The Complete and Authoritative Guide to Caring For Your Teenager: The American Academy of Pediatrics

First Chapter

PARENTING TEENAGERS IN TODAY'S WORLD

"Adolescence is when children start bringing up their parents."

--Anonymous

What if parenting a teenager were a job like any other, advertised in the want ads? Imagine picking up the classifieds and finding this:

We have an exciting, demanding position open in our department of growth and development. You will be in charge of grooming a small but dynamic team of up-and-coming young adults. Be prepared to put in endless hours and expect your authority to be challenged frequently. Fluency in two languages required: yours and theirs. Other prerequisites include infinite patience and a working knowledge of psychology, sociology, popular culture and all secondary-school and college curriculum. Must have car! Zero room for advancement; compulsory demotion in several years. Don't bother sending salary requirements; there are none.

If you didn't already have this job, you'd probably keep moving right on down the page.

Adolescence can be a challenge for parents. Your youngster may at times be a source of frustration and exasperation, not to mention financial stress. But these years also bring many, many moments of joy, pride, laughter and closeness. Too often, though, our culture seems to overemphasize the pervasive stereotypes of adolescence, many of them negative. Countless books, movies and news accounts create sensationalized portraits of disaffected youth flouting authority at every turn and often getting into serious trouble. As a result, the accomplishments of the good youngsters who make up the majority of America's approximately sixty million adolescents tend to beovershadowed.

Denver pediatrician Marianne Neifert objects to the barrage of disparaging messages parents receive about adolescence. As the mother of five children now grown to adulthood, she observes a parallel between the so-called "turbulent teens" and what is known as the "terrible twos." Just as not all toddlers go through the terrible twos in the same way, not every kid transforms into a defiant, capricious creature upon turning twelve. To assume that the teen years will be fraught with conflict can distort our perception of our children's behavior and result in a self-fulfilling prophecy, says Dr. Neifert, "because kids tend to rise or fall to our expectations of them."

Recent studies dispute the long-held belief that adolescence is inherently a time of turmoil. Four in five youngsters negotiate adolescence without any major problems, while in a 1998 nationwide poll of more than one thousand thirteen-to-seventeen-year-olds, 97 percent claimed to get along with their parents "very well" or "fairly well."

PARENTS MAKE A DIFFERENCE!

Granted, adolescence is a time when kids come under the pull of their peers and fall susceptible to the attitudes and values promoted by TV, movies, morning-radio personalities, advertisements, sneaker-peddling sports stars and the latest brooding rock singer. But as a large nationwide study demonstrated, mothers and fathers still exert a great deal of influence in shaping their children's moral and ethical beliefs and character.

The National Longitudinal Study on Adolescent Health, published in 1997, surveyed nearly twelve thousand students in grades seven through twelve. Across the board, youngsters who said they felt secure in their parents' love and caring were far less likely to experiment with tobacco, alcohol and drugs, engage in sex or violent behavior, or contemplate suicide than those who claimed not to feel emotionally connected to their families.

What does the study tell us? "It says that parents have a tremendous influence on their kids," says Dr. Robert W. Blum, one of the researchers. "And that influence remained constant across the age group." Adds Dr. Lia Gaggino, a pediatrician in Kalamazoo, Michigan, "Parents don't appreciate how important they are."

HOW THIS BOOK CAN HELP YOU

Not only do parents need to prepare their youngster for the journey from childhood to adulthood, but they need to prepare themselves as well. Caring for Your Teenager contains the collective wisdom and experience of the approximately fifty-seven thousand primary-care pediatricians, pediatric medical subspecialists and pediatric surgical specialists who belong to the American Academy of Pediatrics. In it you'll find practical advice for helping teenagers adjust to the changes of adolescence and make good decisions about drugs, alcohol, tobacco, premature sexual activity and other threats to their physical and emotional well-being. You'll also learn strategies for helping teens who have struggled with these or other problems to reclaim a happier, more fulfilling future. Consider this book a guide to what these years may hold in store.

Naturally every youngster is unique, but the biological changes that occur in adolescence are accompanied by certain predictable psychological changes. This is a time when behaviors that are considered inappropriate in both young children and adults have to be accepted as normal, healthy manifestations of growing up-even if they age you in the process. Once you understand the developmental mechanisms at work, you may find that you're better able to identify which situations warrant your concern and which you can take in stride.

The following examples of adolescents in action may have you nodding in recognition at least once. The good news? Barring extremes, these behaviors are perfectly normal. The bad news? These behaviors are perfectly normal.

It's a Friday night, and your seventeen-year-old daughter is going to a friend's party. She trots downstairs wearing the vampiric makeup and all-black uniform of the self-proclaimed "gothic"-rock movement.

"I'm goth," she intones solemnly, while you struggle to suppress a grin. Or, if you're not sufficiently up on teen subcultures, perhaps you mistakenly think she said, "I'm Garth," leaving you scratching your head as she kisses you good-bye and heads out the door.

Cause for alarm? Not beyond the normal concerns you would have about any teenage party; namely the availability of alcohol and drugs-and parental supervision. In sculpting her own identity, a teenager routinely experiments with different personas. Each incarnation, expressed through fashion, hairstyles, interests, beliefs, a particular group of friends and so on, is typically short-lived. By next year she may have adopted an altogether different look and attitude.

As a boy, your son seemed to hang on to your every word and saw you as infallible. Remember how proud that made you feel? Now this fourteen-year-old points out your every shortcoming, and "Boy, Dad, you know everything!" has been replaced by an exasperated, "How would you know?"

It is common for adolescents to suddenly cast a critical eye on Mom and Dad, as they seek to separate from their parents and form their own system of values. Try not to take it too personally, but do make it clear that expressing himself disrespectfully is unacceptable.

Lately your thirteen-year-old daughter has been fixated on her ever-changing body and bodily functions. She's constantly asking her mother: "Do you think I'm too fat?" "When am I going to get breasts?" "Am I pretty?"

The body is a source of endless fascination-and anxiety-for self-conscious teens. This is also a time when kids tend to behold themselves as the center of the universe; consequently, the discovery of a pimple can seem like a catastrophe.

Since the start of the school year, your seventh-grader has grown moody and irritable. He spends increasing amounts of time barricaded in his room, and your attempts at finding out if something is bothering him are met with a testy, "I'm fine. Just leave me alone."

Should you be alarmed? That depends. Some boys and girls are introverted by nature, and perfectly content to be by themselves. Does this describe your youngster? Or is this behavior out of character?

Rising tides of hormones and the struggle for self-identity may account for his moodiness, which is normal. Sadness and emotional withdrawal, too, are not uncommon during adolescence. But as with adults, depression that persists for more than two weeks should be brought to the attention of your pediatrician, who may in turn refer you to an adolescent mental-health specialist.

THE STAGES AND GOALS OF ADOLESCENCE

Adolescence, these years from puberty to adulthood, may be roughly divided into three stages: early adolescence, generally ages twelve and thirteen; middle adolescence, ages fourteen to sixteen; and late adolescence, ages seventeen to twenty-one. In addition to physiological growth, seven key intellectual, psychological and social developmental tasks are squeezed into these years. The fundamental purpose of these tasks is to form one's own identity and to prepare for adulthood. Table 1's condensed preview of adolescence shows how these events typically unfold.

Physical Development

Puberty is defined as the biological changes of adolescence. By midadolescence, if not sooner, most youngsters' physiological growth is complete; they are at or close to their adult height and weight, and are now physically capable of having babies.

Intellectual Development

Most boys and girls enter adolescence still perceiving the world around them in concrete terms: Things are either right

or wrong, awesome or awful. They rarely set their sights beyond the present, which explains younger teens' inability to consider the long-term consequences of their actions.

By late adolescence, many youngsters have come to appreciate subtleties of situations and ideas, and to project into the future. Their capacity to solve complex problems and to sense what others are thinking has sharpened considerably. But because they are still relatively inexperienced in life, even older teens apply these newfound skills erratically and therefore may act without thinking.

Emotional Development

If teenagers can be said to have a reason for being (besides sleeping in on weekends and cleaning out the refrigerator), it would have to be asserting their independence. This demands that they distance themselves from Mom and Dad. The march toward autonomy can take myriad forms: less overt affection, more time spent with friends, contentious behavior, pushing the limits-the list goes on and on. Yet adolescents frequently feel conflicted about leaving the safety and security of home. They may yo-yo back and forth between craving your attention, only to spin away again.

Social Development

Until now, a child's life has revolved mainly around the family. Adolescence has the effect of a stone dropped in water, as her social circle ripples outward to include friendships with members of the same sex, the opposite sex, different social and ethnic groups, and other adults, like a favorite teacher or coach. Eventually teenagers develop the capacity for falling in love and forming romantic relationships.

Not all teenagers enter and exit adolescence at the same age or display these same behaviors. What's more, throughout much of adolescence, a youngster can be farther along in some areas of development than in others. For example, a fifteen-year-old girl may physically resemble a young adult but she may still act very much like a child since it isn't until late adolescence that intellectual, emotional and social development begin to catch up with physical development.

Is it any wonder that teenagers sometimes feel confused and conflicted, especially given the limbo that society imposes on them for six to ten years, or longer? Prior to World War II, only about one in four youngsters finished high school. It was commonplace for young people still in their teens to be working full-time and married with children. Today close to three in four youngsters receive high-school diplomas, with two in five graduates going on to college. "As more and more teens have extended their education," says Dr. Joseph Rauh, a specialist in adolescent medicine since the 1950s, "the age range of adolescence has been stretched into the twenties."

Reflect back on your own teenage years, and perhaps you'll recall the frustration of longing to strike out on your own-but still being financially dependent on Mom and Dad. Or striving to be your own person-yet at the same time wanting desperately to fit in among your peers.

Adolescence can be a confusing time for parents, too. For one thing, they must contend with their children's often paradoxical behavior. How is it that the same son given to arias about saving the rain forest has to be nagged repeatedly to sort the recycling? Or that in the course of an hour your daughter can accuse you of treating her "like a baby," then act wounded that you would expect her to clear the table after dinner?

But beyond learning to anticipate the shifting currents of adolescent emotion, mothers and fathers may be struggling with some conflicting emotions of their own. The pride you feel as you watch your youngster become independent can be countered by a sense of displacement. As much as you may accept intellectually that withdrawing from one's parents is an integral part of growing up, it hurts when the child who used to beg to join you on errands now rarely consents to being seen in public with you, and then only if the destination is a minimum of one area code away.

It's comforting to know that feeling a sense of loss is a normal response-one that is probably shared by half the moms and dads standing next to you at soccer practice. For pediatricians, offering guidance and advice to parents makes up a considerable and rewarding part of each day. In the course of shedding light on your child, Caring for Your Teenager will help you be more attuned to your evolving feelings as you guide your youngster through the adolescent years.

TODAY'S UNIQUE GENERATION OF PARENTS AND TEENS

Perhaps it's human nature for each generation to inevitably find fault with the next. But take a look at a group of teenagers milling about outside school, and chances are that aside from clothing baggy enough to accommodate a family of four and the ubiquitous beepers and cellular phones, the scene looks oddly familiar. Who'd ever have thought that chunky-heeled shoes and bell-bottom pants would come back in style?

You belong to a unique generation in that unlike your parents or your grandparents you probably had an adolescence very similar to your teenager's, because the teen years of today bear a strong resemblance to what they have been since the 1960s. Now, as then, the times are relatively affluent, our current recession notwithstanding. Culturally and socially, teens are still consumed by many of the same interests you probably had: TV, sports, music, dating, movies. Unfortunately, they still face many of the same social problems, including widespread substance and alcohol abuse, unplanned pregnancies and sexually transmitted diseases.

Compared to parents of a generation ago, you probably have a greater understanding of the obstacles confronting your child. And while today's moms and dads aren't going to agree with everything that teens do in the name of expressing their individuality (if we did, our kids would never forgive us), perhaps we're more inclined to be accepting of their need to do it.