March 6, 2024
Cindy Lopez: Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. Adolescence is a period of growth in which youth are discovering who they are and where they belong. In this insightful podcast episode, we discuss the dynamic and sometimes challenging journey of parenting adolescents as children transition into the teen years, parents face new and unique challenges. Although this time can be a fearful time for parents or caregivers because they’re not quite sure what to expect, it really can be a time of joy and hope. So listen in to this conversation with CHC experts, Dr. Patrice Crisostomo and Dr. Emily Hsu, both licensed psychologists, as we explore practical tips, expert advice, and proven strategies to help parents and caregivers navigate this crucial phase of their child’s development.
Dr. Crisostomo and Dr. Hsu, thank you so much for joining us today and spending some of your time with us. I’d like to start by asking you to tell us a little bit about yourselves and why you think this topic is an important one to discuss today.
Dr. Patrice Crisostomo: Cindy, thank you so much for your interest in the topic, and to our listeners tuning in, just wanted to acknowledge that you made an active choice to join us and listen in, which really suggests just an earnest, authentic desire to support the young people in your life. So I am Dr. Patty Crisostomo. I am a licensed clinical psychologist and a program manager within the division of clinical services here at Children’s Health Council, and I’m super passionate about working with teens and young adults and their caregivers. I really think that adolescence is such a critical, formative time of development in an individual’s life. And for caregivers, it can be so confusing about how to actually support adolescence in a way that feels supportive to the teen and the kind of support that’s like effective. I feel like there’s a sweet spot that can be really challenging in family dynamics, and so I feel super excited to be here to talk with you and Dr. Hsu.
Dr. Emily Hsu: Hi, I’m Dr. Emily Hsu. I echo a lot of Dr. Crisostomo’s sentiments and feelings about this topic. The adolescent years I feel are met with a lot of trepidation, a lot of concern from parents of many different careers, which is why I’m really excited to talk about this topic because adolescence really is, if we were to do a reframe, an amazing time of development when a lot of different things are happening, and I am passionate about this topic. What I hope to achieve, what Dr. Crisostomo and I hope to achieve, is to kind of shed light on some things to expect and to also validate the experience of parents as they navigate with their teens this new period of their life. I am a bilingual clinical psychologist. I also work for clinical services. I provide parent collateral, therapy primarily, and I also am part of the evaluation team doing evaluations for six plus. I’ve also worked with individuals throughout the lifespan, so six plus all the way to 99 years of age in multiple settings.
Dr. Patrice Crisostomo: Wow.
Cindy Lopez: Wow. Thank you both. And as, both Dr. Crisostomo and Dr. Hsu have noted, reframing adolescence kind of as this like exciting time can be a really positive period of growth in a child’s life and often we get that there’s probably a little fear and trepidation around thinking about teenagers and adolescents. So let’s talk about that first, let’s define adolescence. What is it? What certain ages are we talking about today?
Dr. Patrice Crisostomo: So today we’re talking about the ages of 12 to 18, however, we know from the research from the last 20 plus years that actually young adulthood, so the age of 18 to 25, has been considered this last stage of adolescence, but today for the purposes of our talk, we’re really going to focus on adolescents who are 18 and below. And as you’re talking, Cindy, I was chuckling because on the way into the office today I had run into one of our colleagues who’s expecting his first child with his partner, and the amount of excitement and the joy that comes with welcoming a newborn, you know, certainly that’s a stressful time too, but it’s like there’s this sense of renewal and life and just connection to this larger, like developmental framework and humanity. And there’s a completely different reaction, I think, when we encounter parents who have, for example, multiple teenagers at home, there’s like oftentime, like, a shared look, like, oh yeah, okay, you’re in the thick of it. And I think that’s why Dr. Hsu and I really enjoy working with this population, with this age range, because adolescence–it can be tumultuous, it can be chaotic, but it also can be a really wonderful age of opportunity for a growing individual to begin to explore who they are, what their values are, what they want to be, their interests, and you know, it’s all supported by what’s happening in the brain, in their body. And sometimes I think the challenges that come with big emotions, difficulty with communication, effectively advocating for yourself, like that is what actually leads to these challenges that are quite common in a household when you’ve got parents or caregivers with a perspective and then teens who also have a different perspective.
Cindy Lopez: Yeah. Yeah. And Dr. Crisostomo, you just alluded to brain development and we have other podcasts on lots of adolescent and teen health topics, teen mental health topics, but the brains of adolescents are still developing, so that’s part of what you’re seeing as a parent or caregiver, those who work with adolescents, you’re seeing this person who’s becoming a young adult, but their brain is still developing. So just understanding that and expectations around that and how you can support them, I think that that piece of information is a valuable piece of information to have. So for our listeners who are probably parents and caregivers whose children are maybe heading into adolescence, not there yet, let’s talk about what they can expect. How can they prepare?
Dr. Emily Hsu: I think it’s one of those things is recognizing that there are two critical periods that we all go through. It happens when we’re a child at around the age of two when we’re starting to meet some of those developmental milestones like walking and talking, and the second critical period typically starts around puberty. It’s that time where we’re more ready to make decisions, and we’re also deciding which decisions aren’t working for us, because if you think about it, you’re born with an excess of synaptic connections and based on your experience and what works for you, what feels good. And this is like a time when you’re starting to be like, oh, this feels good, so I’m going to keep doing it, which is why we do see teens tending to seek out an activity that feels good for them because they’re like, oh, it feels good. So they kind of might look like they’re stuck on it, but they’re also trying to, like we see with, you know, younger children, they’re trying to figure it out. And this process when they’re going through adolescence is known as synaptic pruning where basically they’re trying to figure out in their brain during adolescence, what they’re going to keep, you know, what’s going to work for them. And if we were to go into some of the areas of adolescence in which a teen goes through during this period, if we’re talking about between under the age of 18, up to 18, starting at 12, you know, there’s a couple of tasks that we start seeing teens experience, which is where there might be more conflict potentially between adolescents and adults, which is, for example, independence, body image, peer relations. We’re starting to see that shift where maybe the immediate family was more of the individual’s cohort, but now that’s shifting and also this is the time when identity is also starting to come and be more created and solidified.
Dr. Patrice Crisostomo: Totally agree with everything that you said, Emily, and I want to roll back a little bit about the adolescent brain. The reason why the last stage of adolescence, young adulthood up to age 25, it’s because the frontal lobes, which are responsible for executive functioning, and I’m sure you all have a podcast about that, but the down regulation of impulses, that is still forming. So we’ve got a very uneven development that’s happening neurobiologically, right? So we’ve got a really, perhaps, overdeveloped, one might argue, emotion center, and so that makes teens brains more sensitive to rewards, whether or not that’s like sex, or drugs, or money, candy, phones, what have you. And then they’re also more driven by immediate rewards as opposed to being able to kind of think through, oh, hmm, if I delay this gratification, I actually might get a bigger, better outcome. And so they’re actually less attuned to long term consequences. They’re more attuned to like, what can I get right now? Because in our brain, right, we get these little dopamine bursts, right. And it feels good and so, you know, to piggyback off of what Dr. Hsu was saying, we’ve got an individual who’s having so many, you know, active things that are happening developmentally. They’re more likely to take risks. They’re more interested in new novel things and this is all evolutionarily based, right? It’s adaptive for adolescents to begin to explore, and if we zoom out a bit more in the context of a family system, you’ve got one individual in a family or maybe multiple if you’ve got multiple teens ready to kind of go out and explore in the world, and then we’ve got parents or caregivers who’ve had more life experience, who want to pass on, you know, their lived wisdom, their lived knowledge. And that’s where that conflict comes from, right.
I think Emily and I agree because we operate and we both practice a type of therapeutic intervention called dialectical behavior therapy and one of the core beliefs in DBT is that at any given time anyone is doing the very, very best that they possibly can. And I truly believe that’s the case, even in the context when there’s real conflict, painful conflict between teens and a caregiver. When we look at what is the function of this behavior in the context of this family system, you know, I really encourage caregivers to not take it so personally, and it sounds more easily said than done, right, but like, this is part of the human experience, the human development. It’s important for our adolescents to begin to explore who they are, what feels good, you know, for our population, it’s actually really important, right? That’s why it’s an age of opportunity. It’s an opportunity for growth, development, creativity and we want our caregivers to be able to have the tools to continue to facilitate that, not stifle it, provide enough balance around the support and supervision without shutting teens down.
Cindy Lopez: This phase of development for our kids as you’ve noted, both Dr. Crisostomo and Dr. Hsu, like it’s one where the child is becoming more of an individual, right? And so, sometimes it’s like the parent’s no longer cool, right? When the kids are younger, it was all about, you know, trying to please a parent and please a teacher and all those kinds of things, but now where peers are becoming more important, students want to kind of grow up as fast as they can. It’s like, “Oh, I’m not a kid anymore.”
Parents are seeing what is coming for their teen, and they want to protect them and they want to help them to avoid pitfalls and mistakes. So should you let your child lead? What would that look like? What are the conversations that parents might be having with their teens?
Dr. Patrice Crisostomo: It really depends on the child, the teen, because we know that development is not necessarily even, right? So if we think about adolescence, the job or that time in adolescence, we’re basically trying to support an individual to move from total dependence on adults, on caregivers for basically everything, right, providing food, shelter, figuring out, you know, how to get from one place to another. And at the end of adolescence, we’re hoping that these individuals have the whole toolkit to be able to “adult.” I put that in quotations, right, but you know to be able to hold a job, to be able to fend for themselves when it comes to making food, making enough money to purchase that food, et cetera, right? And so, you know, when thinking about do we let our child lead, I think it really depends because in every domain, right, when it comes to cognitive development, they might be intellectually very, very bright. They might get straight A’s through elementary school, middle school, and yet they might still need more support when it comes to social problem solving, right? And also just the importance of organization and planning. And so I think it really depends on what the teen is demonstrating with regards to their behavior. And that can help the caregiver kind of know when to like zoom in and provide more supervision, more support, and when to kind of take more of a backseat. I like to use that analogy of a car, like this, this life is your child’s life, right? And initially, parents are really holding that steering wheel, pumping the brakes, right, providing the gas, and eventually, you know, at the end of this, we want a fully fledged driver who can make good decisions. And so it’s a coaching. It’s a fine tuning that happens more towards the perhaps end of adolescence, but at the very beginning, it’s all kind of based in this foundation of trust, of understanding, that, hey, you know, we’re in this together, I’m here, this is what I hope a caregiver would be able to either say or demonstrate with their actions, like, I’m here, I’m safe, I am going to be there for you regardless of the mistakes that you make, you know, the actions that you take because at the end of the day, it’s that foundational relationship that allows our teens to feel safe enough to go on and explore and to eventually leave the nest. I often tell my caregivers, I have them think back to, okay, while you have, like, a 12 year old with, like, really intense emotions, think back, that 12 year old was also two at one point, and you were a caregiver to that two year old. You’re a caregiver to that 12 year old now. You’re gonna still be, if the whole thing is going well, right, you’re gonna still be a parent or caregiver of a 22 year old and a 42 year old. So how do you want to show up in your relationship with your child? Because they’ll always be your child, right? Regardless of their age. But, so it comes from this, like, core place of, I see you, you are worthy, you are respected, you are whole. And what often gets in the way is challenges with, like, perspective taking, rigid thinking, communication, of which, like, there’s coaching and there’s skills available for all of those areas.
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Cindy Lopez: Dr. Hsu, any specific thoughts or strategies or conversations like parents or caregivers might be having with their teens, with their adolescents, especially as they see their teen in this process of decision making about something, right? You are really moving into this coaching mode and so what does this coaching mode look and sound like? Do you have thoughts about that, Dr. Hsu?
Dr. Emily Hsu: Yeah, first off, I agree with what Dr. Cristosimo said where, in terms of letting your child lead while providing guidance, I do think it depends on where they are developmentally. And I think that is going to be different in terms of how you lead your child with guidance. And in terms of how you support your youth, I think it’s one of those things where, like Dr. Crisostomo said, it’s a balancing act, right? It’s also recognizing, I think, where you come from in terms of your own experiences and what you’re going into in interaction with your teen, like, where are you emotionally? What are some of the thoughts and what is your goal in this interaction? You know, going back to some of the concepts of dialectical behavior therapy, also known as DBT, and some of the things that we talk about in relationships is interpersonal effectiveness, like how do you interact with, and this is anyone, not just your teen, in a way that respects your needs, and also the needs of the other individual with whom you’re speaking to or having an interaction with.
Once you’ve identified that relationship is important and one in which you want to keep. And also being able to be regulated enough to be able to have that interaction. In my work with parents, I remember having to tell a caregiver–she’s working with a teen right now, did not expect to be a caregiver and this teen is 15. And I had to kind of give her permission to not respond right away because I wanted this caregiver to model, you know, waiting.
And I have to give you know, permission to be like, if nothing coming out of your mouth or behaviorally is going to help the conversation go towards where you want it to, if it’s not going to meet your goals, if it’s set in any of those traditionally more negative emotions, then I would let the adolescent know, like, I’m going to need some time, pause. So I think regulating is also important and knowing where you are as a parent as a way to support your youth because your job as the adult in general, but especially during this stage of adolescence when they’re trying new things, experiencing so many different emotions is to make sure that you are regulated so that you can co-regulate and then balance in terms of offering support and acceptance, while affirming that your teen is growing up, they’re trying to find who they are, monitoring and observing without judgment, again, something that you’ll hear in DBT is being mindful of what you think and feel without judging, guiding and limiting, again, going back to that theme of balance, modeling desired behaviors. And consulting, you know, getting teen feedback, oftentimes I will tell my parents and my work with them is ask your teen, what do they think about X, Y, and Z, keeping that communication open, and also providing a supportive home environment and advocating, recognizing that since you as the parent may not be their primary source of conversation or where they go to, how to expand that network with other adults. This is where mentoring is really great, whether it’s, let’s say your child / adolescent is 15. There’s some great 18 year olds who may be able to mentor, finding a program where there’s mentoring opportunities. Is there an aunt? I’m a godparent. So, is there a godparent? So that’s how I would recommend supporting.
Cindy Lopez: So what advice do you have for our listeners, parents or caregivers who are getting ready for their child to enter into adolescence, maybe their child’s 9, 10, 11, and they’re, you know, looking forward. So how can they prepare themselves?
Dr. Patrice Crisostomo: I think what you’re hitting at Cindy is the preparation for adolescence is the relationship now, whether or not your teen is three years old or 12 years old, like, you can’t make changes to things that have happened in the past. You can only operate in the present. And, you know, plan for the future, of course, but not get stuck there, developing those foundations of being able to have those difficult conversations that, like, some people feel uncomfortable talking about, right? And that’s important across the lifespan, but particularly in adolescence for the reasons we discussed before, you know, I think my recommendation for parents and caregivers is to really take care of themselves, right? Self-care, that’s the buzzword, buzz term, right, but like, authentic self-care that allows parents and caregivers to show up, regulated, authentic, because teens can see through fakeness because we are really, as caregivers, trying to model the kind of behavior we want to see in our teens, right? And so if there’s like a mess up, if you as a parent, like, are coming into a situation hot and you’re, like, ready to fight, right, and engage in a conflict and, you know, an hour later you realize, wow, I said some things I didn’t mean to say, being able and willing to acknowledge, you know, let’s do a redo on that. I’m human.
Cindy Lopez: Yeah.
Cindy Lopez: Dr. Cristostomo, Dr. Hsu, thank you so much for joining us today, for sharing your expertise, your insights, your wisdom. What final words of advice or what final wisdom would you like to leave with our listeners?
Dr. Emily Hsu: I agree with what Dr. Cristosomo has said, and I want to empower parents to reach out to their community. I have a lot of psychologists who are also expecting adolescence to be really hard and have been told, “Yeah, so is this going to be the age where my children start hating me?” And they work in the field of child and adolescent psychology. And so I’m telling you that because I want to validate that even professionals who work in this field are experiencing, if I’m going to use the word, not knowing exactly how they feel or their thoughts, maybe fear, maybe worry. And I think using that and being like, I am worried. I too seek help and seek support because at the end of the day, no one expects anyone to have all the answers, but again, being open to seeking out that information from your community, from providers at Children’s Health Council, for example, your pediatrician, anyone else in your community that has someone who’s going or has already gone through working with a teenager, I think would be helpful.
Dr. Patrice Crisostomo: And if I could just jump in one last thought, you know, connected to community, right? It doesn’t fall just on the nuclear family, the primary caregivers to be the one responsible for shaping our teens, our teens perspectives, right? Actually, teens tune out parents and caregivers, and there’s research for the auditory reasons for this, I but I think it’s important for parents to remember that there are so many opportunities to cultivate competencies for our teens to understand themselves, their inner experiences because they are in lots of different spheres socially, right? They will learn about themselves and through their mistakes with peers, with coaches, and other instructors, right? And so it’s not just on caregivers. I think there’s oftentimes like a pressure to do it all, right? And just know that like there is a community of formal help, but also there’s untapped social support around you.
Cindy Lopez: Well, thank you so much Dr. Cristostomo, Dr. Hsu for joining us today, for everything that you shared. To our listeners, thank you for joining us. As Dr. Hsu noted, if you need help, please reach out, chconline.org. We have a care team that you can reach out to specifically. You can reach them at careteam@chconline.org. You can call 650-688-3625. We have lots of services, including parent coaching, therapy for teens. If you’re listening to this and you have a teen and your teen is in the middle of crisis, reach out, we have an intensive outpatient program called RISE that we do with Stanford. So all kinds of resources. You don’t have to do it alone. So thank you for joining us today.
Dr. Patrice Crisostomo: Thanks for talking with us, Cindy.
Dr. Emily Hsu: Thank you.
Cindy Lopez: Visit us online at podcasts.chconline.org. Make sure to subscribe to Voices of Compassion so you never miss an episode, and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.
