Our most important goal in preparing this issue of Paediatrics & Child Health, which is dedicated to the second decade of life, was to avoid the onslaught of negative themes that so often accompany both the public media and the medical literature when issues of adolescence are addressed. The article by Saewyc and Tonkin (pages 43–47) is dedicated to this very idea. In reading this paper, it is heartening to hear that most teens are content and well adjusted, do not get pregnant or use drugs, feel connected to family and community, and go on to lead self-sufficient lives. We read that teenagers are hopeful and optimistic, and are generally not involved in behaviours that put their health in jeopardy. The ‘paradigm shift’ discussed by the authors proposes that we move away from identifying risk in teens, and instead, identify protective factors and resilience in our clinical work. This shift is vital to the future of Canada’s teens, and as paediatricians and health care professionals, we can lead the way to changing the prevalent focus on the negative and redirect our energies to identifying the strengths of the youth we care for.
Our second goal in preparing this issue was to focus on topics that would be of use and interest to clinicians. Therefore, the articles and statements included deal with topics we see everyday in our clinics, hospitals and emergency rooms. Some of the topics deal with a presenting symptom such as fatigue, adherence, sexuality or drug use, while others are related to a patient population such as teen boys or hospitalized youth. Improving our communication with teens is the focus in the commentary by Grant et al (pages 15–18) and the Canadian Paediatric Society’s statement on harm reduction (pages 53–56), which discusses the principles of engaging youth in reducing negative health outcomes. All of these papers are intended to present an approach to understanding and intervening with youth to improve well being. These articles also demonstrate the diversity of topics seen by adolescent medicine specialists, and the diversity of activities they engage in, such as clinical care, conducting and interpreting research, and advocating for Canadian youth.
Although no overriding ‘theme’ was intended for these articles, we saw that one did emerge: dialogue. In this issue, the authors emphasize that the ability of health care professionals to dialogue with teens and their families is paramount; irrespective of the teen’s reason for visiting the doctor. We learn that dialoguing with teens is very different from interviewing teens. When we dialogue, we listen in a different way, we try to engage the teen more in the interview and we pause to provide some feedback along the way. Techniques such as motivational interviewing and active listening are becoming expected tools of clinicians who work with youth. In the commentary by Grant et al, the authors provide techniques to connect with teens and emphasize the importance of using every opportunity to do a psychosocial assessment on a teen, irrespective of the chief complaint. The article by Findlay (pages 37–42) discusses dialoguing with teens about the impact their symptoms have had on their lives, while the Canadian Paediatric Society’s harm reduction statement emphasizes engaging youth in discussing what they like about drugs (and not just focusing on reasons not to use substances).
The need for adults to dialogue with teens is also stressed in the article by Frappier et al (pages 25–30), which reveals that teens would rather learn about sex from parents and doctors than the media and their peers. The dialogue is what they want from the grown-ups in their lives. Westwood and Pinzon (pages 31–36) encourage physicians to initiate dialogue on health with teenage boys who may feel too shy to bring up these issues on their own. In the article by Saewyc and Tonkin, we learn that, through dialogue and promoting resilience, we can empower teens.
The articles in this issue also stress the importance of a dialogue to obtain a comprehensive evaluation of the concerns and problems of a teen before suggesting an intervention. Too often with teens, we are tempted to dictate a solution without having a thorough and complete evaluation. If a real dialogue is engaged, adolescents will tell their story and concerns, and will participate in problem-solving if given time, space and respect during the clinical encounter.
This is an exciting time for adolescent medicine in Canada. In the commentary by Katzman et al (pages 12–14), the history of adolescent medicine in Canada and abroad is discussed. The next few years will be a challenging and interesting time for adolescent health in Canada. Research focusing on adolescence is becoming more abundant, educational opportunities for health professionals to learn more about this time of life are increasing and more paediatric residents will have opportunities to do subspecialty training in adolescent medicine. The goal with these initiatives, as well as the goal of this special issue of Paediatrics & Child Health is the same, which is to improve the care we provide to the teens and their families, who we are privileged to serve.
Acknowledgments
We would like to thank the authors who contributed to showcasing the emerging subspecialty of adolescent medicine. Working alongside this diverse group of clinicians and researchers has been an honour and a pleasure.