1. 1
Conversations with Adolescents:
What Adults Say
and What Teens Hear
Presented at Annual Conference of
Center for Health Literacy
Plain Talk in Complex Times 2012
September 7, 2012 Arlington, VA
William O. Donnelly, Ph.D.
Donnelly Community Psychology
Adjunct Clinical Faculty, Psychology Department
Bowling Green State University,

2. What Adults Say
“Teenagers think they are invincible.”
What do teens think when they hear that?

3. “When adults say, ‘Teenagers think
they are invincible’
with that sly, stupid smile on their faces, they don't
know how right they are. We need never be
hopeless, because we can never be irreparably
broken. We think that we are invincible because
we are. We cannot be born, and we cannot die.
Like all energy, we can only change shapes and
sizes and manifestations. They forget that when
they get old. They get scared of losing and failing.”
- John Green, Looking for Alaska

4. What Adults Say
“When I was a boy of fourteen, my father
was so ignorant I could hardly stand to have
the old man around. But when I got to be
twenty-one, I was astonished by how much
he'd learned in seven years.”
- Mark Twain

5. What Do Teens Think
When Adults Say …
- When I was a boy of fourteen …
- When I was your age …
- I understand what it’s like to be your age.
I was a teenager myself.

7. Teenagers are Different:
3-D Effect in Adolescent Health Care
• Development: Dramatic biological unfolding; shifts in
social supports and social influences
• Dependency: Parents, guardians, adults make health care
decisions and provide resources (or don’t) until … independence
• Diagnosis: Diagnostic criteria developed on adult samples
are sometimes misapplied to youth

8. Development: Biological Changes
• Sexual development: physical appearance,
sexual arousal, sexual behavior
• Physical growth: size, strength, speed, sound
changes in coordination
• Implications/complications for physical and
emotional health

9. Cognitive and Social Development
• Established capacity for abstract thought
• Intellectual discovery
• Emotional complexity, intensity, variability
• Moral reasoning. Re-evaluation of values, new
ideals
• Social Development – Peers. Mentors. Peers.

10. Development and Identity
• Transitions from a childhood sense of identity
that was greatly influenced by others
(parents, family members and community)
and was relatively unquestioned
• Evolves into a teenager’s exploration of
personal and group identity, sense of
belonging, and purpose

11. Engaging Youth about Identity:
What Matters?
• Identity exploration – Who am I, what are my
guiding values, beliefs? How am I unique?
• Social identity and affiliation – who are my
peers, where do I belong, what kind of
relationships do I want, how do I develop
those relationships?
• Purpose – What are we here for? What am I
here for?

12. Brain Development and Risk Taking
• Logical, abstract thought is reasonably
developed by mid-teens*
• Other functions that affect risk-taking
decisions are still under development*
▫ Emotional regulation
▫ Impulse control
▫ Delay of gratification
* Steinberg, L. (2004). Risk Taking in Adolescence: New Perspectives From Brain and Behavioral
Science. Current Directions in Psychological Science, 16, 55-59.

13. Dependency
• For minors, adults are in charge.
Until they’re not.
• Legal, educational, financial decisions
• Health care decisions
• Housing, food, clothing
• For young adults, transition from this is
typically abrupt, incomplete, challenging.

14. Diagnosis
• Diagnostic criteria may not be sensitive to
developmental differences and patterns
• May lead to misleading diagnostic labeling and
inappropriate treatment of adolescent concerns
• May be culturally tone deaf to adolescents

15. Adolescent Development: Health Concerns
• Sexuality. relationships. birth control.
pregnancy. stds.
• Physical appearance. acne. tanning. weight.
eating disorders. fitness. exercise.
• Depression. suicide. anxiety. stress. alcohol
and substance use. tobacco.
• Traumatic stress. exposure to violence.
family conflict. family mental illness.
• How to seek, access, and pay for health care

16. Youth and Young Adult Mortality
Top 3 causes of death, ages 15-24
• Accidents (predominantly motor vehicle)
• Homicide
• Suicide
- Source: Centers for Disease Control and Prevention

17. There is a lot to talk about!
So how do adults communicate health
information to and about teens?
• Mostly, through conversations with other
adults
• Health care communication addressed to
adolescent health issues is typically designed
for adults (parents, teachers, health care
providers)

18. Engaging Teens in the Conversation
• Parents and other adults still matter and still
need pertinent health information as they
make decisions for or consult to youth
• But engaging teens in the conversation about
their health and well-being is not only
appropriate, it is a developmental fit
• The most helpful communications will
respect teen concerns and abilities

19. CDC for Teens
• CDC engages teens on vaccines:
• “Learn more so that you can talk to your
parents and your doctor about the vaccines
you need and the diseases they prevent.”
• Strategy: empower teens to protect
themselves from cancer

20. What Do Teens Think?
• When CDC says “Learn more so that you
can talk to your parents and your doctor
about the vaccines you need and the
diseases they prevent”, do teens feel
empowered?
• May depend on whether they trust that the
CDC website provides truthful, accurate,
evidence-based information.

21. Warning Shots?
• Empowerment immediately followed by:
“Preteen and teen vaccines
4 shots (preventing 6 diseases):
Meningoococcal, tetanus, diptheria,
pertussis, human papillomavirus and
influenza”
(to be followed by field-testing with youth)
http:// www.cdc.gov/vaccines/who/teens/for-preteens-teens.html

22. Adolescent Themes and Patterns
• Increased recognition of adult/parent
imperfections and inconsistencies
• Increased reliance on peers for guidance
• Increased openness to changing personal
beliefs, values, behavior
• Desire for respect and autonomy
• Risk taking, feelings of invulnerability

23. Adolescent Themes and Patterns
• Short-term planning, foreshortened sense of
time
• Intellectual discovery
• Expansion of cultural influences
▫ (music, art, politics)
• Idealism
• Search for new heroes and heroines, mentors

24. Connecting to Teens
• Choose topics that are important to teens and
tie into developmental themes
• Share data from other teens, including risk
data. Share all sides of the story.
• Provide interactive option for teen to share
opinions/thoughts/questions
• Feature teen/young adult commentaries and
personal stories on the topic

25. Connecting to Teens:
Motivational Interviewing
• Motivational Interviewing
Miller and Rollnick
http://www.motivationalinterview.net
• Method developed initially related to helping
individuals appraise benefits and risks related
to their personal substance use behavior
• Helps adolescents identify areas of behavior
or functioning that are of concern to them

26. Connecting to Teens:
Motivational Interviewing Style
• Helps teens look at risks, harm, or concerns
related to some behaviors or situations while
acknowledging potential benefits or interest
or rewards of the situation
• Non-confrontational questioning
• Exploration and factual, objective use of data

27. Developmental - Generational
Interactions
• Teens rapidly master new technology
• Teens - and their mentors, yesterday’s teens -
facile with smart phones, social media, video
games
• Communication styles established during
adolescence become generational traits
• Reinforced by culture and brain wiring

28. Communication Strategies
• Use of story, personal narratives about teen
discovery, exploration
• Use of peer stories and data
• Use of slightly older mentors
• Stories of self-discovery
• Integration of stories and scientific data

29. Communication Strategies
• Create an interactive dialogue of evidence-
based data and adolescent’s experience
• High interest, interactive visual materials
• Provide information about resources
• Limit advice. Encourage reflection.

30. Communication Strategies
• Video games as teaching tools
• Popular, engaging, interesting to teens
• Require mastery of skills and information
• Levels of skills, leading to mastery
• Immediate and intermediate reinforcement

31. Conversations with Adolescents:
Examples
• Online interactive simulation training:
helping educators talk with teens about
psychological distress.
▫ www.kognito.com
• Classroom delivery: program helps teens help
peers find help for mental health problems.
SOS Signs of Suicide Prevention Program
▫ www.mentalhealthscreening.org/programs/youth-
prevention-programs/sos/

32. Conversations with Adolescents:
Examples
• Florida Military Family Peer Support Program
Peer guides use interview quotations from
youth for peer, family, and provider training
about the mental health needs of military
families. (Citation, slide 36)
• Coping 10.1. Adolescent stories, role plays
and vignettes highlight classroom curriculum
for tenth graders about understanding and
coping with traumatic stress.
• Donnelly, W.O., Dubow, E.F., Zbur, S., Hassan, S., Veits, G., Hayman, J., Bradbury, S.,
Reinemann, L., Ghoul, A. and Bonadio, A. (2012). Coping 10.1: A Psychoeducational Curriculum
to Help High Schoolers Handle Traumatic Stress. Unpublished Manuscript. Department of
Psychology, Bowling Green State University, Bowling Green, OH.

33. Online Interactive Role Play
• Example: Kognito.com/demos
• Interactive role-play simulations
• How to engage, support and refer adolescents
experiencing psychological distress, including
thoughts of suicide
• For educators (how to talk with students)
• For college students

34. 34
SOS Signs of Suicide DVD,
Teens discuss peers and suicide

35. Teens Discuss Their Feelings About
Military Deployment of a Parent
• Nervous, worried, afraid – not knowing if or
when they would see the parent
 I
was
angry
at
everybody.
I m
like
a
big
daddy s
girl,
so
I
was
really
sad
he
was
going
away.
And
I
was
scared
something
bad
might
happen
to
him.

36. Teens Discuss Their Feelings About
Military Deployment of a Parent
• Conflicted (multiple and changing emotions)
• Well
I
was
kind
of
happy
that
he
was
going
away
because
then
I
wouldn t
have
somebody
who s
always
ge=ng
mad
about
something
that
I
would
do
wrong.
But
then
I
was
sad
because
he
might
not
come
back.
I
might
never
see
him
again.
• Granzow, E., La Greca, A.M., Hershman A.L., Prinstein, M., Sevin, S. and Coyle, A.
(2011). North
Florida
Military
Family
Peer
Guide.
Coral
Gables,
7-­‐Dippity,
Inc.

37. Sharing Health Data with Youth:
Traumatic Stress Survey Items
Last year, we surveyed 120 students in
the 10th grade at (your) High School on
common stressor. They told us a lot
about their experiences dealing with
stressful situations, including some
that were really troubling to them.

38. Engaging teens about stressors
experienced by other teens
Can you guess what percentage of
teens reported being harassed because
of skin color, religion, sexual
orientation, appearance or where their
family was from?

39. Final Thoughts
• Respect adolescent experiences, insights and
interests regarding their health concerns
• Illustrative peer and mentor narratives. Stories.
• Tie information to adolescent developmental
concerns. Use dialogue, interactive gaming.

40. Final Thoughts
• Recognize strengths: abstract thinking,
exploration of ideas; sensitivity to social and
emotional cues
• Accept that emotional regulation and impulse
control, especially related to risk-taking, are
works in progress
• Motivational interviewing style encourages
reflection, more thoughtful appraisal of risks

42. contact information
William O. Donnelly, Ph.D.
Donnelly Community Psychology, LTD
429 W. College Avenue, PO Box 105
Pemberville, OH 43450-0105
billd@bgsu.edu
(419) 287-7073