“What are they thinking?” Engaging young people for collaboration and growth

Why would a young person choose to lose a kidney rather than take their medicine?

For transplant recipients between the ages of 10 and 25, the leading cause of rejection isn’t surgical error or bad luck. It’s “medication non-adherence.” In other words: they stop taking the very drugs that prevent their new kidney from being rejected.

At first glance, it seems unthinkable. After all the pain of dialysis, the cost of surgery, the support of parents and doctors, the sacrifice of a donor — why risk throwing it all away?

Why it happens

Imagine being that teenager or young adult. Dialysis has meant hours tethered to a machine, painful procedures, and restrictions that shape your entire life. A transplant offers hope and freedom.

But then comes the daily reality of immunosuppressants. The medicine prevents your body from rejecting the kidney, but the side effects are brutal: weight gain, unwanted hair growth, bad breath. And while you’re on them, you can’t drink alcohol.

To an adult, the long-term benefit of staying alive seems obvious. To a younger person, the near-term threat of social exclusion — of being teased, rejected, or left out — can feel far more dangerous.

Psychologist David Yeager captures this dynamic in 10 to 25: The Science of Motivating Young People. The adolescent brain is hyper-attuned to status and belonging. Respect and social standing matter more than almost anything else — even survival.

What works better

That’s why so many well-intentioned health campaigns backfire. “Just say no.” “Think. Don’t smoke.” These slogans can sound patronizing, even disrespectful. Instead of motivating change, they reinforce resistance.

Yeager highlights a campaign to reduce teen smoking that took a different approach. It was called Truth. It didn’t lecture. It didn’t tell teens what they already knew. Instead, it cast them as savvy truth-tellers exposing the manipulations of Big Tobacco — something adults had failed to do. Not smoking became a way to claim status and independence. And it worked.

The broader lesson

Maybe you’ve had moments when a younger colleague, student, or family member reacted in ways that seemed irrational or overly sensitive. Yeager’s work suggests the problem may not be them — but the way we engage them.

He shows you can hold demanding standards and provide support for meeting them. But it requires shifting from:

• Telling → Including

• Judgment → Respect

• Control → Empowerment

Although Yeager’s research focuses on ages 10–25, the insights apply much more widely. Who among us hasn’t chosen short-term acceptance over long-term benefit? Who hasn’t resisted being told what’s “good for us” and what we “should” do?

The truth is, we all want dignity, status, and respect. By understanding this, we can shift our interactions — at home, at work, throughout our day — from stressful and judgmental to collaborative and empowering.

For me, Yeager’s book was a powerful reminder that the choices that look irrational on the surface often make perfect sense once you understand the need behind them. There’s nothing wrong with “young people these days.” We simply need to practice better ways of engaging with them.

👉 If you’d like to dive deeper, I highly recommend David Yeager’s book 10 to 25: The Science of Motivating Young People.

Image credit: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.