Supporting Adolescent Health and Development: What Decisionmakers Need to Know

Research has fundamentally changed our understanding of how adolescents—young people ages 10 to 25— develop, grow, and learn. Changes in the brain occur throughout adolescence, affording young people a remarkable capacity to learn and create, adapt to changes, form relationships with peers and adults, and explore their own environments. Investments in programs and interventions that capitalize on the brain’s capacity to change during adolescence can promote beneficial shifts in young people’s life trajectories, helping them achieve their full potential in adulthood. Two recent reports by the National Academies of Sciences, Engineering, and Medicine examine healthy adolescent development and recommend actions for promoting it: • The Promise of Adolescence: Realizing Opportunity for All Youth (2019) • Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century (2020) Both reports identify opportunities for policy makers to promote positive adolescent development, optimize adolescent outcomes, and address the needs of this increasingly diverse population.

THE PROMISE OF ADOLESCENCE: REALIZING OPPORTUNITY FOR ALL YOUTH Adolescent brains are create incentives for discovery and innovation uniquely fit to prepare rather than focusing narrowly on containing risks. young people to meet new In adolescence developmental changes heighten life challenges. During ad- reward sensitivity, a willingness to take risks, and olescence, connections the salience of social status, necessary propensi- between brain regions be- ties for exploring new environments and building come stronger and more non-familial relationships. By exploring and taking efficient, and unused con- risks, adolescents build cognitive, social, and emo- nections are pruned away. tional skills necessary for productive contributions Such heightened neuroplas- in adulthood. ticity during adolescence 2) Learning how to make decisions and to take re- provides opportunities for sponsibility for shaping one’s own life are key resilient responses to trau- developmental tasks of adolescence. Youth-serv- ma and stress, and for re- ing systems should ensure that adolescents are mediating maladaptation in viewed as respected partners in decision making. brain structure and behavior that accumulated from Adolescents’ developing competencies in flexible earlier developmental periods. This report outlines problem solving, their awareness of and concern how the systems and settings that adolescents most with others, and their openness to exploration and frequently encounter can be redesigned and reimag- novelty make this an opportune time to support ined to promote well-being and resilience and to ad- agency and leadership and promote engagement. dress inequalities. 3) Forming personal identity is a key task of adoles- The report identifies several cross-cutting principles in- cence. The increasing diversity of U.S. adolescents formed by developmental science to guide policy and and the nation as a whole requires youth-serving practice across systems. systems to be culturally sensitive and to be at- 1) Adolescence is a sensitive period for develop- tuned to the integrated needs of each adolescent. ment and learning, providing opportunities for Young people become increasingly aware of and life-long impact. Policies and practices should attuned to their social status during adolescences, and institutions, policies, and practices may re- and resulting inequalities in opportunity and inforce status hierarchies and stereotypes about access curtail the promise of adolescence for members of groups that are nondominant or many youth. An effective strategy to reduce ineq- stigmatized in society. uities needs to address the main sources of these 4) Supportive familial, caregiver, and adult rela- disparities. Greater coordination is needed across tionships play a role in fostering positive out- the systems responsible for adolescents. Disad- comes for adolescents. The least advantaged vantaged youth will likely require disproportion- parents need resources through social assistance ate funding to reduce or eliminate disparities. to effectively support adolescents, so investing in Based on these principles, the committee makes youth also requires investing in the adult caregiv- recommendations for the health, education, child ers who support them. Such investments must welfare, and justice systems. Taken together, these be multilevel and multisectoral; interventions to recommendations constitute a blueprint for devel- change parenting behavior are limited if systems opmentally informed systems change. For the health themselves are not attuned to parents’ most press- sector specifically, the committee made the following ing needs. recommendations: 5) Investments in programs and interventions that • Strengthen the financing of health care services for capitalize on brain plasticity during adoles- adolescents, including insurance coverage for un- cence can promote beneficial changes in devel- insured or underinsured populations. opmental trajectories for youth who may have • Improve access to comprehensive, integrated, co- faced adverse experiences earlier in life or are ordinated health services for adolescents. facing them now and prevent future challenges and risks. Adolescents’ heightened sensitivity and • Increase access to behavioral health care and treat- responsiveness to environmental influences im- ment services. plies resilience, meaning adolescence provides an • Improve the training and distribution and increase opportunity for healing and repair leaving them the number of adolescent health care providers. better equipped to handle future adversities. Redi- • Improve federal and state data collection on ad- rection, recovery, and resilience are possible. olescent health and well-being, and conduct ad- 6) Disparities in family and neighborhood re- olescent-specific health services research and dis- sources and supports, biased and discriminato- seminate the findings. ry interactions with important social systems,

PROMOTING POSITIVE ADOLESCENT HEALTH BEHAVIORS AND OUTCOMES: THRIVING IN THE 21ST CENTURY This report expands on The federal programming initiatives focused on adolescent Promise of Adolescence: health. Realizing Opportunity for Risk taking in adolescence. Adolescents must ex- All Youth by delving deep- plore their environments to build the cognitive, social, er into adolescent health and emotional skills necessary for adulthood. The skills programs and health pol- gained during adolescence also provide the capacity icy. In the report, the com- for other aspects of psychological development, such mittee reviewed research to as identity formation and the capacity for self-direction. identify core components of programs that can im- • Risk-taking activities are normal and necessary prove adolescent health during adolescence. outcomes and developed • Healthy risk behaviors are constructive and are risky evidence-based recommen- due to the uncertainty of their potential outcomes. dations for implementing Examples of health risk taking may include enrolling

2 in a challenging course, reaching out for help, or > begin in early childhood and are offered during asking someone on a date. Healthy risk taking al- critical developmental windows, from child- lows adolescents to learn, grow, and thrive. hood throughout adolescence; • Adolescents are also more likely than members of > consider adolescent decision making, explora- other age groups to participate in unhealthy risk be- tion, and risk taking as normative; haviors, such as unprotected sexual activity, binge > engage diverse communities, public policy drinking, and tobacco use. These behaviors can lead makers, and societal leaders to improve modi- to negative health outcomes. fiable social and environmental determinants • “Discontinuation of risk” is applicable only to those of health and well-being that disadvantage and unhealthy risk behaviors (e.g., unprotected sexual stress young people and their families; and activity, substance abuse) that can lead to negative > are theory-driven and evidence-based. health outcomes (e.g., diseases, unintended preg- nancy, STIs). • The Centers for Disease Control and Prevention (CDC) should Healthy risk taking can be supported by providing guidance in decision-making and encouraging adoles- > update and expand the Youth Risk Behavior Sur- cents to engage in less dangerous risks. vey to include: Core components. Core components research iden- + out-of-school youth, (e.g., homeless, incar- tifies the “active ingredients” of evidence-based pro- cerated, dropped out), and grams which can be used to create shorter and more + survey items that reflect a more comprehen- effective programs that are also more accessible to di- sive set of sexual risk behaviors with specific verse populations. The committee found: definitions; and • Evidence of effectiveness of specific core compo- > further research on the ideal setting and mode nents was inconsistent because current research is for administering the YRBS with today’s adoles- not designed to identify which components of pro- cents. grams are more effective than others. The committee also suggested two promising ap- • Programs incorporating social-emotional learning proaches that deserve more meaningful attention in and positive youth development help equip chil- research, program, and policy development: dren and adolescents with the foundational skills • Implementing and evaluating practices and policies they need to make healthy decisions in a variety of that promote inclusiveness and equity; and situations. • including youth from diverse age groups, racial/ The committee made the following recommendations ethnic backgrounds, socioeconomic status, rural- for the U.S. Department of Health and Human Ser- ity/urbanity, sexual orientations, sexes/genders, vices: and disability/ability status in all decision-making • Fund additional research aimed at identifying, mea- processes. suring, and evaluating the effectiveness of specific core components of programs focused on promoting positive health behaviors and outcomes among adolescents. • Fund universal, holistic, multi-component programs that meet all of the following criteria: > promote and improve the health and well-being of the whole person, laying the foundation for specific, developmentally appropriate behavioral skills development;

3 Learn more and download the full reports for free today.

The Promise of Adolescence: Realizing Opportunity for All Youth (2019) Available: http://nationalacademies.org/adolescentdevelopment

Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century (2020) Available: http://nationalacademies.org/adolescent-health

The Hauser Fund was created to ensure that social science analysis and synthesis help guide informed policy decisions across the DBASSE portfolio—national statistics, science education, children's well-being, criminal justice, environmental change, the implications of aging, among othersthe DBASSE portfolio—national statistics, science education, children's well-being, criminal justice, environmental change, the implications of aging, among others.

Division of Behavioral and Social Sciences and Education