Joe Dunn
At the recent 7th National Congress of the Canadian Association for Adolescent Health, I attended a unique workshop dealing with issues stemming from the question, "When is a child or youth ready to be in charge of his medical treatment?"
Dr. Jorge Pinzon, an assistant professor of Paediatrics at the University of British Columbia examined several issues raised by this question in his presentation "Empowering Youth in their Health Care: Strategies and Tools". Developmentally, early adolescents have trouble with abstract concepts, and so discussions with them should be based on concrete issues and material rather than abstract ones. Il is important that the youth knows all the facts and outcomes of each decision that lie or she will be making. Il is also essential that the youth understands that the decision that lie/she is making now may affect him/her later in life, a level of awareness that is hard to achieve with an 11 or 12-years-old.
In late adolescence, teenagers are better able to cope with, negotiate, and understand these health concepts. They are also more mature in their decision-making. Again, it is important for the physician to make sure that the teenager has all the facts before making important health decisions. The physician also needs to be supportive and as helpful as possible. The youth is likely to be scared, and having the family at the appointment will make him or her a little more comfortable.
But families also need to know that adolescents need confidentiality around their health care. An understanding of confidentiality, its role in treatment, and a knowledge of situations when it may have to be broken should be discussed with teenagers and parents.
Education is a good way of helping the adolescent deal with the anxiety of making his or her own health care decisions. Il is helpful to have both the teenager and the parents informed and educated about the health issues and decisions that need to be made. Good education discusses both the facts and potential outcomes of treatment, the medical and social needs of the patient, and how to access community resources needed to support these treatments.
All of this means that it is important that adolescents are involved in their own health care decision making as early as is practical. Parents should be encouraged to allow the adolescent to participate in or direct this decision-making. If parents are mature and relaxed about this process, it allows the teenager to relax and focus on the tank at hand rather than worrying about the anxiety needs of the parents, and what they will think. In the end, it is important the teenager shares in health care decisions that will affect him or her for the rest of his or her life.
Dr. Key, a psychiatrist at the Montreal Children's Hospital, said that there are many reasons for intervention in the lives of adolescents who are showing signs of severe depression, suicidal behavior, or conduct disorder. Warning signs of suicide should be reported immediately to the parent by the teacher, peer, school counselor, or physician. This is a good reason for referral for psychiatric consultation. Signs of potential suicide are a good reason for breaking confidentiality and involving the parents in the teenager's health cane. Warning signs of suicide should also be recognized as important cries for help and should not go unnoticed.
Depression is increasing as a major health problem for today's youth with many teenagers not even realizing that they are depressed. Intervention plays an important role in dealing with depression and its symptoms such as anger and school dysfunction. Parents can often get the ball rolling by getting help for themselves, a step that makes it easier for the teen to accept help. Trust is a major issue of therapy, and gaining that trust early in treatment creates a comfortable environment. It is important for the therapist, once trust and empathy are established, to remain open and accepting, yet focused on the issues and feelings the patient needs to talk about.
Medication is a second line of intervention. Initially, Dr. Key suggested, begin with individual and family therapy, and if depressive symptoms are not improving medication can be added.
At that time it is important to make sure that parents and teens understand the expected positive and negative effects of the medication, the appropriate dosage, and safe storage of the pills. Teenagers usually know if the dose is too high, and so checking with them soon after starting medication may prevent or decrease side-effects.
Anger problems and conduct disorder are also major signs to "worry" and can usually be easily identified. Fighting, not listening, lack of concentration, irrational behavior, disobedience, violence, and not thinking about consequences, are all signs of conduct disorder. These symptoms are a good reason for referral for psychiatric help because these problems tend to become worse over time, with drug abuse, theft, and violence as potential developments.
Physicians, psychologists, and psychiatrists play an important advocacy role in getting kids the help they need and in guiding parents in their efforts to help them. Having parents look at the problems within the family and finding ways to deal with these issues is an important task of therapy.
Attention deficit disorder leads to anger and conduct disorder. The signs of this disorder are fairly easy to identify, but referral for medication can make a big difference in the teenager's functioning. Signs of ADD should be reported by counselor so that a treatment plan can be implemented.
Dr. Key concluded by stressing the importance of early recognition and treatment for depression, anger, and ADD.
Reproduced form Monthly News in Adolescence, June 2000.