Help me help my young adult with ADD
January 11, 2010 3:47 PM   Subscribe

Young adult ADD: I'm the mother of an almost 19-year-son with long-diagnosed ADD. I'm looking for ways to help him transition from being a kid with ADD to an adult with ADD, tips on medications, life strategies, etc.

My 18-old-son was diagnosed with ADD in the first grade and has been on medication ever since (Adderall at first, then a period of Wellbutrin because Adderall made him too "flat", and for the last several years Concerta), along with IEPs in the school setting. Over the middle school/high school years, he became more and more resistant to taking his medication as he says he doesn't like the way it makes him feel ("too flat") and the last year of high school he was rarely taking medication at all. He barely squeaked by grade-wise.

He graduated high school in May, started at community college in the fall, got a part-time job which he seemed to enjoy. Fast forward to end of semester and the discovery that he failed his classes and lost his job, both primarily due to lack of attendance. During this time he was extremely resistant and refused to take medication for his ADD.

Last week when we (his parents) discovered the failing grades and the loss of the job, his hypercritical father (whom I am no longer married to) predictably became irate, saying some very hurtful things to my son, and my son moved out of his father's house and back in with me (we have always had fluid living arrangement and it's not unusual for him to live with one parent a while and then another a while) and his dad says he has "washed his hands of it."

In the week since he's been back under my roof he has started a new semester at community college (important so that he can keep his health insurance coverage) and I have made an appointment for us to see his pediatrician to discuss transitioning to a physician with experience treating adult ADD, hopefully to get started on a new, more successful medication, and to discuss the possibility of personal and/or family counseling, although, again my son is very resistant to the idea of counseling of any sort. I also wonder if he is not at least mildly depressed and has been for a long time; since he was about in fifth grade we have occasionally had comments from teachers regarding his affect, he sleeps more than normal I think (even for a teenager) and depression issues run in my family. This was never pursued when he was younger as his father was adamantly against any sort of therapy and would not have been open to medication therapy for depression.

My questions are on two fronts:

-- First, how can I, as the mom, be of most help to my son. I don't want to be an micro-managing over-controlling parent and I want him to take responsibility for himself and his issues, but I also want to be supportive and helpful and give him whatever support he needs until he is capable of managing this himself.

-- Secondly, what can he do to educate himself about adult ADD strategies and life hacks, etc. I think he still very much sees ADD as a "kid" issue not something that many "cool" adults have to learn to deal with in ,their daily lives. Right now the things I try to encourage, like structure, routine, regular sleeping times, etc, are NOT appealing to him at all.

It's hard to separate the wheat from the chaff, so any books, websites, reading materials either directed at parents of young adults with ADD or to the young adult themselves would be appreciated. Even more appreciated would be your antecdotes, experiences and successful medications and other interventions as either a parent or as the person with ADD. I plan on sharing the appropriate answers with him.

We live in the RDU/Triangle area, so if anyone knows an outstanding physician or program that would be appropriate for a situation like this, that would be a bonus!!

Thanks for your help!
posted by SweetTeaAndABiscuit to Health & Fitness (8 answers total) 3 users marked this as a favorite
Response by poster: P.S. I should also say that other than his ADD issues and possible depression, he seems to be a fairly well-adjusted kid, outgoing, with friends and a social life and no other behavior issues other than a tendency for him to lie when he hasn't done what is expected (take his medicine, go to school, do his homework, etc) which I tend to attribute to his experiences with his hypercritical father, although I realize my son needs to take responsibility for this behavior himself.
posted by SweetTeaAndABiscuit at 3:52 PM on January 11, 2010

Duke University Medical Center appears to have an ADD/ADHD program that includes college students and so may be worth investigating. The website also links to other organizations that this program has found useful.
posted by beaning at 4:51 PM on January 11, 2010

I am two years later in this process. My son flunked out of the second semester of community college, after barely passing the first one. He then lost a couple more jobs, moved out with some friends and then moved back in when he couldn't swing the expenses. We then paid tuition at a bartending school because that's what he wanted to do. He's now living at home and has found a job waiting tables/bartending at a place he really likes. The hours appeal to him, and the owner of the place was patient with his learning curve because he liked him, I think. Not a bad way to make a living if you're 21 (but not great ten years later) but the upside is that he can pretty much always find a job. Older brother states that bartending is the sure-fire way to figure out you need to go back to college. He does not have medical insurance, along with millions of other Americans. Tuition is more expensive than a bare-bones medical insurance premium, anyway, so if that's the only reason your son is still in school it really isn't cost-effective. We don't charge our son rent, but don't pay any of his expenses either, except for food. The best motivation was that we don't give him any money, period. If he wants to hang out with friends and do whatever, he's gotta pay his way. If he's broke, he stays home. He's finding his way, it's just going to take a little longer.
posted by raisingsand at 5:03 PM on January 11, 2010 [2 favorites]

I feel like there is a big part of this story missing. What does your son want to do?

He's an adult now. You will not be able to force him into medication, therapy, college, etc. Please keep this in mind, because although you mean well, you sound like you are talking about a minor child, not an adult. If you continue to treat him like a child who isn't 'smart enough to know what's best,' I guarantee you will continue to see him live up to your expectations.

Likewise, if you make college funding/place to live/car conditional upon his taking meds, etc., expect that you will get lip service, a fake show, and then eventually he will slack off again.

Do you really want to see your son transition into a successful adult? Then I suggest you support his decisions and allow him to accept and enjoy the full benefits and consequences of his choices with an open mind.

This is a great chance to teach your son a valuable lesson about being a responsible adult by first changing how you relate to him. I'm thinking of some sort of "co-familying" type-phrase for this that would mean instead of decisions coming by fiat (from parent to child) you will work together or allow him the time and respect to work out his path on his own - ideally some combination thereof.

(FWIW - I am not a parent or a doctor, but I urge you not to make the same mistakes my divorced parents made with my younger (add) brother. As we matured to college-age, they treated us like crap, and we performed crap, until we broke free in our own ways. YMMV.)
posted by jbenben at 5:09 PM on January 11, 2010 [1 favorite]

Datapoint: my younger brother had a remarkably similar path. ADD, hated the way the medicine made him feel. Quit taking it after high school. Quit college a few times, but did finally complete a 2-year degree. He delivered pizzas, worked in fast food, and lived in various sketchy arrangements before finally getting a great job in a field he loves. That happened about age 25. Now he has a great apartment by himself, a great job, hobbies, friends...he hit his stride, just a lot later than most kids. And caused my parents a lot of grey hair in the meantime.
posted by shopefowler at 8:36 PM on January 11, 2010

Best answer: Ok, so I'm about eight years out from where your son is, partial successful, partially not. I was also diagnosed in first grade, put on meds in fourth (the years from first through fourth were, quite possibly, the worst of my life- I have no problem taking my meds on a daily basis, as long as I can remember where I put them (after writing this, I realized that I didn't and spent ten minutes hunting through various bags and pockets until I found the new bottle)). I pulled through high school with a decent GPA and went to a four year college, so part of what I'm going to describe may not be relevant, but I'm going to try.

ADHD as an adult is different than having it as a kid. It doesn't go away, it just changes. Maybe by the time he's 30 he'll be over most of it, but at the age of 19, he's still in the grips of it. The hyperactivity will probably have died down by now, but the inattention issues, the executive function and the organizational stuff will haunt him for a while now.

My first big recomendation, if you can afford it, is CBT therapy. I've been doing it for two years now and it's helped me get over some of my ingrained habits that caused me all sorts of problems. As my shrink said "I taught myself to fail." It wouldn't surprise me if he's done something of the same, not seeing himself as a reliable person, he self-sabotages himself in both school and work. I got through college but had to take two leaves of absence to do it. I'm currently on leave from my grad program, hoping that my delay in contact the dean won't mean that I have to wait another semester to return.

Which brings me to my second point. As much as things get better, they are never fixed. This will be an ongoing battle for him. Unfortunately, that's something he's going to have to learn for himself. Realizing this is, quite possibly, what he needs most.

As for how much supervision, I'm really torn on this. As his mother, you are, perhaps, the worst person in the world to hold him accountable (here I'm generalizing from my own experience, but my parents being the ones to hold me accountable almost always backfired). The problem with ADHD is that the self-accountability is very weak (cf your note about him losing his job and failing and my mention of executive function). Sitting down with him to brainstorm some accountability habits is probably your best bet. I started carrying around a day timer, on paper, and that helped me immensely, as did a small notebook. Both of these easily fit into any pocket. I shy away from to-do lists personally, but they may work for him. The trick to it is not to dismiss any strategy until he has tried it for at least two weeks if not more, long enough that it could become a habit. Any less and it isn't really trying it. The other thing to watch for is the tendency to drop the habit after a certain period of time, when things are going right.

As for meds, as I said, I have no problem with mine. If he has trouble with stimulant medication, there is Statera, although that comes with a black box warning and messed me up when I took it. (DO NOT have him take it with a stimulant at the same time. My shrink at the time put me on it in addition to concerta and that was part of the problem.) How much caffeine does he consume? I know plenty of people with ADHD who self medicate with coffee or soda. And a few who do so with pot, although for me, it never did anything to help, so I wouldn't really recommend it.

Also, with medication, what was his dosage? Could he go onto a lower dosage, and would that make him feel less flat? There is always some personality change with any medication that does anything to the brain, but this might reduce it while still helping him out. He does need to be honest about his medication habits though. If he stops taking something, he needs to tell people so they can figure out how to help him without the meds.

As a wrap up, I'm going to reiterate what I said before. Cognitive-behavioral therapy (CBT) works really well for ADHD. And it doesn't require meds. You might want to see if he is open to that, as the therapy is straight forward, problem solving (no "tell me about your mother") and done by a psychologist, so there is no push for any drugs.

Re-reading your post, the first thing is he needs to be honest with himself about ADHD. Arguing with him about it probably won't help, and on this front I don't have much advice. As this comment is getting into the serious essay range (instead of just the short essay range), feel free to MeMail me if you want to chat about this more.

Good luck with all this. And if you find a way that helps him keep his room clean, please let me know. I'm still struggling with that.
posted by Hactar at 9:37 PM on January 11, 2010 [2 favorites]

For depression: the gym. Or exercise of any sort.
posted by dfriedman at 10:39 PM on January 11, 2010

You need to work with a Psychologist and Psychiatrist. The physician can prescribe the meds, but they really are the best folks to deal the the ADHD. It is important that they specialize in ADHD in adults, if there is someone in your area.

I was diagnosed 4 years ago ( I am in my late 30's)

I know what he is saying about the meds, I struggle with it too. Bottom line is he needs to weigh the cost of not taking them. It's his life, his body he is ultimately responsible.

Also check out this site. It is a great resource for ADDr's and their loved ones.

If your ex-husband would be up for it I would be willing exchange emails with him about my experiences with my very well intentioned, and strict parents. Your assessment that his approach is counter productive is in line with my experience and many psychologists in the field.

I also did these courses and they helped but are not a substitute for treatment. They will benefit you and your ex-husband in dealing him as well. They are not directly related to ADHD but they do help.
posted by empty vessel at 1:01 PM on January 12, 2010

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