I am super excited this month because the newest version of “Reaching Teens” by Dr. Kenneth Ginsburg (a pediatrician and adolescent health specialist in Philadelphia) is being released and this is my favorite book on how to connect with teens. More than any other age group, skills in passing the “trustworthy test” with teens are equally important to any medical skills or degrees a doctor may have. You won’t get respect just because you are an adult with a medical degree…and you can’t force a teen to take pills or use a cream! I have used this textbook to guide the design of our dermatology office, and regularly read it and watch its videos to improve my adolescent communication skills. If anyone wants to know how I will interact with adolescents, this is my starting place.
Principle 1: Communicating with adolescents is not the same as talking with someone our own age.
- There is a cultural barrier between adulthood and adolescence. So, make no assumptions, we must listen and understand that they are the experts in their own lives.
- There is a cognitive barrier between the way an adult thinks and the way a young teenager thinks. So, we must know how to convey information in a way that a 14-year-old will understand, which is different from conveying information in a way that a 30-year-old will understand.
- Trust is earned, rather than given just because we have a medical degree. So, we practice strategies on creating respectful and collaborative relationships between teenagers, providers, and caregivers.
- Creating an adolescent-friendly location that celebrates diversity on all levels has an elevated importance. Fundamental questions of adolescence are “Who am I?” and “Am I normal?” It is our responsibility to make our encounters safe and make our office a place that embraces and fosters the unique differences of teens.
Principle 2: Although trust is something that is built over time, there are things a provider can do to show that they may be worthy of a teen’s trust during a dermatology appointment.
- Show respect and be empathetic: If the teen has a chronic illness, acknowledge that it is difficult and that they have more on their plate than the average teenager.
- Be non-condescending: Although teens won’t have a medical degree, they are equally capable of understanding health problems. Indeed, they are the experts in their own lives and know better than anyone else how it feels to have the illness and how they are affected.
- Don’t blame or judge: While behaviors can be judged healthy or unhealthy, the adolescents who choose to engage in them are not judged.
- Set up expectations: Make sure adolescents and parents know one of our goals is to help transition teens into being their own spokesperson and advocate. Therefore, unlike a 4-year-old, the adolescent patient should be the primary informant. So, we always try to address the patient with each question before the parent.
- Be prepared: Many adolescents won’t be as good of historians as their parents (parents have been doing this for years), so we are patient and prepared to ask follow-up questions for clarification.
- Include the patient in all steps of the health encounter: There is a lot of research showing that 14 to 21-year-olds are equally competent at making health care decisions and equal to the average adult. So, they should definitely be included in discussing the treatment plan.
- Never talk about the patient in in the third person: Rather than saying “I’m going to give this medication to your daughter. Please make sure she takes it twice a day,” it is much more respectful to say, “I’m going to be prescribing this to you. Maybe your mom can help remind you…”
- Encourage parents and adolescents to make decisions together: Although the parent is the authority, the teen should be involved in decision making. It will be very hard for a treatment plan to work if the patient is not on board (i.e. you can’t force medications down the teen’s throat).
- Let teens know that we are a source of honest information: We will share what we know and be honest about what we don’t know. Also, we will assure them that we will not withhold information about their health at any time.
- Encourage open communication: Sometimes parents are afraid that children and teens may not be able to handle things; however, honest and complete information is often reassuring to children and teens. Actually, when we try to hide things, what children and teens have conjured up in their own minds is often much worse than the actual truth.
Principle 3: The teenage years are not a time of “storm and stress.”
- There is an unfair and inaccurate perception that adolescents lie to adults; however, most teens are very honest when they judge adults to be trustworthy.
- Youth live up or down to expectations of them, and many of the media messages teens receive about themselves are wrong and toxic.
- Many messages to teens have also been twisted to be alarming instead of healing.
- Think about the differences in these statements (both reporting the same data): “Did you know that X% of teens have sex before the end of Grade Q?” vs. “Despite the fact that popular TV shows focus on teens having sex, in a recent study, less than half of teens were choosing to have sex by Grade Q.” Or “Binge drinking is a growing problem on campuses; X% of freshman say they have blacked out after a night of drinking.” vs. “Although X% of college freshmen say they are drinking to dangerous levels on the weekends, the good news is that most teens are choosing better ways of spending their weekends.”
Much of communicating with teens requires cultural humility. Even more, investing time in learning about each young person who we interact with—their family customs, ideals, beliefs, foods, religions, socioeconomic status, and neighborhoods—represents an opportunity to role model cultural humility. Understanding cultural humility and celebrating the differences of “others” can go a long way in breaking our generational cycles of passing along “-isms.” How we communicate with teens is really important!
For parents and adolescents who want to learn more about communicating with young people, I recommend this book: Building Resilience in Children and Teens, 4th Edition from the American Academy of Pediatrics: https://shop.aap.org/building-resilience-in-children-and-teens-4th-edition-paperback/
For our younger audience, who want to learn about embracing differences and including others, I suggest these books:
- Strictly No Elephants by Lisa Mantchey: A boy and his elephant don’t fit in with other members of “The Pet Club,” so he and a girl with a skunk start their own club where all are welcome.
- Janine by Maryann Cocca-Leffler: Janine is excluded from a party because she is different, but instead of getting upset, she makes her own party and invites everyone. The book is based on the author’s own daughter who has courageously navigated life with disabilities.
- Odd Velvet by Mary Whitcomb: Velvet is a girl who starts the school year without a new dress and without friends but is slowly appreciated for her uniqueness.
- The Friend Ship by Kat Yeh: A lonely hedgehog hears some animals say “Friendship is out there—all she has to do is look.” So, he sets sail on the “Friend Ship” to find companions.