The first section provides background information on the young adult period with which young adults with diabetes, their parents, and care providers should be familiar. After that, the book is written in two voices. One voice, introduced in the second and third sections and directed to young adults and their families and friends, focuses on the challenges and demands of living with diabetes and presents guidance in making informed individual and family decisions about diabetes management during this complex phase of life. The other voice, arising in the fourth section, provides a perspective on how the complexities of this developmental stage affect the health professional’s clinical role.
Although we have used different voices for each section, this hardly means that each part of the book is exclusive to that audience. We strongly encourage you, whether you are a young adult, parent, or care provider, to cover all of this material. Knowledge, particularly when concerning diabetes, is one of the most important tools in optimizing care, especially for a patient group that has been largely overlooked in clinical history.
Howard A. Wolpert, MD
Joslin Diabetes Center, Boston, MA Barbara J. Anderson, PhD Baylor College of Medicine, Houston, TX Jill Weissberg-Benchell, PhD, CDE Children’s Memorial Hospital, Chicago, IL
P A R T
One
The Challenges of Young Adulthood
DEVELOPMENTAL ISSUES IN THE YOUNG ADULT (EMERGING ADULTHOOD)
Over the past century, traditional developmental psychology theorists such as Erik Erikson (1950, 1968) defined the time immediately after adolescence as the “young adult period.” In contrast, J. J. Arnett (2000, 2004), a leading contemporary developmental theorist, argued that young adulthood does not begin until youths are in their late 20s or 30s and that the developmental stage between approximately 18 and 25 years defines a period called “emerging adulthood.” Recent cultural trends in America for young people in their 20s lead them to delay assuming adult roles with respect to marriage, parenting, and work. Arnett suggests that today’s young people should:
“…explore the possibilities available to them in love and work, and move gradually toward making enduring choices…. This period is a time of high hopes and big dreams. However, it is also a time of anxiety and uncertainty, because the lives of young people are so unsettled, and many of them have no idea where their explorations will lead. They struggle with uncertainty even as they revel in being freer than they ever were in childhood or ever will be once they take on the full weight of adult responsibilities. To be a young American today is to experience both excitement and uncertainty, wide-open possibility and confusion, new freedoms, and new fears.” (Arnett 2004)
Furthermore, in contrast to the views of traditional developmental psychology, more recent developmental theorists subdivide the young adult or post-adolescent period into two phases: an early phase corresponding to the years after high school (∼18–22 years of age) and a later phase when more traditional adult roles are assumed (∼23–30 years of age). This age division is somewhat arbitrary and may not apply to all individuals, and not all individuals or cultures progress through the young adult period according to these two phases. However, thinking about young adulthood as consisting of two phases provides a valuable framework when considering diabetes management and may help to ensure that the clinician’s approach and focus is appropriately matched to the young adult’s life circumstances and readiness to become an active participant in his or her own diabetes management.
THE FIRST PHASE OF THE YOUNG ADULT PERIOD
Levinson et al. (1978) and Arnett (2004) theorized that, in the U.S., there is frequently a misfit between the developmental tasks of young adults just after high school and the expectations of the various institutions responsible for young adults. Arnett studied individuals between the ages of 18 and 24 years and asked them what attributes made someone an adult. Four specific achievements were cited: 1) the ability to accept responsibility for oneself, 2) the ability to make independent decisions, 3) the ability to become financially independent, and 4) the ability to independently form one’s own beliefs and values. Interestingly, most of the young adults interviewed did not believe that they had achieved these goals. In fact, the majority of young people in the U.S. do not believe that they have achieved these goals until they are in their late 20s.
Several dilemmas confront patients in the first phase of the young adult period. This phase brings desire for independence, yet also fear of independence. Freedom from parental supervision and rules also brings responsibilities than can be quite daunting. The young adult begins to face issues such as, how do you find/keep a place to live, pay your bills, balance a checkbook, manage credit, begin a relationship/keep a relationship that might be “forever,” and choose a career? While young adults are trying to balance all of these new freedoms and responsibilities, they are probably doing this with less help from their parents and less structure in their daily routine. In addition, if young adults have moved away from their hometown, they are making these decisions in a place where few people know them, often removed from their closest friends. Arnett suggests that individuals in this first phase are beginning to “explore the possibilities available to them in love and work and move gradually toward making enduring choices.” He suggests these actions might lead them to feel unsettled, since they do not yet know where these explorations will lead them.
Similarly, the young adult’s family faces several dilemmas as the family begins to address issues such as the following:
To place the dilemmas young adults and their families face in perspective, the data from the 2000 Census tell us that 56% of men and 43% of women between the ages of 18 and 24 years still live at home with their parents. Moreover, 30% of men and 35% of women in that age-group live with roommates. In fact, only 4% of individuals in this age-group live alone. Therefore, the assumption that individuals in this age-group are independent may be false, both from a theoretical perspective on adult development and also from a fact-based perspective regarding where and with whom they live.
During
