Adolescents are medically, developmentally and psychologically distinct from children and adults. Although we all have patients in this age group who are communicative, adherent and capable, many of us have been faced with young people who are difficult to work with, for a variety of reasons. The aim of this article is to consider which young people are most challenging to rheumatology professionals, why they appear challenging and to offer some practical solutions to addressing such behaviours in clinical rheumatology practice.