Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care.

Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.

The Developmental Timing but Not Magnitude of Adolescent Risk-Taking Propensity Is Consistent Across Social, Environmental, and Psychological Factors.

PURPOSE: Risk-taking is thought to peak during adolescence, but most prior studies have relied on small convenience samples lacking participant diversity. This study tested the generalizability of adolescent self-reported risk-taking propensity across a comprehensive set of participant-level social, environmental, and psychological factors. METHODS: Data (N = 1,005,421) from the National Survey on Drug Use and Health were used to test the developmental timing and magnitude of risk-taking propensity and its link to alcohol and cannabis use across 19 subgroups defined via sex, race/ethnicity, socioeconomic status, population density, religious affiliation, and mental health. RESULTS: The developmental timing of a lifespan peak in risk-taking propensity during adolescence (15-18 years old) generalized across nearly all levels of social, environmental, and psychological factors, whereas the magnitude of this peak widely varied. Nearly all adolescents with regular substance use reported higher levels of risk-taking propensity. DISCUSSION: Results support a broad generalizability of adolescence as the peak lifespan period of self-reported risk-taking but emphasize the importance of participant-level factors in determining the specific magnitude of reported risk-taking.

Pubertal development underlies optimization of inhibitory control through specialization of ventrolateral prefrontal cortex.

Inhibitory control improves into young adulthood after specialization of relevant brain systems during adolescence. However, the biological mechanisms supporting this unique transition are not well understood. Given that adolescence is defined by puberty, we examined relative contributions of chronological age and pubertal maturation to inhibitory control development. 105 8-19-year-olds completed 1-5 longitudinal visits (227 visits total) in which pubertal development was assessed via self-reported Tanner stage and inhibitory control was assessed with an in-scanner antisaccade task. As expected, percentage and latency of correct antisaccade responses improved with age and pubertal stage. When controlling for pubertal stage, chronological age was distinctly associated with correct response rate. In contrast, pubertal stage was uniquely associated with antisaccade latency even when controlling for age. Chronological age was associated with fMRI task activation in several regions including the right dorsolateral prefrontal cortex, while puberty was associated with right ventrolateral prefrontal cortex (VLPFC) activation. Furthermore, task-related connectivity between VLPFC and cingulate was associated with both pubertal stage and response latency. These results suggest that while age-related developmental processes may support maturation of brain systems underlying the ability to inhibit a response, puberty may play a larger role in the effectiveness of generating cognitive control responses.

Hippocampal-Prefrontal Connectivity Prior to the COVID-19 Pandemic Predicts Stress Reactivity.

BACKGROUND: By adolescence, foundational cognitive and affective neurobehavioral processes specialize based on environmental demands, such as stress, to determine the basis of adult trajectories. The ongoing COVID-19 pandemic has increased stress for everyone, particularly adolescents who face unique stressors such as restrictions in socialization and education. However, variability in brain processes supporting stress reactivity is not well understood. Here, we leverage pre-pandemic brain development studies to identify how maturity of prefrontal connectivity with the amygdala and hippocampus (HPC) is associated with response to COVID-19. We hypothesized that age-related changes in connectivity of affective and cognitive brain systems may underlie the emotional response of adolescents during the pandemic. METHODS: In this study, 10- to 31-year-old participants (n = 111) completed resting-state functional magnetic resonance imaging scans prior to the pandemic and then completed a questionnaire 9 months into the pandemic measuring worry, COVID-related stress, sadness, perceived stress, and positive affect. Associations between pairwise functional connectivity of HPC/amygdala subregions with prefrontal cortex subdivisions and affective reactivity during the pandemic were examined. RESULTS: Regression analyses indicated that both worry and COVID-19-related stress increased with age (false discovery rate-corrected p < .05). Furthermore, greater connectivity between the anterior ventromedial prefrontal cortex and posterior HPC was associated with greater worry and COVID-19-related stress (p < .05 corrected), which was primarily driven by individuals younger than 18 years. CONCLUSIONS: Taken together, our results indicate that increases in stress reactivity to the COVID-19 pandemic across the transition to adulthood are driven by maturation of posterior HPC-ventromedial prefrontal cortex coupling, which integrates stress response and emotional memory processing.

Influences of affective context on amygdala functional connectivity during cognitive control from adolescence through adulthood.

Emotion processing is believed to dominate over other brain functions during adolescence, including inhibitory control. However, few studies have examined the neural underpinnings of affective states during cognitive control. Here, we characterized the brain in an affective state by cross-sectionally assessing age-related changes in amygdala background connectivity during an affective inhibitory control task. Participants completed an antisaccade (AS) fMRI task while affective auditory stimuli were presented, and a 5-minute resting state scan. Results showed that while adolescents reported similar arousal levels across emotional conditions, adults perceived negative sounds to be more "arousing" and performed better than adolescents in negative trials. Amygdala background connectivity showed age-related increases with brain regions related to attention and executive control, which were not evident during resting state. Together, results suggest that amygdala connectivity within an affective context is fairly low in mid-adolescence but much stronger in adulthood, supporting age-related improvements in inhibitory control within an affective state. These findings suggest limitations during adolescence in differentiating between the arousing effects of various emotions, potentially undermining the ability to optimally engage inhibitory control. Furthermore, the age-related fMRI findings suggest that low amygdala connectivity to brain areas involved in executive control may underlie these limited abilities during adolescence.