Just when you thought your obedient, personable, willing to please elementary-school aged child was ready to become more independent; alas, they become preteens and start adolescence! Welcome back to the possibility of a reprise of "toddlerdom." As I have alluded to many times, it is my belief that many of the tasks of separation and individuation that occur in the toddler years come back in full force once puberty begins. No longer are we worried about your child climbing onto the furniture or running into the street; we are now concerned about your child climbing into dangerous territory or driving in the street.
Teenagers have the physical capacity to perform as an adult; however, they often lack the cognitive and emotional skills to understand the meaning of their actions. They are concerned about how they relate to their peer group and are again trying to step away from the family unit. At times they achieve this separation by persistent irritating behavior, thus provoking parents to exasperation who actually may want their teen to go elsewhere! Adding this normative behavior to a chronic illness such as diabetes is a dangerous mix. Acting out is expected from teens and adolescents. However, when they use their diabetes to act out, the consequences are escalated enormously. Impulsive behavior and diabetes management can be disastrous and therefore may become the dreaded nightmare of many parents and caregivers.
My office visits with teens are filled with the drama and angst so prevalent in the family and I experience a microcosm of what may go on in the home environment. I never know what to expect during these visits. Indeed, sometimes the same teen can be completely different from a visit only 3 or 4 months ago. How can you get the most adaptive behavior from your pre-teen, adolescent, or young adult with diabetes? After many years of trial and error, I have several suggestions that have worked in various degrees with this age group. As such, I have come to love these kids and try to come up with creative ideas to engage them towards proactive diabetes behavior. The most important thing to remember is that you and your child should keep coming to visit us at appointments. There generally will be an epiphany...some day. And when that epiphany comes (for whatever reason) it is a memorable event. The key for me and probably the caregiver is to somehow keep the adolescent engaged or connected. That is why I am up on all young adult literature and the latest movies. I also have read various books based on the recommendations of my teens. WHY? It gives me something to talk about other than diabetes! Sometimes, a teen will come in with a parent and be engaged texting with their cell phone, etc. I need to find something to talk about to get their attention. It generally won't be about the number of times they are testing blood sugars!
Potential Solutions for Engaging the Teen with Diabetes
1. Try to get into their world and find out what actually matters to them. You can then use that information to consider incentives to encourage diabetes self-care skills. Every teen is different and what matters to one will not necessarily work for another. Thus, I use various incentive plans to assist the adolescents in diabetes management. One was "Bolusing for Dollars" written by one of my young adult patients. Other incentives are working towards acquiring technology equipment (iPod, iPod), or iTunes, etc., based on improved self-care skills.
2. DRIVING: I am very strict when it comes to driving. Driving is such an adventure for those without diabetes; consider how erratic blood sugar control may contribute to the adventure even further! About a year before my teens turn 15 9/12 (the age one may acquire a Learner's Permit in Maryland) and thereabouts, I give them a heads-up that I will not sign the MVA form application unless they are testing at least four times/day. In Virginia and DC, it seems that there is not a requirement for a physician to give written permission. It never ceases to amaze me that a parent also may refuse to sign the form if the adolescent is not performing diabetes self-care skills appropriately or safely. It is okay for you as a parent to set limits and develop a contract for your child if he/she wants to drive.
3. PARENTING: Think toddler behavior again! It is ok for you to set limits on inappropriate behavior. Oftentimes, a teen will push you so that you WILL set the limits (to the relief of the teen)! Example: Your child is invited to a friend's home for a party. Your child knows that the parents are in Hawaii (and you don't). He is afraid that there will be alcohol and other recreational drugs and is worried about drinking and hypoglycemia. He really doesn't want to go but doesn't want to look uncool in front of his peers. If you are concerned, get more information about parental supervision and if not to your satisfaction, refuse to give permission (your kid will rant and rave, but secretly may be relieved).
4. Independence issues: Your teen may want to go on a class trip, spend a summer studying in Italy, etc., and you as the caregiver are concerned that he may not take care of his diabetes. Now is the time to determine if your adolescent is capable to care for him/herself independently. It is hard to let your kid go away for a month, let alone for a day, so why not practice with overnight stays with friends, wherein your child touches base with you periodically by texting, tweeting, or even phoning, etc. You can increase the time interval away from home as your child demonstrates safe behavior. By the time your teen is ready to leave home for college, you will be comforted by the fact that he can take care of himself. Likewise, if your teen did not perform appropriately, you should act accordingly and limit the outings until he/she is ready.
5. Natural consequences for actions work well with teens. They know when they have blundered and there should be appropriate consequences for undesired behavior (just like with toddlers). They certainly will not like it; but you are the ones with the power (and the money).
6. A word about young adults: Our psychology team often performs research on various age groups. We have limited data demonstrating that young adult behavior in junior and senior year of high school has a predictive value in college. What does that mean? It is best to try to improve diabetes self-care skills before your adolescent goes to college. We know this and will work hard to help you come up with strategies that may work for your teen.
We certainly won't give up trying to find what works for your teen and neither can you!
Published On: September 14, 2011