Originally published in The Medical Post, VOLUME 39, NO. 29, August 12, 2003

By uncovering the motives of adolescent behaviour, you, your patients and the teens themselves all stand to gain

Your 15-year-old patient wants to go on the Pill. Why? What does she stand to gain from a sexual relationship? Does she fear her boyfriend will dump her if she does not take this step? If so, what does this imply about respect and the state of their relationship? What will they do if she does become pregnant?

My previous column discussed the stages of adolescent development and many of the problems children face as they progress toward adulthood. The “adolescent toolkit” is designed to help foster the development of age-appropriate behaviours and decisions, and promote independence based on respect, honour, dignity and integrity.

These staid qualities are not just words. Indeed, today they seem to be branded as quaint human characteristics from an era long ago. The tangible loss of these qualities contributes to the difficulties our children face.

Witness the willingness to sacrifice self-respect and honour for a chance at fame and fortune on the take-your-pick reality TV show.

The loss of the meaning of these words leaves many to act selfishly; we can do what pleases us as long as it does not harm others. This is first-order thinking—the concrete, immediate response to a problem or situation with little consideration of the consequences.

For example, teen sexual activity while living at home does affect the rest of the family. The family deals with the fallout if pregnancy or serious illness occurs. Drug and alcohol abuse acts like a virus, infecting everyone around it. The angst and stress due to illness, infection, surgery or depression is not borne alone by the individual.

The toolkit contains these important pieces: three defining questions, two “life rules,” the concept of true self versus false self and second-order thinking.

The three questions help many teens understand their concept of friendship, relationships and their self image:

• “What do you like and dislike about yourself?” This focuses on personality and physical characteristics and attributes.

• “What is good and bad about you?” What are their moral and ethical values? How does it affect their behaviour?

• “What are your definitions of a friendship and a relationship?” Many teens confuse the two or provide incomplete definitions. A starting point would include independence as a prerequisite in any relationship—two independent people contributing love, trust, compassion and support so their union exceeds the sum of each individual’s qualities with neither losing their sense of self.

One can discern possible contradictions and congruencies in the answers and use them to help the teen discover broader, more reliable and consistent definitions to use in their lives. It can challenge the first-order thinking inherent in their early and middle stages of development.

The life rules focus on two straightforward statements: “It is not what people say but rather how they act that reveals their true intent,” and “People always do things for a reason.”

Many teens choose to ignore these rules for reasons of discomfort, lack of support and feelings of hopelessness. They do not hold others accountable for their behaviour, in effect condoning it through their own inaction or denial. The undercurrent in this response is fear of rejection if they do not project an image of compassion and understanding.

For example, many of us have heard a spouse’s explanation of living with his/her alcoholic wife/husband as “He/she is great when they are sober,” and “She/he promised they would stop but they always return to their drinking.”

The alcoholic’s actions continually supercede their words of promise.

Yet the spouse continues to give one chance after another until the act loses its value. This damages one’s sense of self and independence.

The concept of the true self versus false self defines who we are. The true self usually discerns right from wrong. It is our conscience, sounding an alarm if confronted by something that threatens our commitment to be true to ourselves. People who follow their inner voice tend to respect themselves and their motives.

They become more self-confident and self-reliant. They are not afraid to say no.

The false self ignores the alarm. He/she knows the action is wrong but do it anyway. Frustrated with this contradiction, they direct their anger inward, damaging their self-respect.

Over time, this pattern of behaviour and decision making leads to a loss of independence. These people have difficulty saying no.

They try to solve everyone else’s life problems except their own, and rarely experience similar acts of consideration from others.

Before parents use these tools, it is essential they try to avoid first-order thinking. Visceral reactions (“Are you out of your mind?” or “What were you thinking?”) rarely solve problems. Second-order thinking invites the person to step back and ask a series of questions to uncover the true reasons behind a behaviour, action or thought.

It gives the adolescent a chance to reflect on their motives for their actions and holds them accountable in an adult framework.

Adolescents strive for independence. Appealing to this desire is a pragmatic means of providing a solid foundation of rules, limits and encouragement.

Mature and appropriate actions in response to the rules deserve respect: Parents can loosen the reins in an age-appropriate manner.

Flouting the rules should have predetermined consequences. The adolescent bears the responsibility of his or her decisions if they wish to be treated as an adult.

We can promote and nurture this desire for independence by using the toolkit in the office setting.

It is truly remarkable watching the changes as our patients travel the path toward adulthood.