The family physician’s role in keeping parents involved in their adolescents’ lives
William B. Shore
Adolescents are often portrayed in the media as living beyond their parents’ control, often making irresponsible, self-centered, even life-threatening decisions. Parents are frequently portrayed as powerless, ineffective and frustrated. But recent studies indicate that effective parenting styles (authoritative, but not authoritarian) can have a positive impact on behavior while promoting autonomy for their adolescents.
Authoritarian parenting is characterized by attempts to shape, control and evaluate the behavior and attitudes of children in accordance with an absolute set of standards. Authoritative parenting, on the other hand, sets the expectation of mature behavior and clear standards for the child, firmly enforcing rules and establishing appropriate consequences.1 Because adolescents are often seen by family physicians, and because family physicians work with both adolescents and their parents, family physicians can play an important role in facilitating authoritative parenting styles and effective communication.
Parents of adolescents need information about the risks their adolescent faces with respect to sex, drugs, violence and poor school performance. Studies show that most parents significantly underestimate the degree of drugs, and driving by adolescents, especially with regard to their own children. Parents of children enrolled in school-based clinics have reported a desire for more information on such adolescent health topics as drugs and alcohol, and teenage pregnancy and contraception.
Studies have also consistently shown that adolescents who have discussed sexual issues with their parents demonstrate more responsible sexual behavior. In relation to school performance, children from families in which parents demonstrate some interest in school and use authoritative parenting function at a higher level in school.
Other studies have identified factors that seem to protect an adolescent against a poor outcome. These factors have been found to cross racial and gender groups. They are the following: (1) Family connectedness was the most powerful factor. Adolescents who perceived a meaningful relationship with their family (however this was construed) were more likely to also report a sense of general emotional well-being. (2) Positive body image was an important protective factor for both girls and boys. (3) A sense of connectedness with other adults (other than parents) was also associated with a sense of well-being.
The Family Physician’s Role
Family physicians can help parents and teenagers negotiate the adolescent years. Family physicians must appreciate adolescence as a distinct period in the family life cycle; the care offered to this age group should be as distinct and focused as well-baby care or geriatric care. Family physicians can help prepare parents and adolescents for the changes and stresses of adolescence by providing anticipatory guidance.
Family physicians should discuss with parents how they can remain involved and connected with their teenagers while at the same time promoting autonomy for their teenagers. Anticipatory guidance includes teaching parents how to discuss, in a mutually respectful atmosphere, alcohol and controlled-substance use with their teenagers and how to stress the risks that are inherent when substance use is mixed with use of weapons or driving. For example, a family physician might advise parents to acknowledge (not condone) that experimentation with alcohol and other substances occurs at parties or social events. Parents can be encouraged to discuss potential risks and to stress that their priority is to have their teenager arrive back home safely This discussion might also include such topics as designated drivers and permission to call home for assistance, if necessary, without repercussions. These kinds of mature, negotiated decisions between the parents and their adolescent can help promote a sense of family connectedness and responsibility for the adolescent.
Family physicians can also help parents feel more comfortable discussing safe and responsible sexual behaviors. They can advise parents to use opportunities, such as television programs, movies and the news, to discuss sexually relevant issues with their teenagers. Parents should frame these discussions in the context of expectations that their children will make responsible and safe decisions about sexual behaviors (including the decision not to be sexually active). Parents can also be advised to reassure their adolescents that issues the teenagers discuss with their family physician will be confidential. These discussions can help teenagers develop a more positive body image and assuage their ever-present concerns about their changing bodies. Because of the current epidemic of violence and weapons, another important area of anticipatory guidance now involves asking parents about their child’s exposure to violence and access to weapons in the home.
Physicians should also encourage parents to stay actively involved in their children’s school activities, attending open houses, parent-teacher meetings and other activities. Often a teacher or counselor becomes another adult with whom the adolescent feels a sense of connectedness. The family physician’s acknowledgment of such relationships can help parents understand the importance of the relationship and the need to support their child. Basically, our work involves helping our patients remain active, involved, connected parents throughout these important teenage years.
Anticipatory guidance and parent education can be built into regular visits with parents who come in for blood pressure or diabetes checks or for regular screening visits. Simply raising these issues with parents and having appropriate parent information materials available in our offices,[8-10] in addition to acknowledging that parents want to do their best for their children, will go a long way toward decreasing the isolation that many parents and their children feel today. This kind of preventive intervention is at the heart of family-oriented health care and health promotion. President Clinton has identified adolescent health care as a high priority. It is our responsibility as family physicians to raise and discuss issues of adolescence in an informed and concerned way
REFERENCES[1.] Adolescent health. Vol. 2. Washington, D.C.: Office of Technology Assessment, 1991:35-55. [2.] Beck KH, Lockhart SJ. A model of parental involvement in adolescent drinking and driving. J Youth Adolesc 1992;21:35-51. [3.] Dryfoos J, Santelli J. Involving parents in their adolescents’ health: a role for school clinics. J Adolesc Health 1992;13:259-60. [4.] Furstenberg FF Jr, Moore KA, Peterson J. Sex education and sexual experience among adolescents. Am J Pub Health 1985;75:1331-2. [5.] Dornbusch SM, Wood KM, et al. Family processes and educational achievement. Conference on Education and the Family Washington, D.C.: Office of Research, U.S. Dept. of Education, July 14, 1988. [6.] Resnick MD, Blum RW, Harris LJ. Protective and risk factors for adolescent emotional well being. Annual Meeting, Society for Adolescent Medicine, March 20,1992. [7.] Alexander B. Violence: a public health problem. Am Fam Physician 1992;46:67-8. [8.] McCoy K, Wibblesman C. Crisis-proof your teenager. New York: Bantam, 1991. [9.] Teenagers and driving: a guide for parents. Elk Grove Village, Ill.: American Academy of Pediatrics, 1992. [10.] National Institute of Mental Health. Plain talk about adolescence. Rockville, Md.: Public Health Service, 1981.
Dr. Shore is associate clinical professor in the Department of Family and Community Medicine at the University of California, San Francisco, School of Medicine, where he is also coordinator of adolescent curriculum. He is a former chair of the Group on Adolescent Health Care of the Society of Teachers of Family Medicine.
COPYRIGHT 1994 American Academy of Family Physicians
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