While there is still a great debate about how opioid use disorder (OUD) should be treated, more experts are coming to the conclusion that pharmacotherapy access must be expanded. However, there remain several disparities in race, sex, and age that dictate who receives medication.
This is according to a new study from JAMA pediatrics, “Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder among Adolescents and Young Adults, 2001-2014.” The national retrospective cohort study looked at 20,822 young people aged 13 to 25 years with OUD.
OUD is characterized by a problematic pattern of opioid use. It encompasses opioid addiction and dependency and often begins in adolescence or young adulthood, with 7.8% of high schoolers reporting lifetime opioid misuse. Two-thirds of OUD patients used before the age of 25, and a third used before age 18. Many experts advocate for early pharmacological intervention. Overall, only about 1 in 12 young adults receive treatment for any kind of addiction.
The study looked at the rates of buprenorphine and naltrexone prescription, since both can be offered in primary care and subspecialty settings. There have been issues surrounding naltrexone, and it is less commonly prescribed than buprenorphine. However, only 1% of pediatricians have the certification to prescribe buprenorphine.
About one in four youth, 26.8%, received either buprenorphine or naltrexone within 6 months of diagnosis. From 2002 to 2009, respectively the lowest (3%) and highest years (31.8%) of youth OUD medication rates, rates increased over 10 times. In 2014, the most recent year studied, the rate was 27.5%.
The younger the patient, the less likely he or she was to receive medication for OUD. For patients under 16, the group with the lowest rates (1.4%), this can be explained by the fact that buprenorphine is not approved for patients under 16. However, patients 16 to 17 were the next lowest group (9.7%). Patients 18 to 20 years had a 22% rate and patients 21 to 25 had a rate of 30.5%.
Females, blacks, and Hispanics were less likely to receive medication than non-Hispanic white males. 24.4% of males received medication while only 20.3% of females did and23.1% of non-Hispanic whites received medication, compared to 14.8% of non-Hispanic blacks and 20% of Hispanics.
To help fix these problems, the authors recommend exploring strategies to increase access to evidence-based treatments. One of these strategies is to increase the number of addiction subspecialists, since pediatricians and family physicians have new opportunities to become certified. But because rates of OUD are so high among youth, the study also recommends using pharmacotherapy in pediatric primary care settings.
“In the face of a worsening opioid crisis in the United States,” the authors say, “strategies to expand the use of pharmacotherapy for adolescents and young adults are greatly needed, and special care is warranted to ensure equitable access for all affected youth to avoid exacerbating health disparities.”
By Nicholas Hamm
21 June 2017
University of Pittsburgh professor Karen Matthews explored biological links to persistent social inequalities in childhood health during the 2017 Bronfenbrenner Lecture, held June 15 in Martha Van Rensselaer Hall.
Hosted by the Bronfenbrenner Center for Translational Research in the College of Human Ecology, Matthews guided nearly 50 audience members through the most recent research on the inequality in health between children in different socio-economic groups.
“I was given the task of trying to lay out some of the key biological pathways that might be important in understanding connections between the social environment and children’s health,” said Matthews, a Distinguished Professor of Psychiatry and professor of epidemiology, psychology, and clinical and translational science at Pittsburgh. “And this is really a daunting task because there are so many things that impinge on children’s development that are important in this context; one could spend an entire semester on this topic.”
The lecture highlighted the mission of the Bronfenbrenner Center and the work of the late Cornell scientist Urie Bronfenbrenner, whose ecological systems theory recognized the need to consider multiple levels of interacting influences on a child’s development, including family, community and the greater culture.
Matthews’ work addresses the psychosocial and biological connections between socio-demographic factors and poor health; the development of cardiovascular behavioral risk factors in childhood and adolescence; the influence of menopause on women’s health; and the role of stress-induced physiological responses and sleep in the etiology of heart disease and hypertension.
Matthews stressed that poverty and low socio-economic standing are about more than dollars and cents; they also involve a slew of environmental and psychological factors that can impact a child’s development. Family turmoil, exposure to community violence, early childhood separation, substandard housing and exposure to toxins, noise and crowding all can impact a child’s health, she said.
“As you can imagine, poverty in childhood is not simply low income relative to needs, but also exposure to disadvantaged environments more generally,” she said. “Research points to 65 percent of median-income children in the analysis had zero or one of these particular exposures, whereas the poor had three to four.”
Matthews also reviewed how day-to-day factors can impact several of a child’s physiological systems including the cardiovascular, immune, inflammatory and sympathetic nervous systems.
“A number of the theories of how low socio-economic status or poverty gets under the skin of children have to do with exposure to chronic stress,” Matthews said. “Emotional stressors impact the cerebral cortex, which in turn impacts the hypothalamus, which activates corticotropin-releasing hormone and eventually leads to the release of cortisol.”
Cortisol, a byproduct of chronic stress, increases the risk of numerous health problems including anxiety, depression, heart disease, weight gain and concentration impairment, she said.
“You can imagine that this environment would not be conducive to positive children’s health,” Matthews said.
Matthews concluded the lecture with ideas for, and a small discussion about, future research focusing both on additional physiological parameters as well as holistic data measurement and research design that narrows down models for easier analysis.
She also discussed interventions that are considered low-hanging fruit. These include policy changes to prevent exposure to toxins, such as lead exposure through water pipes, and public service commitments to inform families about the research to help them make changes at home.
By Stephen D'Angelo
21 June 2017
Rocsana Enriquez started thinking about yoga again when she was pregnant. She was 19 and in an abusive relationship.
When she was younger, Rocsana, whom I interviewed as part of my research, had taken part in a yoga program in a San Francisco Bay Area juvenile hall run by The Art of Yoga Project. She began using the skills she learned on the mat to slow herself down when she got angry and to pause before reacting. She remembered the breathing techniques and poses that made her feel better about herself.
Now, seeking the same quietness she had been able to achieve in class back in juvenile hall, she reached out to the program, never expecting to hear back.
Childhood trauma has a devastating impact on both the mind and the body of children who experience it. But that mind-body connection also offers a path toward healing. A growing body of research demonstrates the effectiveness of addressing the mental and physical impact of trauma through yoga and other somatic, or body-based, programs.
The Georgetown Law Center on Poverty and Inequality, of which I am executive director, released a first-of-its-kind report in April that synthesizes existing research, interviews with experts across the country and two original pilot studies focused on at-risk girls.
Our conclusion: yoga and mindfulness programs can equip girls like Rocsana – especially those in the juvenile justice system – with tools that help them thrive.
Widespread abuse leads to widespread anxiety
Research shows that Rocsana is not alone in experiencing abuse as a young person. Children in the United States experience trauma at breathtakingly high rates. In the seminal Adverse Childhood Experiences survey of more than 17,000 participants, 21 percent reported experiencing sexual abuse as children; 26 percent reported physical abuse; and 14.8 percent reported emotional neglect. Youth in the juvenile justice system are the most vulnerable, reporting higher rates of trauma than their peers. These experiences take a long-term toll not only on their mental health, but their physical health as well. These children are more likely than others to experience depression and substance abuse as adults – and they exhibit higher rates of heart disease, cancer and liver disease.
Studies reveal that yoga programs designed specifically for victims of trauma – programs that include regulated breathing, controlled movement and mindfulness practices – can have far-ranging benefits for any participant. Improvements have been shown in mental health (self-regulation, self-esteem) and physical health (better sleep, a reduction in gastric symptoms and many other positive outcomes).
As our report makes clear, these programs’ potential to help at-risk adolescent girls is only beginning to be realized. The next step is to design curricula that specifically address girls’ unique experiences and perspectives.
For example, yoga and mindfulness programs should emphasize relationship-building, to reflect the value that girls often place on interpersonal connections. Somatic therapy should also account for the fact that girls experience much higher rates of sexual abuse than boys. According to a recent study by The National Crittenton Foundation, the differential between girls’ and boys’ reported rates of sexual abuse is 32 percent – a discrepancy seen in other studies as well.
In addition, a disproportionate number of girls in the justice system are girls of color; and many girls are LGBT and have been targeted for violence because of their identity. These layers of identity profoundly shape their experiences of trauma and the world’s response to them. To be truly effective, yoga and mindfulness programs must respond, thoughtfully, to these unique factors.
If they do, the physical and mental benefits of yoga can reach – and help – a much wider range of girls who are greatly in need. And that need is profound: In the justice system, girls are often underserved, with inadequate access to mental health services.
From student to teacher
The Art of Yoga Project did call Rocsana back. Not only that: She has now made the transition from student to teacher, employed by the program that she credits with changing her life and helping her become the kind of parent and role model she wants to be.
Rocsana told me that if people can learn the skills of regulated breathing, physical engagement and mindfulness, it can help break the cycle of trauma. Our research supports her belief.
1 June 2017
The growth of the online world in recent decades has had a huge impact on all our lives from the way we consume media to how we socialise to how we shop.
Depressingly, these rapid changes have been accompanied by a corresponding growth in online issues around child protection. These challenges include the production and proliferation of child abuse images, bullying among children on social media, body image anxieties felt by young people and the danger of children being groomed by sex offenders masquerading as one of their peers.
For the NSPCC (National Society for the Prevention of Cruelty to Children), online safety is among the key child protection issues of the 21st century. Governments and law enforcement are of the same mind: in Wales alone our police forces are recording increases in crimes stemming from the online world year-on-year as they get to grips with the problem.For example, there were 150 recorded crimes of adults meeting a child following sexual grooming over the last five years across Wales' four police forces with more than 60 per cent of these cases having an online element.
Despite this focus on internet safety too little is known about the methods used by paedophiles when they target children online. In the majority of cases, research into the tactics used by adults seeking to groom children in the offline world is merely applied to the online world.
Now new research carried out by a team led by Professor Nuria Lorenzo-Dus at Swansea University is some of the first which attempts to close this gap.
Drawing on the research findings, the NSPCC and Swansea University have joined forces for a six-month collaborative project designed to support professionals in social work, health, education and child protection and provide them with new skills for use in the front line. The Online Grooming Communication project, funded by Swansea University's Cherish-de centre, aims to improve understanding of the language used by groomers as they seek to build a relationship with a child.
The research underpinning the project is some of the first to identify online grooming as a communicative process and develop a model to explain how groomers use language to achieve their goals: from how they build their victims' trust, and isolate them mentally, through to how they gauge their victims' compliance levels at different stages during the grooming process and how they use grooming communication to obtain sexual gratification.
With grooming defined as when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or trafficking, it's clear that the language used is important in this process.
The Swansea University project has already generated national headlines following its insight that paedophiles can successfully groom a child and arrange to meet them in less than 40 minutes.
It has also dispelled several myths: that groomers coerce children with sexually-explicit language from the start. In fact, the project has found that the language used is patient, complimentary, caring and persuasive, aimed at building a trusting relationship with the victim.
Progress is undoubtedly being made to better protect children in the UK while they are online. Following a campaign by the NSPCC new legislation was introduced in England and Wales in April this year making it an offence to send a sexual message to a child. Previously adults could not be prosecuted for sending such messages until the grooming escalated.
But the fight continues. It is hoped that high-quality research – like that taking place at Swansea University – into the communication strategies used by groomers, will help prevent more children being placed in danger in the real world as a result of their interactions online.
By Des Mannion
19 June 2017
Des Mannion is head of service, NSPCC Cyrmu
Having a mood disorder significantly boosts the odds that young people with autism will be hospitalized for psychiatric care, according to a new study.
People with autism are often hospitalized when their behavior problems overwhelm their caregivers, the study authors said.
"The demand is far greater than the number of clinicians, the number of programs and the number of beds we have," said study leader Giulia Righi. She is an assistant professor of psychiatry and human behavior research at Brown University's Warren Alpert Medical School.
Righi's team reviewed records of 473 people with autism, aged 4 to 20. The risk of hospitalization was seven times higher for those with a mood disorder.
In addition, sleep problems more than doubled the chances of a hospital stay. And those with high scores on a scale of autism symptom severity had a slightly increased risk, the investigators found.
Children and teens living with married caregivers were slightly less likely to need hospital care than those living with only one adult caregiver. The researchers said that's probably not about family structure or stability but more likely owes to the resources available to care for a very needy child.
Having a high score on a standardized scale of basic life and coping skills lowered hospitalization odds, the study found.
"One of the biggest issues is the availability of acute care services – such as day hospital programs and in-patient units – to support families when their children's behaviors have escalated to the point of making a situation unsafe at home, at school or sometimes both," Righi explained in a university news release.
The report was published recently in the Journal of Autism and Developmental Disorders.
Addressing factors that may lead to hospitalization could help, Righi
said, adding that the strongest risk factors are not necessarily linked to
autism spectrum disorders (ASD).
"Our results underscore the importance of a multidisciplinary approach to the assessment and treatment of children and adolescents with ASD that addresses behavioral, psychological and psychiatric, adaptive, sleep and medical functioning, in order to decrease behavioral crises and the utilization of inpatient psychiatric services," Righi and her co-authors wrote.
16 June 2017
Overweight kids are excluded and ostracized by classmates in school more often than their thinner peers, new research indicates.
Examining friendship dynamics among more than 500 preteens in the Netherlands, California researchers found that those who were overweight or obese were 1.7 times more likely to be disliked by their peers. Not surprisingly, the reverse was also true. Overweight or obese preteens were 1.2 times more likely to dislike their peers, the study revealed.
Study author Kayla de la Haye is an assistant professor of preventive medicine at the University of Southern California Keck School of Medicine. She also led earlier research that reinforces the new findings, which she said would be similar in the United States.
"We consistently find overweight kids are ostracized by their peers, which plays out over middle school and high school to the point where they're pushed to the periphery of these big social groups," de la Haye said. "We really need to take this seriously," she added. "Experiencing stigma has such big implications for these kids, impacting their social development and mental health, and probably their physical health."
The number of obese children in the United States has tripled since 1970, now comprising about 17 percent of all American children, according to the U.S. Centers for Disease Control and Prevention. Meanwhile, childhood obesity worldwide rose by nearly one-third in just over 20 years, with about 42 million overweight or obese children in 2013, according to the World Health Organization.
De la Haye and her team based their findings on questionnaires given to children between the ages of 10 and 12 in classroom groups, who were asked to list their best friends and enemies.
Approximately one in six kids was overweight.
Overall, children were listed as a friend by five classmates and as an enemy by two. Overweight kids, however, were considered a friend by four classmates and were disliked by three. They were more likely to call classmates friends when the feeling wasn't mutual and they disliked greater numbers of their classmates than their thinner peers, the study found.
A vicious cycle can stem from these negative peer interactions, de la Haye said. Overweight children who feel socially isolated may end up eating more and participating less in sports and physical activities, leading to further weight gain.
"The medical community and [larger] community think they can't make obesity OK" because of its associated health risks, she said. "That sort of dominates the conversation. But we can't buy into this argument anymore that stigma is OK."
Dr. Elsie Taveras is a professor of nutrition at the Harvard T.H. Chan School of Public Health and chief of the Division of General Academic Pediatrics at Massachusetts General Hospital for Children. She wasn't surprised by the new findings.
"We've known for some time this starts young – this weight bias and stigma," she said.
In her practice, Taveras said she often sees children who are bullied and marginalized because of their excess weight, which she said can trigger depression and other mood disorders.
"We always screen children with obesity for things like high blood pressure and diabetes, but a silent condition many experience is weight bias and stigma," said Taveras. "It's the type of thing clinicians rarely ask about, but also the thing that affects these children so much more, in some ways, than an abnormal cholesterol level."
Taveras and de la Haye agreed that addressing weight-based stigma, especially with children who aren't overweight, should be a standard component of obesity prevention efforts.
"It's been talked about traditionally as this individual problem – when we see someone who's fat, they're [said] to be lazy, that it's some sort of failing," de la Haye said. "And that's really the opposite of what we now know causes obesity. It's really that we've created a society and environment that promotes lots of food consumption and makes it really hard to be active."
Taveras suggested parents of normal-weight children encourage them to include peers of all shapes and sizes in social situations.
"I'm sure [children] are hearing about tolerance and inclusion for other characteristics that may be as obvious as obesity," she said. "The message is to expand that language ... to think about the real, troublesome stigma happening with children with obesity."
By Maureen Salamon
7 June 2017
The study was published June 7 in the journal PLOS One.
A leading charity has urged parents to do more to keep their children safe online as new figures reveal how often young people are exposed to violence, hatred, sexual content, bullying and other inappropriate content when using the internet.
Amanda Azeez, associate head of child safety online at the UK’s National Society for the Prevention of Cruelty to Children (NSPCC), said parents should have regular, open conversations with their children about their online lives, and discuss basic safety in the same way they are also are taught how to cross the road and not to talk to strangers.
“It’s normal to have conversations about crossing the road, bullying and talking to strangers, but with the digital world changing all the time, it can be hard to have conversations about staying safe online,” Azeez said. “We really want to help parents and carers to feel more confident and to talk to their children at least every two weeks, if not more regularly.”
In the NSPCC’s latest Net Aware survey, two thirds of children admitted to using apps while under the age limit. Popular sites such as YouTube, Facebook, SnapChat, Instagram, Twitter, Periscope, WhatsApp and Musical.ly all have a minimum age of 13.
The survey of more than 1,600 children and young people in schools across the UK found that a third had seen violence and hatred online, a fifth had seen sexual content and bullying. In every category, live-streaming sites were the worst offenders, with content relating to suicide and self harm, bullying and violence reported by 18%, 31% and 46% of reviewers respectively.
More than a third of the children surveyed had added a stranger to their contacts in the past six months, and quarter said they were likely or very likely to add someone they didn’t know in the future.
Last year, a YouGov survey found that while one in five UK parents talked to their children about their online lives roughly once a fortnight, many were not confident that their children were using the internet safely.
Speaking ahead of an event on child safety at Cheltenham Science Festival on Tuesday evening, Azeez said that as soon as children have devices they should learn to be “share aware”. “They need to know how to think about the images they are sharing, the types of information they share, such as their location, and to think about who they are speaking to,” she said. “You wouldn’t want them to talk to strangers in real life, but when they’re on Minecraft, do you know who’s messaging them?”
By having regular conversations as soon as children go online, Azeed said parents can keep up-to-date with the apps and games their children like and the safety issues they may present. “We know most children, like all of us, are on their devices every day,” she said. “Having frequent conversations will help parents spot any problems, but will also encourage children to talk when they are worried about anything.”
The NSPCC is campaigning for online social networks to be regulated, so firms can be held to account if they fail to protect children. The charity has also called on government to draw up safeguarding standards and wants internet companies to offer children safer accounts that come with strict privacy and filter settings as default. To help parents who find themselves baffled by online safety measures, the charity has set up a free helpline and trained staff at high street O2 stores to go through devices and change the settings if necessary.
“Children want their parents to be part of their online life and to talk to them about it just as they do about their day at school,” Azeez said. “To children, online friends are real friends. Online life is real life. There is no distinction. Just like in real life, children need our help to stay safe online.”
By Ian Sample
6 June 2017
Being overweight or obese, from as young as 3, has been linked to an increased risk of heart disease later in early midlife.
New findings, from a study into the health of 1037 people born in Dunedin in 1972-1973, has found that childhood obesity can have lifelong implications.
Lead author of the research paper, published in the International Journal of Obesity, professor Michael Williams said those who were overweight, obese or severely obese in early childhood were more at risk.
He said while adult obesity was a known risk factor for developing cardiovascular disease – the number one cause of death worldwide – these findings showed the link could be traced back to early childhood.
Researchers had collated the body mass index of those involved in the study at regular periods during their life and classed them within each of the weight groups. Those who were in the overweight, obese, or severely obese groups over time were more likely to develop a disease of the inner lining of blood vessels known as endothelial dysfunction.
Williams said the research findings showed a gradient, where "the more different you are from normal, the worse your function".
The study said the link between childhood obesity and the disease was an important finding as endothelial dysfunction had been independently linked to an increased risk of heart disease and death. "Childhood obesity sustained into adulthood may contribute to an increased risk of cardiovascular events [as a result of the condition]."
Williams said the fact the prevalence of obese and overweight children was on the rise combined with findings linking this to heart-health in later life highlighted a serious problem. "This means we are facing a real time-bomb in terms of the potentially enormous burden of ill-health in a substantial proportion of our population."
While Williams said reducing one's weight could help reduce the risk, he couldn't say this conclusively. "Since we don't know if you can turn it around, it's best not to become obese as it's very difficult to change that substantially."
The latest New Zealand Health Survey showed 11 per cent, or one-in-nine Kiwi children aged 2-14 were obese; a rise of 3 per cent over the last decade.
A further 21 per cent of children were also considered overweight, but not obese.
Children living in the most deprived areas were three times as likely to be obese as those living in more affluent areas.
Williams said this study, combined with others on the issue of obesity, served to highlight how important it was to develop strategies to prevent obesity quite early – "potentially from birth".
By Corazon Miller
7 Jun, 2017 7:24pm
Teenagers’ late-night mobile phone use is harming their sleep and potentially their mental health, say researchers who advised that “physical boundaries” be set over use of such devices in the bedroom.
A longitudinal study of 1,101 Australian high school students aged between 13 and 16 found poor-quality sleep associated with late-night texting or calling was linked to a decline in mental health, such as depressed moods and declines in self-esteem and coping ability.
Lead researcher, Lynette Vernon of Murdoch University in Perth, said her
findings were evidence of the need for curfews for teenagers to be
established around use of devices in their bedrooms. Adolescents who used
their phones as alarms should replace them with clocks in order to maintain
“physical boundaries”, she said.
Researchers examined teenagers’ mobile phone use and their subsequent changes in wellbeing over four years of high school from 2010 to 2013, and found increasingly unencumbered access led to increases in psychosocial maladjustment.
Vernon said mobile phones had become entrenched in young people’s lives, and many did not have their use restricted. She pointed to international research that found about 80% of the young had access to a mobile phone.
The former high school teacher said she had observed her own pupils coming into the classroom tired. “I noticed it was affecting their performance – that was a few years back, too.”
Though the link between late-night phone use and sleep, and between sleep and wellbeing, had been established in previous research, this was the first study to assess all three together, she said.
“It’s important to have the research to translate to parents and teachers, who probably haven’t experienced to the same extent what kids are doing. If you’re finding your son or daughter is more moody and not coping at school, you often put that down to adolescence – but it could be as simple as them not sleeping at night.”
The study specified sending and receiving messages and/or phone calls, so did not distinguish between mobile phones and smartphones or social media.
Students in Year 8 who reported higher levels of night-time mobile phone use also reported higher levels of depressed mood and externalising behaviour and lower self-esteem when surveyed one year later.
Few teenagers indicated that they never used their phone after lights out, and on average, younger teenagers’ healthy mobile phone habits became more problematic as they advanced through high school.
“The outcomes of not coping – lower self-esteem, feeling moody, externalising behaviours and less self-regulation, aggressive and delinquent behaviours – the levels increase as sleep problems increased.”
Teenagers who reported “constantly texting into the night” said when surveyed a year later, the problem had worsened. “It’s escalating – they’re highly invested in it ... Some kids are staying up until 3am.”
The study," Mobile Phones in the Bedroom: Trajectories of Sleep Habits and Subsequent Adolescent Psychosocial Development", was published in the Society for Research in Child Development on Tuesday.
Teenagers need eight to 10 hours of sleep for healthy development, Vernon said.
Phones disrupted sleep in two ways, with the bright light from screens disrupting natural circadian rhythms, and messages received before sleep spiking “cognitive and emotional arousal”, said Vernon.
Education was the best prevention, Vernon said, and it was most effective if it began before children were given their first mobile phone. “As a mother of teenage kids, I think you’ve got to negotiate, and negotiate early.”
Parents could also set a good example by demonstrating good habits around phone use themselves. “Back when they’re aged seven to 10, you have to role model – you put your phone in a basket at night, it doesn’t go into your bedroom, it becomes normalised in the household and you have a much easier job.”
By Ellie Hunt
30 May 2017
For most people, trips to the doctor can be quite scary. For adolescents and young adults with autism, taking control of health care decisions is not only frightening, it also can be a barrier to independence. Now researchers from the University of Missouri have found that the health care process not only impacts adolescents with autism, but caregivers also feel they lack the skills and support necessary to help those adolescents achieve health-related independence. As more children with autism enter adulthood, improved communication between providers, adolescents and caregivers is needed to help those with autism transition to independence.
"A significant part of adulthood is managing health care, which includes regular trips to the doctor, following treatment plans, and being aware of symptoms and changes in health," said Nancy Cheak-Zamora, an assistant professor in the MU School of Health Professions and researcher in the Thompson Center for Autism and Neurodevelopmental Disorders. "This can be especially challenging for adolescents and young adults with autism."
Cheak-Zamora and her team conducted interviews with adolescents with autism and their caregivers. They found that both groups had a strong desire for the adolescents to manage their health care needs and that they attempted to take small steps toward independence, such as using pill boxes to help adolescents manage their own medications throughout the week. However, both groups lacked confidence when it came to building independence with adult health care. In many cases, caregivers were confused about their role in their adolescent's path toward independence. Decisions about guardianship and who makes legal health care decisions were found to be especially problematic. Adolescents expressed feeling upset that health providers would not talk directly to them, instead speaking only to the caregivers.
"Many caregivers said they felt forced to remain involved in their adolescent's care, even when their goal for the adolescents was independence," Cheak-Zamora said. "Meanwhile, adolescents want to overcome their fears. They feel it is important to have alone time with doctors and are frustrated when doctors communicate mainly with caregivers. These findings reiterate the importance of understanding the perspectives of both caregivers and adolescents and improving communication between caregivers, adolescents and providers to achieve shared independence goals."
31 May 2017