Mother to teenage son:  “Hey, have you taken your medicine yet?”

Son (playing video games): “I will in a minute!”

Mom (wondering whether it’s worth the fight):  “You know, you’re gonna move out in a few years and you’re going to have be able to do this without me telling you.  And you know you don’t want flare-ups if you can help it!”

Son: “Nope, you’ll have an alarm on your phone and you’ll just call me and keep nagging until I take it.  Can’t wait for that!” [insert sarcasm]

And, end scene.   Mom walks offstage slowly, imagining how many more times she’ll ask before he takes it, if he’ll ever fully be in charge of his body, maybe whether he’ll be living on her couch at 40….

Is this exaggerated?  Maybe.  But I know many families in this boat.  They don’t have emergencies, and they get a clean “Good job, no problems this quarter!”  during the GI checkup. The child has a good quality of life when it comes to school and sports and social time and… it’s because mom stays in charge. She’s in charge of the medicine, the questions for the doctor, all the IBD knowledge necessary to lead a good life.  She’s running this show!

How much should we push our teens to start taking charge and showing responsibility?    It’s difficult.  If we push too little, they don’t grow up.  If we push too hard, they may retreat and we'll keep doing everything anyway “because someone has to.”  And by the way, ‘Why wasn’t that last flare and hospitalization enough to make him wake up and start doing something about it?’

Deciding when responsibilities and consequences belong squarely on the shoulders of a teenager is difficult.  So I believe in not placing it squarely on their shoulders, at first.  Too many experiences in your child’s life will happen too fast for them.  Generations ago most children were shown early the value of very hard work and developed the ability to value important things in life.  In the culture of today these milestones are sometimes delayed too long and kids end up not being ready for adulthood’s responsibilities.  George Bernard Shaw is credited with writing: “Youth is wasted on the young.”  Many of us look back on our own youth longingly, and wish our children could appreciate what they have while they are in their best form with the fewest problems and fewest responsibilities. But then we’re frustrated when they’re not ready for adulthood.

What I recommend to my parents, and practice with them during transition consultations, is a very intentional, dedicated and patient shift from parent-only to parent-child partnership through contract.  Remember, childhood and adolescence are not just about fun, freedom, and all the time in the world.   Across all cultures, youth is generally a time of great education and preparation.  But we sometimes lose our perspectives as adults and forget that we are supposed to be their most important teachers.  So here’s how we can teach them to prepare for adulthood.  We show them, we do things together, we set expectations, and then we structure their lives so they’re rewarded for moving forward, for accepting apprenticeship, while we supervise.  And while they’re learning, while they’re taking a little more on for themselves, we encourage and reward them for trying and for succeeding (and we stand by them when they do not succeed).  After all, mistakes are proof that you’re trying, right?

Mother to son:  “Okay, honey.  I am going to tell you something important.  Right now, I’m your mom, and I’m used to being in charge of your health.  I use my insurance, I make your appointments, I take you to the doctor, I ask the questions, I go to the pharmacy, I pick up your medications, I put them in the day minder boxes, and I nag you until you take them. You’re going to take all of this over one day, because I love you and you have to live your life; I can’t live it for you. It’s not going to be today, or tomorrow; it’s going to take a while.  But we’re going to do it a little bit each day, together, until you feel good about it, until you know how to solve the problems that come up, and until you are absolutely on top of everything you need to do to live well on your own.”

This principle applies, of course, to laundry, to keeping a room clean, to fixing food in the kitchen, to homework, even to friendship and romantic behavior.   It is apprenticeship. The training starts early, it starts deliberately, and is more difficult for the parent than for the child.  Again, this is the way it’s supposed to be.   You cannot point, demand, and then leave responsibility for medical adherence in the hands of a child.  But you can hold the hand of the child, guide them through the experience, and slowly transfer, through gradual steps and support, all the responsibility they’re ready to accept. And they’ll be ready.  Ask a psychologist, like me, who has seen parents and children do this well.

Start today.  Age 8?  Great.  Age 12? Go, go, go! Age 18:  It’s time to sit down and have a conversation.  And roll your sleeves up.

Mother to son:  “Honey, you did a great job this week getting your pills organized into the day minders while I watched, and taking all but two of your evening pills just based on your phone alarm. That's why I have an alarm on my phone, too! Together, we didn't miss a single dose. I’m proud of the progress you’re making, and I want you to know I know you’re going to be ready for what life throws at you! I’m behind you all the way.”

Son: “Mom, it’s not like I’m leaving tomorrow!  Don’t get all gushy.  And don’t EVER do that in public.”


Noel Jacobs, PhD is a child psychologist serving kids with chronic illness at OU Children's Hospital in Oklahoma City.

This post was originally published on January 23, 2013. It was reviewed and edited on January 29, 2018.

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