Parents can help their adolescent cope with growing up, provide a good example, establish consistent firm limits, being always involved and warm (4). Parents are the child's and adolescent's first role model and teacher. From his/her parents, the child will learn that he/she is unique and deeply loved. These feelings can last a lifetime. Parenting involves the care, teaching, and guidance that enable adolescents to make appropriate decisions for themselves.
Adolescents are still immature in their formal thinking (the brain is only fully mature after age 20), and they may rebel or believe they are more capable than they really are. And that is were they can get into trouble. Parents should be able to discuss their choices with them and advise them on how to improve their own decisions (5). They (the parents) should give reasons for their decisions and not be afraid to say no. Moreover, they should prepare them to be independent, responsible adults, and not expect more from their adolescents than what they can realistically accomplish.
The impact of a chronic condition on the fulfillment of the developmental tasks of the adolescence may be huge (6). Throughout adolescence new competencies are acquired: Physical development including sexual (pubertal changes, body image); cognitive (development of abstract thinking and identity construction), and social (development of autonomy: change in the relationship with parents and peers, planning for the future). However, and above all, an adolescent with a chronic condition is an adolescent.
The main adolescent developmental tasks are the building of autonomy and identity. The adolescent with a chronic rheumatic condition may face additional challenges in fulfilling these tasks. The development of independence may be interrupted as the child retains childish behavior while becoming adherent to treatment regimes, leading to a compliant but still childish adolescent. On the other extreme, frustration and anger may lead to nonadherence and rebellion.
Regarding peer involvement, there might be fear of rejection and segregation from peers leading to increased absence from school and other activities and social segregation. As far as identity is concerned, an inferior self-image with lower self-esteem, sometimes depression, may lead to concerns about the future and their emerging sexuality. Of course, both the severity of the condition and personal and family history are major influences. Family becomes then a critical element. Health professionals may also play an important role. They need to understand the family in this new life-cycle stage, how family dynamics may influence the adolescent's development and how they may facilitate communication among the different elements of the family system. Assessment of the adolescent psychosocial maturation and autonomy is a priority when dealing with teenagers and is covered further in Chapters 2 and 4.
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