Could this anger be due to ADHD?
January 9, 2016 2:55 PM   Subscribe

How can I help my family deal with my adult brother's potentially violent behavior? I live several states away, and he recently started ADHD meds as an adult.

Thanks for reading. Here's the background.

I've lived far away and had my own life for many years now. My much younger brother (22 yr) is still in the local college and living at home with my parents.

All his life he's had difficulty with school and making friends. It was hard to carry a conversation with him because he'd say random things or get distracted, and he'd make lots of mistakes in school and forget about deadlines. I don't know why he was never diagnosed as ADHD (I think there was a backlash against diagnosing too many kids at that time), but they did take him to speech therapists (he had a lisp) and spent hours with him every night on homework help.

Six months ago, my mom convinced him to start taking ADHD meds. I think it's Adderall, but not sure. The difference in him was really startling. It was like he got way smarter and more aware instantly, noticeable even in casual conversation. However, while my brother has been fine to me, my mom says there's a dark side. Apparently he has turned really mean and on the verge of violent to them. She doesn't know if she should be afraid of him.

He is angry at my parents for a "shitty childhood" and not taking care of him earlier. My mom has her flaws, but she sacrificed her whole life to be a stay at home mom and help us. Our family had problems, like my dad being stressed when we were younger and very irritable with us, but I've gotten over it as I've put it in context as an adult.

However, my brother is so upset by all these old things that he has ruined my mom's purse by pouring coffee in it. He wakes up at 3AM and stomps on the floor (which is above their bed) so they can't sleep. He bangs on their bedroom door, so my mom is scared. He recently went away for a semester abroad and writes my mom nasty emails telling her she is a bitch. My grandmother is near the end of her life, and he told her she was an asshole. He bought her a Christmas gift, broke it, and sent it to her in the mail. He picks fights with relatives we haven't talked to in years.

My parents are saying they won't let him move back into the house when he gets home from his semester abroad. I hope they live up to that - I don't want them to get taken advantage of by him. I'm shocked by this - he was always a quiet kid who liked taking care of others. They said his psychiatrist gives him 15 min appointments and he bluffs his way through them. The psychiatrist won't let them speak to him alone, and the one family therapy session only resulted in worse behavior afterwards they said.

What on earth can I do to help? Is it normal to have pent-up rage if you start ADHD meds as an adult? All of this started at that time. Should my mom and dad be afraid of his behavior? I feel like there's more she's also not telling me. What should they do when he gets home? He has enough credits to graduate, but will have a hard time finding a good / professional-level job.
posted by hyperion to Human Relations (16 answers total)
I don't doubt your story, but where in this Ask have you spoken to your brother about his behavior?

It sounds like you are hearing this from your parents and that you are all still treating him like he's a little kid.

Yes, treating an adult like he's five years old results in rage. Similarly, it does sound like he's been missing out on developmental skills from his youth, and that coupled with his dramatic cognitive improvement could be giving him significant problems.

Talk to him. Then update.
posted by jbenben at 3:20 PM on January 9, 2016 [2 favorites]

A lot of ADHD meds are amphetamines, amphetamines are known for making people edgy, angry, irritable, etc. Adderall is pretty addictive and aggressive behavior is an indication of a side-effect and taking more of the drug than is prescribed.

Since your brother is an adult, all you can do is suggest that he discuss this behavior, and his feelings with his doctors and investigate other meds. If he's unwilling to do this, there's nothing to do but cut ties until he's willing to seek help.

Your parents have a perfect right not to have him back in their home. They've taken care of him into adulthood and if he chooses to be hostile to them, to be abusive to them and other family members, they're within their rights to bar him from their home.

At 22 your brother is a grown man, and if he's not willing to be nice to your parents, he can simply arrange for his own housing by finding a job or two and getting an apartment of his own. Your parents don't owe a nasty, mean and destructive person a home, and the world doesn't owe your brother a professional-level job. He can get two kind-of okay jobs to support himself, as so many of us have done before.

If you think an intervention is in order, you can try it. But Adderall is a bitch.
posted by Ruthless Bunny at 3:26 PM on January 9, 2016 [7 favorites]

Seconding everything RB said above, wanted to add that you generally cannot solve other people's behavioral health issues, you especially can't do so from a distance and with only second-hand information.
posted by PMdixon at 3:29 PM on January 9, 2016 [1 favorite]

One-on-one therapy has been great at helping me get some perspective on my interactions with family members, real and imagined. It can be great for understanding where they're coming from and definitely with forgiveness. With your brother's new medication, he's probably now having to face various conflucts and issues that have been making him unhappy, however he doesn't have the confusion/avoidance level that he had before the meds. I don't know if that makes sense - basically as he gets healthier, the feelings he's been able to supress are coming to the surface. I'd reccommend 1:1 therapy for him.
posted by bendy at 3:46 PM on January 9, 2016 [3 favorites]

This could absolutely be a side effect of medication. I know two people who discontinued their add medicine and switched to another (with doctor's approval) because of anger issues. One person was on Wellbutrin, and I can't recall what the other was on.
posted by amarynth at 4:06 PM on January 9, 2016 [1 favorite]

Yeah - I am close to someone who got extremely irritable on ADHD meds, and wasn't positioned to recognize it. It took not only his girlfriend and family mentioning this to him, but his good buddy sitting him down to explain that he was acting like an asshole for him to recognize that the meds were having this effect. Resistance to this idea came from the impact the diagnosis had on him - it was a powerful revelation, an explanation for the ways and reasons his life hadn't been working until then.

And the diagnosis was tied in his mind to the meds that were helping him in other ways. Once he recognized what was happening with the side effects (after his buddy's intervention), he went off the meds and looked to non-drug ways of managing the ADHD. It took work with a therapist experienced in helping people with ADHD for him to understand that this was no less useful a way of dealing with things, and that going off the drug didn't invalidate the diagnosis.

I imagine that your brother, like the person I'm close to, has a lot of ambivalence about the answer the diagnosis provided, and is grieving the time lost before it. Things I heard my close person say about their parents: "Why didn't you help me when you knew I wasn't functioning? Anyone could see things were wrong!" And a lot of anger, too, about the moralizing around his behaviour that happened before the diagnosis. Before your brother understood that he had ADHD, he probably heard - from a lot of people - that he was just a bad kid, that something was wrong with him. That is deep and painful stuff. It's not just his age, I think, although obviously it's playing a role; it's the fact that this diagnosis has completely shifted his narrative, and he's got big feels about it. Because of the side effects of those meds, his feels are looking like Godzilla going to town.

Has anyone other than your parents, someone your brother trusts, noticed that he's acting like a jerk? Could they talk to him? Maybe another family session would help. The psychiatrist *should* be aware of these effects. Your brother should also see a therapist experienced in dealing with ADHD. And you and your parents would benefit from learning more about ADHD, treatment for it, and the meds he's taking. Because without a really good grasp of that framework, of course it's going to be hard to make sense of his behaviour.

Personally, I think cutting ties isn't going to help anyone, though I do think setting boundaries on his more outrageous behaviour - while understanding that it's the meds, not him - needs to happen, if he is not yet at the point where he is ready to agree that the particular solution that emerged from his answer isn't working (and he is too invested in the diagnosis and the narrative, and tying the meds to that). I think that validating his sense of loss and grief and anger about the impact his disorder has had on his life - when he is calm - would go a long way towards creating more trust. That's a lot of work, but I think the outcomes would be better for everyone.
posted by cotton dress sock at 4:11 PM on January 9, 2016 [16 favorites]

The psychiatrist won't let them speak to him alone

This makes sense as he is the p-docs patient. But they can certainly write his pdoc a brief, bullet-point letter factually explaining your brother's behaviour and that he is no longer welcome in their house due to the threat of violence. Whether the pdoc takes the information seriously, if only to limit the pdoc's own liability, is out of your hands but it is a concrete action they can take.
posted by saucysault at 6:14 PM on January 9, 2016 [3 favorites]

This is anecdotal, but I found that being on Adderall made me angry all of the time, to the point that I discontinued it because I hated that I was turning into an asshole. Concerta, another ADD medication, had nothing like the same effects for me.

All of which is to say: it very well could be the medication, and there might be meds that treat the ADD that don't turn him into a raging asshole. But I nth all the observations above that there's not much you can do secondhand like this. Maybe suggest the possibility of trying alternate ADD medications to him to bring up with his psychiatrist? If you're worried that he won't be receptive, see if you can start a conversation with him in which he talks about some of the side effects (whatever he perceives them to be), and raise it as a solution to those.
posted by forza at 6:25 PM on January 9, 2016

I can't really say with regard to what the medication may or may not be doing, but the behavior your mom is reporting is frightening.

I honestly wouldn't get in between by calling him and reporting back to him what your parents have said. What if he totally denies it? If you talk to him, maybe ask him something neutral about how he's feeling on the meds and see if he wants to share with you, but I wouldn't be all "Mom says..."

About this:

He is angry at my parents for a "shitty childhood" and not taking care of him earlier. My mom has her flaws, but she sacrificed her whole life to be a stay at home mom and help us. Our family had problems, like my dad being stressed when we were younger and very irritable with us, but I've gotten over it as I've put it in context as an adult.

Siblings can have completely different ideas of what their childhoods and parents were like. Especially if you have a large age difference as you seem to suggest, and he faced challenges you didn't, they might have been completely different parents to him. I wouldn't downplay or disregard his experiences. You say you don't really know why he didn't get diagnosed earlier and think it was because of a backlash against treatment - he might think that your parents didn't try hard enough to get him the right diagnosis, or maybe had shame over it, or hoped it could go away. He might be right about that, maybe not.

More than anything, everyone, including you, has to stop treating him like a child and not a 22 year old man. Your parents are taking a very good step in this direction by not allowing him to stay with them when he returns. He has to decide what to do about the meds. A psychiatrist is of course not going to consult the parents of a 22 year old man.

I know this position very well, as the older sibling (though maybe not such a big difference) who lives states away and the younger sibling being scary and living at home. You have to set boundaries with all of them - you're not going to "help," but can be a sympathetic ear, encourage EVERYONE to get therapy, you too. It's really easy to get into a situation where you want to help out, especially if it seems temporary or out of character, and then having it drag on for years.

I would take all this to a therapist and have them help you with a plan for this.
posted by sweetkid at 6:28 PM on January 9, 2016 [4 favorites]

I just want to add that I don't think his behavior is just angry or asshole, it's really aggressive, with the coffee in your mom's handbag, and breaking a gift for your dying grandma and sending it to her. I'm not saying it's not the meds or it's permanent or anything, but I think it's good that your parents recognize this as scary behavior they don't want around themselves, wherever it came from. My parents just ignored/downplayed my brother's scary behavior for years, which made it worse, and now he's in his 30s and still a super angry person who takes it all out on the family, especially me, so I quit "helping."
posted by sweetkid at 6:31 PM on January 9, 2016 [1 favorite]

I have a family member who was addicted to Adderall and did a lot of impulsive, horrible things. I don't have enough information to tell you if this is what is happening, but it pinged a familiar scenario for me so that is what I suspect. Her psychiatrist also would let her bluff her way through appointments until finally everything came to a head during a confrontation and she agreed to let me come to her appointment with the psychiatrist, where she then admitted her addiction to him. Shockingly, he knew she had a problem but continued to prescribe her the medication because...I don't know? He's the worst? (I quote, "yeah, she would always be out of the medication immediately and give me an implausible excuse that she needed more so I had a hunch.")

Whatever the case, this psychiatrist isn't working for your brother. There's not much you can do but I would speak to your parents about setting FIRM boundaries with him. The behavior you have described is scary. It's not their job or your job to make sure he has a job when he gets home. I don't think 22 is too old to have parental involvement, but that doesn't apply to someone like your brother who is acting violently towards family. Accept that he might not want help for a long time. You and your parents should definitely seek (individual) therapy for help with setting boundaries with someone acting like this.

I was lucky enough that my family member listened to me after I absolutely lost my shit with her about how things had to change (I don't recommend this, it ended with her threatening suicide and me having to call 911.) But it took years to resolve and I lost a lot of time trying to help her. The best thing you can do, regardless of what your brother is going through (addiction, mental illness, just a bad reaction to the ADHD meds), is to take care of yourself first.
posted by the thorn bushes have roses at 6:38 PM on January 9, 2016 [1 favorite]

I read the topic of this post and I was all set to come in and say, "oh, yes, emotional volatility and anger! Totally an ADHD thing." But I was thinking of things like "getting angry quickly and yelling a lot." Not pour coffee into a handbag. Not premeditated. Not grudges.
posted by instamatic at 6:42 PM on January 9, 2016 [2 favorites]

Two things based on my own experience of being diagnosed with ADHD in my twenties.

1. I also went through a period of being angry with my family. The clarity of the meds enabled me to see a lot of things about my childhood which I'd never really dealt with before. And I was definitely angry about the fallout from a childhood with undiagnosed ADHD. I was seeing a therapist at the time and apparently this phase is extremely common among people who are diagnosed as adults. For me it did pass.

2. I was on Adderall for a while and I did not like the effects it had on me. Frankly, it made me somewhat manic. I switched to Ritalin and have had no negative side effects. Drugs don't always work well with a person's brain chemistry.

None of this is to excuse his behavior, which sounds unacceptable for an adult, but just to confirm that it could be ADHD related. Have you talked to him?
posted by the essence of class and fanciness at 10:36 PM on January 9, 2016

Adderall makes me irritable but I know this and generally don't let it affect my behavior beyond a snappish tone of voice.

He might be on too high of a dose or needs to learn to practice self-awareness and to not act on his drug-induced anger.
posted by Jacqueline at 3:21 AM on January 10, 2016

I have ADHD. If anything, Adderall helps me chill out.

If ADHD meds lead to him being agitated and prone to anger and rage, like, oh, an average person on amphetamines, then maybe his diagnosis and medication need work. The fact that he's more focused when he is on ADHD meds doesn't mean he's got ADHD, most people get more focused on ADHD meds, thats why students use them as a study drug.

At the same time, its not hard to imagine that now that he sees the difference between his life with treatment and his life before, that he's feeling frustration and anger. Even so, he's a young adult now, and part of being a young adult is taking responsibility for your own life. Not going home seems like a great step in that direction. I think ongoing therapy with someone who has expertise with adult ADHD would also be beneficial, in addition to whatever medication het gets.
posted by Good Brain at 4:05 PM on January 10, 2016

IANAD: however, amphetamines can cause mania and psychosis in a minority of people, especially if abused. That can absolutely include suspicious, aggressive, and hostile behavior. Maybe he's just going through something emotionally, but I think you or someone in your family needs to tell his psychiatrist about his behavior in very concrete terms, in case this is a reaction to his medication. A letter is a good idea. The good news is that if this is a reaction to medication, his behavior is very likely to normalize when the drug is stopped. There are other options for treating ADHD.
posted by en forme de poire at 4:38 PM on January 27, 2016

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