When we were adolescents, we had the opportunity to test ourselves with respect to our abilities and identity. Most of what we did was helpful in that the period permitted us to bridge being a dependent child to being an independent adult. How we achieved this change varied from person to person, but most of us made the transition in one piece. If we happened to have a chronic illness, however, the shift from childhood to being an adult presented other difficulties. In a review from Australia, Sawyer and colleagues focused attention on the interaction between adolescents with chronic conditions and the health systems that support them. At least 12% of adolescents live with a chronic condition. Some conditions are characterized by increasing incidence, such as diabetes, or improving survival rates, such as cystic fibrosis, while others, such as cancer, are concerning because of there are differentially poorer outcomes in adolescents in comparison to both children and adults. Sawyer and coworkers pointed out that growing evidence suggests that young people with chronic conditions are doubly disadvantaged--they engage in risky behaviors to at least similar if not higher rates as healthy peers, while having the potential for greater adverse health outcomes from these behaviors.

COMMENTS. The conclusion of this review was that in addition to increase their life chances, we need to better understand how the social and emotional outcomes of young people with a chronic disease can be improved, while better supporting their emerging capacity for self-management. What was not mentioned in the review was how we can achieve these aims. Fortunately, the literature on several chronic illness, including asthma, diabetes, and cystic fibrosis, suggests that we have made progress by developing self-management programs specifically for children and adolescents. The approach has proven efficacy and efficiency. However, we need not applaud just yet: there are no doubt that by considering problems faced in adolescence, we can develop and test even more effective self-management programs in the future. This will mean that we help adolescents develop self-efficacy, a lesson that will likely help them throughout their lives. This remains the challenge for scientists and patients alike.

S.M. Sawyer et al. Adolescents with a chronic condition: challenges living, challenges treating. Lancet, 2007;369:1481-1489.