Paula M. Duncan, MD, FAAP
In 1987, after 3 years in practice in Vermont, I informally asked my patients how I could
better serve adolescents. One 16-year-old girl said, “Well, you know you are always say-
ing, ‘Don’t do this and don’t do that.’ I could be sitting in my room on a Friday night NOT
doing drugs, NOT having sex, NOT drinking and driving…NOT doing ANYTHING and being
perfectly miserable. You could try to ﬁgure out what kids need to ‘say yes’ to and start talk-
ing about that too.” That teen moved out of my care to a happy and successful life, but
I have never forgotten her wisdom.
Another 16-year-old girl entered my world and provided me with a front-row seat for a
3-year longitudinal course in “what it takes to turn your life around.” In addition to actu-
ally doing that work, she generously spent some of her time thinking about “what helped
and what didn’t.” Her experiences and thoughts demonstrated that the strength-based
approach was the key.
• “I didn’t think I had any strengths until someone pointed them out to me.”
• “I would say it was not just one adult really caring about me that made the difference. My
list would include some people who had no idea how much they helped me—just by treat-
ing me with a positive attitude and respect.”
• “My advice to people trying to help kids like me would be to just never give up. It might be
the 99th time that we are ﬁnally able to start to turn things around.”
• “It would be a great help if adults interacted with teens in a way that supported their
strengths rather than just talked about what wasn’t going well for them.”
This young woman has also thrived, and she remains for me the real-life embodiment
of what the literature in positive youth development and resilience demonstrates. As
reflected in her words, focusing on strengths allowed her to make the changes only she
We have to start the conversation by clearly stating that focusing on and reinforc-
ing existing strengths is not just a “positive” approach that feels good, it is an important
strategy to approach and mitigate risks. It is a sound strategy to turn kids’ lives around.
Why We Need This Approach
• It is related to better outcomes for kids in overall health and well-being, which is sum-
marized and explicated in the positive youth development and resilience literatures.
• Many of our best intentions may not translate into meaningful encouragement and
guidance because the young people can see our mouths moving but not really hear what
• There should be some explicit assessment of a youth’s developmental trajectory, similar
to what is done for younger children. Developmental milestones for teens can be identi-
ﬁed through an evaluation of their strengths.
• All youth can beneﬁt. For those youth coming back from one or even a couple of bad
decisions, its influence can be lifesaving, but even youth who are avoiding serious risk
behaviors may not be thriving and may need help staying on course. Our goal has to be
that all youth will thrive!
We can help parents and guardians beneﬁt from this approach as well, giving them
feedback on what they’re doing right whenever we see it. Such input also provides direc-
tion on what they are trying to get their teens to “say yes” to. As one parent said, “I knew EW
what I didn’t want them to do, but I wasn’t sure what I speciﬁcally was hoping they would or
do.” A framework like the Bright Futures developmental tasks, the 7 Cs of resilience, or D
Brendtro’s Circle of Courage lets parents routinely and easily do a “spot-check,” asking