The teenage years bring new opportunities, new responsibilities, and new questions about independence. This stage can feel both exciting and stressful.

Many parents find themselves balancing two competing truths:

• "I want my child to become independent."

• "I know things about their health or development that make me worry."

At the same time, teens with CHD are discovering who they are. Some may see their CHD as part of their identify, but others may not. They may be taking on more responsibility at school, with relationships, healthcare, hobbies, and future plans while also navigating challenges that aren't always visible to others.

This month, we're focusing on how independence may unfold differently for some teens with CHD, and how parents can support growth while staying connected.

Many aspects of independence rely on executive functioning—the self-regulation skills that help us get started, plan, organize, remember, problem-solve, and follow through.

For some teens with CHD, executive skills develop more slowly than expected. This doesn't mean a teen lacks motivation or ability. It often means they need more time, practice, and support to build the systems that allow independence to grow.

Do you notice...

• your teen is capable but struggles with follow-through

• responsibilities seem inconsistent from day to day

• your teen relies on you more than others the same age

• you're wondering whether to step in or step back

For parents and caregivers:

• Independence is built through practice and small steps, not sudden expectations based on age.

• Focus on helping your teen develop systems. When a routine is predictable, it can be internalized and become automatic.

• Shared calendars, reminders, checklists, and systems or routines are tools for learning. If a simple calendar, paper schedule, or chore chart won't wok, what apps can you try with your teen to get them activated?

• Allowing teens to experience manageable mistakes can build important problem-solving skills. Age appropriate stressors build resilience and distress tolerance.

Examples might include:

• Select chores based on abilities - give them choices and let them pick. When the week is hectic - reserve for the weekend.

• Cook one meal a week, starting with the recipe, gathering ingredients from grocery store, and so on.

• Assisting with medication refills and making appointments.

• Helping you research a big family purchase (e.g., grill, mattress, TV, car, etc).

For your conversation with your teen:

• It may not be "fun" to fulfill these responsibilities, but starting now makes it less overwhelming later. They become routine and more tolerable.

• Showing responsibility and initiative indicates a readiness for preferred opportunities in the future (e.g., learning to drive, getting a job, dating, taking a trip with the school).

• Knowing how to ask for help, use available tools (e.g., reminders on your phone, a calendar, etc), and solve problems is part of being independent. Self advocating is an important skill that every adult needs.

One of the most important developmental tasks of adolescence is building a sense of identity.

For teens with CHD, this can be complicated. Some feel defined by their medical experiences or diagnosis. Others want nothing to do with it. While some may move back and forth between these perspectives depending on their age or medical status.

Parents often face their own challenge: Learning how to support a growing teen while managing understandable worries about safety, health, and the future.

Do you notice...

• your teen is pushing for more independence

• your teen is avoidant of doing things to improve their independence

• conversations about responsibility lead to conflict

• you're struggling to balance protection and trust

For parents and caregivers:

• Independence grows best when responsibility increases gradually over time. Starting early and slowing increasing expectations will make it easier in the long run.

• Try shifting from "Can they do it?" to "What support would help them succeed?" Break things down into steps and figure out the best place for them to start.

• Let things be messy and imperfect as they show their independence. Adjust your standards. Praise small steps. Build their confidence first. Then slowly increase your expectations.

• Confidence develops through successful experiences, not repeated reassurance. Over time, your teen will naturally feel empowered and intrinsically motivated when they do things for themselves.

• It's normal to feel anxious when stepping back. Tolerating that discomfort will get easier. Can you connect with another parent of a teen to get support?

For teens:

• Your CHD may be part of your story, but it is not your whole story.

• Learning about your health is an important step toward adulthood.

• Developing confidence starts with small responsibilities each day that become bigger over time.

A helpful question to explore together is:

"What is one thing you're ready to take more ownership of this season?"

Notes About the Newsletter: Each month’s newsletter highlights a few themes that commonly come up for families raising children with CHD. As your child grows and circumstances change, different topics may feel more or less relevant over time.

This newsletter is for educational purposes only and does not replace individualized medical or behavioral health care. For urgent concerns, contact your care team.