Turbulent teen years require understanding

Medical Post
Helping Hand Column, October 25, 2005

Physicians should put away their professional role when helping their kids become individuals

Q: My 15-year-old daughter is sullen lately, and has stopped talking to me. We used to be so close, and suddenly she does not want to spend any time with me. She is rude, dismissive and even critical of me. Her marks have fallen and she does not seem to care. As doctors and parents, we try to encourage her to do her best, but she thinks we are nagging and wants to make her own decisions. She is basically a good kid. How can we best support her now?

A: It is heartening to read your comment that she is a good kid. Remembering this is one of the best ways you can support her during this phase. Going through our children's adolescence is normal and necessary—but it can often drive us crazy.

Adolescence is a time of transition. As adolescents, children go through a developmental stage in which they learn to separate from their parents, become individuals and be more independent. The "terrible twos" are when children are learning to do more physically than ever before and test it, and their parents, constantly. Adolescence is a similar process, in which the new-found skills are cognitive, not physical. Thus, teenagers are expanding and testing their cognitive abilities. They are learning to think differently, in a more abstract and broader manner. They can now think and reflect on things they may have never seen or experienced, such as world hunger, poverty and peace. They try to solve these problems, and it is interesting to see them grapple enthusiastically with the same issues that we grappled with in our time.

As they separate and become individuals, they have their own thoughts and ideas. This can often mean doing the opposite of what they think their parents would like. It takes time to realize that whether they comply and do as expected, or defy and do the exact opposite, their behaviour is still dependent. Eventually, healthy teenagers recognize that independent thoughts can actually be the same as those of their parents

Separation involves a loss of the relationships and connections previously experienced with the family. Sometimes, teens downplay or criticize what they are losing, as a way to minimize and manage the loss. They can be moody and unpredictable.

There are times when this turbulence causes trouble at school—academically or behaviourally. It is important to keep an eye out for more serious and prolonged problems, such as depression, drug or alcohol abuse, or school failure. Talking to your teenager and suggesting followup with a family doctor or counsellor may be helpful.

Children of doctors can experience additional stress and conflicts during adolescence. Physicians may find it hard to put away their professional roles with their children. Just as they spend much of their day problem solving and advising others on what to do, they try to do the same with their adolescent. However, since the adolescent is trying to separate, they are usually not open or interested in being advised or having their problem solved by the parent. Most physicians have high standards, are very dedicated and hardworking and expect the same of their children. Many of them see their children as reflections of themselves, or want them to carry out their own hopes and ideals. The children struggle to set their own goals, and must deal with feelings of inadequacy if they cannot or choose to not meet their parents' goals of them. Physicians are also able to provide a privileged lifestyle for their families, and sometimes inaccurately assume that more is better. They give to their children all that they would have liked to have had, yet do not realize this may not be what their children want.

Healthy adolescents want to be separate, yet still want and need to be connected to the family and have rules and expectations. This is a fine balance. I recall a two-physician family who sat in my office with their teenage son. He was angry at them, and they were bewildered. They felt they had been so caring, understanding, giving and flexible, and gave him all the freedoms any teenager would want—his own suite in the basement with a separate entrance, his own car and no curfew, even on school nights. He was hurt and angry, and hurled at them, "You don't care about me. My friend John's parents—they care about him. They want him home at 10 o'clock before they go to bed, so they know he is all right. You just go to sleep at night and don't care if I'm lying dead in a ditch somewhere."

There is no easy prescription to the healthy development of adolescents. Here are some tips that parents have passed on to me over the years.

• Allow the teen some space and a degree of separation. Respect their privacy. Give them some responsibilities. Show them you trust in them.

• Set reasonable rules and expectations regarding behaviour. Be clear, and have specific deadlines and consequences if these are not met. Let your teenager know what the non-negotiable rules are. Include them in setting the rest of the expectations and being a part of the decision-making process.

• Teach them how to get required information, think critically and to make good decisions for themselves. Allow them to make some poor choices and manage the consequences, but be there to support or assist them during this.

• Talk openly about your concerns about sex, drugs, alcohol. Make sure they have the information needed to make good choices. Explain how your concerns are not about restricting them or preventing them from having fun; but actually about their ensuring their safety and health.

• Be open to what they want to do and be. As doctors, we want them to succeed, but have narrow definitions of this. Recognize they are different and unique, and may not enjoy what you do.

• Share your own experiences as a teenager. Show them you are human and do understand what they are going through.

• Make time for them. Be available and accessible regularly. When you are with them, give them your full attention. Shopping with your teenager and bringing along a colleague to discuss medical politics is not shopping with your teenager. Driving in the car is a great place to be together and talk. It is safe, private, with no "escape."

• Listen actively. Ask about their thoughts and feelings. Active listening means letting them know you have heard them, but not responding with a suggestion, criticism, judgment, label, order or lecture; or taking on their problem and solving it for them. Show respect for their thoughts and ideas.

• Talk to them as you would to a friend, especially when you are angry with them. Be calm and explain your point clearly.

• Offer genuine praise. Look consciously for things they do well. Provide regular and frequent positive feedback for who they are and what they do.

• Reach out and hug them, at appropriate times and situations. They will respond positively and appreciate the intimacy. We all need reminders that we are loved.

• Have fun with them. See what they are doing and are interested in, and share in it appropriately without intruding. Go to a concert, go for coffee, watch their soccer games, walk the dog together, talk about a book you have read. Laugh together.

Enjoy your time with them. They grow up and are gone all too soon.

Mamta Gautam is an Ottawa psychiatrist who specializes in treating physician patients. If you have a question you would like addressed in this column, please contact Dr. Gautam at mgautam@rogers.com. Please include “Helping Hand” in the subject line. All inquiries will be confidential. Your questions will not be replied to, but may be selected to be answered in this column, which is intended to be educational, not therapeutic.