Chronic illness affects an increasing number of adolescents as medical science continues to deal more effectively with illnesses that used to kill in the womb, at birth, in infancy or in childhood. Examples are chronic kidney disease, cystic fibrosis and haemophilia.

Chronic illness may present for the first time in adolescence, eg. epilepsy, asthma and schizophrenia, and thus presents new challenges to the developing adolescent and their family.

The difficulty for teenagers suffering a chronic illness is that they must deal not only with the problems the illness brings but also deal with the burden chronic illness adds to the normal adolescent struggle for self-esteem. Chronic illness in an adolescent also presents complex challenges to schooling, career development and social success.

There are three main components that may be problematic:

• Normal adolescent turmoil may be constrained by the dependence of the illness, leading to adjustment difficulties.
• The illness itself may be altered by the physical effects of puberty, eg. the hormone oestrogen interacting with the drug insulin, for example.
• Developing autonomy and independence is slowed as doctors and parents may neglect to give the teenager enough information to manage their own therapy, so as to tailor it to their own lifestyle as they grow older.

It may help to follow some of these guidelines to ensure that your teenager is allowed to develop their own sense of autonomy and self-confidence:

• Encourage your teenager to take as much control over the management of their disease as possible. Try not to be over-protective.
• Remember that the small size and delayed puberty that occurs with many chronic illnesses may result in people forgetting how old the child actually is and how mature they have become.
• Self-reliance breeds confidence that reduces dependence and increases compliance.

Non compliance (where the teenager does not want to do anything to help their illness) can be a problem for adolescents as they adjust to accepting their illness and its role in their lives. Most teenagers do not wish to be different.

Aids to good compliance:

• Make sure they have a full understanding of the disease and its treatment.
• Be prepared to discuss side effects and treatment alternatives.
• Agree a treatment plan and make it as straightforward as possible, eg. try to avoid mid-day dosages of drugs.
• Negotiation rather than instruction is ideal.
• Flexibility by the treating GP is needed, although some bottom lines such as insulin treatment cannot be negotiated
• Be aware that at some time the adolescent may be old enough to choose to reject the burden of life-supporting treatment.