When adolescents begin to stretch their wings, parents enter a whole new world. Here, Ellen Rome, MD, MPH, explains why teens behave impulsively and how you, as a parent, can help.
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Q: Do well-adjusted teens ever take risks?
A: Every day! You can have a 9th grader with a path to college all lined up. She may know on a Tuesday that her friends’ weekend plans are not a good idea. But despite processing this well in the daylight, come Saturday night she may make a poor in-the-moment choice.
When you think of the rule of family versus the rule of peers, tweens (8- to 12-year-olds) listen to their parents.
Kids in mid-adolescence (ages 13 to 15) and high school, however, may decide to do something risky. The reward of fitting in with peers has become more important than following family guidelines and may outweigh the consequences of a bad choice.
By the time kids reach college, their peers have less influence, and kids begin making more decisions independently.
Q: How does brain development come into play?
A: Your brain develops in stages, and the areas that develop earlier are your limbic system, responsible for your primitive “gut” reflexes and your emotions.
The frontal cortex, in charge of executive function for your brain, is not fully myelinated (hard-wired with a protective layer of fat) until you’re 26. Between ages 15 and 25, your brain’s neural pathways are still developing.
One of my favorite studies shows how impulsive choices can happen when adolescents get behind the wheel of a car. The researchers did PET scans of their brains to see which areas lit up when teens drove on a simulated race course.
The teens were told different people were watching them from behind a screen — the researchers, their parents or their friends. When they thought their parents were watching, the teens drove better. (A small minority drove worse just to make a statement.) But when the teens perceived a friend was behind the wall, they drove worse.
Sleep and diet also affect teens’ decision-making abilities. When you’re totally sleep-deprived, your brain’s executive function won’t work.
And adult brains can handle variations in diet better than adolescent brains. A zero-fat diet may help some adults with heart disease, but an under-26-year-old brain needs fat to make myelin.
Q: What can parents do to reduce risky behavior in the teen years?
A: From early childhood on, parents can help kids learn to take risks safely. It’s hard for helicopter parents to do. But setting loving limits helps kids develop safe boundaries so they don’t keep looking for them. Kids need to learn to be safe — without living in a bubble.
This means letting them test their boundaries, letting them try and fail. This will help hard-wire good habits — and decision-making — for life.
When not-so-positive habits get hard-wired, they can be heard to break. For example, kids who get into substance abuse lose the concept of delayed gratification and don’t develop the resilience needed for job and relationship success.
They may not learn to emotionally regulate themselves, or hard-wire physical pathways in a useful way, or develop abstract thinking. Fortunately, with recovery, adolescents and young adults do catch up.
Q: How should parents talk to teens about making good decisions?
A: Parents can practice actively listening to what teens think and believe, saying “I value your opinion and would love to hear your thoughts about this…” if the moment presents. Or even better, they can actively create a dialogue, as adolescents do better when they know concretely what the parents believe and value.
Use situations to create dialogue; going to a PG- or R-rated movie can prompt a conversation on casual sex. If parents disagree with the teen, they can discuss it or say, “We respect your thoughts. Here are our opinions, and these are the rules in our house designed to keep you safe.”
Q: How do you, as a doctor, try to help teens with decision-making?
A: All physicians who work with adolescents take some time without their parents present in order to establish confidentiality and its limits. (“I will keep our conversations private unless you tell me something life-threatening or dangerous, in which case we will need to bring your parents into the discussion to partner with us to keep you safe.”)
Confidential care provides teens with a safe space to talk to a caring adult with medical and practical knowledge. This gives them a chance to clarify values and to practice negotiating “no” in a risky situation, and helps the teen gain the motivation and skills to make healthy choices.
We look for the kid’s motivation and build on it. This “alone time” helps kids practice making healthy choices, learn what they may be doing that’s not healthy, and discover what they can do differently.
If kids are seriously depressed, or stressed, or not functioning well in school or at home, counseling can be a life-saving addition. Parents can help the teen understand the need by using a coaching metaphor: Good therapy is like good coaching — if you want your kid to excel at tennis, you hire a tennis coach rather than just give him a racquet.
Coaching, practice and praise can lead to better stress management skills and resiliency. Catch kids doing something right and say, “Do more of that!”