From healthcentral.com
How you discuss your teen’s psoriasis can help empower them to take charge of their condition now and as they become adults
SHARON STEVENSON’S DAUGHTER, Paige Alday, was diagnosed with plaque psoriasis (PsO) when she was 3. But it wasn't until middle school that Paige’s condition really became an issue. Not because the flares were worse, but because that's when other kids at her Iowan junior high began to notice.
For example, her school had swim class almost every day, and changing in the locker room filled her with dread. Even if her one-piece suit covered the thick, scaly, red patches on her stomach, she still felt everyone was looking at her. When the patches were on her scalp and forehead, that made every day tougher. Stevenson could tell as soon as the bus dropped off her daughter what kind of day it had been.
"It was devastating for her, and of course I felt helpless because we were doing all the treatments recommended by our doctor, but some of the sores were so large and visible that she felt self-conscious," says Stevenson. "When it was that bad, she didn't want to talk about it directly. So we had to find other ways to let her know she was supported, usually by asking an open-ended question."
If you have a tween or teen, those type of questions can make all the difference, adds Shawna Newman, M.D., director of child and adolescent psychiatry at Lenox Hill Hospital in New York. "The key to beginning this conversation is starting from a neutral place," she says. "Adolescence is already such a vulnerable time that it makes talking about difficult issues even harder. Then you add in something like PsO, and it increases the challenges."
Consider these five questions for getting the conversation rolling, Dr. Newman advises, and keep in mind that even if you feel like you’re not getting anywhere with them, that doesn't mean your teen isn't listening.
1. How Are You Feeling? Or, How's Everything Going?
Although these seem bland and obvious, they might be enough to spark discussion, Dr. Newman says. That's because you're not asking a more direct version like, "How is your PsO affecting you?" which may feel confrontational to some teens, or even like prying if they're feeling sensitive about it.
This opening gives them a chance to talk about what they want to discuss, Dr. Newman says, and that may or may not include their condition. Or the conversation could start with mundane topics and gradually veer toward more sensitive areas. The important thing, she says, is letting your child determine where the conversation goes (so if they don’t bring up their PsO, neither should you).
2. Are You Happy With Your Treatment?
For Alday, who is now 26, one of the most powerful indications of support that her mother provided was including her in treatment decisions. "From about seventh grade on, my mom always turned to me at the doctor's office and asked if I had questions or opinions they needed to know," she recalls. Not only did that help her feel more in control of her treatment, but it also prompted her to research the condition on her own when she got older.
3. How Do You Like Your Doctor?
As a result of Alday's research, she decided when she was a teenager that she wanted to switch doctors. She felt like she wasn't being heard by her dermatologist, so when Stevenson asked her for an opinion on what treatment options she wanted to consider, Alday expressed her frustration about feeling dismissed. They worked together to find another dermatologist covered by Stevenson's insurance, and ended up going to a doctor Alday connected with almost immediately.
"That made me feel much more confident, because I felt like it wasn't just my mom who was listening to me," she says. "That helped, too, when the time came for me to start going to the doctor by myself."
4. Did I Tell You This Story About When I Was a Teenager?
Although opening with a question that sounds like, "When I was your age..." might garner an eye roll at first, tweens and teens do connect with stories about vulnerability, problems, and resilience, Dr. Newman says.
For example, if a parent was teased for her appearance or felt isolated because he seemed different from everyone, it doesn't matter whether it was about PsO or not, she notes. Those emotions, and how the parent dealt with the situation, are a powerful tool for letting a child know they're not alone.
"You have to be careful to make sure you're not saying your situation was worse or diminishing what they're going through," Dr. Newman says. "Instead, you're saying that bullying is rotten, it's always been rotten, and here's what you did to make yourself feel better."
5. What Do You Think Could Be Causing This Flare?
When there's a PsO flare, it's helpful to understand what's going on as a root cause, Dr. Newman says. Rather than automatically taking your child to the doctor, which can feel dismissive, check in with your tween or teen first. For instance, Alday realized that her PsO was getting worse due to chlorine from those daily swim classes, and was able to arrange an alternate activity for gym class. For others, it may be stress, which is very common. "Asking your child to be part of the assessment about what's going on can make them feel heard," Dr. Newman says.
When You Get Shut Down and Locked Out
Although these conversation starters can be helpful, let's be honest: There are times when tweens and teens are much more likely to shrug and look back at their phones than have a meaningful conversation. And that's OK, Dr. Newman says. Even without a chronic condition, adolescents need space and that can mean scant conversation.
"The good news is that most of the time, they do hear you," she adds. "So, if you are gentle and show support and ask questions, don't be discouraged if you seem to get shut down. It might just be the case that your teen isn't ready to answer yet. But if you keep showing that you're there, and you're interested, they might be the ones to start the conversation about their PsO and its effects."
https://www.healthcentral.com/article/teen-psoriasis-essential-questions
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