BY: Elizabeth A. Pector, MD Dr Pector is a board certified family physician in Naperville, IL and a member of the MOST Advisory Board. Her letters and articles have been published in medical journals and lay publications. She is married, and is the mother of David, born in 1991, and twins Jared and Bryan, delivered in 1997 the day after Bryan’s death from a cord accident. She has spoken on bereavement and special needs in multiples to local and national audiences, and remains interested in issues facing multiple-birth families including parent stress, prematurity, special needs, and cultural beliefs about multiple births.
Adolescence is a challenging time. Physical, mental and social development occurs at a whirlwind pace. Helping two or more children together through this transition to adulthood is both gratifying and mystifying to parents. Fortunately, most multiples have no greater trouble than singletons in navigating adolescence, and some find it easier. Twin studies in Finland revealed that twins smoked less, drank less alcohol and were more physically active than singletons, so teen twins may actually be healthier than their peers! (Ed. Note: It would be nice if this is true for higher-order multiples as well but such studies have not been done yet.)
Physical growth
Profound physical changes occur during adolescence. Girls hit their peak growth rate about two years before boys. Identical twins tend to be very close in the timing of growth spurts and in their adult height and weight. Even identical twins with very different birth weights tend to be similar in size by the time they reach puberty, although a smaller child may not entirely catch up. Fraternal twins may go through puberty at different times. Friends and family may be concerned when one such twin develops much faster than the other, who is just biding his time before “taking off.” A smaller child may go through puberty later; meaning the size difference between twins will be exaggerated during the larger child’s early growth spurt. This can affect choice of athletic activities during middle school and high school. The physical talents and abilities of each child need to be taken into account along with their interests. Both twins may not be able to participate in the same activity if no suitable sport can use both children’s best features.
Tasks of multiples
Adolescent multiples must break ties with their parents AND with their womb mates. They need to set their own timetable for separation and independence. Fraternal multiples tend to have a greater sense of their individuality than identicals, even in the 11-14 year-old age group. My patient’s 12 year-old fraternal sons already have started down different paths, with one taking up wrestling while the other is on the sidelines for the first time this year. Mary Kay Stenger, a counselor and mother of three teenage surviving quadruplets, reports individuation was never a problem with her children. They have always shown distinct personalities and talents. In contrast, my colleague’s 15 year-old identical sons have only in the last year developed distinct interests and friendships. It’s best to encourage twins to find ways to differentiate themselves early in childhood. Otherwise, teen twins will find their own ways. One may become sloppy and one neat, or one conservative and one radical, just so people can tell them apart. Some twins greatly fear being apart. The inevitable separations that occur in high school can be very difficult for them. Other people will relate to each child as an individual, not knowing about her twin, and this can be strange to a child who has always relied on her twin for support.
Tasks of parents
Parents’ duties during these years are stressful. The parents of teen multiples need to separate from each of their children as they become more 
independent. As each develops his or her own identity, parents also gradually lose their visibility and status as parents of multiples. Parents must strive to achieve balance in relating to each child and to settle conflicts fairly. This can be quite draining. One mother of 15 year-old quadruplets and their teen singleton sibling sighed knowingly at the beginning of summer vacation as she faced three long months with five teens in the house! Mary Kay Stenger, another high-order multiple mom, says she needs to take life one hour at a time some days.
Privacy and confidentiality are hard to maintain. A mother of 12 year-old twin boys told me there are no secrets in their family. If one boy gets in trouble at school, his brother is sure to tattle, so the culprit often rushes home to admit his transgression before his twin has a chance to exaggerate the story! Parents are in a tough bind when one twin confides a secret about the other, but doesn’t want the co-twin to know the secret’s out. Parents need to encourage the twins to discuss their concerns with each other, only involving the parents with the open knowledge of both twins.
Lastly, parents must avoid stereotyping one twin as “the better one,” or siding too closely with one child instead of the other. Studies show that the first twin to come home after birth, or the first-born or healthier, is often the favorite during childhood. Parents tend to consider this twin even more superior during adolescence, although teachers see no major differences between the twins. Expecting one child to be an underachiever or troublemaker tragically damages his self-image and limits his potential.
Teaching multiples to drive is the ultimate challenge. Mary Kay Stenger is a professional stress management “expert,” but finds her skills tested “to the max” by teaching three children the fine art of maneuvering an automobile. Her tip: approach it one child at a time, one lesson at a time. One child couldn’t find the brake pedal right away but finally located it just in time to avoid a crash. Another mother of quadruplets allowed two children to take lessons one year, and two the next. This maximized practice time for each child while reducing parental stress. Mary Kay suggested jokingly that CPR equipment in the car might be helpful – presumably to resuscitate the parent who has a heart attack during their child’s driving practice.
Effective coping strategies can help parents save their sanity. If you keep life as simple as possible and focus on the important things, you’ll reduce your stress considerably. Mary Kay Stenger stresses the following points. You cannot love a child too much. Praise your children early and often. Encourage the children’s sense of responsibility from an early age. Teaching your children to do laundry or cook may create obstacles in the short-term (like 4 foot high piles of laundry)! But in the long run, the children will be proud of their self-sufficiency, and you may even enjoy the variety of their dinner menus. Flexibility, in Mary Kay’s words, keeping an open mind and “going with the flow” is also important. Creative problem solving is a must – especially with children who are quite different from each other. The rules which work for one may not apply well to another. Humor, in large doses, is essential. Look for it, find it, or create it yourself. Mary Kay years ago began taking photographs of her children when a “catastrophe” or mess occurred. The time it took to focus the camera helped her gain perspective on how important the problem of the moment was in the “big picture of life.” Now she has funny memories of her children’s younger years, and reports there are still a lot of entertaining pictures taken in their house!
Academics
School performance is affected by twinship. Australian studies in the 1970s compared twins to singletons in literacy and mathematical ability. Twins of both sexes at age 10 scored worse than singletons. By 13-14 years of age, girl twins caught up with singleton peers, but boy twins still showed lesser abilities. Attention deficit disorder, but not the hyperactive form of it, is more common in twins than in singletons, and more common in boys than girls. Ten percent of twin boys are diagnosed with ADD. Prematurity does not appear to increase ADD risk. Speech and reading difficulties are also more prevalent in twin students. This information can alert parents to potential problems, but shouldn’t excuse laziness or discourage parents and children from setting lofty goals. My colleague’s twin boys are academically gifted, and the brightest student in my high school graduating class was a twin boy.
A positive approach to children’s performance in academics and other activities is important. Celebrate each child’s uniqueness, and avoid negative comparisons which may damage the less successful child’s self-esteem. Encouraging children to study different subjects, or when necessary to attend different schools, may prevent feelings of inferiority in the less able twin. Bad effects of comparisons only worsen if one child is held back a grade. This should be a last resort. Separating twins in school should not be mandatory, but might be helpful if children are excessively competitive. Identical twins that attend small schools, or have similar interests, should be allowed to take classes together. Teachers must recognize each twin as an individual and give independent, not joint, assignments. Identical twins can have similar thought processes and shouldn’t be accused of cheating without proof. Each child deserves a grade based on his or her performance, not a duplicate of his twin’s marks because of teacher concerns about poor self-esteem or jealousy between twins. Parents may be fearful of the effects that differences in evaluations and rewards will have on the twin relationship. However, such events are an opportunity to teach children how to cope with the unequal treatment they’ll encounter in life. Parents cannot, for example, expect a college to grant an undeserved scholarship to the other twin just because one earned the honor.
Friendship
Forming friendships is sometimes difficult. A girl used to a close relationship with her twin can be baffled when a new singleton friend is scared off by her expectation of instant closeness. Friends won’t instinctively understand a twin the way womb mates do, so twins must work harder at communication in their friendships than they might expect. Many twins share the same circle of friends as they enter adolescence. Gradually, each child also finds his own unique friends. Twins may become best friends with other twins, as my colleague reports with his teen sons. Some twins are more secure in social situations because they have a partner. A mother of 12 year-old boys feels her sons are less lonely and need less attention from others than their older singleton sister. On the other hand, a twin who relies excessively on her twin or her twinship in social situations may be terrified when she is alone, responsible for her own actions. She can feel lost or “cut in half.” This is particularly true of some identical girls who use their twinship as a way to gain friends and attention.
Dating and marriage
Romantic relationships can be thorny for twins’ relationship with each other. Early studies showed that twins, particularly girls, were less likely to marry. Such differences do not currently appear to exist.
Twins have a great need for individuality, yet when they develop a serious attachment to another person they still struggle with anxiety over the effects on their twin. Some twins view dating as a contest to prove social dominance by establishing the first serious relationship. Other dating twins may feel guilty leaving the co-twin home alone. Girlfriends or boyfriends of a twin may envy the relationship between twins. Dating a twin is not a very private experience, since the other twin usually ends up knowing everything about the romance!
Parents face difficult decisions when one of the pair is ready to begin dating and the other is less mature. The socially mature child shouldn’t be deprived of dating experiences, but parents must develop careful explanations and creative sets of rules to forestall jealousy and bitterness. In 15 year-old fraternal sisters I know, the less mature twin isn’t interested in boys and readily accepts her sister’s dating as just another difference between them. A girl may be more socially advanced than her twin brother, and may look down on him when she begins keeping company with other young men. Her brother may simultaneously view himself as his sister’s protector, and feel profoundly insulted when his sister’s boyfriend treats him as an inconsequential “little brother!” Identical twins want their dates to recognize and relate to them as unique individuals. An identical twin will greatly resent being compared to, or mistaken for, his brother.
Relationship between twins and multiples
Pat Malmstrom, founder of Twin Services Consulting and co-author of The Art of Parenting Twins, characterizes the relationship between twins as closer than any other human relationship, including marriage. The need to develop a separate identity during adolescence causes uneasy tension between twins. Twins, whether identical or fraternal, tend to be less alike when raised together than if they were separated at birth. This may be partly due to the constant comparisons made between twins who grow up in the same household, and their strong need to establish individuality.
Teen twins fight a tug of war between cooperation and competition. They can be allies through the trials of adolescence, but also may distance themselves from each other, taking pains to develop unique appearances and interests. The twins’ own mixed feelings, and pressures from family, teachers and friends influence whether they’re more cooperative or competitive.
Competition and jealousy can be fierce. Female twins tend to dominate in boy-girl pairs, probably due to their earlier social maturation. Twins in the same class or sport can never both be “the best.” Encouraging twins to enter different classes or participate in different sports avoids damaging comparisons and enhances self-esteem. Even this may not alleviate difficulties. I know an academically gifted fraternal girl twin who envies the newspaper coverage of her twin’s sports accomplishments. Identical twins cannot escape from the living mirror image who reflects their own quirks and imperfections back to them.
The conflict between individuality and loyalty to one’s twin is present in any decision made by an adolescent twin. Choices about relationships, marriage, college and careers always raise the question, “How will this affect my twin?” Pat Malmstrom quotes an 18 year-old twin girl as saying, “It’s as if we have to get a divorce before we can get on with our lives, but we still love each other.” Parents may worry that twins are excessively dependent on each other, but twins tend to stay in closer contact as adults than non-twin siblings, and genetic similarities between identical twins may influence their talents. It is not necessarily a cause for concern if twins, especially if identical, choose similar courses, colleges or careers.
Not much has been written about the relationships among triplets and higher-order multiple siblings in the teen years. Swedish studies of 9 year-old triplets reveals even at that age there are complicated interactions. Monozygotic (“identical”) triplets can be extremely close. However, fraternal triplets may think of themselves just as siblings in a family rather than as “triplets.” An identical pair within a threesome, or two girls with a triplet brother, can leave the lone child feeling like an outsider. The “neglected” child usually copes well, seeking outside friendships. Triplets enjoy the benefits of sibling companionship, but also feel the pangs of noisy households and competition for attention. In one sense, triplets find safety in numbers. They are popular with their peers, at least in part because peers recognize that three children banded together would make a formidable foe! Multiples are loyal to each other, and if one gets in a fight, the other two will quickly come to the rescue.
Problems and challenges
Counseling may be helpful for certain families. Twin relationships usually follow one of three patterns: mutual dependence (each child relying equally on his partner), mutual independence (each child striving to establish her identity apart from her twin), and unilateral dependence (one twin relying heavily on an independent co-twin who does not want a close relationship). The last pattern is associated most often with adult psychological problems. The independent twin may reject the clingy one, and professional help can assist the more dependent twin to develop a healthier self-concept and may perhaps salvage the twinship before permanent estrangement occurs.
Difficulties also occur in pairs that are extremely close. Sometimes the “leader” is devastated when the “follower” exerts her independence and initiates a separation. If the leader’s only role in life has been as decision maker in the twin relationship, she has no identity of her own. At other times, the “follower” feels cut adrift when she is left to think for herself. Twins can feel devastated when their co-twin decides to marry, chooses a different college or moves into an apartment alone.
Intense competition can definitely be unhealthy. Eating disorders, where each twin strives to be the thinnest, require careful professional intervention. Less dramatic difficulties occur when twins are very competitive in the same sport, same classes, etc. and one becomes devastated by consistently being the “close second” and never winning the prize.
Disability in one twin is another unfortunate circumstance. The healthier twin may feel embarrassed about her twin’s impairment, guilty for being healthy, or resentful of the 
disabled child’s demands and restrictions on her time. She may crave a sense of normalcy and not reveal her special circumstances to casual acquaintances. My friend was surprised to discover her teen babysitter had a disabled twin sister at home. The girl had never mentioned her twin in the many months they’d known her. Some healthier partners develop special empathy and decide to enter caring professions. Their disabled twins are blessed with a role model, mentor and special friend.
Death of one twin during adolescence tragically disrupts an incompletely developed relationship. The surviving twin can have great difficulty if the twins were in conflict, were very dependent on each other, or viewed the twinship as their main source of identity. A twin may feel guilty that he caused or failed to prevent the death. Reactions can include: guilt, insecurity, unwillingness to continue growing up without the twin, romanticizing of death and risk-taking behavior, fear of one’s own death, taking on characteristics of the deceased twin, other personality changes, and substance abuse. The parents’ reactions have a crucial impact on the survivor. Parents may feel ambivalent toward the living child, overprotecting and/or rejecting her. They may idolize the twin who died. It is important that parents not retreat into silence and denial, or glorify the deceased child without also remembering his faults. Surviving twins and their parents may be acutely aware that the living child is a perpetual reminder of the twin who died. A grief counselor familiar with twin psychology can be of great assistance to families dealing with this crisis.
Conclusion
Twins or other multiples and their parents face unique challenges in physical, academic, social and romantic arenas as the children go through adolescence. Fortunately, the relationship between multiples is beneficial as well as burdensome, and the vast majority of children emerge as healthy, well-adjusted adults. I end with a final quote from Mary Kay Stenger: “Multiple children in my mind equals multiple joy, multiple challenge, sometimes minimal sleep, and maximum personal growth. It is a real blessing and privilege to be trusted to teach and guide these children and launch them into their own independent lives. Each stage of parenting brings challenges and rewards, and enjoying the journey is part of the plan.”
Acknowledgements
The writings of Dr. Elizabeth Bryan, Dr. David Hay, Dr. John Buckler, Dr. Robert Williams, Britta Ackerman, Mary Kay Stenger, Pat Malmstrom, Kay Cassill and the Parents of Multiple Births Association (POMBA) are sources of information in this article. I am also indebted to other parents of multiples who shared their insights with me.
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