How to help teens and parents navigate adolescence

The adolescent years are a challenge, but pediatricians can help both parents and teenagers navigate the difficult parts-however, these efforts have to start early.

Adiaha I.A. Spinks-Franklin, MD, a â€‹developmental-behavioral pediatrician at Texas Children’s Hospital and â€‹associate professor of pediatrics at Baylor College of Medicine in Houston, Texas, offered up insights on how to do this in a session presented on October 27, 2019, titled, “Teens Gone Wild: Helping Parents Navigate Adolescent Challenges,” at the 2019 American Academy of Pediatrics (AAP) Annual Conference and Exhibition in New Orleans, Louisiana.

 “When a child becomes a teenager, the parent becomes the coach,” Spinks-Franklin says. “Enforce early on that the parent doesn’t need to be the friend, and must start a healthy relationship early on. By the adolescent years, you should not be trying to establish parental authority.”

Behavior management techniques are longitudinal, she adds, and children need to be taught early to respect authority in order to grow into well-adjusted adults.

While the first step is realizing that establishing authority and creating a parenting plan starts early, Spinks-Franklin says the bigger focus-for parents and pediatricians-is learning what is normal when it comes to adolescent brain development.

“That is really key,” she says. “If we don’t understand what to expect neurologically and developmentally, then we won’t understand their behaviors, and they will be a lot harder to manage.”

Pediatricians should counsel parents on the need for independence in adolescence and how to handle challenges to authority. Risk-taking behaviors should be addressed, with a focus on how to watch for and handle behaviors like experimentation with drugs, high-risk sex, and eating disorders. Whereas some risk-taking behaviors may be common in adolescence, Spinks-Franklin says it’s important for parents to understand which are common and which are normal-and when there is a difference.

“Recognize that there is a difference between common and normal. Just because a particular behavior happens a lot doesn’t mean that a parent has to tolerate that behavior and accept it as normal,” she says. “It might be common for a teenager to talk back, but if in your family that is not allowed, that is okay. I like for parents to be aware, and to give them a tool to say ‘no, these are the expectations in our household, and that’s a behavior we’re not going to tolerate.’”

One challenge in addressing these issues with parents and teenagers, she says, is that physician visits are less frequent in the adolescent years. If a teenager is coming in for some reason with a parent, Spinks-Franklin says this is an ideal time to conduct assessments, screen for depression an anxiety or disruptive behaviors that may emerge in adolescence, offer guidance, and if needed, make referrals for additional help. Parents and teenagers that struggle with high-risk behaviors that are dangerous may be beyond the realm of the pediatric office, and referrals to mental health counselors, other specialists, and community organizations may be appropriate, she says. To do this, pediatricians have to be aware of what is offered in the community, and perhaps have a list of resources ready.

“Know what resources are in your community. If not, it will be hard to refer patients when they come in for these issues,” she says. “It may also be helpful for pediatricians to have handouts or websites that they can refer families to for medically accurate information.”

Pediatricians may also want to arrange their offices in a way that makes it a comfortable place for teenagers to visit-outside of toddler toys and cartoon characters.

“Maybe make an adolescent section in waiting rooms, and consider blocking out longer appointment times so the doctor can talk to the parent and teenager individually. Or make a separate appointment for the teenager, then ask for a visit with parents,” she says. “You’re establishing trust with the teenager.”
“Cultivating a good patient-physician relationship with teenagers is important to both their adolescent and life-long health, she adds. Teenagers should know about privacy laws and what they can discuss in confidence with their physician, and what pediatricians will have to dial parents in for. The adolescent years are also a good time to work on establishing good healthcare practices, Spinks-Franklin says, adding that she encourages parents to give their teenagers an insurance card, and walks young patients through the process of setting their own appointments.

“That way, if they ever need to go to the doctor, at least they know the doctor’s name and what insurance the have,” she says. “It also helps to establish health literacy.”