The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social anxiety disorder was the most common disorder among adolescents still meeting anxiety disorder criteria at follow-up. Treatment modifications to improve efficacy for school-refusing adolescents presenting with social anxiety disorder are suggested.

Cognitive Behavior Therapy for Anxious Adolescents: Developmental Influences on Treatment Design and Delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the ‘why’ and the ‘how’ of developmentally appropriate CBT for anxious adolescents. ‘Why’ it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. ‘How’ clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents.

Fear of negative evaluation modulates electrocortical and behavioral responses when anticipating social evaluative feedback

Cognitive models posit that the fear of negative evaluation (FNE) is a hallmark feature of social anxiety. As such, individuals with high FNE may show biased information processing when faced with social evaluation. The aim of the current study was to examine the neural underpinnings of anticipating and processing social-evaluative feedback, and its correlates with FNE. We used a social judgment paradigm in which female participants (N = 31) were asked to indicate whether they believed to be socially accepted or rejected by their peers. Anticipatory attention was indexed by the stimulus preceding negativity (SPN), while the feedback-related negativity and P3 were used to index the processing of social-evaluative feedback. Results provided evidence of an optimism bias in social peer evaluation, as participants more often predicted to be socially accepted than rejected. Participants with high levels of FNE needed more time to provide their judgments about the social-evaluative outcome. While anticipating social-evaluative feedback, SPN amplitudes were larger for anticipated social acceptance than for social rejection feedback. Interestingly, the SPN during anticipated social acceptance was larger in participants with high levels of FNE. None of the feedback-related brain potentials correlated with the FNE. Together, the results provided evidence of biased information processing in individuals with high levels of FNE when anticipating (rather than processing) social-evaluative feedback. The delayed response times in high FNE individuals were interpreted to reflect augmented vigilance imposed by the upcoming social-evaluative threat. Possibly, the SPN constitutes a neural marker of this vigilance in females with higher FNE levels, particularly when anticipating social acceptance feedback.

Anxiety disorders in children and adolescents: Psychosocial developmental theory in relation to anxiety and its disorders

We must advance beyond the simple ‘stimulus charting’ of fears in youth if we are to truly understand their significance in development and their long-term impact on adjustment Ollendick, King & Frary, 1989, p. 26 Introduction Epidemiological and clinical studies have indicated that the prevalence of the different anxiety disorders is related to age, and that the average age-at-intake and age-at-onset also differ for the various anxiety disorders. At the same time, however, virtually any anxiety disorder may occur in any age cohort. This chapter addresses the question whether the differences both between and within age cohorts may be explained in terms of general theories of psycho-social development. The following age pattern was observed for nonphobic anxiety disorders (Kashani & Orvaschel, 1990; Last et al., 1987; Westenberg et al., 1999; see also American Psychiatric Association (APA), 1987, 1994): (a) separation anxiety disorder (SAD) occurs most frequently in childhood, (b) overanxious disorder (OAD) ismost characteristic of adolescence and (c) panic disorder (PD) appears most frequent in late adolescence and (young) adulthood. Yet, SAD may also occur in adolescence, and PD may occur even in childhood (Ollendick, 1998). DSM-IV no longer includes OAD, and merged this classification with Generalized Anxiety Disorder (GAD; APA, 1994). However, the core criteria and the clinical features of OAD are highly similar to those in children with GAD (see APA, 1994). Tracey et al. (1997) observed that ‘DSM–IV GAD criteria are identifying the same sample as the DSM–III–R OAD criteria’ (p. 409).