Adolescence is simultaneously a wonderful and a scary time in our lives. In our late teens, especially, we can feel indestructible. It’s a time to take risks and have fun.
But when chronic illness enters the picture, some adolescents struggle. I’m reminded of two patients in particular: one with newly diagnosed epilepsy and the other with a recent diagnosis of insulin-dependent diabetes.
Claire* was 15 when she was diagnosed with diabetes. After the initial shock of hospitalisation she seemed to settle into a routine of self-injecting insulin twice daily. Her mum and dad were supportive. Initially her blood sugar readings were reasonably good. However,her mum began to report some mild hypoglycaemic episodes in the evenings.
Then, during a morning surgery, I heard a commotion in the waiting area. I was called by the receptionist to find Claire thrashing around the room. She wasn’t able to talk to us and seemed quite confused.
Eventually I managed to get a blood sample from her which showed a very low blood sugar. An injection with a drug called glucagon – which acts to counteract insulin in the body – brought her blood sugar back up and she settled.
Seizure
Johnathon*, a useful schools rugby player, had a seizure out of the blue. It didn’t seem to be related to any recent sports injury. But when it happened a second time, and lasted longer, we arranged for a speedier assessment by a consultant neurologist.
I didn’t see Johnathon again until he dropped in one day with a letter from the hospital; he had been diagnosed with epilepsy.
He put a brave face on it. We discussed his new anti-epileptic medication, its side-effects and a schedule for monitoring drug levels in his blood. A couple of months later, however, the medication seemed to stop working. Johnathon had a series of seizures and ended up back in hospital.
In Johnathon’s case it was an astute specialist epilepsy nurse practitioner who figured it out. As for Claire, I had a hunch about the reason for the poor diabetes control, which my female partner was able to work through with her. The cause, in both instances, was the same: non-adherence to treatment.
In neither case was there any question about the young person having the cognitive ability to carry out the treatment tasks. But the capacity for self-management develops over time; when combined with the many other changes going on in a young person’s life, managing a chronic illness may not be straightforward.
Indeed, a scientific review of medication use found that adolescence is associated with poorer illness management and a peak in non-adherence.
Some of the reasons for this are explored in the current edition of the medical journal Drugs and Therapeutics Bulletin.
An outright denial of the disease or at least refusing to acknowledge its seriousness is understandable: having to accept limitations on your activities when your peers are still enjoying the “indestructible” phase of adolescence is difficult.
Medication may be a problem; all drugs have side effects, some of which, for example weight gain, may have a greater impact on young people. Medication may also be seen as a sign of weakness or as potentially addictive.
Relationships can also be a factor: feeling stigmatised by the disease in front of peers; a natural striving for independence from parental control; and relationships with healthcare professionals who may not have thought through what the diagnosis means for the young person’s everyday activities.
Of course, not taking the correct dose at the right time could simply be due to forgetfulness or being away from home without a full supply of tablets or injections.
I’ve just finished a week’s course of antibiotics, during which I missed one dose. Although this physician definitely wanted to heal himself, clearly non-adherence to treatment is not just an adolescent issue.
*Names have been changed
mhouston@irishtimes.com @muirishouston