Originally published in The Ottawa Citizen July 20, 2001

You are in a line for a movie and you pass gas or do some other embarrassing activity. Your first reaction usually is “Oh my god, they all know I did it!” This is a remnant of your teen years. Teens are naturally self- centered and experience that reaction you had about ten times more intensely sometimes on a daily basis. Despite the teen horror stories, most adolescents cope well with their development process.

Eight years ago, I, along with Dr. Peter Côté, established at Canterbury High School the first school based full service medical center in Canada. It was incorporated into the family medicine teaching program at the University of Ottawa providing to residents the opportunity to learn about adolescent issues.

It is also important for parents to have an introduction to adolescent development. In order to understand the dynamics and interactions between adolescents and their parents a brief general description of the three stages of adolescence is in order. These are not hard and fast rules becuase children develop at different rates.

The early stage (girls 11 to 13, boys 12 to 14 years of age) focuses upon the rapid physical changes of puberty. They are concerned about their body image and sexual changes in comparison to others their age. They have to adapt to new school environments and the social structures. Their dependence upon their parents conflicts with their desire to be independent. A battle rages within them between the safety of childhood and the need to enter the new adolescent world. Many times I have heard a parent lament that “Steve used to go out with us on family outings but now he wants to spend time with his friends. He can be like his old self at times and then be just impossible to deal with!”

In the middle stage (girls 13 to 16, boys 14-17), there is a consolidation of body image and sexual identity. The school environment is comfortable. Peer groups become their new family and safe haven. They are a form of tribalism with all its rituals, markings and lingo. Peer pressure becomes the dominant behavioral influence. In the quest for independence they test their limits and compare themselves to their friends. Paradoxically, they conform to their peer group in order to feel more independent.

In the late stage (17 to independence) there is a crystallization of identity. Career choices and their future plans become important. After graduation high school friends head off in their own direction. The need to associate with peer groups diminishes and they seek more intimate one-on-one relationships. They leave the tribe and come back to their family for guidance and help.

The natural instinct for parents is to protect their children from harm. When a child is ill we tend to their needs. This normal parental response can interfere with a child’s foray through adolescence. They can stall at one of the three stages. Parents need to be mindful and encourage their child through this process as much as the situation allows. Completion of these stages is essential for normal social development. Alcoholism and drug abuse can forestall successful passage into adulthood.

Prior to the age of 16, teens live in the here and now. In general, areas of the brain that are responsible for abstract reasoning have not yet fully developed. They have difficulty understanding the consequences of their actions with risk taking behavior becoming more common. This can be bewildering for parents.

Teens are masters of body language. If they perceive through your body language that you are not listening to them they will tune you out. Look directly at them when communicating even if they do not reciprocate. It may seem that they ignore your words but in reality they do hear everything you say. Use metaphors when explaining your point of view. They do not use the word “like” for nothing!

So what to do? Our children must inevitably break away from us. The challenge is to maintain a good relationship and avoiding festering conflicts. Teens need and want limits with well-defined consistent positive and negative consequences. Without these limits they are adrift without direction. They usually test your rules. But rules that are reasonable, age-appropriate, fair and consistently enforced have the best chance of guiding your teen through these times. They build upon this foundation on their path to adulthood.

Trust and confidentiality are of paramount importance. Adolescents are concerned that their family doctor will talk to their parents about their problems. Rightly or wrongly, that is their perception. Teens need to know that this will not happen unless their life is in danger or they are suicidal. Our experience at Canterbury has been that although behaviours are difficult to change, you can minimize the potential of a bad outcome. Talk to your doctor with your teen as an equal participant about confidentiality issues. It can provide your teen with another safe place to go for help. Adolescents will continue to obtain care and health information in a haphazard manner through different walk-in clinics, the ER, their friends, or not at all if we do not give them better options.