Surviving adolescence

For many teenagers, difficult times come and go, but most teenagers don't develop serious problems. However, adolescence can be very difficult. The anxiety experienced by parents is more than matched by the periods of uncertainty, turmoil and unhappiness experienced by the adolescent.

Parents may sometimes feel that they have failed. However, although it isn't always apparent, parents play a major role in providing the stability that is needed during adolescence.

What changes occur in adolescence?

Rapid changes can occur both physically and emotionally. There may be many new challenges such as peer pressure, bullying, self-image, using drugs/alcohol and sexual relationships.

Physical: hormones, timing and changes

The process of rapid physical changes in adolescence is called puberty. It starts gradually, from around 11 years for girls and 13 years for boys. The hormone changes responsible begin before the physical changes of puberty become apparent, and these hormone changes can also cause emotional difficulties, such as moodiness and restlessness.

With the speed of these changes during puberty, some adolescents become very concerned about their appearance. They may feel worried, especially if these changes happen earlier or later than in other teenagers of the same age.

Growth and the physical and emotional development during this time uses a lot of energy, and this can cause tiredness and needing a lot of sleep.

Psychological and emotional changes

As well as the physical changes during puberty, adolescents start to think and feel differently. They make close relationships outside the family, with friends of their own age.

Adolescence is the time when young people start to learn about the world and to find their place in it. Adolescents spend a lot of time in each other's company, or on the telephone or internet chatting to each other. These friendships are part of gaining a sense of identity that is distinct from that of the family.

Relationships within the family also change. Parents seem to become less important as their life outside the family develops. Disagreements may emerge as young people develop views of their own that may not be shared by their parents. Parents may feel rejected and worried, but it is essential for young people to develop their own identity, in order to become independent and have their own life.

Being upset, feeling ill or lacking confidence can make an adolescent feel vulnerable. They may show this with sulky behaviour rather than obvious distress. Parents have to be flexible to deal with this, and may feel under considerable strain themselves.

As they become more independent, young people want to try out new things, but often have little experience to fall back on when things get difficult. This may produce rapid changes in self-confidence and behaviour, feeling very adult one minute, and very young and inexperienced the next.

Some adolescents want to try out new experiences that may be risky or even dangerous. Fortunately, most young people manage to find their excitement in music, sport or other activities that involve a lot of energy but little physical risk.

Patient picks for Pre-teen and adolescent

Children's health

Adrenarche

This leaflet was originally provided by Miriam Leach (written when a 4th year MB ChB student at Manchester University), used here with permission.

by Dr Hayley Willacy, FRCGP

What kind of difficulties can a young person have?

The young person can present with a number of difficulties. However, he majority of adolescents do not have significant or severe difficulties.

Emotional problems

• Overeating, excessive sleepiness and a persistent over-concern with appearance may be signs of emotional distress. Anxiety may produce phobias and panic attacks.

• Some adolescents feel so miserable that they want to get away from everyone and everything. During their adolescence, more than one in five teenagers think so little of themselves that life does not seem worth living. In spite of these powerful feelings, depression may not be obvious to other people.

Sexual problems

The dramatic physical changes of adolescence can be very worrying to some teenagers, especially to those who are shy. At the other end of the scale, some express their concern with excessive bragging about sexual ability and experiences.

Sensitive support, clear guidance and accurate information about different aspects of sex are essential, from parents, schools, healthcare professionals and family planning clinics. Teenagers can get confidential advice on contraception from their GP who does not have to inform their parents. Emergency contraception from pharmacies is only available to those aged 16 or over.

The age of consent for intercourse, both heterosexual and homosexual, is 16 in England, Scotland and Wales, and 17 in Northern Ireland. It is illegal to have sex if either partner is under this age, even if they give consent.

However, a number of young people in the UK will have had their first experience of sex before the age of 16, and so the risk of pregnancy is an important part of adolescent life. Research suggests that girls who are close to their parents are less likely to become pregnant in their teenage years. Those who start having sex early are at greater risk of early pregnancy and health problems. Sexually transmitted diseases are common, and HIV infection and AIDS are becoming ever more common.

Most adolescents choose their partners quite carefully. Sleeping around and having risky, unprotected intercourse are often signs of underlying emotional problems. They may also be the signs of a risk-taking lifestyle. Adolescents who take risks in one way tend to take risks in other ways as well.

Behaviour problems

Teenagers and their parents complain about each other's behaviour. Parents often feel they have lost any sort of control or influence over their child. Adolescents want their parents to be clear and consistent about rules and boundaries, but at the same time may resent any restrictions on their growing freedom and ability to decide for themselves.

Children are at a greater risk of getting into trouble if their parents don't know where they are. So, parents should try to make sure that they know where their children are going and what they are doing.

School problems

Emotional problems will often affect schoolwork for teenagers. Worrying about themself or about what is going on at home makes it difficult to concentrate. Pressure to do well and to pass exams may come from parents or teachers, but most adolescents want to do well and will push themselves. Excessive nagging can be counterproductive. Exams are important, but they should not be allowed to dominate life or to cause unhappiness.

Bullying can cause problems at school. Around 1 in 10 secondary school children are bullied at some point; about 1 in 20 are bullied every week. If worried that this is happening, it is essential to talk to the school to make sure that they enforce their anti-bullying policy.

School refusal may be because of:

• Difficulties in separating from parents.

• Being a perfectionist, and becoming depressed because they can't do as well as they would want to.

• Disturbed family life, with early separation from or death of a parent.

• An established pattern which may have started at primary school. These children often have physical symptoms, such as a headache or stomach ache.

Those who go to school, but then play truant, are usually unhappy at home and frustrated at school. They prefer to spend their days with others who feel the same way.

Trouble with the law

Most young people do not break the law. When they do, it is most often trivial and only happens once. If a parent doesn't feel that breaking the law is particularly important, it is more likely that their children will offend.

Unhappiness or distress can also lead to behaviour that will get adolescents into trouble with the police. It is always worth asking about their feelings if an adolescent is repeatedly getting into trouble.

Eating problems

If an adolescent is overweight and is criticised or made fun of, they are more likely to dislike themselves and to become depressed. This can lead to inactivity and comfort eating, which worsens the weight problem. Being overweight is an important risk for poor general health but it is very important to ensure that the young person feels happy with themself, whatever their weight.

Many adolescents diet. Fortunately, only a few will develop serious eating disorders, eg, anorexia, bulimia. However, eating disorders are more likely to occur in those who take up serious dieting, think very little of themselves, are under stress and who have been overweight as children.

Drugs, solvents and alcohol

Many teenagers experiment with alcohol and illegal drugs. It is important to consider the possibility of drug or alcohol misuse when an adolescent has a sudden or dramatic changes in behaviour.

Although cannabis has been widely felt to be relatively harmless, there is now good evidence that it can make mental health problems worse in adolescence, and can increase the risk of developing schizophrenia. Despite publicity about other drugs, alcohol is the most common drug to cause problems for adolescents.

Abuse

Physical, emotional and sexual abuse may occur in adolescence and may cause many of the problems mentioned earlier. Families with these problems need expert advice and should seek help. Children or teenagers who are being abused can find someone to talk to at ChildLine (see 'Further Reading' below).

Mental illness

Much less often, changes in behaviour and mood can mark the beginning of more serious psychiatric disorders. Although uncommon, bipolar disorder (manic depression) and schizophrenia may emerge for the first time during adolescence.

Top tips

Don't be jealous

The good times and opportunities that adolescent children have may well make parents feel old. Jealousy can cause all sorts of arguments and trouble.

Make home a safe base

Adolescent children are exploring life, but need a base to come back to. Home should be somewhere they feel safe, where they will be protected, cared for and taken seriously.

Mutual support

Parents need to agree between themselves about their basic values and rules, and support each other in applying them. It is difficult for a teenager to respect parents who are always arguing or undermining each other.

Easy listening

Adults need to be a source of advice, sympathy and comfort. A teenager needs to know that his or her parents will not automatically judge or criticise them, or just provide routine advice, without listening to them and providing understanding and support.

Rules

Although adolescents may protest, sensible rules can be the basis for security and agreement. They must be:

• Clear, so everybody knows where they stand.

• Where possible, agreed with the children.

• Consistent, so everyone sticks to them.

• Reasonable.

• Less restrictive as children become more responsible.

There can't be rules for everything. Although some issues will not be negotiable, there should be room for bargaining on others.

Sanctions, such as grounding or loss of pocket money, will only work if they are established in advance. Threatened sanctions are pointless if they are not then carried out. Rewards for behaving well are just as important, and probably more important.

Managing disagreements

Involve teenagers in making family rules. They are more likely to stick to rules if they can see some logic to them and have helped to make them. If a teenager is reluctant to discuss rules for him or herself. If they don't want to get involved, they will just have to put up with the rules that are decided for them. Parents should pick their battles carefully. Constant arguments tend only to make matters worse.

Set a good example

Although they are becoming more independent, teenagers will still learn a lot about how to behave from their parents. Therefore, parents should try to set a good example at all times. This will help teenage children to behave well and provides a much stronger argument when parents discuss when their teenage children are behaving badly.

When all else fails, get help

Sometimes, all of this may not be enough and the whole situation feels out of control. It is very important to seek help when needed.

Adolescents who experience turmoil or distress for more than a few months (eg, persistent depression, anxiety, serious eating disorders or difficult behaviour), generally require outside help.

Counselling agencies may be suitable if things have not gone too far. They exist for young people and for parents and some organisations are listed under 'Further Reading' at the end of this leaflet.

However, specialist help may be needed from the child and adolescent mental health services (CAMHS). They mainly offer outpatient treatment and can be contacted through the GP.

As they grow older, teenagers will want more privacy. Adolescents may, quite naturally, wish to see the doctor on their own. The law allows them to agree their own treatment from the age of 16, or younger under certain circumstances.

When problems arise at school, obviously teachers may be a useful source of information. The teacher may suggest that an educational psychologist become involved. Psychologists can find out if there are any particular problems with learning, but can also offer counselling if relationships are the issue.