The developmental stages of adolescence include pushing boundaries, determining your sense of self, and forging new relationships. Add a chronic illness into the mix, and life as a teen can get extremely complicated. For teens with chronic diseases, such as diabetes or asthma, this means that on top of finding out who they are, then need to give themselves life saving medications daily, arrange medical visits, and be vigilant about what they eat & how they eat, or what activities they can participate in that won’t trigger a flare in their disease. It’s no wonder that many teens decide they are done with having a chronic illness and decide to ignore their self care.
In medicine we have a term for this: non-compliance. This term implies that the teen is ignoring medical advice to spite authority. I prefer the term non-adherence because they aren’t skipping doses of insulin because they want to have complications or because they dislike their doctors. At some point during adolescence, most teens with chronic disease simply get fed up with having the illness and I can completely understand why!
The downside to being fed up and ignoring a problem is that the disease isn’t going to go away and ignoring it can result in serious consequences. For a teen with asthma, this could mean a life-threatening asthma attack. For a diabetic, this could mean elevated blood sugar levels that lead to coma, kidney failure, even death. Unfortunately, telling a teen all of the complications rarely works to change their behavior (scare tactics rarely work in real life!). So how can we encourage them to continue to care for their health?
I base my own practice on the stages of change. I start by asking how motivated a teen is to make changes and then determine if they have the resources to actually follow through with those changes. If a teen isn’t willing to try different behaviors it’s very unlikely that I’m going to be able to force them to take care of themselves. However, most to the time asking them about change is a big prompt to get them thinking about how they’d like their lives to be. This consideration and contemplation is the first step to actually changing behavior!
The stages of change include 1) not considering change 2) contemplating change (knowing there’s a problem, but still weighing pros and cons 3) preparing to change 4) taking actions to make changes 4) maintaining the changed behavior. Here are some tips for parents:
- Meet them where they are. If a teen isn’t ready to change behavior, you’re unlikely to convince them to make drastic changes. Instead talk about some of their goals and ask them what steps they need to take to get there.
- Set small goals. Don’t aim to run a marathon next week before you can even jog a mile.
- Make sure their environment supports the changes they’re trying to make. If a teen with asthma is trying to remember to use their inhaler regularly, put the medication at their bedside or have them set an alarm on their phone. Don’t leave it in a cabinet where they rarely will see it.
- If you need help, talk with your teen’s health care provider about ideas on improving their self care. Providers help motivate people every day. We also have access to helpful tips, groups, camps, and school resources that may all be useful for your teen to help them manage their chronic disease.
- Don’t stop encouraging your teen. While nagging them can be counter-productive, don’t give up on your teen. Continue to remind them of their health care goals and give praise for their accomplishments! Every small change is a step towards improved health.