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We sit down with Eleanor Menzin, a pediatrician, to explore the changing landscape of young adulthood. Join us as we delve into the shifting social norms, technology’s impact on parent-child relationships, and the evolving understanding of brain maturation—all of which challenge traditional notions of when young adults are ready to transition from pediatric to adult care. Discover how redefining this milestone can better align with cognitive age and life stage, ensuring that young adults receive the health care they need while navigating the intricate journey to adulthood.

Eleanor Menzin is a pediatrician.

She discusses the KevinMD article, “Navigating adulthood in the digital age.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Eleanor Menzin. She’s a pediatrician, and today’s KevinMD article is titled “Navigating adulthood in the digital age.” Eleanor, welcome back to the show.

Eleanor Menzin: Thanks for having me.

Kevin Pho: So Eleanor was on recently. Just go to KevinMD.com/podcast; in the upper right-hand corner there’s a search icon, and you can search for her name to hear her story in her last episode. But today, let’s jump right into your most recent article, “Navigating adulthood in the digital age.” How did this article come together?

Eleanor Menzin: It’s really a combination of things. I’ve been a pediatrician for about 22 years, and I’m also the parent of three kids in the young adult range, 18 to 23. In the old days, when I first trained, people talked about kids leaving pediatric care at 18, and over the course of my career that has come to seem increasingly inappropriate, for a variety of reasons.

My own opinion on this was informed years ago, when I read an article by a college health staff person who said, “Please, pediatricians, do not discharge your patients at 18.” What they said was that a healthy kid who is dropped from pediatric care at 18 tends to just see no doctor for years and years, and for an unhealthy kid who has lots of medical problems, it’s a terrible time to learn to trust somebody new, when you’re living away from home and you have chronic medical conditions. So the college health people said you really should hold on to these kids, and that has informed my practice.

I used to think, “Well, when you finish college, you’re done.” But increasingly I’ve become aware, first of all, that that border is fuzzy. The majority of American students don’t graduate at 22 anymore; the average age is actually about 23 and a half. Most people don’t take four years anymore; it takes longer. And the year after college is really challenging. So it’s become increasingly clear to me that, for all of those reasons, it’s not a great time to transition to adult medical care.

Kevin Pho: I think we talked about this offline last time: I have a daughter who is a freshman in college, at that age, 18, where traditionally she’s supposed to be transitioning out of pediatric care. So let’s talk about that college age, 18 to 22. What specific issues are they facing that would call for continuing pediatric care?

Eleanor Menzin: I think it’s a great question. What we know is that the overwhelming majority of things that affect the health of 18- to 25-year-olds are mostly in the realm of lifestyle habits and psychosocial things. We’re talking about substance use, disordered eating, anxiety, depression, sleep, exercise, nutrition and relationship-building. Those are the things that have the most impact on health in young adults, and for most people, the ideal person to discuss them with is someone who has known them their whole life. There’s a level of comfort there. When an 18-year-old who used to be really outgoing and friendly shows up a little blunted, I think an adult provider meeting that person for the first time has no way to recognize it, whereas somebody who’s taken care of them their whole life is very quickly going to be able to say, “Hey, are you OK? You don’t seem quite right.”

I think a lot of those issues involve really digging into the details of kids’ lives. Pediatricians are accustomed to saying to kids this age, “What do you eat for breakfast? What time do you go to sleep? Exactly how many drinks are you having when you go out?” It’s that specificity, I think, that is the heart of good care for this age group. Those folks are much more similar to 16-year-olds than they are to 60-year-olds.

Kevin Pho: Now, what about your fellow pediatric colleagues? Do they feel similarly, that they should be continuing care up until after college, the mid-20s?

Eleanor Menzin: It’s an excellent question. I think there are a lot of us who do feel that way. I think a lot of it depends on your comfort level with some of these issues. For pediatricians who are comfortable with contraception, with sexually transmitted infections and with substance use, and I would argue very strongly that all good pediatricians should be comfortable with those subjects, 18 to 25 is really no big deal. It’s really more of the same, honestly. For pediatricians who say, “I don’t want to deal with all that stuff,” I would say you really should be dealing with that stuff in your 16- to 18-year-olds, too, so you kind of have to lean into it.

Kevin Pho: So talk about some of the other challenges today’s young adults are facing that may not have been so prevalent years ago.

Eleanor Menzin: This is a hard time to be a young adult, right? People talk a lot about social media, and I think what should be clear to everybody is that it’s not going away. But even for young adults who are insightful enough to understand that what they see on Snapchat or Instagram is highly curated, it’s still painful to watch. When I was sitting in my college dorm room alone, I just assumed there were some other people who were alone, too. And there probably were. I could hear people outside, but I also knew there were some people who weren’t outside. Now I think young adults face a barrage: Everybody they know is having a great time, everybody they know has made their best friends for life, everybody they know has a job they love and is going to fun restaurants every Friday night. That’s what they’re shown, but it’s different from reality, and I think it’s so hard and so isolating for young adults to live with that cognitive dissonance between their reality and the highly curated reality they see on social media. I think that’s one piece of it.

I also think many in the current generation had a hole in their lives for 18 months to two years from the COVID pandemic, so a lot of them missed some of those formative years of learning how to negotiate relationships, deal with other folks and live with roommates. There’s also been a huge mental health fallout from the pandemic, so many of the folks in this age group are also struggling with their own anxiety and depression. I think those are really big issues that make it especially hard to navigate this age.

Kevin Pho: So what can parents do? What can I do if my daughter at college is experiencing some of these things? What pieces of advice could you share with parents?

Eleanor Menzin: That’s a great question. I think the first thing is to stay connected. If you’re a parent, check in: “How are you? How was your day?” But also be more specific: “What are your plans for this weekend? Who are you going to hang out with?” Pay attention anytime you notice a big change: a kid who used to be an A student and is now a C student, a kid who used to go to sleep every night at 11 and is now up at 4 in the morning. All of those are red flags. So are changes in substance use: A kid who never used to drink and has been to the infirmary for alcohol poisoning is obviously a huge red flag, and it’s more than a mistake. There’s something going on there. So I think staying connected is really important.

I think normalizing bad feelings and imperfection is also important, saying to our young adults, “This is hard. The transition to college is hard. The transition to being a grown-up is hard. Adulting is hard. It’s sometimes really demoralizing to get up in the morning and go to work.” Normalizing those feelings is really important. Then provide resources and say, “Hey, if you feel like you’re not yourself, there’s help out there, and we can try to figure out together what you need to get there.”

And obviously, since I wrote this article, it’s my belief that you should start with your pediatrician, a health care provider who has known you your whole life and can say, “All right, let me help you dig this out.” One of the things I try to say to my patients before they go to college, and I think it’s true for parents of kids this age, too, is, “I can’t solve problems I don’t know about. I can help you with almost any problem if you tell me what’s going on. If you hide it, I have no way to help.”

Kevin Pho: So how can we direct our college-age children to support? A lot of times they’re not in the same city as us. Sometimes they’re halfway across the country. They can’t see their regular pediatrician, and their parents could be thousands of miles away. Let’s say we recognize one of those red flags. What can we do in that scenario?

Eleanor Menzin: I do think it’s worth reaching out to your primary care doctor, because they may have resources, they may be able to see your child virtually, and we do that. They may also have connections. We’re all sort of interconnected, so sometimes I’ll email an old residency or medical school friend and say, “Hey, I need somebody in Pittsburgh.” So I think that’s one thing.

College health centers are usually set up to do short-term counseling. I think that’s a great option for crisis counseling, but it’s usually not a great option for the long term. Interestingly, though, most college health centers have a list of practices in the community that they refer patients who need longer-term care to, so I think getting your hands on that list and then just emailing and calling until you find somebody is worthwhile.

One thing I would say is that there’s a very adult-medicine tendency to say, “Well, you’re 18, so you have to do this yourself.” What I would say is that that’s a big ask for a struggling 18- or 20-year-old. So I think it’s totally acceptable to say to that young person, “Listen, it sounds like you would really benefit from a therapist, and I’d like to help you find one. It can be a lot of work, so could I make the initial inquiries and some phone calls for you and find somebody who has availability? Tell me what your schedule would support, where you can get to or what blocks of time you have free, and let me do the legwork, like your personal assistant here.” Because for a kid who’s struggling with anxiety and depression, saying, “Call student health and get yourself an appointment,” is often a daunting task.

Kevin Pho: In your article, you talk about the neuroscience perspective on young adults as they mature into adulthood. Talk a little more about that.

Eleanor Menzin: We know from really good cognitive science that cognitive maturity, we now think, arrives closer to 25 or 26, so it certainly doesn’t line up with the legal definition of adulthood at 18. I think one of the things that’s so hard for physicians, caregivers and parents of this age group is this. Let’s say, and this number is totally made up, that you’re 90 percent cognitively mature. I don’t think that means you make decisions 90 percent on cognition and 10 percent on some premature schema. I think what it actually means is that 90 percent of the time you act cognitively like an adult, and 10 percent of the time all bets are off. That’s the problem: You can have a young adult who’s a great decision-maker 90 or even 95 percent of the time, but the other 5 or 10 percent of the time they do things no adult in their right mind would ever do. That’s cognitive immaturity, but it’s so hard to understand, because it’s the same person who made a great decision yesterday. And the answer is, yep, that’s how cognitive maturity works.

Kevin Pho: So we’re talking toward the end of September, and a lot of us freshman parents have had kids in college for about a month now. What would you say are the highest-yield things we should do, and what are the biggest red flags, the things we should not do?

Eleanor Menzin: I think the biggest red flag overall, the parental behavior I wish we could all avoid, and this is probably true for life, is minimizing or dismissing a child’s attempt to express emotion. When your 19-year-old calls you crying and says, “I have no friends, and this is terrible,” I think the single worst phrase is “Don’t be silly” or “Don’t be ridiculous.” Because even though you, as a grown-up, know this will pass and your child will be fine, they don’t know that. If they reach out to you to express an emotion and you minimize it by dismissing it, saying, “Don’t be silly. Don’t be ridiculous,” they’re really stuck. What they hear in response is, “My dad’s not listening to me.” That leaves them two choices: They can close down and shut you out, or they can up-level their expression of emotion by doing something like no longer going to class, and then you’ll see how unhappy they really are.

So I think the biggest thing is not to minimize or dismiss that emotion. The counterpart, of course, and the best thing you can do, is to acknowledge it and say, “I get it. This is terrible. It’s so hard.” It’s so hard. Then try to help them do a little home CBT: “Do you think it’ll be like this forever? Or was it one bad day? What was yesterday like? Do you have plans for tomorrow?” Try to help them reframe it as maybe not the end of the world, and maybe not fall into catastrophizing, which is the favorite habit of many young people. And also be open about the fact that there are resources for help and support, and that if your kid needs them, you are there to help them find them.

Kevin Pho: We’re talking to Eleanor Menzin. She’s a pediatrician. Today’s KevinMD article is titled “Navigating adulthood in the digital age.” Eleanor, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Eleanor Menzin: I think my take-home message is that 18- to 25-year-olds are awesome. It’s a great age group. I like to think of them as emerging adults. They’re not adolescents, but they’re also not adults, so I would encourage providers and parents, and people that age, to think of them that way, as a separate category, and to make sure they’re getting the health care they need. If you’re the parent of a kid this age, I would not assume that they can or should transition to adult care. I would have that conversation openly with their pediatrician, and if they do transition to adult care, I would make sure it’s with somebody who feels really comfortable taking care of this age group, because they come with their own special needs that really need to be paid attention to.

Kevin Pho: Eleanor, thanks again for sharing your perspective and insight, and thanks again for coming back on the show.

Eleanor Menzin: Thanks for having me.