Our clinical visits are important opportunities to support development and position parents to nurture their children’s growth. This may be particularly true when those visits take place on the cusp of adolescence. We have to deliver information that is at once important and sensitive.
The information presented matters, but so does how it is delivered. The choices in how clinicians say what they say influence what parents and young people think about the time of life that they are about to enter, how they feel about their respective identities, and how they will choose to play their roles. For example, an encounter that begins by acknowledging the dominant public understanding that adolescence is an unfortunate and unpleasant time for both parents and adolescents, even in an effort to debunk this idea, can activate and engrain these ideas, establishing unproductive ways of looking at and acting in the years to come. Instead, avoiding these myths and advancing the idea that adolescence is a time of tremendous opportunity, in which experiences and relationships are vital inputs and lifelong interests ignite, establishes a very different way of thinking, feeling, and acting. All of this from the choice of just a few words.
These clinical moments are framing opportunities. Understanding the importance of the choices we make in how we present information and having evidence-based guidance on the effects of these choices is vital. Framing is a tool that can add value in the examination room and in the roles that many pediatric clinicians play as researchers, influencers, and advocates.
At some level, we are aware that the words we choose matter. We recall times when we have said something in a way that motivated engagement or adherence or that positively changed behavior. We also know of times when we thought we said something clearly and effectively, only to find it generated a takeaway miles away from what we intended. We may know the choices we make as communicators matter but may not be aware that there is a science of framing that can help us more wisely choose words and phrases that lead to our intended impact. In Table 1, we use our communication with parents and caregivers in the preadolescent or adolescent clinical visit to illustrate how to apply framing strategies.
Cuing Productive Thoughts About Parenting Adolescents
| About . | Say This . | Why This Cues Productive Thoughts . | Avoid Saying This . | Why This Cues Unproductive Thoughts . |
|---|---|---|---|---|
| The arrival of adolescence | Adolescence is an exciting time when young people explore the world and discover who they are. It will give you a glimpse at the adult your child is to become and an opportunity to be a guide on their journey. | Adolescence is painted as an opportunity and framed as a process of discovery. It offers parents a clear and productive role, as a guide, and a chance to see the future. | Are you ready for this? Adolescence is a time of many changes, with lots of ups and downs. We want to make sure that your teenager avoids any risky behaviors and that you are there to protect them from what we know is a dangerous world. | Much of the literature on parenting adolescents leads with “survival.” Anything parents hear about the difficult times to come reinforces their fears. It may lead them to “duck and cover” rather than engage. |
| Parents’ role in adolescence | As a parent, you remain the most influential person in your teenager’s life, both because they watch what you do, and because they seek your advice. It is an adolescent’s job to become increasingly independent. Don’t be surprised if they push you away sometimes to prove they can stand on their own. | It may be that the fundamental question of parenting adolescents is “Do I still matter?” Research is clear that adolescents look to parents as the most influential people in their lives.8 Parents deserve to know this. Here, we reinforce that parents are both role models and guides. We also prepare them for challenges but do so in a way that places it in developmental context rather than rejection. | They might push you away. It is hard and painful, but it is only temporary. | Here, parents’ fear of rejection is cued, rather than their sense of empowerment. And they are reminded that they are supposed to think of adolescence as a horrible time. Although well-meaning, stating that it is temporary, without placing it in developmental context, reinforces the tendency to minimize contact until this period passes. |
| The adolescent brain | Adolescents are “super learners.” Their brains are growing at astounding rates. Our job is to guide them to have the kind of experiences that allow them to safely expand their knowledge and skills. It is also important that we support young people in a way that allows them to think and work through their own solutions. The key is to keep our conversations caring, calm, and thoughtful. | The adolescent is presented as a learner. This cues adults’ desires to be teachers and create opportunities for learning. Here, the emotional nature of adolescence is approached but coupled with a clear solution: when we remain calm, we can help them think through issues and develop skills in the process. | The emotional centers of the brain are further developed than the thinking centers. That is why adolescents seem like they are “all engine and no brakes.” | The stereotype of the out-of-control and emotional teenager is cued with this widely used metaphor. There is no solution offered and, therefore, no engagement is invited. The parent is left with no idea what to do and is likely to fall back on the familiar “just get through it” trope. |
| The importance of discipline and monitoring | It is an adolescent’s job to explore the world and expand their boundaries. It is your job to create the limits within which this can happen safely. The key is for them to know that your boundaries are there because you want them to have a safe place to explore and learn. | Experimentation here is placed in a developmental context. This cues the parent to (1) set protective boundaries, (2) create healthy and safe avenues for exploration, and (3) have open communication with their adolescent that places boundaries in the context of caring rather than control. (This is central to the well-proven benefit of balanced parenting).8 | Adolescence can be a risky time, and the world is a dangerous place these days. It is critical that you protect your child from harm. | Although this statement is true, it cues caregivers’ desire to set rules to protect young people from themselves. Furthermore, it does not guide the parent to engage youth in understanding why rules are being set, which is a vital piece of the story. |
| Peer relationships | Young people need to learn how to have important relationships outside of the family. That is a critical step on the way to adulthood. It is important to support them to have healthy relationships with their peers. | This places peer relationships in a developmental context. It cues caregivers’ understanding that peer relationships are a necessity for young people and that they, as parents, need to focus on supporting healthy relationships rather than ruling them out. | Peer pressure can be painful and have harmful effects on your child. It is therefore important to talk about healthy peer relationships and to be on the lookout for problems and negative influences. | Leading with the word “pressure” cues caregivers’ protective instincts that will likely favor them promoting protection of the youth from their peers. It activates surveillance rather than a supportive mindset. |
| Communication strategies that guide adolescents to make health-promoting decisions | Parents can empower adolescents to make wise, health-promoting decisions. The emotional centers of the brain are well developed in young people. Therefore, the key to helping your teenager bring out their reasoning skills is to keep conversations calm and thoughtful and encourage thinking through decisions and solving problems. | This cues the parent to the idea that proper engagement can build their teenager’s skills. It also positions them to be able to coregulate with their adolescents. This, in turn, will help the young person engage their reasoning centers and develop skills. | Adolescents can be impulsive and make some very unhealthy choices, especially when they get emotional. | The teenager-brain literature too often emphasizes the hyperemotional nature of adolescents and inadvertently implies they have little ability to harness rational thought. This cues parents’ protective and controlling instincts. It can backfire because they will come to conversations emotional and therefore be less likely to be able to coregulate and model thoughtful engagement. |
| Accessing mental health services | Your child deserves to feel better. This is an opportunity for her to get the professional support that will develop her skills to learn to manage the uncomfortable feelings she is experiencing. | The word “deserves” reinforces the inherent goodness of the youth. In addition, the language reinforces that mental health services address distress by building on people’s strengths (their mental health) rather than fixing what is broken. They also cue action by reinforcing the idea that emotional discomfort is treatable and professional guidance can make a real difference. | Your child needs professional help. I am very worried about her wellbeing. We need to act quickly. | The word “needs” cues a state of brokenness. This reinforces feelings of shame and social stigma. The “professional help” cues a sense of powerlessness and may reinforce a parent’s despair that they were unable to be helpful and a sense of hopelessness about whether anything can really be done. |
| About . | Say This . | Why This Cues Productive Thoughts . | Avoid Saying This . | Why This Cues Unproductive Thoughts . |
|---|---|---|---|---|
| The arrival of adolescence | Adolescence is an exciting time when young people explore the world and discover who they are. It will give you a glimpse at the adult your child is to become and an opportunity to be a guide on their journey. | Adolescence is painted as an opportunity and framed as a process of discovery. It offers parents a clear and productive role, as a guide, and a chance to see the future. | Are you ready for this? Adolescence is a time of many changes, with lots of ups and downs. We want to make sure that your teenager avoids any risky behaviors and that you are there to protect them from what we know is a dangerous world. | Much of the literature on parenting adolescents leads with “survival.” Anything parents hear about the difficult times to come reinforces their fears. It may lead them to “duck and cover” rather than engage. |
| Parents’ role in adolescence | As a parent, you remain the most influential person in your teenager’s life, both because they watch what you do, and because they seek your advice. It is an adolescent’s job to become increasingly independent. Don’t be surprised if they push you away sometimes to prove they can stand on their own. | It may be that the fundamental question of parenting adolescents is “Do I still matter?” Research is clear that adolescents look to parents as the most influential people in their lives.8 Parents deserve to know this. Here, we reinforce that parents are both role models and guides. We also prepare them for challenges but do so in a way that places it in developmental context rather than rejection. | They might push you away. It is hard and painful, but it is only temporary. | Here, parents’ fear of rejection is cued, rather than their sense of empowerment. And they are reminded that they are supposed to think of adolescence as a horrible time. Although well-meaning, stating that it is temporary, without placing it in developmental context, reinforces the tendency to minimize contact until this period passes. |
| The adolescent brain | Adolescents are “super learners.” Their brains are growing at astounding rates. Our job is to guide them to have the kind of experiences that allow them to safely expand their knowledge and skills. It is also important that we support young people in a way that allows them to think and work through their own solutions. The key is to keep our conversations caring, calm, and thoughtful. | The adolescent is presented as a learner. This cues adults’ desires to be teachers and create opportunities for learning. Here, the emotional nature of adolescence is approached but coupled with a clear solution: when we remain calm, we can help them think through issues and develop skills in the process. | The emotional centers of the brain are further developed than the thinking centers. That is why adolescents seem like they are “all engine and no brakes.” | The stereotype of the out-of-control and emotional teenager is cued with this widely used metaphor. There is no solution offered and, therefore, no engagement is invited. The parent is left with no idea what to do and is likely to fall back on the familiar “just get through it” trope. |
| The importance of discipline and monitoring | It is an adolescent’s job to explore the world and expand their boundaries. It is your job to create the limits within which this can happen safely. The key is for them to know that your boundaries are there because you want them to have a safe place to explore and learn. | Experimentation here is placed in a developmental context. This cues the parent to (1) set protective boundaries, (2) create healthy and safe avenues for exploration, and (3) have open communication with their adolescent that places boundaries in the context of caring rather than control. (This is central to the well-proven benefit of balanced parenting).8 | Adolescence can be a risky time, and the world is a dangerous place these days. It is critical that you protect your child from harm. | Although this statement is true, it cues caregivers’ desire to set rules to protect young people from themselves. Furthermore, it does not guide the parent to engage youth in understanding why rules are being set, which is a vital piece of the story. |
| Peer relationships | Young people need to learn how to have important relationships outside of the family. That is a critical step on the way to adulthood. It is important to support them to have healthy relationships with their peers. | This places peer relationships in a developmental context. It cues caregivers’ understanding that peer relationships are a necessity for young people and that they, as parents, need to focus on supporting healthy relationships rather than ruling them out. | Peer pressure can be painful and have harmful effects on your child. It is therefore important to talk about healthy peer relationships and to be on the lookout for problems and negative influences. | Leading with the word “pressure” cues caregivers’ protective instincts that will likely favor them promoting protection of the youth from their peers. It activates surveillance rather than a supportive mindset. |
| Communication strategies that guide adolescents to make health-promoting decisions | Parents can empower adolescents to make wise, health-promoting decisions. The emotional centers of the brain are well developed in young people. Therefore, the key to helping your teenager bring out their reasoning skills is to keep conversations calm and thoughtful and encourage thinking through decisions and solving problems. | This cues the parent to the idea that proper engagement can build their teenager’s skills. It also positions them to be able to coregulate with their adolescents. This, in turn, will help the young person engage their reasoning centers and develop skills. | Adolescents can be impulsive and make some very unhealthy choices, especially when they get emotional. | The teenager-brain literature too often emphasizes the hyperemotional nature of adolescents and inadvertently implies they have little ability to harness rational thought. This cues parents’ protective and controlling instincts. It can backfire because they will come to conversations emotional and therefore be less likely to be able to coregulate and model thoughtful engagement. |
| Accessing mental health services | Your child deserves to feel better. This is an opportunity for her to get the professional support that will develop her skills to learn to manage the uncomfortable feelings she is experiencing. | The word “deserves” reinforces the inherent goodness of the youth. In addition, the language reinforces that mental health services address distress by building on people’s strengths (their mental health) rather than fixing what is broken. They also cue action by reinforcing the idea that emotional discomfort is treatable and professional guidance can make a real difference. | Your child needs professional help. I am very worried about her wellbeing. We need to act quickly. | The word “needs” cues a state of brokenness. This reinforces feelings of shame and social stigma. The “professional help” cues a sense of powerlessness and may reinforce a parent’s despair that they were unable to be helpful and a sense of hopelessness about whether anything can really be done. |
The word “parent” is used to include any adult caregiver with primary responsibility for the adolescent.
Framing refers to the choices we make in presenting information. These might be decisions about the values we use to argue for why an issue matters, such as using the values of both compassion and justice to call for racial equity. It might be using the metaphor of building “brain architecture” to emphasize the importance of the first months and years of human development.1 Framing is also more subtle and nuanced. It is in the pronouns that we choose, whether we talk in “us” and “them” terms or use “we” and “our.” It is about how we choose to emphasize resilience in the face of hardship rather than only speaking of “vulnerability,” which can perpetuate stigma and stereotypes when not placed in full context. It is in the verbs we select and how they imply or deny agency or assign responsibility (for example, talking about the increase in the number of families that have “skipped” versus “not been able to attend” well-child visits and scheduled vaccinations).
The early 1990s saw the beginning of a multidisciplinary science of framing. The field emerged from political science and was focused on the effects of news and media framing on perceptions and behavior, for example, testing how different ways of presenting information in news broadcasts triggered underlying racial biases and altered support for criminal justice policies2 or examining how different ways of telling stories affects perceptions of political responsibility.3
The science of framing is now used to explore issues directly relevant to pediatrics. For example, research has found that the use of metaphor can help correct misperceptions and build understanding of the developmental science of resilience.4 Researchers have also found that subtle choices in how nutritional information is presented to middle schoolers leads to significant differences in the food choices young people make.5 Other researchers have found that vaccine communications that highlight the physical risks and dangers of not receiving the measles, mumps, and rubella vaccine backfire and make vaccine-hesitant individuals believe more strongly in the misinformation that touts its side effects.6 This growing body of research demonstrates that framing choices can open productive space for people to consider and act on scientific information or close it down, further entrenching existing beliefs and even leading to outright rejection of recommendations.
The importance of framing led to a project that explored how Americans think about adolescent development and how frames can move people past unproductive understandings and unlock new ways of thinking about how we can best support young people.7 It set out to support those communicating about adolescence with evidence-based framing strategies. This led to new ways of understanding the cultural underpinnings of stereotypes of young people and our proclivity toward policies that restrict, rather than develop, adolescents in an effort to protect them, and worse, that protect us from them.
The project produced a set of evidence-based strategies that communicators can use to shift the conversation and open space for productive engagement on adolescent development. For example, presenting people with concrete examples of adolescents making positive contributions to their communities shifts people’s thinking away from the dominant preoccupation with adolescence as an inherently dangerous and unfortunate time that we just need to make it through toward a sense of the promise and opportunity that characterizes this time of life. Emphasizing the idea of “discovery” shifted people from a view in which our goal should be to insulate and protect young people from contexts and experiences to one in which we need to provide rich and challenging experiences to young people and support them as they learn how to navigate situations. These frames also shifted people’s thinking about the role of parents from strict protector to supportive guide.
These recommendations can help clinicians have more productive interactions with young people and their parents. They can help open productive dialogue, increase the uptake and application of information, encourage specific types of relationships and, importantly, avoid traps and missteps that send things in the wrong direction. These framing strategies can encourage parents to realize that they matter more, not less, than ever in the lives of their children.
Pediatric clinicians are child advocates who often influence policies and programs. Framing offers us a skill set to use as we wear each of our hats. The examples in Table 1 cover different contexts or topics that may arise in the preadolescent or adolescent clinical visit and offer suggestions on how best to frame discussions with parents and caregivers. Our goal is to cue productive discourse about adults’ vital role in supporting adolescents in their journey toward adulthood. Highlighting the importance of parents supporting adolescent development early in the visit creates the kind of parent-clinician partnership that may help the caregiver better understand and accept that the confidential portion of the visit that follows is also intended to support their adolescent’s health. The language suggested in Table 1 should be adapted depending on the context of the clinical encounter, the provider-family relationship, and the background and identity of the patient and parent or caregiver(s).
Drs Kendall-Taylor and Ginsburg drafted, reviewed, and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
FUNDING: The research on translating the developmental science of adolescence was sponsored by the Funders for Adolescent Science Translation. This consortium includes the Annie E. Casey Foundation, the Bezos Family Foundation, the Chan Zuckerberg Initiative, the Ford Foundation, the Hemera Foundation, the Conrad N. Hilton Foundation, Pivotal Ventures, the Raikes Foundation, the Robert Wood Johnson Foundation, and the National Public Education Support Fund. This publication was also made possible through the support of Spring Point Partners, LLC, and a grant from the John Templeton Foundation. The funder or sponsor did not participate in this work.
References
Competing Interests
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
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