About the Guest
Wonder how your teens come up with the things they do? Learn more about the teen brain from pediatricians Dr. Den Trumbull and Dr. Michelle Cretella. Dr. Trumbull and Dr. Cretella give moms and dads some sound advice for preparing their sons and daughters for adolescence.
Den TrumbullDen Trumbull is board certified in pediatrics and former president of the American College of Pediatricians. Dr. Trumbull was born and raised in Panama City, Florida. He received his Bachelor of Science degree in Chemistry at the University of Florida and then attended the University of Miami School of Medicine for his medical degree. After serving in the U. S. Air Force as a pediatrician for four years, Dr. Trumbull joined Drs. Glover and Morrison in private practice in Montgomery, AL in...more
Michelle CretellaDr. Michelle A. Cretella, MD, FCP is the President of the American College of Pediatricians. She is a board certified general pediatrician with a special interest in adolescent mental and sexual health. She graduated from the University of Connecticut School of Medicine in 1994; completed her internship and residency in general Pediatrics with honors at Connecticut Children's Medical Center in 1997, and completed a College Health Fellowship at the University of Virginia Health Center in 199...more
Pediatricians Dr. Den Trumbull and Dr. Michelle Cretella give moms and dads some sound advice for preparing their sons and daughters for adolescence.
Bob: Dr. Den Trumbull is a pediatrician. Today, he sees a lot of parents who are pretty sure their son or daughter has Attention Deficit Disorder—ADD.
Den: Twenty years ago, I had to tell parents: “Hey, I think your child may have ADD.” “Can you write that down? Well, what does that stand for?” Today, they come to me: “I filled out a questionnaire on the internet. I know my child has ADD. He needs medication.” But a lot of the symptoms of ADD are related to a fast lifestyle—insufficient sleep, insufficient nutrition, insufficient exercise—in that order.
Bob: This is FamilyLife Today for Friday, October 9th. Our host is the President of FamilyLife®, Dennis Rainey, and I’m Bob Lepine. We’re going to talk today with a couple of pediatricians about Attention Deficit Disorder and other issues being faced by teens and preteens. Stay tuned.
And welcome to FamilyLife Today. Thanks for joining us. You know, when your kids hit the teen years and you have to take them to the doctor, there are sometimes you just want to leave them and say, “Can I just pick them up in a couple of years?” [Laughter]
Dennis: “Doc, would you finish this process, please? I mean, seriously.” Well, we have a couple of pediatricians who know what we’re talking about. Dr. Michelle Cretella and Dr. Den Trumbull join us on FamilyLife Today. Dr. Trumbull / Dr. Cretella, welcome back to FamilyLife Today.
Michelle: Thank you very much.
Den: Thank you.
Dennis: They serve at an organization known as the American College of Pediatricians. Dr. Trumbull, how many years have you been a pediatric doc?
Den: Twenty-eight to thirty, I believe.
Dennis: There you go—and Dr. Cretella, we know has been one for fifteen years. She practices in Rhode Island.
I just kind of want to get after a more basic question.
It’s kind of what Bob was talking about here—can you explain the teenager’s brain to us? [Laughter]
Bob: We’re going to turn that one over to Dr. Cretella.
Dennis: Well, did you see that Dr. Trumbull pointed to her with both fingers!
Bob: —and backed away from the microphone.
Dennis: Exactly. [Laughter]
Den: She has some teenagers in this—
Michelle: Yes, I do.
Dennis: Well, that makes you the real authority, then.
Bob: Is there something going on, physiologically, in the head of a teenager?
Michelle: Yes, absolutely.
Dennis: That’s a great question. No, it really is, Bob—thanks for the question. Is there something going on in there?
Bob: Is there anything going on there? [Laughter]
Den: They would say, “Yes.”
Michelle: You know, it used to be thought that the brain was complete in its development by age 12—not at all. The most dramatic period of growth and development of the brain is taking place between 12 and age 25. And what matters most / what parents need to take away from this is—
—between the ages of 12and 25—those are the critical years for our children to develop the brain’s CEO. In other words, if you want to know why kids do not make / or teenagers do not make very good risk assessments or decisions, it’s because that decision-making capacity / that risk-assessing capacity of the brain, which is in the frontal lobes, is not fully mature until age 25. We know this now—neuroscientists have demonstrated it.
Den: Teens are not small adults.
Michelle: Teens are not.
Den: They are not small adults, and that’s the popular theme—contemporary theme, I might add—that is propagated by the media and even experts—so-called experts. They need parental oversight.
Bob: Well, you were explaining to me that a lot of parents look at a 12-year-old—and the 12-year-old is starting to say, “I can do this on my own.” A lot of moms and dads are going: “I guess he can. Okay”; right?
Den: And many are not saying it that respectfully, as you just did.
Michelle: That’s right.
Den: And then, parents become a bit intimidated. They have been told, “This is a small adult.” So, they back off. And we see that even in the exam rooms in the pediatrician’s office, where confidentiality does not allow the pediatrician to talk to the parent, and actually, does allow for the pediatrician to be alone with the child. The supposition there is that this child is capable of making wise life decisions. No, they need the parent. We must not back off at age 12—we must stay engaged.
Dennis: Let’s go back to the beginning of this thing. Let’s talk about preparing your child for adolescence. You’ve taken advantage of a resource we created, here at FamilyLife, called Passport2Purity®.
Dennis: You believe parents need to be very intentional about preparing their son and daughter—between the ages of 10 and maybe 13—for the issues they are going to face as they finish the process that Dr. Cretella was talking about—
—the process of growing up and becoming a truly mature adult.
Den: If the only information they are receiving is what they see on TV, on the iPad, on the computer, or from their friends, they are going to be sorely misled. This is where parents need to become engaged—on sexuality and on these sexual issues—
Den: —where they need to be taught the benefit / the blessings of abstinence—sexual abstinence—until marriage. It’s not just prohibitions for the sake of prohibitions; but rather, “This is what’s best for you.” Then, like Passport2Purity does, it teaches the parents and the child how to resist following the herd / how to resist the peer pressure.
Dennis: What else do parents need to know about the adolescent years? In fact, let’s just reduce it down to this. If you had a single piece of advice to a mom or a dad, as their preteens are entering in this stage of life, what would be your best coaching tip you’d give them?
Michelle: What I love is: “Learn how to listen to your child so that your child will talk to you.” If they see that you are truly interested in how they are feeling, and what they are involved in, and their friends—if they see you truly listening to them versus just dictating—“Oh, you have to do this, this, and this,”—they will be more likely to open up to you. It will allow you to remain more connected with them.
Bob: You are talking about ongoing relational involvement in the life of a child.
Bob: And Dr. Trumbull, you are an advocate of families having a common meal every day as often as possible because this is a part of that relational connectedness piece; right?
Michelle: That’s right.
Den: What I was going to mention is the most important point I would encourage your listeners—is be available. Be available to your teens.
Michelle: Yes, that’s right.
Den: Be connected / be available.
One means to that is the family table. At the American College of Pediatricians, we’ve taken a look at that. We have on our website the research behind the family table. You say: “Well, actually, we’ve got sports. We’ve got school. We’ve got this, that, and the other.” There will be a lot of challenges. You may not be able to accomplish it but three times a week. Do your best to sit down, turn off the digital devices, and have pleasant conversations—it’s not a time to correct your child for misbehaviors during the day—and engage one another in conversation.
Here is another one—everybody stays at the table until everybody finishes. Over time, they come to assume, “Well, gosh, I’ve got to stay here until the end, even though I’ve finished eating,”—and guess what happens? We talk. So, family table—yes.
Bob: And by the way, again, we’ve got a link on our website, at FamilyLifeToday.com, if folks want to see what you advocate around the family table. This is something you can print out, put on the refrigerator, and say, “This is what we’re going to start doing in our home.”
Dennis: Yes, and I would encourage listeners to take advantage of that.
What I want to do for the remaining part of our time together is—I just want to come across the desk from you two, as a pair of pediatricians, and I want both, Bob and me, to become advocates for parents, asking the questions that you are seeing up close and personal every day through your practice.
The first one I’m going to talk about is substance abuse. How can a parent know their child is abusing alcohol / drugs?
Bob: How do you even know if they are using—they are playing around / they’re experimenting with this?
Michelle: Prevention is always the best. So, staying connected with your kids through the elementary years / the middle school years. Knowing your children’s friends is very critical. Have your house be the house where the kids hang out—both prior to high school and even during the high school years.
The symptoms of substance abuse are very similar to depression.
You may see some emotional swings—withdrawing from their friends / withdrawing from the family. Their grades start to drop. Typically, they will withdraw socially; or perhaps, they’ll even—you’ll notice a shift in their friends that: “Gosh, I’m not so sure I like who they are hanging out with right now. That’s a big change.”
Dennis: One of the things we did was we, actually, sought to get to know the families that our teenagers were hanging out with.
Michelle: Absolutely. And I’ll share one short story with you. I had a mother come in—married / good Christian family—and her daughter was 14. And while I was examining her through conversation, I learned that she had good friends who were smoking and having sex. She was not, but that is a big red flag because, if your children’s friends are doing these things—
—they are either doing them themselves already or they are at high-risk for engaging in them.
Dennis: I just want to double underline what you just said. By the time we finished raising four teenagers at one time—and six total; alright—I was in absolute awe and very respectful of the power of peer pressure upon—
Michelle: Oh, yes.
Dennis: —our children. These are children who had been trained, since birth, to know the difference between right and wrong; but in an instant—
Michelle: It’s like a switch—it can flip.
Den: And Dennis, let me tell you what’s intensified it now even more—social media. The peer pressure that comes through social media to do the wrong thing, or to do the cool thing, or the in-thing is enormous and very different from what it was 10 years ago / 20 years ago.
Bob: I saw, just yesterday, that—I think it is one in five teenagers has taken a picture of a body part and sent it to a friend. This is more and more the norm.
This is a whole new world that our kids are growing up in.
Michelle: And I’m glad you brought that up, too, because sexting—taking pictures of private parts and sending them around to be seen—links to pornography and brings us back to the development of the teen brain. The teen brain is going through such rapid development—that when you are exposed to things like pornography / like substance use—the brain is actually more easily addicted to these things. In cases of porn and violence—sex and violence / visual imagery—because of the teenage development, that brain becomes desensitized. The kids are more likely to engage in those behaviors.
Dennis: Okay, let’s talk about cell phones, and communication, and little screens. There is the issue of safety—of knowing where your child is / of being able to track your child and have GPS systems that let you know where your child is, even if they don’t know that you know.
At what point did you give your children a cell phone?
Den: Our rule was: “When you’re driving, you need a cell phone for communication.” Now, had we had young children now—boy, that’s a tough question because, unfortunately, there is tremendous peer-pressure, not only to have a cell phone, but a smartphone. That opens up a child’s world to a lot of what is not healthy for the developing brain.
Bob: So, you’ve got them at home, right now, Michelle—
Michelle: I do.
Dennis: Well, now, wait. Before he gets done with that—so, if you were back in—raising 13, 14, 15—would you give them a smartphone?
Den: No, I wouldn’t—I wouldn’t. A cell phone is all you need for communication. A smartphone is dangerous in the hands of a teenager.
Michelle: Our rule is: “When you graduate eighth grade, and you’re going to be going into high school—when you start high school, you can have a cell phone /
basic cell phone for communication—to text us, or to call us, and to receive our texts, and whatnot.” There’s an additional rule: “All electronic devices, including cell phones, charge overnight on the kitchen counter. You are not allowed to have your cell phone, laptops, or there is one iPad mini in the house—those do not go to the bedrooms.” The bottom line is: “It’s for safety—communication for safety,”—that’s the rule in our house, and it is ninth grade and up.
Bob: So, we’re talking—I mean, basic parenting skills here—but we’ve got a couple of pediatricians. What are the sicknesses / what are the medical issues that are most present during adolescence? I’m thinking to myself: “It’s a number of depressed kids, who are 15, 16, 17 years old, suffering depression/suicidal.”
Den: There is another disorder that is increasingly popular, and that’s ADD.
Twenty years ago, I had to tell parents: “Hey, I think your child may have ADD.” “Can you write that down? What does that stand for?” Today, they come to me: “I filled out a questionnaire on the internet. I know my child has ADD. He needs medication.” Of course, this starts before adolescence. A lot of the symptoms of ADD are related to a fast lifestyle—insufficient sleep, insufficient nutrition, insufficient exercise—in that order. So, that is new / that’s different—just that the parents would ask for medication for a child who is inattentive is very different from the way it was 20 years ago.
Bob: So, you’re saying it is over-diagnosed/over-medicated today?
Den: Yes. The reason why is the medications work. They work on a sleep-deprived mind, and they work on a true child with ADD; okay? There is a true entity called ADD, but they also help any child be more attentive. That is the challenge, unfortunately.
Never before have we seen such an explosion of psychotropic medication use as we have in the past five to ten years.
Dennis: Okay, I’m going to shift us away from some of the emotional diseases and talk about STDs—sexually-transmitted diseases.
Dennis: And I’m going to cut to the chase on this. If you had a daughter, today, who is about to enter adolescence, would you give her the shot that prevents her from getting—what’s it called?—HPV?
Den: I’ll answer that by saying what I say to my patients. With every patient, 15 years and older, I talk about sexual activity. I give them the VIS—the Vaccine Information Sheet—on HPV as full disclosure.
If that child is sexually-active or prone to sexual activity, based upon their peer group, I do recommend the HPV vaccine; but if that child follows my advice and has a family committed to these convictions and pledges to abstain from sexually activity until marriage, I think it is fine to wait—
—maybe, never receive it—or a couple of situations where a child might benefit from that is—number one, the husband could bring it into the marriage—HPV, that is—and number two, he or she could have a weak moment at college and contract it. But in general, it’s a choice based upon the parent and the child and how well that parent knows that child.
Dennis: This is a real issue, though. These are—some of them—cancer-producing diseases that can take your life.
Michelle: Right. I would, basically, concur with Dr. Trumbull. It’s also my approach to my own children. I talk to families and say: “There is a big difference here between the Human Papilloma Virus—the HPV—and diphtheria, or mumps, or measles. You’re not going to get the HPV any other way except through sexual activity.”
So, I tell the families that:
“There is no reason for your 12-year-old daughter or son”—it is available to boys too—“There is no reason they absolutely need this vaccine at age 12; but you may want to consider, down the line,”—as Dr. Trumbull was saying—“They could have a weak moment or even, if they are perfectly abstinent until marriage, their husband or wife could have fallen in the past and could bring it in that way.”
Den: Because it’s not an airborne disease, like Michelle says, you can’t just catch it from being in the same room with a patient. You can customize.
Den: And the CDC has made this recommendation for all of the people in the United States. Many are sexually-active at age 12. Others have pledged to be abstinent until marriage. So, that is why we think, at the College, that you can customize the administration of that to the child and to the family.
Dennis: Okay, one last hot question here: “What do you advise parents who come in and want to give their child birth control pills?”
Michelle: I explain, up front, to parents that I will not prescribe birth control specifically to prevent pregnancy. I will use it if it is medically indicated for menstrual irregularities or for severe menses pain; but I explain to them that I am here to promote the very best healthful decisions for their child, and that I will do my best to work with them so that their child will choose abstinence until marriage. I am simply drawing my line in the sand that: “I am not going to put you at risk because, if I put you on birth control, I’m giving you the message that sex, as a teenager—
Michelle: —“is safe and healthful; and that’s not true.”
Dennis: You’re encouraging the hookup culture, at that point.
Michelle: I’m encouraging the hookup culture, but I’m also putting them at greater risk for sexually-transmitted diseases, greater risk for mental illness / emotional illness.
Den: I entirely agree with Michelle. Again, we’re speaking, individually, not necessarily for the College; but—
Den: —birth control only prevents pregnancy. I mean, that’s definitely a sad outcome from a promiscuous, recreational sex;—
Den: —but the dangers involved in recreational sex are so much greater than that—both physically, with infections / but emotionally, both for that time and for the future marriage—that I do not want to advocate that and send the wrong message. So, I would entirely agree with Michelle’s position.
Dennis: Well, I want you both to know that I appreciate your conviction-based practice of medicine and just appreciate you, as pediatricians, and the American College of Pediatricians. I hope that grows. If you know a pediatrician that is looking for a values-based collection of physicians to join with—
—this is an excellent group to throw your heart into the ring with—and just want to thank you for making the journey from Montgomery, Alabama, and from Rhode Island to be able to be on FamilyLife Today.
Den: It’s been an honor to be here.
Michelle: It’s been a great privilege.
Bob: Well, and I’ve already mentioned that we’ve got a link on our website, at FamilyLifeToday.com. If folks want to find out more about the ACP—the American College of Pediatricians—go to FamilyLifeToday.com and click the link in the upper left-hand corner of the screen that says, “GO DEEPER.” Look for the link for the American College of Pediatricians. Find out more about what they have to offer, not just to physicians, but what they have to offer for all of us in the area of health and wellness for our children, as we raise them to adulthood.
Let me also mention—because we talked a little bit about this today—if you’d like more information about the Passport2Purity resource that FamilyLife has put together, which is designed to help you and your son or daughter have some meaningful conversations about dating and about sex, as your kids head into adolescence.
There have been tens of thousands of parents who have done a Passport2Purity getaway with their kids. They’ve told us: “It’s a great getaway experience.” It’s been important / it’s been meaningful for the moms [with their daughters] and the dads with their sons. Go to FamilyLifeToday.com and click the link that says, “GO DEEPER,” to find out more about Passport2Purity and schedule a getaway, like this, with your son or daughter—especially if you’ve got a 10-, 11-, or 12-year-old at home. Now is the time to start talking about a Passport2Purity getaway with your child.
You know, one of our goals, here at FamilyLife, is to be available to you—as husband and wife / as moms and dads—as you go through the issues that come up related to marriage and family.
We want to be here as a resource with our daily radio program / articles that we have online—we’ve got more than a thousand articles available to you, covering all kinds of subjects related to marriage and family. We have resources in the FamilyLife Resource Center. Of course, we’ve got the Weekend to Remember® marriage getaway and other events that we host—like the upcoming I Still Do® one-day event that’s next weekend. It’s going to be live in churches all across the country, coming from Lynchburg, Virginia.
Everything we do is designed with this in mind—we want to provide practical biblical help and hope for your marriage and for your family. And we want to thank those of you who join with us in this effort—those of you who support the ministry of FamilyLife Today with your occasional donations. We’re grateful for your support, and we’re always encouraged to hear from you.
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And we hope you have a great weekend. We hope you and your family are able to worship together in church this weekend.
And I hope you can be back with us on Monday when we’re going to continue talking about some of what we’ve talked about this week. We want to talk about the screen generation and about the effect of video games and just the constant iPhone, iPad, computer screen, television stuff that is all around us. Kathy Koch is going to join us to talk about the impact of screens on teens, and I hope you can be here for that.
I want to thank our engineer today, Keith Lynch, along with our entire broadcast production team. On behalf of our host, Dennis Rainey, I’m Bob Lepine. We will see you back next time for another edition of FamilyLife Today.
FamilyLife Today is a production of FamilyLife of Little Rock, Arkansas.
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