Social cognition and psychopathology in adolescence

Abstract

Adolescence is a period of transition, with developmental changes occurring at multiple levels simultaneously (e.g., hormonal, cognitive, neuronal, and socio-environmental). The co-occurrence of these transformational processes could compound risk for mental health problems for a subset of teens, especially towards developing mood and anxiety disorders. In order to progress towards identifying symptoms early and providing age-appropriate interventions, we need to map out trajectories of social-cognitive and affective change and associated neural maturation more comprehensively.

Key take-home messages

• Distinct changes in social behaviour and cognition occur during adolescence
• Behavioural and cognitive changes in adolescence are accompanied by on-going development in underlying neural networks
• Age-of-onset data suggest that adolescence is a time of vulnerability for developing anxiety and mood disorders
• Mapping out typical developmental trajectories can inform the identification of risk profiles

Social cognition in adolescence

Adolescence is a period of transition, spanning the years between the onset of puberty and adulthood. It is marked by distinct changes in social behaviour, with parents often reporting familial conflict, preoccupation with peers and heightened emotional responding in their youths. As youngsters move toward adulthood and independence, peer relationships outside the family become increasingly important. Hence, many cues that carry emotional importance for teenagers have been suggested to be interpersonal in nature.¹ Given the substantial changes that take place during this period, it is perhaps not surprising that adolescence is also characterised by a heightened vulnerability for the development of anxiety and mood disorders, as evidenced by age-of-onset data for these conditions.² To better understand what underlies these characteristics of adolescence, researchers have begun investigating trajectories of social and emotional development in both healthy youths and youths with emotional and mood difficulties.

A time of vulnerability

Many psychiatric disorders, specifically anxiety and mood disorders such as social anxiety and depression often have their onset in adolescence. Social Anxiety Disorder is a condition characterised by impairing fears of negative evaluation and has a particularly pronounced onset at the juncture to adolescence, with ~90% of cases experiencing impairing symptoms between late childhood and early adulthood.² Similarly, prevalence rates for Major Depressive Disorder, characterised by persistent low mood, also increase drastically during adolescence, from 2% in early adolescence to 15% by mid-adolescence.³

Systematic biases in how (social) cues in the environment are processed are thought to play a crucial role in the maintenance and possibly onset of these disorders.^4,5 For example, adolescents high in social anxiety have been shown to direct their attention preferentially to social threat in the environment (e.g., threatening faces or words) and interpret ambiguous social situations in a negative manner.^6,7 As social information is often ambiguous (e.g., hearing laughter or whispering from behind you), systematic negative interpretations of these cues may contribute to the maintenance of symptoms by increasing perceived negative social feedback. Similarly, adolescents with increased depressive symptoms have been suggested to process information in a biased way, often attributing negative events to stable, global and internal characteristics of themselves.⁸

Neuroimaging studies comparing functional brain responses between adolescents with elevated social anxiety and/or depression and typically developing youths have confirmed heightened sensitivity to emotionally laden information in the former group. Notably, differential activation patterns and connectivity in brain regions involved in social-emotional responding and emotion regulation have been found in response to anticipated social feedback and socially threatening cues in anxious and depressed teens compared to their healthy counterparts.^9,10,11

Why is the transitional period of adolescence a time when symptoms of psychiatric conditions often first emerge? Mental health difficulties in adolescents occur against a backdrop of protracted age-typical changes in social-emotional cognition and behaviour, and associated neural networks. To answer this question, we first need a detailed understanding of typical social-emotional development as the adolescent years unfold – a relatively new field of research.

What is changing in adolescence?

With the onset of puberty, hormonal release sets in motion a cascade of physical developments that result in reproductive competence. Pubertal hormonal changes also affect neural circuitry, including networks linked to social-cognitive and emotion processing.¹² These physical changes are accompanied by psychosocial changes such as increased interest in peer-related cues (e.g., social status and opinions of peers), heightened sensitivity towards (social) reward and engagement in increasingly complex, nuanced interpersonal exchanges, including romantic relationships.¹³ Paralleling these physical and psychological developments are important changes in the social environment, too. As children move into adolescence, they face increasing academic demands and societal expectations regarding autonomy and independence. Hence, change happens at multiple levels simultaneously (hormonal, neural, behavioural and environmental), with large individual differences in the rate of change.

In order to measure exactly what and how behaviours, cognitions and neural substrates develop, we need to move beyond anecdotal accounts to data derived from experimental research, i.e., studies that probe social-cognitive and affective processes under controlled conditions. Several such studies indicate continued development across adolescence in social-emotional understanding. For instance, the ability and automaticity with which youths are able to put themselves into another’s shoes, i.e. take another person’s perspective into account, increases throughout adolescence.^14,15 There is also a growing capacity to engage with others’ emotional states.¹⁶ Importantly, these changes happen alongside developments in complex reasoning, learning and reward processing, particularly, but not exclusively, in the processing of social reward.¹⁷

Changes in the developing brain

In the last two decades, researchers have started to detail the neural bases of these behavioural changes using functional magnetic resonance imaging (fMRI). FMRI allows researchers to study how the human brain responds in a non-invasive manner during a task, and is suitable for use with adolescents and children. Across many different studies and tasks that probe different aspects of social cognitions and emotional responding, researchers have consistently found a set of brain regions involved processing these cues termed the ‘social brain network’.¹⁸ This network includes fronto-temporal and also limbic regions including the posterior superior temporal sulcus, temporo-parietal junction, temporal poles, fusiform gyrus, amygdalae and medial prefrontal cortex (see Figure 1 for an illustration). Crucially, these regions correspond to those implicated in differential functioning in depressed and anxious teens.

A growing body of neuroimaging studies attest to protracted functional changes in the social brain network across adolescence in terms of both basic (e.g., processing facial identity or facial emotional expressions) and more complex interpersonal cognitions. However, developmental patterns found across studies have not always been consistent, possibly due to the relatively small sample size used in neuroimaging studies, with differences in age and gender compositions across samples.

With regards to basic social-cognitive skills, the cortical network supporting face-processing abilities (e.g., the fusiform gyrus and the superior temporal sulcus) has been shown to develop continuously across adolescence. For example, Cohen Kadosh and colleagues^19,20 showed that developmental changes in the ability to quickly and accurately process facial identity and emotional expressions are mirrored by the protracted fine-tuning of underlying supporting brain networks.

Beyond studying how faces and expressions are recognised, emotional face stimuli have also been used to study emotional responses and emotion regulation in adolescents. Interestingly, response profiles of the amygdala (a limbic region involved in fear recognition and learning) to threatening faces across development has been suggested to display quadratic patterns across adolescence, such that there is an increase in emotional responding to these cues from early to mid adolescence, and a decrease towards adulthood^21,22,. However, it is important to note that there are also studies that attest to linear declines from late childhood to adulthood, which suggest that more research is needed to fully understand the developmental changes in this period.²³

More complex aspects of social cognition, such as emotional responding to social interactions and the regulation of this emotional response, have also been probed using fMRI. Researchers have begun to utilise tasks that are interactive and realistic for adolescents, for example by simulating peer rejection in an online chat room,²⁴ examining self-consciousness to real-life peer observation via a “Skype-like” camera²⁵ or reactivity to social media rewards (e.g. “Likes”). ²⁶ Results suggest that i) functional responses of social/emotion-processing networks develop at different rates, depending on the region and ii) adolescents often show idiosyncratic activation patterns (i.e., trends are not necessarily linear form childhood to adulthood) in regions involved in reward/threat processing and cognitive/attentional control.

Adolescent-typical changes of increased emotionality and sociability likely serve an adaptive function and increase learning about novel social cues and move adolescents towards independent functioning in society.²⁷ However, the co-occurrence of several transformational processes could compound the risk for atypical development and mental health problems for a subset of teens.²⁸ It is plausible that these normative changes in adolescence may ‘push’ vulnerable youths at the more extreme ends of the spectrum to experience functionally impairing symptoms.^29,30 A central research aim will be to work towards a more comprehensive framework of developmental changes during the adolescent years, which will hopefully provide us with an understanding of how we can detect mental health problems early. This is particularly pressing as early difficulties have been shown to be precursors to persisting mental health problems in adulthood.^31,32

Conclusion

A plethora of changes in both basic and complex social cognitive processing abilities occurs during the adolescent years. While these may be adaptive, for a subset of individuals, they may increase vulnerability towards developing debilitating mental health disorders. Mapping developmental trajectories would be important for determining what might represent cognitive and neural risk markers for the development of mental health disorders and may inform the development of early interventions.

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