The terms “adolescent” or “young adult” are not differentiated by age but by the responsibilities that separate them.
Adolescence is referred to as a period of transition bridging childhood to adulthood. As parents begin to decrease their involvement in the diabetes management of their adolescent, the teenager must become more responsible and independent in his or her diabetes-management skills.
However, it is common for adolescents to test the rules set by authorities, which often leads to self-destructive behaviors.
So, how does a family determine readiness to begin the transition from adolescent to young adult?
1. Establish Honest, Open Communication
Parents must clearly identify their expectations of their child. They should express their concern but try not to nag.
Parents should give adolescents the tools they need to succeed and set small, achievable goals for them, which will lead to an increase in independence.
Allow time for the parents and the child with diabetes to share their emotions related to the diabetes and all the responsibilities that go along with it.
Praise achievements and continue to discuss problem areas. Parents should continue to show support and stay involved. Let the child know that he or she can come to you if a task becomes overwhelming and that you will provide help through difficult times.
There may be times when a task that had been mastered may need to be shifted back to the parents due to other stressors that are interfering with the child’s success. For example, the adolescent has been keeping blood glucose records. While at an appointment with the doctor you discover that your child has been falsifying the numbers. It’s very easy to become angry because you can’t understand why your child would do such a thing. It is more constructive to express your concern and explore the reasons why your child falsified the records. Was your child upset about seeing high readings from eating foods that were outside the meal plan? Once you discover the true reason for the deception, you can work together to find solutions, such as adding special foods to the meal plan and helping your child make better decisions. If the only emotion you express is anger, your child will most likely become defensive. That will hinder communication, and he or she will become less willing to tell you about what is going on.
2. Develop a Specific Plan With Achievable Goals
Individual tasks should be clearly identified as you transfer responsibilities from parents to child.
All new challenges should be supervised. There should be spot checks even as a procedure is mastered, such as our above example about keeping records. You want to be sure the task is being done correctly. Just because the adolescent is capable of writing the numbers down doesn’t mean he or she is ready to utilize the readings to make adjustments to the doses.
At least once a week a parent should review those records with the child to help her begin to understand how the different insulin doses affect her blood glucose. As time goes by, the young adult should be able to tell the parent what needs to be done with her insulin regimen, and the parent will play the role of an overseer in the decision-making process.
Encourage the teenager to establish a professional relationship with a specific educator on the diabetes team. Have her establish a review time for records or questions she may have regarding her diabetes.
3. Teach Meal-Planning Skills
In order to truly prepare our children to be adults, we need them to be able to prepare their own meals.
Work together to plan a shopping list. Find time to prepare meals together. Most everyone has a hectic lifestyle, so schedule your planning and cooking sessions on the calendar, just like an appointment. Not many people cook every meal everyday, so also discuss healthful choices for eating out.
Do not assume your adolescent is aware of how to analyze combination foods like pizza to determine correct doses while out with friends. Teach him how to make his favorite foods and how to freeze them in single-portion containers. You can even mark the carbohydrate amounts on the package to reinforce learning. Encourage him to gather nutritional facts from his favorite restaurants. Review the carbohydrates and doses that would accompany certain foods they enjoy.
4. Change the Format of Your Diabetes Appointments
If you always accompany your teenager to his or her diabetes appointment and still answer most of the questions, you have to begin to let go. There needs to be a time for her to speak to the diabetes team alone. She may have questions and concerns about more adult issues such as intimate relationships or drinking alcohol.
Even if adolescents are not engaging in adult behaviors, they probably have questions about them and may feel uncomfortable discussing those issues with a parent in the room. The diabetes team will encourage open communication between children and their parents but will also be able to take a few minutes to teach them about the consequences of smoking or drinking on a person with diabetes, as well as to discuss birth control and safer sex, including information about the risks to the baby associated with an unplanned pregnancy when the mother’s glucose control may not be optimal for healthy, normal fetal development.
The appointment should end with the parents returning to the room and discussing what was just said with the child’s healthcare provider. There will be a time when the diabetes team, parents and teen agree that he or she has matured enough to attend future appointments alone. The parents would again provide a supportive role and be available as needed. This comes with the understanding that they may need to step back into the picture if the responsibilities become overwhelming to the young adult or if the diabetes team believes that he or she needs some help.
5. Shifting Responsibility For Non-Daily Diabetes Tasks
The daily tasks such as blood glucose testing, diet adherence or taking insulin are monitored through the blood sugar records and blood work. Some of the later responsibilities to be transferred to the young adult are making appointments for all doctor visits including the dentist, ophthalmologist and primary care physician.
Obtaining referrals or ordering prescriptions are usually the last tasks to be turned over to the young adult. He or she must learn the process and help to complete them before being expected to perform them independently.
Again, the recommendation is for the young adult to watch the process, perform the tasks with supervision and then have a trial period to test independence.
Making the transition from a child’s total dependence to the independence of a young adult takes years to accomplish. It is important that the parents and teenager realize that success requires communication and a clear plan that identifies everyone’s roles throughout the process.