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Editors
The Adolescent and Long-Term Illness
Essentials
- Experiencing puberty and long-term illness simultaneously is challenging for an adolescent patient.
- A long-term illness affects the adolescent's mental and physical development. Simultaneously, the development in adolescence affects the course of the illness and its treatments as well as the treatment situation itself.
- In a young patient's care, it is important to take into account the patient's age and continuity of the treatment relationship.
Developmental processes in adolescence
- Adolescence refers to a developmental stage between childhood and adulthood from the age of 12 to the age of 22 years, starting at physical puberty. The changes that take place during this stage are both psychological and physical. The essential developmental goal is individual autonomy of the young adult.
- Separation from parents and mental individuation provides enough room for the growth and development of the adolescent.
- The adolescent starts to perceive his- or her self in a new and more realistic way with the aid of friends of the same age and peer groups.
- The physical and sexual development often confuses the adolescent's mind. The adult, sexually functioning body must be identified as part of one's new body image.
- If the adolescent successfully passes through these developmental tasks, he/she forms the identity of an adult, which also entails strengthening of self-esteem, an ability to orientate towards the future. Also mature personal relationships are part of it.
Illness development
- Even a slight physical illness can mean surprisingly much to an adolescent. Many threats are linked to the developmental processes of adolescence: one's own body does not function as reliably as earlier thought and insecurity about recovery creates anxiety.
- An adolescent may be forced to become dependent on his or her parents, and also on professional helpers, which fits poorly with the adolescent's stage of development. The adolescent's relationships to other adolescents of the same age may suffer, and the - in adolescents common - experience of being different strengthens.
Long-term illness
- A long-term illness entails the possibility of incurability or a permanent deviation. Several long-term illnesses cause retardation of growth and delay in puberty.
- A child is capable of understanding the actual nature of his or her illness only once he or she reaches adolescence, e.g. how the illness will affect functional capacity, career choices or fertility. It also becomes possible for the adolescent to perceive the long-term illness as a part of him- or herself.
- Many of the problemsin the cooperation between an adolescent and the nursing personnel are generated by a situation in which the adolescent perceives the illness to be an external enemy. The adolescent must adjust to repeated treatment procedures, medications and restrictions of functioning. Long-term illnesses in which the adolescent is forced to encounter the fact that he or she is actively different from others are problematic from the point of view of mental adaptation. Such diseases include e.g. diabetes, rheumatoid arthritis, epilepsy, asthma, malignancies as well as traumas that damage the body permanently.
- Mental reactions mainly include
- The severity of the reactions varies, and the adolescent may have very severe psychological symptoms, even attempts to commit suicide Self-Destructive Behaviour in Childhood and Adolescence Risk of Suicide in Adolescence.
- Mental reactions can be influenced by
- the adolescent's weak ability to analyse the factors that are associated with the illness
- the adolescent's inability to anticipate things.
Views on treatment
- In addition to treating the basic illness appropriately, one should discuss with the adolescent realistically, emphatically, openly and considerately with respect to the adolescent's state of mind.
- The goals of treatment should be in proportion to the patient's age period. To maintain a basic treatment relationship over the turmoils of adolescence may be a sufficient intermediate goal on the way towards good disease management of a young adult.
- A stable relationship with a personal doctor is beneficial for an adolescent with a long-term illness. The young patient should have access to the doctor's appointment on short notice when he/she so wishes, and the appointment situation should be unhurried.
- The coping of the adolescent is promoted by
- a possibility to speak about the threats that are associated with the illness
- support of faith in the future
- a realistic approach to the situation
- perception of the illness as a part of one's self
- development of therapeutic interaction.
- Courses on how to adapt to the situation may also help the adolescent learn to cope.
- In order to gain an overall view of the adolescent's situation, e.g. the so-called HEEADSSS questions can be used (home, education, eating, activities, drugs, sexuality, suicide, safety from injury and violence) .
- An adolescent who suffers from a long-term illness is not mentally ill if he or she cries, becomes distressed or slightly depressed, or rebels against the treatment of the illness.
- However, if an adolescent's behaviour endangers his or her health, consultation with an adolescent psychiatrist is warranted. The referral to special care must take place discreetly, and the justification for the referral must be explained to the youth concretely. In a crisis reaction, medication should not be initiated until an adolescent psychiatrist has evaluated the situation.
- When the adolescent with time is moved from the children's clinic to adult treatment unit, the shift must be well planned . It must be carried out in a controlled way, accompanied if necessary.
References
- Goldenring JM, Rosen DS. Getting into adolescent heads: An essential update. Contemp Pediatr 2004;21:64-90
- Peters A, Laffel L, American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care 2011;34(11):2477-85. [PubMed]