Advice for 12yo boy with ADHD when he feels stressed

January 28, 2020 11:18 PM

My son has a hard time getting himself to school in the mornings. Any suggestions for how he can cope with feeling overwhelmed so he doesn't procrastinate?

My husband and I leave for work before 8 am, so our 12yo son N. and his 13yo sister go to school on their own. N. needs to make his own breakfast and lunch, dress and brush his teeth and hair, take his ADHD medication (Concerta) at 8 am, and leave at 8:30 am to walk 30 minutes to school.

N. attends an alternative school, and they are cool with kids arriving late. He has no homework and no tests, and he has Fridays off. He seems to be doing well at school, although he just started this year (Grade 7) so he's still getting to know the kids and hasn't seemed to make close friends. He has good relationships with his teacher and classroom aide.

N. says that he often feels stressed and overwhelmed in the morning and that he procrastinates leaving for school. Some days he doesn't go to school at all, and other days he leaves 30 - 60 minutes late.

So far we have gotten a planner with a calendar and made a checklist of the six things he needs to do before leaving for school. He says the checklist helps him know what to do, but he still feels stressed. We've talked about him seeing a counsellor but he doesn't want to right now.

I told N. I would post this question here to see if anyone, especially others with ADHD, have any suggestions to help him deal with the feelings and to get out the door on time with all his tasks done. Thanks so much.

posted by alicat to Health & Fitness (18 answers total)

I would make mornings as streamlined as possible so he needs less willpower and executive function to get them done- his stimulants likely won’t have kicked in before he leaves for school, so his brain isn’t quite up to speed.

Shunt as many of his morning tasks as possible to the night before. Get him into a nightly routine (maybe with a very clear checklist): look ahead at his planner to know what the day and week will bring, pack schoolbag as needed, lay out clothes, make lunch, and even put out the bowl, spoon, and cereal box for tomorrow’s breakfast.

Also, maybe make the morning checklist more granular, and add target times to start and end each task.
7:00 Bathroom stuff: Shower, deodorant.
7:12 get dressed,
7:15 eat breakfast,
7:27 put away breakfast items,
7:30 brush teeth (make sure there’s a toothbrush for him on the ground floor, even if that means it’s in the kitchen), grab lunch and bag, put on coat and shoes, lock door,
7:45 start walking, or whatever.

These checklists can be paper or on his phone, see what works for him. I’m an adult and I basically still do exactly this for all busy days!
posted by nouvelle-personne at 11:32 PM on January 28, 2020 [8 favorites]

I have had good luck as an adult with ADHD using the Brill app to help manage time blindness, anxiety, and stress of getting ready for school and work.

Therapy helped me in general learn where different emotions were coming from.
posted by HMSSM at 11:46 PM on January 28, 2020 [1 favorite]

I would def shift breakfast and lunch prep to the night before. Even I cannot cope with that level of organisation in the morning and I’m an adult without ADHD. I would suggest adding outfit planning and laying the clothes out as well.
posted by like_neon at 1:15 AM on January 29, 2020 [18 favorites]

Lunch prep definitely needs to be done the night before - I'm an adult without ADHD and I couldn't deal with making lunch in the morning.
posted by EndsOfInvention at 1:56 AM on January 29, 2020 [5 favorites]

Definitely shift lunch prep to the night before.

Put his meds somewhere extremely difficult to miss. Maybe make a station by the door with his pills and backpack and a bottle of water, although you can get a lot cleverer about this - I know someone who keeps their pillbox in their shoes by the door so they literally cannot leave the house without stepping on them. If he has a phone you can set up notifications so he's reminded every 8:15am (or whatever) to take his meds, too. If he skips all the other stuff at least ensuring a steady course of medication can go a long way for things like spikes of anxiety and formation of beneficial habits.
posted by Mizu at 2:10 AM on January 29, 2020 [1 favorite]

Best answer: My son was in a similar situation and the doctor’s recommendation was to try and take the pill earlier if possible. My kid is hard to wake up so it didn’t work, but perhaps you can personally give him his pill before you leave and let him go back to sleep until his usual wake time?
posted by JoeZydeco at 4:24 AM on January 29, 2020 [8 favorites]

Almost all our school routine gets done the night before. Breakfast is down to two options in rotation that can be prepped half sleep in minutes. Everything is laid out in the table the night before, hairbrush, socks, meds etc.

I would consider texting him at eight am a reminder and using phone alarms for literally every 5 steps, like brush your teeth, get your shoes on, etc. We used a visual countdown timer for the first six months of this routine and it really helped get a sense of time.
posted by dorothyisunderwood at 5:13 AM on January 29, 2020

Oh wow, I feel him. Here are things I do even as an adult:

Lunch and breakfast prepared the night before. (On days he forgets to make lunch the night before, would it be possible for him to buy lunch?)

Clothes chosen and guaranteed clean the night before (incl. underwear, etc).

Pills live on his nightstand. The night before, put a FULL glass of water on the nightstand. He should take his pill before he even gets out of bed to pee in the morning. ******This works really well, try this if nothing else****

Shower/dress and brush teeth.

Put lunch into otherwise packed bag.

Leave!

Personally, I always kept a brush in my bag to brush my hair on the way.

Personally, I eat breakfast only once I’ve got where I’m going. Otherwise I will lose track of time and never get there.

If allowed, keep spare pills, breakfast-y snacks, a hairbrush, and some spare lunch money in his bag, so that if he forgets that stuff he’ll still be OK.
posted by rue72 at 6:49 AM on January 29, 2020 [6 favorites]

(I'm a parent but my kid doesn't have ADHD.) 12 is still pretty young to be coordinating all this stuff. Other people have chimed in with good suggestions for streamlining the morning stuff, but I wonder if you'd consider hiring an older teen or college student to basically be the morning coordinator: arrive at your house, keep kid moving, get him out the door, and/or drive him to school.
posted by BlahLaLa at 8:36 AM on January 29, 2020 [13 favorites]

I have a similar kind of kid, and the two things that have helped the most are having a list over his backpack of all the things he needs (sounds like you have this covered) and having a reward for him when he's ready on time. For my kid, he's highly motivated by screen time so if he's ready by 8:15 he can watch 15 minutes of infernal YouTube videos (he sets a timer). I wish we weren't starting our days with screen time but...mornings are much more peaceful. I'd say it works about 75% of the time. YMMV, of course (and I'm home in the mornings to monitor) but wanted to share in case you can find something your kid is similarly motivated by. My kid is not motivated by "getting to school on time," ha.
posted by Empidonax at 9:40 AM on January 29, 2020 [1 favorite]

Best answer: For me, if I take my stimulant ADHD meds (adderall xr) too soon before I have to Be Outside and Responsible, it can feel very tense and stressful. I mostly solved this by being able to spend like 3-4 hours after waking up just faffing around the house, but since that presumably won't work in his case, he can try what I did when I was still working, which is to set an absurdly early alarm, take the meds, go back to sleep, and wake up at the regular time.

The first burst of medicated alertness can be mentally and psychologically taxing even when the medication itself provides undeniable benefits, but IME it's very easy to go back to sleep after taking it, especially if it's an extended release medication. If the anxiety persists it might be worthwhile looking into an extended release formulation if he's not already taking one, as that works a lot better for me personally with it's slower build and ore gentle tapering off at the end of the day.

Another option to look into are the Daytrana patches, which are basically just ritalin in a transdermal patch. You're not locked into a time of day to take it, it can stay on longer in the afternoon if you need it for studying, or take it off earlier if you feel like having an earlier bedtime. It can have some skin irritation side effects if he's doing sweaty athletics, but it's easy enough to remove and put back on afterwards. I did end up having some weird asthma related side effects but my neurologist was like "this never happens to normal ppl" so it's probably pretty rare/unusual. It's expensive even with good health insurance, unfortunately, but was the closest I ever came to declaring something ADHD-related a miracle drug.

NB I'm basing all this advice on my potentially incorrect assumption that his morning anxiety is medication-exacerbated, as mine is, so obviously YMMV. The fact that he's persistently the same amount of time anxiously late as it takes for some ADHD meds to "level out" is what's making me think this.
posted by poffin boffin at 9:47 AM on January 29, 2020 [3 favorites]

I agree that 12 is pretty young to be doing all this on his own, or at the very least, maybe it's too much for this particular 12 year old. Could you make his lunch for him the night before? Is breakfast really easy (i.e. cereal)? Is he responsible for waking up at a certain time too? Maybe he just needs more time to get ready in the morning.

Is he deadline-driven? It honestly stresses me out more when I don't have to be somewhere by a particular time (i.e. where a school doesn't care if you're late).
posted by purple_bird at 10:11 AM on January 29, 2020 [1 favorite]

Breakfast can be a protein bar in the backpack and communication with the teacher to remind him it is there if he hasn't eaten it yet.

I got my adult partner this clock to help with time blindness. Perhaps you could add images of the various tasks at different points along the timer, to break down the steps in time visually.
posted by crunchy potato at 10:16 AM on January 29, 2020

I have ADHD and I too HATE MORNINGS! I wrote a longer comment below with specific strategies but reading it over, I think the main takeaway is: The best time to do anything requiring executive functioning is when you're medicated.

I take my Concerta, then go back to sleep for an hour, then get up and get ready. Sometimes I sleep the entire hour, sometimes not. This is the single biggest intervention that took me from being hours late for work and school on a weekly basis to being mostly within 10 minutes of on-time.

I use alarms on my phone for this, but for a parent helping a kid, I would suggest starting with you waking him for the meds (probably as you're leaving for work?), then transitioning him to a loud alarm clock across the room, then eventually to independent.

It's also very helpful to set an alarm for when I have to leave, or when I have to put my shoes on.

Agree with other posters about moving all of the executive function stuff to night or weekend. I try to meal prep on the weekends for lunch (12 is definitely old enough to be learning some chop-and-dump CrockPot meals, which are more or less the only thing I make) and lay out my work wardrobe for the week (I have hangers with tags for Monday-Friday). Doing a big Sunday prep is also good because it gets you in the habit of thinking about the week ahead and planning ("I don't need lunch on Thursday because I'm working a half-day, I'm going to a community meeting on Tuesday so I need my logo polo, oh, I need to call the mechanic for an oil change Thursday afternoon, I should print brochures tomorrow because I won't have time Tuesday because I have another meeting right before, oh, I need to pull that file..." Obviously for a kid the specifics will be different but the principle holds). That kind of planning doesn't come naturally to Team ADD so you have to practice and train it.

For me, if I'm overwhelmed, it's either because I have to choose something and get stuck, or because I can't break the task down enough. So I might get stuck on "make lunch" because I have choose what to make, which I solve by doing it on the weekend or night before, or because there are too many steps, in which case a more specific checklist might help ("Take out bread, mustard, ham, cheese, sandwich bag, plate, and knife. Make sandwich. Close food items and put away. Put sandwich in bag. Put bag in lunch bag.") You would have to talk to N. and maybe play around a bit with different strategies to figure out which of those, if either, is tripping him up mornings.

If there's no consequence (positive or negative) for being late to school, it can help to make one. Make sure it is positive! I sometimes buy myself a bunch of, like, drugstore eyeshadow and barrettes and stuff and dole them out to myself one-by-one for being on time a certain number of days in a row. The key is to find the right number of days and a decent enough reward.

Also, solidarity to N. Mornings suck but they can get better.
posted by Snarl Furillo at 10:49 AM on January 29, 2020 [2 favorites]

...having a reward for him when he's ready on time.

My 12 yo doesn't think he's being rushed when he's setting the pace, and getting ready early so he can read the comics or some other time-waster really works for him. (Except if he's wicked over-tired. When he stays up all night reading with a flashlight there's no hope for anyone, the little creep.) Now if he gets too accustomed to having the time and starts freaking out about losing it you've just added a new pressure, so use your parental insights here.
posted by Cris E at 5:56 PM on January 29, 2020 [1 favorite]

My kid and ex are doing something like this, both ADHD and kid is ten. Lunch is always prepped the night before, for both. Breakfast is the exact same thing. She bathes at night time so only needs to wash her face, brush her teeth and hair - all of those things are packaged together into one routine in her bathroom. They usually have breakfast together, he showers while she takes care of her toiletry, then he goes to work and she leaves for school a half an hour or so later. There is an alarm for when she leaves, and whatever she needs is already in her bag, outfit/uniform laid out. It means she can take her time eating and getting dressed, and isn't under a massive looming NOW NOW NOW alarm. Her meds are on the counter in the kitchen, along with toothbrush and toothpaste, keys and shoes by the door.

It doesn't always work, occasionally lunch is left somewhere in the house, or keys, or homework, or someone is late or forgets a special event. But that is what works for them in their house, and they are both reasonably happy in the morning.

She also follows a very similar routine on the weekend, even with me at my house.
posted by geek anachronism at 11:06 PM on January 29, 2020

As an adult with ADD, just wanted to nth the suggestion to rethink the timing of the meds. For me, I'd need to take them earlier than your kid is in order for them to be at all helpful with getting ready for school. (Also if you can ensure he takes it before you leave, that gives him one less thing to remember himself).

Your kid might be the opposite of me, like poffin boffin, but either way it's probably worth doing a bit of experimentation, especially when combined with some of the other excellent suggestions above.
posted by forza at 11:41 PM on January 29, 2020

Is he stressed by the routine, or by the idea of going to school?

If it's the routine, I strongly cosign the above suggestions to take medication earlier, move prep to the day before, and consider using Brili for the morning routine checklist. Brili has made a HUGE difference in my ability to be out the door on time, because it shows me what time I'll be done with the whole routine if I continue at my normal pace so I know when I'm ahead or behind.

If it's the idea of going school, that would take a different intervention.
posted by squasher at 12:25 PM on January 30, 2020