Should we investigate adhd assessment or anti depressants for my ds19

i work in mental health and would always recommend going to GP first so you can discuss medication/ talking therapy if that is what he wants. The GP should have some knowledge about NDD and can maybe advise although you obviously know a lot too.
Unless we’ve got very lucky Mumsnet comments above arent from GPs or Psychiatrists 😂 It’s free and you can go there on Monday.
As someone else advised, treat current symptoms then consider underlying causes along with environmental adaptions.
By Christmas he’ll hopefully be able to tell you if uni is for him or not. Well done him and you for giving it a good go.

If you feel ADHD is the thing most impacting him right now then go for that assessment first but I do think it sounds like there could be some autistic burnout too.

You could pay for the ADHD assessment and save for the ASC? The assessor would likely give you a nod if they pick up traits that would incidence further assessment.

He could ask the GP for a trial of SSRIs but actually they might not be effective if the difficulty is likely to be explained by neurodiversity.

If he tells uni he suspects both then they can scaffold support around that without a diagnosis.

Maybe it isn’t the right time for him to be studying and if he’s in burnout then he might just need to come home for now.

SSRIs can be very effective in treating OCD with therapy but need to be taken in a very high dose. ADHD meds can make autism and OCD worse.

We don’t know if he has ADHD as it’s just an internet forum, his mum doesn’t either. I had no idea my son had serious OCD as I thought it was just hand washing and locking the door. I had no idea my other son was suffering from extreme trauma. Young people hide things.

OP I really would go to a psych to get an overview look at him and professional help as to what is going on. Strangers on the internet and a suspicion does not ADHD make. I have both and as I said so do my children. Even with that knowledge when my third child was struggling at uni I really wanted expert advice as to what the issue was before going down the ADHD route. I’m so glad I got it as ADhD meds would have been disastrous. If you’re going private, it wouldn’t delay things much. See if you can find a psych with ND knowledge who could go on to help with whatever was the outcome. Ours was qualified to do autism and adhd assessments too so it doesn’t delay things much getting an overview if you do go down the adhd route after.

DD2 suspected herself she had ADHD (inattentive type) in her second year at uni. She was already under the MH services for depression and anxiety (including OCD), so she found it easy to get an ADHD assessment then.

IMO, SSRIs have never worked for her in over 10 years of being on them. Methylphenidate helped her to stop fidgeting, to stop making silly mistakes in her work, and with emotional regulation, but it ramped up her anxiety before exams, and she had to take beta blockers before an exam.

She got a shed load of support from the university after the diagnosis - extra time with coursework and exams, an exam room on her own with movement breaks, study skills mentoring, a post grad student to help with research for her dissertation, a Dictaphone to record lectures, and she could have had money towards a laptop and print cartridges, but she had one already.

However, a three year course took seven years to complete with several long leaves of absence. She got a first; but in retrospect she would have been much better off, not to have gone to university, in terms of her mental health!

Recently, she decided to pursue an autism diagnosis, and the mental health trust had her take the AQ 50 test. She scored 38 out of 50, whereas the rest of the family got between 8 and 14, mainly because we are all introverts. The psychiatrist said hers was a high score; but she changed her mind and decided another label added nothing.

I suggest you get DS to pursue a ADHD assessment and take the AQ 50. It’s online. There’s no point taking SSRIs imo, if they are to mask symptoms, without addressing the root problem.

When I say OCD I don’t mean washing hands etc but intrusive thoughts, pacing etc. Could something have happened that he hasn’t told you about.

I only ask because I have 3 with adhd, autism and differing MH issues. I have 1 with severe trauma about things I didn’t know had happened at the time. Another is just retaking a year at uni and has started SSRIs for OCD. Both presented similar at times to what you have described. OCD boy had debilitating intrusive thoughts tied up to his autism. I didn’t know.I took him to a private psych wanting ADHD meds and we were told they can make OCD worse and to focus on sorting that first. We went with the high dose of SSRI and therapy and the improvement has been stark, even his adhd is better.

So I think I’d go to a psych first for an overall assessment to make sure there isn’t something else there you’re not aware of and the issue is definitely ADHD. It’s about £500 for a general psych appointment. I’d look for one with expertise in young people, autism and adhd.

If you suspect autism then I would stay away from adhd meds tbh. I was diagnosed with adhd a few years ago and after starting adhd meds it quickly became obvious that the adhd was masking autism ( was diagnosed with autism last year )

It was absolutely terrible having the adhd symptons taken away and "just" being autistic. I didn't know what was wrong with me at first

I have found antidepressants to be useful ( and magnesium)

Are you sure being at uni is what your DS really wants to do OP? Or has he just followed that path because - as you describe - he’s “able”? And he wants to stick it out because he’s developed a group of friends?

I promise I mean this kindly, but I’ve read through your posts a few times and there are a lot of comments about how it’s making you feel. For example you say you’re frustrated and also that you don’t want to accept that this might not work out. It could be that your DS is aware of this and that’s putting pressure onto him, exacerbating the PDA and potential burnout. Even if not, this needs to be about your DS and not your feelings.

Also, you talk about de-accommodating his anxiety but that’s a very broad term. While neurodivergent people do need to learn to live in the world, they typically need a lot more resilience to even cope with the basics - as you’re discovering now. That means that de-accommodation isn’t always the right approach. That doesn’t mean you have to be an enabler but it is important to understand that anxiety comes from a very different place in neurodivergence and typically can’t be addressed in the same way.

Personally I’d get his ADHD diagnosed before you consider SSRIs. With a mixed presentation such as AuDHD, there’s a risk of diagnosis being missed. You say you’ll go privately so you should be able to get a speedy appt. I’d make that your urgent priority. Once diagnosed, get onto the right meds and only then consider adding in SSRIs, if they’re still needed.

You talk about needing your own boundaries and that’s entirely fair. You need to be clear with your DS re what you can continue to do and what you can’t. You can then help him to decide whether it’s feasible for him to continue, bearing in mind the level of support you can provide. And it’s fine if you don’t feel able to provide much, but you need to be clear about this now rather than burning out yourself.

I know you don’t want to hear this but it might be the wrong time or the wrong place for your DS. I think you need to be open to all possibilities rather than fixating on him staying at uni no matter what. Maybe a diagnosis and meds will help him. But he deserves to thrive and not just survive.

I hope this doesn’t read critically as I promise that’s not my intention. I’m AuDHD myself with a dyspraxia/ASD DS and an AuDHD DD. I completely sympathise with the difficulties in trying to help neurodivergent DC figure out their future path 💐

It may affect change, if it supports reasonable adjustments at uni, and future work places -

however I would suggest treating the symptoms as priority -
and then considering the cause and long term mitigations to minimise relapse

i would suggest if DS has signs of clinical depression go for treating that first line of with - SSRI
and if there are also signs of burnout, ease back on pressure whilst SSRi kicks in -
then bring in behavioural activation - basic CBT for depression
alongside that seek ND assessment - through right to choose -
so a multi- faceted approach
let professionals do the clinical assessments - is SSRI indicated etc

So much of what you have written here sounds painfully familiar @Anonymous07200408 and it is such a difficult situation especially when DC seemed to manage school life relatively well.

My 21yo DS had his ASD/inattentive ADHD diagnoses from a relatively young age (ADHD meds from age 11) and like yours seemed to manage school well with a group of similarly ND friends. Did well in both GCSEs (albeit covid 2020 year so all CAGs), struggled a bit with A levels but came out with decent grades with additional tutoring. However has needed a huge amount of scaffolding, as you put it so well, at uni. He would readily now admit that he didn't make the most of uni and I feel like he spent much of his time either asleep or in his room on his own 'chilling' (aka gaming/watching shite on Instagram). Home social group fell apart (too complicated to go into on here), struggled to make close friends at uni, social science degree so low contact hours and no real daily routine. Low mood, low energy. It's only with hindsight that I realise how much the daily routine and structure of school life helped him and how the wheels came off when that routine wasn't there any more.

On a positive note, DS did subsequently start anti depressants which have really helped, his DSA tutor (once he finally started accessing that support) was amazing and he did join one uni club which was great. He also eventually managed to graduate with an excellent degree which at times I never thought was going to happen!!

I wish I knew how to advise you. It's definitely worth looking into ADHD diagnosis and meds, and it's really really positive that your DS is enjoying things and participating socially. Does he get DSA? If not, worth looking into. But it's hard when they're reluctant to engage with support...

I'm not sure how much use my post will be but I empathise hugely and I wish you and DS all the best.

His procrastination, inability to start tasks, dreaming, torpor, binge eating, insane avoidance all fit with my understanding of inattentive type adhd (my other son is medicated for combined type adhd so I know a little about it).

• This list also fits with ASD

You say he needed a lot of support before going to uni and going to uni is a massive jump so he was bound to need more than before. Or are you saying he only needed this leave of support since he hit burnout? Do you think he is in chronic burn out? The best info I’ve found on burnout is on the barriers to education website.

I'm autistic/adhd and went into severe burnout.

My aunt who works in the field found this
Which helped me look at depression in Autism and I realised I may need the extra support.

It's not out for general pop as it's still research but this was easier to understand instead of the general depression scale

sites.google.com/view/mentalhealthinautism/resources/tools

Does he have OCD tendencies and could anything have happened to him?

I’d push for the ASD assessment which would pick up the burnout and/or the ADD possibility.

I wouldn't write off SSRIs. My DH who is AuDHD has taken an SSRI for over a decade. It helps with the autistic anxiety, overwhelm, catastrophising and I think it helps some of the inertia and demand avoidance too. My own experience with SSRIs also hasn't been that they dull all emotions: they actually made it easier for me to work out what I was feeling (I'm not ND).

I also agree with a PP that the behaviours you're reading as ADHD could equally be ASD and anxiety (not responding to friends, inertia, inability to plan/start tasks). You need someone to help unpick the route of the behaviours in order to get strategies and/or meds in place to help.

Also, as a parent and a lecturer, I absolutely understand your desire to advocate for him and it might be that, at the moment in this crisis, he does need that to get the ball rolling. But it's clearly both unworkable and undesirable for you to be involved in his studies and social life to this extend - and ultimately it also won't help him. Have you said to him what you are and aren't willing to do going forward?

I think he also needs to make an appointment with his personal tutor and focus on the minimum he needs to do to get to the end of the semester academically and complete assessments. If he explains he's considering an ADHD diagnosis and struggling with starting and planning tasks, they might help him come up with some small first steps.

Nothing to add but watching with interest as I am in a similar situation w my DS.