Adolescence can be defined as that period of time during which an individual passes from childhood into adulthood. Typically, this period is between the ages of 13 and 21 years. During adolescence, individuals often experience significant internal turmoil secondary to physiologic changes in body habitus, as well as changes in the way they and society perceive each other. The adolescent strives to achieve the independence of adulthood while clinging to the security of childhood. To paraphrase Charles Dickens, adolescence is “the best of times and the worst of times.”

Among the issues that adolescents must confront are those related to personal and sexual identity, their sense of self worth, and their role in society. As teenagers become independent from those who raise them, they must struggle with these concepts to enter adulthood successfully with a positive outlook. Adolescents with sickle cell disease must face each of these challenges, as well as the difficulties related to their chronic illness. In addition to becoming an adult, adolescents with sickle cell disease also must accept primary responsibility for the management of sickle cell disease. Physicians caring for adolescents must be sensitive to all of the problems these patients are experiencing, and they must be willing to help guide them during this difficult transition period.

This article focuses on the issues related to the management of adolescents with sickle cell disease. Because the medical complications are similar to those occurring in adults, emphasis is placed on psychosocial and counseling issues. These issues include those related to personal and sexual identity, as well as limitations created by sickle cell disease. Other common adolescent problems including depression, fear of addiction, and pregnancy also are important for young patients with sickle cell disease. Issues related to patient education and genetic counseling also are discussed. Finally, suggested mechanics for transferring care from the pediatrician to the internist are presented, because this is an important step for both health care providers and patients. If the transition is carefully done, patients benefit; if poorly done, patients experience many difficulties. As a part of the transition, an informed health care contract can form the basis of a good relationship between adolescent patients and their physicians.