Risk-Taking Behaviors in Teens and Young Adults

Even though they may look mature, and often act mature, teens and young adults do not have fully-mature brains.

Because their brains are not yet fully developed, they do not yet have an adult capacity to reason, weigh options, consider consequences, and make informed decisions.

The immature thinking of teens and young adults can encourage risk-taking in multiple ways:

• they tend to underestimate the potential danger of risky behavior, and at the same time they tend to overestimate the potential benefit of risky behavior

• they do not yet have enough life experience and knowledge to have a good intuitive sense of which behaviors are too risky

• their decision-making is often based more on emotions than on logic and reason

• they have trouble accurately anticipating the consequences of their actions, and the likelihood of those consequences

• they have lower working memory than adults, so have trouble considering all the aspects of a decision

• they have more trouble controlling impulses than adults

• they often value short-term rewards more highly than long-term rewards

• they require more intense sensations than adults in order to feel excited

Since teens and young adults are often deeply invested in peer relationships, they are particularly vulnerable to peer pressure. Even if they are not pressured to participate in risky behaviors, teens and young adults are often highly motivated to do things that might help them to fit in, or to increase their social status.

For many young people, the combination of immature decision-making and a drive for social acceptance can lead to risky behaviors.

For some young people with heart defects, certain risky behaviors are more dangerous than they are for the general populations. These can include:

• getting pregnant

• drinking alcohol

• smoking

• eating an unhealthy diet

• taking any other drugs not prescribed by a doctor

• any behaviors that could result in a physical injury

Young people and their families should talk with their doctors to understand whether and how their health history would make certain behaviors especially dangerous.

Young people with heart defects can also face risks that many of their peers do not face. For example, risky behaviors for young people with heart defects can include:

• not following their medication regimen

• skipping doctor's appointments, or not following up with doctors as expected

• not following a doctor's recommendations for diet, sleep, exercise, prophylactic antibiotics, dental care, etc.

Many young people with heart defects stop seeing a cardiologist as often as is recommended. This gap in care can put them at substantial risk for worse outcomes in adulthood.

Developmental delays or disabilities can sometimes increase the likelihood of risk-taking behaviors, or it can increase the potential harm of such behaviors. For example:

• people who have reduced social understanding (including those with autism spectrum disorder) are more likely to be coerced or manipulated

• people with intellectual disability (ID) may not understand the dangers associated with certain behaviors

• people with ADHD may seek more thrills, and have a harder time controlling their impulses

Families and young people should talk with their care team about how developmental diagnoses might interact with their risk profile.

Families and professionals can help young people to stay safe while making choices that feel fulfilling.

Depending on the young person, helpful strategies and interventions can include:

• ongoing, frank, open, and nonjudgmental conversations among young people and trusted adults about the appeal of risky behaviors, the dangers of risky behaviors, and the process for making decisions

• teaching about the importance of following medical advice throughout childhood and through the teen and adult years, and regularly checking in with a young person to make sure they are seeing a doctor and taking all medicines as expected

• inviting friends to the young person's own house, and providing some parental supervision

• psychotherapy to work on emotion regulation, decision-making, understanding and reacting to impulses, and managing social pressures

• behavioral or medical management of ADHD (medication changes should always be approved by a cardiologist)

• social skills training, to understand what kinds of social interactions are expected and safe with different categories of people

• meeting with a cardiologist to discuss how risk-taking behaviors might interact with a person's health history

• clinical services to treat certain types of behaviors, such as substance abuse and disordered eating

• access to safe places to spend time with peers

• access to safe outlets for thrill-seeking (for example: joining a rock climbing gym, going to an amusement park, ski racing, traveling to new places, performing in front of an audience)

• mindfulness training to work on impulse control, coping strategies, and self-awareness

• sexual education that includes accurate information about topics such as pregnancy, transmission of sexually-transmitted diseases, strategies for protection from illness or unwanted pregnancy, consent, and signs of coercive or dangerous behavior

Although the teen and early adult years can be harrowing for parents and young people alike, they can also be incredibly rewarding. Families can help to guide their children through these years with open communication, consistent and reasonable expectations, and prompt intervention in the case of any emerging problems.

Families and young people can also embrace the good kind of risk-taking, and celebrate as adolescents take responsible steps towards greater and greater independence.

This content was reviewed by a psychologist at Boston Children’s Hospital.

Families local to Boston can contact the Cardiac Neurodevelopmental Program to learn more about services for teens and young adults with CHDs.