Improved cognitive control with development of the prefrontal cortex is consistent with a linear increase in this ability from childhood to adulthood. Yet suboptimal choices and actions observed during adolescence represent an inflection in development 11 that is unique from either childhood or adulthood, as evidenced by the National Center for Health Statistics on adolescent behavior and mortality 12. If cognitive control and an immature prefrontal cortex were the basis for suboptimal choice behavior alone, then children should look remarkably similar or presumably worse than adolescents, given their less developed prefrontal cortex and cognitive abilities 2. This review addresses the primary question of how the brain is changing during adolescence that may explain inflections in risky and impulsive behavior. In addition, we provide examples of how alcohol and drug use during this period of development may further exacerbate these changes and can lead to subsequent abuse and dependence.
