Question: Discuss the impact of chronic medical conditions on adolescents and identify ways of promoting resilience or positive development.

Chronic medical conditions can have significant consequences in various aspects among adolescents. According to the World Health Organisation (WHO), chronic conditions are diseases that progress over a slow period of time and remain for a long duration of an individual’s life. Adolescence, as defined by WHO, is the period of life from 10-19 years of age. Major developments occur during this stage including cognitive growth, which involves emotional and psychosocial developments. These factors further influence the adolescent’s motivational and behavioral response to everyday life. Adolescents with a chronic condition may perceive these normal experiences as a major challenge compared to healthy adolescents, as their needs to cope with their chronic condition conflicts with typical teenage developments. Resilience is defined as a young person’s capacity to negotiate and successfully adapt to the everyday demands of their illness (Olsson et al., 2002). Identifying aspects that negatively impact on adolescents is vital in order to promote resilience. Health organizations have recognized this concern and have developed programs in an aim for adolescents to gain positive development to cope with chronic conditions.

Emotional developments may become undesirable as a result of a chronic condition amongst adolescents. Santrock (2001) defines emotional development during adolescence as the establishment of an idealistic sense of identity in relation to others. Those that cope well with the emotional aspects of having a chronic illness have effectively achieved resilience. Resilience involves integrating the chronic illness, as a part of one’s self, which is vital as it enables adolescents to accept and establish a sense of self in society. However, a number of government research findings suggest that adolescents with chronic illness have a greater risk of emotional disturbance than their healthy peers (Wolman et al, 1993). This is may be due to the differences in their healthy counterparts, who do not experience the emotional stress of the demands of treating and managing a chronic condition such as constantly taking medication and regular visits to medial centres. This could result in negative emotions including frustration and isolation as the adolescent’s chronic disease restricts them from fitting in with others. For example, teenagers with asthma may experience emotional dilemmas due feeling withdrawn from their healthy counterparts. Asthmatic teenagers may feel limited to participate in physical activity such as social events and sports games due to fear of having severe wheezing or asthma attacks in front of peers, or shame of using an asthma puffer to treat a reaction. The seriousness of the emotional impacts is evident through studies by the University of Chicago which proved that adolescents’ desire to fit in with their peers may cause them to neglect proper asthma care and awareness (Benard, 2010). Furthermore, the emotional impacts on adolescents with a chronic condition include feeling vulnerable hence a lowered self-esteem and self-confidence, due to lack of interacting with peers and an inability to partake in activities that would otherwise enable them to gain confidence within their environment.

It is essential to build resilience in order for the individual to manage the subsequent chronic emotional impacts and develop a positive attitude to living with a chronic condition. Adolescents must adapt an ability to see the different options they have offered to them that would enable them to maintain a stable emotional state similar to those of their healthy counterparts. Peer support programs in schools and health clinics could promote this so that adolescents are able to find a social niche and establish supporting friendships to emotionally develop in a positive manner to maximise their adolescent life. For example, asthmatic teenagers should compensate for their inability to partake in physical activity by participating in other activities that do not have any detrimental effects on their health. Managing delivery of care of their chronic condition becomes less stressful as self-esteem and confidence is increased.

Psychosocial development is a significant factor that is altered amid adolescents with chronic conditions. Erik Erikson (1902 – 1994) studied psychosocial aspects of human beings and theorised that ‘the main challenge of adolescence is the struggle for a sense of identity’. This struggle stems from the idea of autonomy, which involves the adolescent’s capacity to independently manage their own life and decisions without having to be overly depending on others. The psychosocial makeup of adolescents with a chronic condition truly reflects on Erikson’s theory and the capacity individuals have on achieving autonomy. Teenagers with a chronic condition have a reduced independence at a time when independence is normally developing in healthy adolescents. Achieving autonomy is disturbed for adolescents with chronic conditions as psychosocially; the presence of family members plays a key role in the contribution to the health and wellbeing of the individual. The impacts of this are evident in previous longitudinal studies which proposed that teenagers with a chronic illness have poorer social skills in their adult life, face more difficulties in the profession field, are less likely to be married and may experience difficulty achieving financial independence as adults (Kokkonen, 1995; Sawyer & Yeo, 2005).

In recent times however, the availability of health care services and social support aim to promote resilience amongst adolescents in order to gain positive psychosocial development. Health professionals are obligated to provide the adolescent with full information of their chronic disease so that they are able to make their own decisions including treatment methods and processes of managing their chronic condition. Autonomy is to some degree achieved by developing social competence whilst maintaining a supportive relationship with family (Neinstein 2001). To emphasise, research from the American Psychological Association demonstrated that closer relationships established with family and peers greatly influences the adolescent’s positive development of resilience to their chronic condition (Nettles, 2006). This is apparent in a study of adolescents with cystic fibrosis, which revealed that the substantial support from family enabled the individual to lead active, typical adolescent social lives with some degree of independence (Graetz, 2000). Positive psychosocial resilience of chronic conditions involves encouraging the adolescent to live as fully as possible whilst recognizing their strengths and weaknesses. This is achieved by adopting successful family relationships including parental guidance, which provides a comfortable and stable setting for the adolescent to nourish and develop individual sense of identity through others. As a result, this increases the adolescent’s coping process and overall psychosocial wellbeing of living with a chronic condition. The motivational and behavioral responses of adolescents with chronic conditions are influenced by the overall cognitive impacts including emotional and psychosocial outcomes on the individual. These developmental changes lead to teenagers challenging expectations by taking risks that could be detrimental to their health such as drug use, substance abuse and unprotected sex. Those with a chronic condition may be even more likely to partake in risky behavior than their healthy peers that result in severe physiological and mental impacts on their health. According to Jessor (1991), these risk behaviors in adolescents with chronic conditions could be due to an attempt to ‘gaining peer acceptance and respect; in establishing autonomy from parents; in coping with anxiety, frustration; or in affirming maturity’. These behaviours vary depending on the chronic condition that the adolescent has and their emotional and psychosocial mindset. For example, an Australian study of risky behaviors found that asthmatic teenagers are more likely to partake in tobacco or alcohol use than non-asthmatics. On the other hand, diabetic teenagers are more likely to adjust to a good diabetic control during early adolescence therefore have long lasting health benefits (Veit, 1996)

Early promotion of resilience of chronic conditions is vital for adolescents as it allows them to make sensible behavioral choices in the presence of multiple risk factors (Friedman & Silver 2006). Public health interventions have identified risky behavior amongst adolescents with chronic conditions; therefore have adopted methods to promote and manage resilience so that they become aware of protective factors in order positively motivate themselves in life (Wright et al, 2005). For instance, health facilities provide counseling for such adolescents to gain an insight to their current wellbeing in order to educate them about protective behaviors that would motivate them to carry out a successful self-management and positive long-term behavioral change. For example, teenagers with diabetes type 1 are educated about the risky behaviors such as eating disorders that could affect their glycemic control, and ways to prevent any further health problems, such as encouraged healthy eating routines. Therefore, assessments and preventative behaviors of chronic conditions should be reinforced in early adolescence to successfully promote motivational and behavioral resilience.

In conclusion, chronic medical conditions may potentially result in various negative impacts during adolescence. This includes effects in cognition, involving the emotional and psychosocial aspects of individuals. It is the influence of others such as family and health facilities to promote resilience in a way that the adolescent is able to gain a positive attitude in coping with their chronic condition. These attributes enable motivational and behavioral factors to be integrated into adolescent life, contributing to a wholesome health and wellbeing.