How to help a flailing ADHD/ODD teenager live happy and productive life?
December 23, 2018 3:21 PM   Subscribe

“Ben,” an 18-year old male family member with diagnosed ADHD (medicated) and probably ODD (can't remember if there’s been an official diagnosis, but he fits the DSM-5 criteria to a T), is struggling while also making life miserable for his mother and siblings. Mr. Carmicha and I would like to help. Ben’s mother, who is exasperated and exhausted, is open to all ideas. Can any MeFites recommend experiential and/or residential programs for his mother’s consideration that could help Ben turn the corner and enjoy a happy, productive life? TW: suicide.

“Ben” is a high school senior, but will not graduate this year due to the behavioral dimensions of his ADHD/ODD; he barely goes to class or does homework, skips his therapy appointments, doesn’t help around the house, breaks stuff that belongs to other people, and can’t care for his own cat, let alone hold down a job. Instead, he holes up in his mother’s basement and self-medicates through sleep, weed, food, video games, girlfriends, and driving around in his car. Consequently, there’s also concern that he’s also suffering from depression, particularly as he’s admitted to suicide ideation within the last year.

But Ben also has legitimate situational reasons to be at sea. Ben was a star athlete with dreams of greatness before he suffered a career-ending injury. Ben’s sport was a huge aspect of his identity, especially since it was the only thing about his life that interested his deadbeat father. Now that’s gone forever, to the point where Ben isn’t even interested in sport-adjacent pursuits or careers. Ben pays lip service to another interest/career direction, but isn’t doing the work it requires; he’s dabbling. His high school guidance counselor is focused on following the letter of Ben’s IEP and the path to graduation, now non-existent since Ben blew off his first semester final exams.

Lately, Ben has become increasingly explosive and defiant. He torments younger family members, argues about everything, says hateful things, and is becoming physically aggressive, punching walls, throwing things and the like. The younger siblings no longer feel safe alone at home with him because anything can set him off. Ben’s getting involved in minor skirmishes with law enforcement, e.g., picking up speeding tickets, but he also stole and wrecked a car, escaping punishment because it belonged to a family friend and the police looked the other way. More recently, it turned out that Ben was breaking into an empty family property and hosting alcohol/weed parties there, for which there were also no consequences. Some day his luck will run out and he’ll be arrested.

In general, sad to say, no one has ever really consistently enforced discipline, or enacted consequences with Ben, so he's gotten away with a lot. Ben’s “difficult” behavior was “managed” by giving in to keep the peace. Now, as when he was a little kid, Ben’s behavior means his family walks on eggshells around him; they’re all afraid of his outbursts. Since he rules the roost, Ben has an inflated sense of himself and shows little empathy for others, deeming everyone to be fools; that’s why a “Scared Straight”-style program would likely have little impact. Ben has no real plan beyond insisting that he can pull of whatever 11th hour miracle a situation requires (narrator: he can’t). Ben enjoys several privileges, and knows the right words to say, so he’s also successfully talked his way out of various comeuppances. He can be charming, but most of the time he’s an infuriating jerk. To some extent, I think he’s compensating for lacking any sense of mastery or purpose by treating everyone and everything dismissively at best.

Ben claims he wants to move into his own apartment, but at heart, he’s a homebody who doesn’t really want to live independently. But it’s becoming increasingly obvious that he cannot stay at home any longer, with or without the obvious slew of conditions, e.g., go to school, etc. His presence is burdening everyone around him, especially the younger siblings. Ideas have surfaced about setting Ben up in an apartment and providing support which would be gradually withdrawn as he became self-sufficient. But there’s no way Ben can manage independent life and he’s not qualified for college, the military, training in the trades, etc. since he refuses to attend school, obtain his GED, comply with rules/expectations, or perform either physical or mental labor. If provided with an apartment anywhere nearby, Ben’s mother thinks he will just come home (breaking in if necessary) while everyone’s at work/school to raid the fridge and mess with his siblings’ heads by screwing with their stuff.

Ben’s mother doesn’t feel that she has standing to enforce anything or require him to do anything, including solutions like those I’m seeking via this question, because he is 18. Ben’s father has minimal contact or influence. Earlier in Ben’s high school career, there was talk of sending him to boarding school, but it went nowhere. More recently, Ben rejected the idea of transferring to or enrolling for a 5th year at a prep school.

Ben is not a blood relative of mine, but there’s a ton of suicide in my family and so I worry. I want for him to be in a setting where there are people trained to recognize mental health issues, distinguish them from behavioral issues, and intervene. IMO, he needs a place that will challenge him, replicate the team commitment to others that he lost after the sports injury, help him regain his sense of self, offer therapy and medication adjustment if necessary, and provide enough supervision and structure that he succeeds, but not so much (e.g., military school) that he washes out immediately and irretrievably.

But what does that look like? Is it Outward Bound or similar? A group home? Some sort of academic institution geared towards kids like Ben? What are your experiences? Anywhere specific we should investigate? Useful Facebook groups/SubReddits/online communities for concerned parents and family? Fortunately, money is not a factor. Feel free to MeMail me if you prefer.

TL;DR I’m at a loss for how to help a flailing and failing ADHD/ODD 18-year-old young man and seek recommendations, for his mother to consider, of treatment programs ranging from experiential learning opportunities to residential facilities to educational institutions. Thanks, MeFi!
posted by carmicha to Human Relations (8 answers total) 1 user marked this as a favorite
From what I'm reading, Ben is an adult and, as such, any treatment programs are going to require him to consent to attending and to continue once there - with the exception, perhaps, of something court-ordered (which isn't going to happen if people keep preventing him from legal consequences of bad decisions - a decision which I understand, btw, since the legal system has many, many failings). One of the hallmarks of ODD is finding it very difficult to do something that others want you to do - and, generally speaking, doing the opposite. Getting Ben to buy in to a program is going to be a huge challenge.

The best way to help a flailing and failing young man is likely to be supporting his family - you mentioned therapy for Ben (and his lack of attendance) but are his mom and siblings getting any help to deal with what must be really conflicting emotions? They're essentially being held hostage by him and while they can see the problems, to some extent, they feel they can't do anything to change what's happening. That's exhausting and, as you noted, a huge burden on everyone. Can you support them in finding a therapist for individual and family counselling (with or without Ben)?

Ideally, they'd get help to set boundaries, enforce boundaries, determine what's helpful vs enabling, and to figure out how to handle all of the feelings that come up - - which, in turn, allows Ben to find his own path. It's not going to be easy. Ben is likely to make some crappy decisions (which most of us do in our early adult years, to varying degrees) and it's going to suck, but it'll suck less if the family has a stockpile of resiliency, isn't carrying guilt, etc.
posted by VioletU at 4:30 PM on December 23, 2018 [9 favorites]

From your description, Ben is abusing his family members including vulnerable children and he is unlikely to voluntarily comply with any constructive next step. Unfortunately I think the best thing you can do to help his mother is research the local eviction process and find her security companies to keep her home and other children safe when he is no longer a resident. And you might want to consider calling CPS on behalf of the children in the home.
posted by bq at 6:28 PM on December 23, 2018 [14 favorites]

If money isn’t a hindrance, there should be alarms, video, and pressing charges if he breaks into the house after he moves out.

I really don’t understand why you are trying to help when zero boundaries have been in place. You’re just going to get victimized yourself. His mother is the one who needs help to separate him from herself and vulnerable minor children.

It’s not that I lack empathy, it’s that he’s been dangerous long enough. Does his injury prevent him from understanding his actions? Can he be voluntarily committed or legally committed?

I’m really sorry. He seems currently unreachable and his minor siblings deserve safety.
posted by jbenben at 8:16 PM on December 23, 2018 [3 favorites]

Ben’s “difficult” behavior was “managed” by giving in to keep the peace

this is a really typical thing, where because someone was neglected as a child, he is now permitted to abuse others because his parent feels paralyzed by guilt. but you can't make up for grievously failing a young boy by allowing his adult self to commit crimes with impunity. mostly because it doesn't help him in any way.

his mother doesn't lack "standing" to discipline him. she absolutely has that: she's his mother, she houses and feeds him. what she lacks is power. and as horrible as it will be to get the law involved, she has waited long enough that she may have to. it is almost impossible for most parents to throw a teenage child out, knowing that he isn't going to do well on his own. it is too difficult a choice to make, emotionally. but since her first responsibility is to the minors at risk in the household, she's spared that anguish: there is no choice to make. unless he agrees to real therapy and behavior changes, he has to go.

because he is technically an adult she is obligated to protect those who are not, and who can't get out. maybe he will fail at being independent. but he has some small chance at succeeding on his own. his siblings don't.

he has apparently got enough personal charm to have friends and girlfriends; that means he can find a place to stay. maybe a temporary separation will help matters. maybe it'll be permanent. maybe in a few years, with some distance from adolescent tumult, he'll feel like getting his GED.

but if his mother thinks it's bad having one furious violent quasi-adult in the house, wait until his unprotected younger siblings turn 18 and turn their pent-up anger on her, too. this is the dynamic that is being built right now, every day he's allowed to remain and behave this way.
posted by queenofbithynia at 9:21 PM on December 23, 2018 [8 favorites]

Lately, Ben has become increasingly explosive and defiant. He torments younger family members, argues about everything, says hateful things, and is becoming physically aggressive, punching walls, throwing things and the like. The younger siblings no longer feel safe alone at home with him because anything can set him off. Ben’s getting involved in minor skirmishes with law enforcement, e.g., picking up speeding tickets, but he also stole and wrecked a car, escaping punishment because it belonged to a family friend and the police looked the other way. More recently, it turned out that Ben was breaking into an empty family property and hosting alcohol/weed parties there, for which there were also no consequences. Some day his luck will run out and he’ll be arrested.

The risk of arrest seems like the least of the concerns based on what you describe - as noted in the comments above, safety is the priority, and this sounds like a potentially dangerous situation that is getting worse. The MeFi Wiki ThereIsHelp page offers a variety of resources, including hotlines and other resources for abusive situations, and links for help with finding therapy, rehabilitation and treatment.

Ultimately, a local vocational rehabilitation agency may be able to offer services to assist with things like completing a GED, developing a career path, and finding a job, because the IEP paperwork and records related to the injury may be sufficient to qualify for a variety of services. However, safety is the first priority, and there is a real risk that if the mother fails to protect the minor children, the local authorities will intervene, so hopefully she will also get a lawyer quickly to help figure out her options.
posted by Little Dawn at 9:24 PM on December 23, 2018 [3 favorites]

I would send him on Outward Bound and NOT let him return home, with the first three months of rent paid in some sort of shared living facility. He needs to get out, but he needs to get out with some new skills and the motivation to keep himself fed and housed.
posted by DarlingBri at 5:50 AM on December 24, 2018 [2 favorites]

I think you're on the right track in terms of throwing him into a program. Are there local arts classes for things like woodworking? Can he apprentice or work for free for a chef, butcher, or something else? Is there a work program where he can work abroad for a summer?

Find out what he's interested in and throw him in an intensive program. Do not let him sit around in his own basement apartment, smoking weed, doing nothing.
posted by xammerboy at 12:29 PM on December 24, 2018

If you want to help Ben, help his mother get him out of the house, ASAP. The longer Ben is allowed to engage in frightening and abusive behavior towards his siblings and mother, the more likely that is to become a permanent, lifelong pattern for him. His mother is not helping him. By waiting until he is 18, she has lost the window of opportunity to help him.

Ben would be better off in virtually any other setting. His criminal and near-criminal behavior would be addressed by the police and courts. He might be court-ordered to participate in treatment. He is far better off if this happens at 18 or 19 than at 25. At this point he can be rehabilitated, and have something of a life for himself.

It is not going to help Ben if his mother loses custody of the other children because she allows him to frighten and abuse them. (If you don't think this can happen, you are misinformed. These people are not poor. In the middle- and upper-class setting, if one sibling goes to school or coach and tells what is happening at home, there will very likely be an intervention resulting in consequences for the mother, and those consequences may be taking her other kids away because she is unable or unwilling to protect them.)

Helping Ben's mother sit around and think of possible places to send Ben, which he will reject or fail to fully participate in, is just more dithering while the younger siblings are injured. Get the mother an attorney who can evict Ben (with the proper notice, and all that), and get a restraining order preventing him from returning to the home property or any family-owned property. Help her set up the appropriate cameras, alarms, etc. to prove he has broken in and violated the restraining order. Offer Ben a residential program to go to. If he refuses that program, or is kicked out, he is on his own.

It is very unlikely Ben's mom will do this. There is no other way to help her. If you choose to try to help her think through this as if she still has some control over an adult man, other than by using evictions, restraining orders and police intervention, then you are doing the opposite of helping her. And the opposite of helping Ben.

I am not ignoring your concern about suicide. If he mentions suicide again, call 911 and have him hospitalized. Suicidal people in his situation are also at risk to become homicidal, so don't delay with the 911 call. I base this advice on my long experience in law enforcement, dealing with cases where victims failed to get the abuser, the intermittently suicidal abuser, out of the house long after everyone determined it was necessary. Those were homicide cases.
posted by KayQuestions at 2:08 PM on December 24, 2018 [8 favorites]

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