Talk with your teenager

© Fiolka

The transition to adult health care has many facets, one of which is that the parents must let go and allow their teenager to assume some responsibility for his or her heart defect. Healthcare providers can facilitate this process by including the child in all or some of the doctor's visits in their early teen years. On such occasions the teenager must be given the opportunity to ask questions and assume personal responsibility.

You as a parent may feel concerned or frustrated during this transition period. You want to know what is happening, and you may wonder whether a teenager can really be trusted to take such responsibility. You can rest assured that most teenagers are indeed capable of being responsible, but during the transition from paediatric to adult care it is your job to assist your child in this. Various tools are available to help you. You should also be aware that teenagers do not truly function like adults, as their brains are not yet fully developed. Failure to listen and forgetfulness may thus be totally natural.

Also respect the fact that teenagers have a great need for privacy.

The brain

In addition to the emotional peaks and valleys and hormonal effects experienced by teenagers, we now know that teenagers' brains are not the same as those of adults. This knowledge has been obtained by studying the structure of the brain using MRI (Magnetic Resonance Imaging) technology. The brain contains the amygdala, a primitive structure that is part of the limbic (reward and emotion) system. Powerful emotional memories are stored there. If the amygdala perceives something as a threat, it may hijack the thinking part of the brain and, for instance, prepare us to flee. When we see something we perceive as a threat, say a spider, a signal is sent to our sensory centres and then on to the amygdala. While this is happening, a signal also goes directly to the amygdala, and it is this signal that causes us to want to flee the spider. The signal that passes through the sensory centres is slower and is able to be analysed – a little spider is not such a great danger. The amygdala is a part of the brain that learns through practice and action. Emotions and behaviours are consequently things that require practice.

The frontal lobes are the thinking brain, which learns through understanding. This is the part of the brain that understands, for instance, Archimedes' principle – if a body is submerged in a bathtub, a corresponding amount of water will be displaced from the bathtub. This is something that we know and have learned, even if we cannot actually explain it in purely scientific terms. The frontal lobes make up the part of the cortex that analyses and controls how we solve problems and resolve conflicts. The frontal lobes analyse what our body is feeling, and also have to sort out all our visual and auditory impressions.

The teenage brain

The brain develops from childhood until the age of 25-30, at which point it is considered mature. This is when the frontal lobes mature, that is, our ability to analyse and foresee consequences is developed. The very last part to mature is the prefrontal cortex, which is responsible for organising, prioritising and halting impulses. The ability to foresee the consequences of an action is thus not fully developed in a teenager. The cortex also matures slowly, while the amygdala becomes fully developed earlier on. It is thus not odd that a teenager will react emotionally rather than rationally. There are also MRI findings that show that teenagers interpret the emotions of other people via the amygdala, that is, quickly and emotionally, whereas adults interpret such feelings using the frontal lobes, that is, analytically. Where an adult sees an unhappy person, a teenager may see an angry one.

Brain researcher Åke Pålshammar likens the teenage brain to a car that has a very powerful engine, but that also has weak brakes and a gearbox that isn't working properly.

Communication between the various parts of the brain is something that improves with practice throughout life. Such communication develops with particular intensity during the teen years. It is as though new paths are being created in the brain, paths that get deeper and stronger with use. It is also important for you as an adult to care about and listen to your teenager. You can help to instill good habits.

Communicate with one another

But how can you best help your teenager without intruding into his or her private sphere? It is sometimes said that parents of children with severe chronic diseases can be overprotective. How are you to turn responsibility over to your teenager without fearing that you will lose control or oversight, and in such a way that your teenager feels that you trust him or her? Constructive conversation can offer a way of achieving this.

Let’s say that you gave your teenager the responsibility of going to a doctor’s appointment alone – without you – and that he missed the appointment because he was playing football with his friends. How do you talk with him about this?

Because his prefrontal cortex and frontal lobes are not fully developed, the teenager will react emotionally via the amygdala, and he may become very angry if you ask a question in the wrong way, or confront him in the wrong way. Make sure you chat with your teenager at a time when you are not angry, and think about the result you want achieve from the conversation. Now is the time to help your teenager form new habits or, to put it another way, new paths in his brain.

Some tools

  • Stay calm – it is easier to avoid conflict if, as parents, you remain calm
  • Talk clearly about your expectations
  • Do not find fault – fault-finding can easily make your teenager defensive
  • Be patient
  • Spend more time together – that will create opportunities to talk about sensitive topics
  • Learn about your own reactions – when you are on the way to getting angry, be aware of how it feels in your body. Does your jaw clench? You may be able to calm yourself simply by knowing your own inner workings.
  • Use “I” messages – tell your teenager how you feel about the situation in question. “I feel that…” If you use “I” messages, you can communicate what you don't like without finding fault.
  • Find a good time and place to have a serious conversation
  • Listen to your teenager’s needs and feelings
  • Don’t forget to say that you love your teenager

In the case involving the missed doctor’s appointment, you and your teenager could work together to find a way to prevent the same thing from happening again. For example, you could decide that your teenager will set his/her mobile phone alarm so that it rings when it is time to go to the doctor.

If you are experiencing problems with the your teenager’s transition to assuming personal responsibility you can, given the opportunity, speak with the social welfare officer or one of the health care professionals at your child’s heart clinic.


Klingberg Torkel, Den översvämmande hjärnan [The Overflowing Brain], Natur och Kultur 2007

Kimber Birgitta and Molgaard Virginia, Älskade förbannade tonåring [Beloved confounded teenager], Natur och kultur 2009

Interview with Åke Pålshammar Åke, senior lecturer in psychology,  Uppsala University, interview 19/02/2009

The Swedish national encyclopaedia accessed on visited: 15/05/ May 2009

Last updated: 2010-04-05

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