Adolescent Rebellion and Medical Treatment

Why do teens not comply with medical care plans? Because theyıre teens. They donıt consider future consequence of immediate actions; they are focused on self-concept and body image; they are defining themselves separate from parental and adult authorities.

In addition, factors common to adults also operate: locus of control (individual belief that oneıs own actions influence the outcome), cultural practices, and manipulation of symptoms for secondary gain, e.g. to avoid obligations.

Ways to observe "noncompliance" (a personıs informed choice to not follow recommendations) include: behavior observation, objective tests (e.g., serum-glycosylated hemoglobin levels -Hb A1c of persons with diabetes), failure to progress (e.g., emergency room use), increase of symptoms or complications, and missed appointments.

• Success with adolescents can occur by forming an alliance after determining that, in fact, the teen is ignoring medical advice as compared to experiencing barriers. These steps are suggested:
  
• Assess reasons for noncompliance, e.g., manipulation or self-destruction intentions.
  
• Write a contract with the sole purpose to achieve mutually-set goals.
  
• Determine how the teen sees the situation, e.g., asking "if your friend had this condition, how would you want to help?"
  
• Help the teen integrate necessary care into her routines for school and weekend days.
  
• Incorporate the need to socialize with peers and admired others, e.g., encourage friends to show support, connect with a celebrity who has a similar condition, find support groups and camps.
  
• Address needs for independence, e.g., activities that need minimal adult supervision.
  
• Help them identify strengths to develop a healthy self-concept and their abilities to handle the condition.

In other words, make teenagers true partners in the health care plan.

(Muscari M. Rebels with a cause: when adolescents wonıt follow medical advice. Am J Nurs 1998;98(12):26-30)

COMMENT: An orientation to self-care is optimal for the school nurse (and other health care professionals) working with adolescents on any health condition.