Middle adolescence is the period of development during which youth begin to engage in health risk behaviors such as delinquent behavior and substance use. A promising mechanism for guiding adolescents away from risky choices is the extent to which adolescents are sensitive to the likelihood of receiving valued outcomes. Few studies have examined longitudinal change in adolescent risky decision making and its neural correlates. To this end, the present longitudinal three-wave study (Nw1 = 157, Mw1= 13.50 years; Nw2 = 148, Mw2= 14.52 years; Nw3 = 143, Mw3= 15.55 years) investigated the ontogeny of mid-adolescent behavioral and neural risk sensitivity, and their baseline relations to longitudinal self-reported health risk behaviors. Results showed that adolescents became more sensitive to risk both in behavior and the brain during middle adolescence. Across three years, we observed lower risk-taking and greater risk-related activation in the bilateral insular cortex. When examining how baseline levels of risk sensitivity were related to longitudinal changes in real-life health risk behaviors, we found that Wave 1 insular activity was related to increases in self-reported health risk behaviors over the three years. This research highlights the normative maturation of risk-related processes at the behavioral and neural levels during mid-adolescence. Dual systems models suggest that the surge in problematic risk-taking behavior is the result of an imbalance in the development between neurobehavioral motivational reactive and cognitive control systems ( Casey, 2015 , Shulman et al., 2016 ). It is posited that adolescents’ motivational reactive system and associated neural correlates typically found in dopaminergic mesolimbic brain areas (e.g., ventral striatum; VS) develop at a much faster rate relative to the cognitive control system ( Casey, 2015 , Shulman et al., 2016 ). It is also important to note that middle adolescence is proposed to be a critical period in the maturation of the socioemotional system ( Steinberg, 2008 , Casey et al., 2008 , Luna and Wright, 2016 ) and cognitive control system ( Luna and Wright, 2016 ). Across dual systems models, middle adolescence is the period during which the developmental mismatch in these neural systems is at its greatest representing a neurobiological vulnerability for risk taking behavior ( Steinberg, 2008 , Casey et al., 2008 , Luna and Wright, 2016 , Shulman et al., 2016 ). A key element shared across a myriad of problematic health risk behaviors is that the consequences of choices are often uncertain, and individual preferences toward risk have been shown to predict decision making behavior. Specifically, decision-making research has shown that both adolescents and adults process risk, usually defined as the variance of potential outcomes, in the bilateral insular cortex ( Kuhnen and Knutson, 2005 , Mohr et al., 2010 , Platt and Huettel, 2008 , Preuschoff et al., 2008 , van Duijvenvoorde et al., 2015 , Xue et al., 2009 ). We then moved to a conditional LGCM, where the intercept and slope were regressed on insula activation. Although the focus of the present study was specific to insular activation and health risk behaviors, additional exploratory LGCM analyses were conducted to assess whether other risk-related brain areas (left and right VS, anterior cingulate cortex) identified in the whole brain analysis were also related to changes in health risk behaviors. Gender and intelligence were added as covariates to the conditional LGCM. We used full information maximum likelihood estimation (FIML) to control missing data. Furthermore, identifying whether there are gendered pathways to adolescent health risk behaviors via risk or reward processing systems remains an open area ripe for investigation. Being able to identify the longitudinal age-related changes in risk and reward sensitivity and how these changes might differ between genders has implications for guiding how to approach health risk behaviors in different genders. Prior work has suggested that neural risk processing and cognitive control processes in the adolescent brain interact to predict adolescent health risk behaviors ( Kim-Spoon et al., 2016 , Kim-Spoon et al., 2021 , Maciejewski et Based on these studies, individual differences in cognitive control may help account for varying relations between neural risk sensitivity and adolescent risk-taking. That said, future work should examine the concomitant developmental processes of risk processing and cognitive control in the adolescent brain and the relation between these processes and risky adolescent behavior. Although our results indicated that adolescents become more risk-averse over time, the specific mechanisms driving this pattern are unclear. Prominent theories in developmental psychology and developmental cognitive neuroscience have emphasized the importance of contextual factors such as home environment and peer influence and biological factors such as pubertal development in shaping the development of risk-taking behavior during adolescence into adulthood. For instance, adolescents have been shown to increase risk-taking when amongst peers ( Chein et al., 2011 ). Regarding environmental influences, adolescents' insular risk-related processing was positively associated with parental monitoring in households with low, not high, chaos environments ( Lauharatanahirun et al., 2018 ). The cognitive control system is suggested to steadily increase in its development as age increases. Additional data regarding the development of risk sensitivity, reward sensitivity, and cognitive control during late adolescence would provide insights for refining current neurobehavioral developmental theories of adolescent risky behavior. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Background Impulsivity trait as a risk factor which typically displayed in risk decision among school youth. This study aims to examine behavioral and cognitive problems of risky decision among Chinese young people aged 15–25 years. The balloon analogue risk task (BART) and event-related potential (ERP) were combine used to explore the neural mechanism of risky decision process whether infected by impulsivity trait. Methods A total of 31 subjects were included, including 16 experimental subjects with risk behavior (RS), and 15 health control subjects with non-risk behavior (HC). BART were used to measure risk-taking propensity and ERP were to record in real time. RS vs. HC were compared to explain the relationship between impulsivity and risky decision. Results Behavioral data in BART task shown that the RS subjects tended to make risky decisions. ERP results illustrate that P300 in RS subjects is more significant positive-going than HC that means dysfunction of cognitive control, and FRN in RS subjects is more negative-going than HC in negative feedback condition, which means individual with high impulsive would be more sensitive to unexpected outcome. Conclusions Impulsiveness is a risk factor for school adolescent, because RS subjects performed more risky decision than control group, the evidence indicate that individual with high impulsiveness would lead to be less sensitive to harmful consequences and more inclination to immediate rewards. Therefore, the inclination of risk taking can be powerfully informed by different levels of impulsiveness. This study aims to examine behavioral and cognitive problems of risky decision among Chinese young people aged 15–25 years. The balloon analogue risk task (BART) and event-related potential (ERP) were combine used to explore the neural mechanism of risky decision process whether infected by impulsivity trait. Methods A total of 31 subjects were included, including 16 experimental subjects with risk behavior (RS), and 15 health control subjects with non-risk behavior (HC). BART were used to measure risk-taking propensity and ERP were to record in real time. RS vs. HC were compared to explain the relationship between impulsivity and risky decision. Risk taking tendencies are emphasized in the individual pursuit of potential rewarding stimuli and can be motivated by novelty-seeking ( 4 , 5 ). In line with this suggestion, cognitive theory has increasingly shown that risky behavior is linked to change in the prefrontal cortex (PFC) and some limbic brain areas, and dopamine (DA) input to these areas ( 6 , 7 ). These findings are in line with the suggestion that an unbalanced DA reward system may lead to risk-prone behavior in adolescence and that the imbalance can be modulated in late adolescence and adulthood ( 21 , 22 ). This prolonged maturation provides an extended window for external environment factors to exert influence on the development of an individual’s cognitive control ability, which has downstream consequences for the adolescent involved in risky behaviors ( 23 , 24 ). Our study combines used event-related potential (ERP) and BART to explore the cognitive mechanism of risk taking decision in school youth. ERP are induced exogenous by environmental stimuli (such scenario events or sensory stimuli) or endogenous by cognitive processes (such as decision making or conscious attention), and also ERP is a real-time record tool the underlying neural process during a psychological experiment task. Impulsivity can be measured by personality questionnaire, while laboratory trail in rewarding discounting model can provide behavioral and cognitive manifestation. BART is a computer-based tool, which designed the subjects engage in risk-taking pump balloon and would respond an index to reflect the degree of risk-taking. Convincingly, Lejuez et al. The classic BART task was used to explore the role of impulsivity and underlying neural processes involved in risky decision making. The findings are comparison between experiment sample with risk behavior and non-risk behavior and RS sample be more prone to make risky decisions than non-RS sample is expected, to indicate impulsivity trait as a risk factor that led to behavioral and cognitive risk taking in adolescent. We present the following article in accordance with the MDAR reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-21-594/rc ). Methods Subjects All subjects were students enrolled in the public high school and university in Hubei province. Behavioral data and psychological measures were obtained, as such, the evidence was expected to reveal the differences between experiment subjects (RS) and health control subjects (HC) is related to potential impulsivity trait, which overt risk-taking The negative correlation between personal impulsivity (BIS, BART) score and cognitive ERP components (P300; FRN) were in line in with existing studies, that provide more evidence to explain that impulsivity trait would put individuals into poor display cognitive control and less sensitive to negative consequence, which lead to be more involve in risk behaviors. The impulsiveness can be seen as age-related trait in youth people, which characteristic involved acting without thinking or non-planning, this problem should be prevented by promote youth awareness of potential risk and reduce environmental lure such as (pornography advertising or violent online). Therefor the current study can enlighten the psychological intervention to promote the balanced awareness between potential risk and the immediate reward, the evidence that balanced awareness accompanied with the reduce of risky behavior can be expected in future study. Conclusions Our study provides psychological and cognitive evidence that risky decision can be partially attributed to impulsive trait, which lead individual to immediate rewards and relatively deficient in evaluation of long-term consequences.