1. 1Conversations with Adolescents: What Adults Sayand What Teens Hear Presented at Annual Conference of Center for Health Literacy Plain Talk in Complex Times 2012 September 7, 2012 Arlington, VA William O. Donnelly, Ph.D. Donnelly Community Psychology Adjunct Clinical Faculty, Psychology Department Bowling Green State University,
2. What Adults Say“Teenagers think they are invincible.” What do teens think when they hear that?
3. “When adults say, ‘Teenagers think they are invincible’with that sly, stupid smile on their faces, they dontknow how right they are. We need never behopeless, because we can never be irreparablybroken. We think that we are invincible becausewe are. We cannot be born, and we cannot die.Like all energy, we can only change shapes andsizes and manifestations. They forget that whenthey get old. They get scared of losing and failing.” - John Green, Looking for Alaska
4. What Adults Say“When I was a boy of fourteen, my fatherwas so ignorant I could hardly stand to havethe old man around. But when I got to betwenty-one, I was astonished by how muchhed learned in seven years.” - Mark Twain
5. What Do Teens Think When Adults Say …- When I was a boy of fourteen …- When I was your age …- I understand what it’s like to be your age.I was a teenager myself.
6. Teenagers are Different: 3-D Effect in Adolescent Health Care• Development: Dramatic biological unfolding; shifts insocial supports and social influences• Dependency: Parents, guardians, adults make health caredecisions and provide resources (or don’t) until … independence• Diagnosis: Diagnostic criteria developed on adult samplesare sometimes misapplied to youth
7. Development: Biological Changes• Sexual development: physical appearance, sexual arousal, sexual behavior• Physical growth: size, strength, speed, sound changes in coordination• Implications/complications for physical and emotional health
8. Cognitive and Social Development• Established capacity for abstract thought• Intellectual discovery• Emotional complexity, intensity, variability• Moral reasoning. Re-evaluation of values, new ideals• Social Development – Peers. Mentors. Peers.
9. Development and Identity• Transitions from a childhood sense of identity that was greatly influenced by others (parents, family members and community) and was relatively unquestioned• Evolves into a teenager’s exploration of personal and group identity, sense of belonging, and purpose
10. Engaging Youth about Identity: What Matters?• Identity exploration – Who am I, what are my guiding values, beliefs? How am I unique?• Social identity and affiliation – who are my peers, where do I belong, what kind of relationships do I want, how do I develop those relationships?• Purpose – What are we here for? What am I here for?
11. Brain Development and Risk Taking• Logical, abstract thought is reasonably developed by mid-teens*• Other functions that affect risk-taking decisions are still under development* ▫ Emotional regulation ▫ Impulse control ▫ Delay of gratification* Steinberg, L. (2004). Risk Taking in Adolescence: New Perspectives From Brain and BehavioralScience. Current Directions in Psychological Science, 16, 55-59.
12. Dependency• For minors, adults are in charge. Until they’re not.• Legal, educational, financial decisions• Health care decisions• Housing, food, clothing• For young adults, transition from this is typically abrupt, incomplete, challenging.
13. Diagnosis• Diagnostic criteria may not be sensitive to developmental differences and patterns• May lead to misleading diagnostic labeling and inappropriate treatment of adolescent concerns• May be culturally tone deaf to adolescents
14. Adolescent Development: Health Concerns • Sexuality. relationships. birth control. pregnancy. stds.• Physical appearance. acne. tanning. weight. eating disorders. fitness. exercise. • Depression. suicide. anxiety. stress. alcohol and substance use. tobacco. • Traumatic stress. exposure to violence. family conflict. family mental illness.• How to seek, access, and pay for health care
15. Youth and Young Adult MortalityTop 3 causes of death, ages 15-24• Accidents (predominantly motor vehicle)• Homicide• Suicide - Source: Centers for Disease Control and Prevention
16. There is a lot to talk about! So how do adults communicate health information to and about teens?• Mostly, through conversations with other adults• Health care communication addressed to adolescent health issues is typically designed for adults (parents, teachers, health care providers)
17. Engaging Teens in the Conversation• Parents and other adults still matter and still need pertinent health information as they make decisions for or consult to youth• But engaging teens in the conversation about their health and well-being is not only appropriate, it is a developmental fit• The most helpful communications will respect teen concerns and abilities
18. CDC for Teens• CDC engages teens on vaccines:• “Learn more so that you can talk to your parents and your doctor about the vaccines you need and the diseases they prevent.”• Strategy: empower teens to protect themselves from cancer
19. What Do Teens Think?• When CDC says “Learn more so that you can talk to your parents and your doctor about the vaccines you need and the diseases they prevent”, do teens feel empowered?• May depend on whether they trust that the CDC website provides truthful, accurate, evidence-based information.
20. Warning Shots?• Empowerment immediately followed by: “Preteen and teen vaccines 4 shots (preventing 6 diseases): Meningoococcal, tetanus, diptheria, pertussis, human papillomavirus and influenza” (to be followed by field-testing with youth) http:// www.cdc.gov/vaccines/who/teens/for-preteens-teens.html
21. Adolescent Themes and Patterns• Increased recognition of adult/parent imperfections and inconsistencies• Increased reliance on peers for guidance• Increased openness to changing personal beliefs, values, behavior• Desire for respect and autonomy• Risk taking, feelings of invulnerability
22. Adolescent Themes and Patterns• Short-term planning, foreshortened sense of time• Intellectual discovery• Expansion of cultural influences ▫ (music, art, politics)• Idealism• Search for new heroes and heroines, mentors
23. Connecting to Teens• Choose topics that are important to teens and tie into developmental themes• Share data from other teens, including risk data. Share all sides of the story.• Provide interactive option for teen to share opinions/thoughts/questions• Feature teen/young adult commentaries and personal stories on the topic
24. Connecting to Teens: Motivational Interviewing• Motivational Interviewing Miller and Rollnick http://www.motivationalinterview.net• Method developed initially related to helping individuals appraise benefits and risks related to their personal substance use behavior• Helps adolescents identify areas of behavior or functioning that are of concern to them
25. Connecting to Teens: Motivational Interviewing Style• Helps teens look at risks, harm, or concerns related to some behaviors or situations while acknowledging potential benefits or interest or rewards of the situation• Non-confrontational questioning• Exploration and factual, objective use of data
26. Developmental - Generational Interactions• Teens rapidly master new technology• Teens - and their mentors, yesterday’s teens - facile with smart phones, social media, video games• Communication styles established during adolescence become generational traits• Reinforced by culture and brain wiring
27. Communication Strategies• Use of story, personal narratives about teen discovery, exploration• Use of peer stories and data• Use of slightly older mentors• Stories of self-discovery• Integration of stories and scientific data
28. Communication Strategies• Create an interactive dialogue of evidence- based data and adolescent’s experience• High interest, interactive visual materials• Provide information about resources• Limit advice. Encourage reflection.
29. Communication Strategies• Video games as teaching tools• Popular, engaging, interesting to teens• Require mastery of skills and information• Levels of skills, leading to mastery• Immediate and intermediate reinforcement
30. Conversations with Adolescents: Examples• Online interactive simulation training: helping educators talk with teens about psychological distress. ▫ www.kognito.com• Classroom delivery: program helps teens help peers find help for mental health problems. SOS Signs of Suicide Prevention Program ▫ www.mentalhealthscreening.org/programs/youth- prevention-programs/sos/
31. Conversations with Adolescents: Examples• Florida Military Family Peer Support Program Peer guides use interview quotations from youth for peer, family, and provider training about the mental health needs of military families. (Citation, slide 36)• Coping 10.1. Adolescent stories, role plays and vignettes highlight classroom curriculum for tenth graders about understanding and coping with traumatic stress.• Donnelly, W.O., Dubow, E.F., Zbur, S., Hassan, S., Veits, G., Hayman, J., Bradbury, S., Reinemann, L., Ghoul, A. and Bonadio, A. (2012). Coping 10.1: A Psychoeducational Curriculum to Help High Schoolers Handle Traumatic Stress. Unpublished Manuscript. Department of Psychology, Bowling Green State University, Bowling Green, OH.
32. Online Interactive Role Play• Example: Kognito.com/demos• Interactive role-play simulations• How to engage, support and refer adolescents experiencing psychological distress, including thoughts of suicide• For educators (how to talk with students)• For college students
33. 34 SOS Signs of Suicide DVD,Teens discuss peers and suicide
34. Teens Discuss Their Feelings About Military Deployment of a Parent• Nervous, worried, afraid – not knowing if or when they would see the parent I was angry at everybody. I m like a big daddy s girl, so I was really sad he was going away. And I was scared something bad might happen to him.
35. Teens Discuss Their Feelings About Military Deployment of a Parent• Conflicted (multiple and changing emotions)• Well I was kind of happy that he was going away because then I wouldn t have somebody who s always ge=ng mad about something that I would do wrong. But then I was sad because he might not come back. I might never see him again. • Granzow, E., La Greca, A.M., Hershman A.L., Prinstein, M., Sevin, S. and Coyle, A. (2011). North Florida Military Family Peer Guide. Coral Gables, 7-‐Dippity, Inc.
36. Sharing Health Data with Youth: Traumatic Stress Survey ItemsLast year, we surveyed 120 students inthe 10th grade at (your) High School oncommon stressor. They told us a lotabout their experiences dealing withstressful situations, including somethat were really troubling to them.
37. Engaging teens about stressors experienced by other teensCan you guess what percentage ofteens reported being harassed becauseof skin color, religion, sexualorientation, appearance or where theirfamily was from?
38. Final Thoughts• Respect adolescent experiences, insights and interests regarding their health concerns• Illustrative peer and mentor narratives. Stories.• Tie information to adolescent developmental concerns. Use dialogue, interactive gaming.
39. Final Thoughts• Recognize strengths: abstract thinking, exploration of ideas; sensitivity to social and emotional cues• Accept that emotional regulation and impulse control, especially related to risk-taking, are works in progress• Motivational interviewing style encourages reflection, more thoughtful appraisal of risks
40. contact information William O. Donnelly, Ph.D.Donnelly Community Psychology, LTD 429 W. College Avenue, PO Box 105 Pemberville, OH 43450-0105 email@example.com (419) 287-7073