Anyone got ideas to help teenager's executive function?

[vivariumvivariumsvivaria]

DS15 is not SEN, but he definitely does not pick up on his body's cues - so he was very slow to wean/potty train/doesn't feel pain or hunger in the same way as most kids etc.

We are having a problem with him remembering to eat, brush teeth, take his medication, sleep and get up. He's 15, so it won't be long before he's off out into the world and I am concerned that he will live a life in front of a screen not moving and not eating.

He understands the issues, he just CAN'T remember to do them. It is exasperating to parent.

Tried everything, bribery, rewards, notes, alarms, diaries, whiteboards, punishments - nothing works. I do think it's an executive function issue - I left him to it at the weekend to see what he did. Got up at 2pm both days, didn't eat until dinner at 6 and then only a couple of nibbles because it wasn't his favourite one night, so I made his favourite the next and he ate 3 portions. Didn't wash, didn't move, played on his computer with his friends until midnight both days and thoroughly enjoyed himself.

He's not depressed, he's not defiant or sulking, he'll come on family activities that I organise and he'll happily do tasks if I tell him to, but, left to his own devices he initiates nothing.

He understands that exercise, sleep, studying and diet are important - but can't prioritise them. I don't think this is a maturity issue, it seems to be something more than that - I can remind him "feed your pet" and he goes to do it, gets distracted by a day dream half way through and wanders off. Then feels remorseful that he hasn't fed his pet, promises to do better, and repeat.

Anyone found an answer? I was wondering about an apple watch, whether it could be set to buzz when he needs to take his medication, brush his teeth, eat, etc.

ADHD and autism have a lot of similar traits, however the sensory issues would lean towards autism as most likely, although the two often coexist together in an individual

My husband is autistic and you are basically describing him here. He got straight As at school and went to Oxford. But he forgets to brush his teeth.

The not feeling pain or hunger is a very autistic trait, to do with interoception and the way signals in the body are interpreted.

I am agog that he's got to 15 and you haven't looked into this further. I see it all the time on here, kids struggling with clearly autistic traits and parents either not wanting to 'label' them or just blithely continuing without bothering to investigate.

Please see about getting a diagnosis and support for your DS.

Sorry I haven’t read the whole thread. I’m an Ed psych with an interest in this area, and a son with adhd. The Connections in Mind foundation focus on this, with webinars and resources. They also offer coaching. Also, check out Peg Dawson and Richard Guare’s books. They are excellent for those good luck!

The How to ADHD youtube channel has a lot of great tips for issues with executive dysfunction of all types.

For the medicine, maybe a beeping pill box kept near supplies to take it (I say, as someone is terrible at remembering medication, especially as mine requires food so not feeling hungry sometimes compounds that: so I need the pills and some sort of easy appropriate snack).

Ooh, a beeping pill box sounds brilliant! I didn’t know there was such a thing so will have a look. I struggle massively with taking medication. I’ve tried everything: leaving them where I can see them, alarms etc. Thank you

ADHD and autism have a lot of similar traits, however the sensory issues would lean towards autism as most likely, although the two often coexist together in an individual

Not disagreeing with you at all, it could be autism (or it could be nothing, none of us know of course!) but just to say sensory issues can also be a big part of adhd so that wouldn't necessarily rule out the adhd.

I don't have autism or any traits but I hate showers, loud noises, tags on clothes or inside pillows etc, the list goes on. It's too much and distracting. It's basically sensory information competing for your brains attention.

Like I said not trying to disagree, just hopefully educating people who might not be aware.

Well, cripez it is quite hard to know how much is personality, immaturity, hangover from being unwell as a small kid, laziness and normal teen behaviour. That's the thing about neurodiversity, it can be quite hard to spot, especially if the person themselves masks or is not anxious about things.

This is certainly all food for thought. I don't know he'd meet diagnostic criteria, I'll get reading on the resources you have all so kindly shared.

Oh man, this feels like more than I was expecting, but, yes, why on earth did I not wonder about this before?

You're welcome EssexLioness, happy it helped. I've totally been there - I've had it literally sitting next to my computer where I'm at much of most days and then either forgetting or it gets to evening and I sit there trying to remember if I've taken the pills yet or not . And yes alarms, so easily dismissed and then my mind's already gone elsewhere.

vivariumvivariumsvivaria It reads to me like you - and he - have had a lot on your plate and as you said, masking is an issue as is a common social dismissal of it just being X (I've heard it's a just my DS being a boy so many times). I think the teenage years can make masking or the things that were overlooked with everything going on with smaller ones harder, but there are plenty of people who aren't diagnosed or don't get support until well into adulthood.

Aah, yes, ADHD can defo appear without hyperactivity - that's the type I have and DS1 as well. I didn't know either that it could be without hyperactivity until I discovered it on MN.

Agree that sensory issues on a milder scale can defo be part of ADHD. The difference is that for example with individuals with autism the sensory issues can be much more restrictive e.g. causing the person to eat an extremely restricted diet or wear very restricted clothing. DS1 is a fussy eater, and will only wear joggers, t-shirts and hoodies, but those are at least fairly ordinary clothes which I can buy in normal shops. And if we go to something like a wedding I can persuade him to wear something different just for that one day.

Just to mention that sensory issues can also occur with dyspraxia.
There's a lot of overlap between ASD, Dyspraxia and ADHD.

Sounds exactly like ADHD.

ADHD is poorly named and would be better named Executive Function Disorder or similar as that's exactly what it is. It's poor executive functioning.

If he's not hyperactive then he could be inattentive type.

ADHD is very disabling and reduces life expectancy but it's also very treatable. I'd get him assessed if you can.

I have inattentive type ADHD.

Sounds a lot like my son, who has ADHD. He forgets to drink during the school day, body doesn't register thirst, and then he comes home with a banging headache. He now has a drinking bottle which has times written on it, which helps a bit. For older teens, I have seen pagers working quite well to remind (but then they have to not lose the pager...) You can also get vibrating watches which remind about medication etc

REDUCES LIFE EXPECTANCY?

Because people forget to take their medication? Or exercise? Or eat?

Oh man, yes, I get it. Hadn't thought of that, but, yes, that is my worry, he's not looking after himself in a way that I'd expect at 15. And kids who have been chronically ill tend to rebel at some point against their treatment regime.

He sounds just like my 13 year old, who, after years of being told off by teachers for being "lazy" is now on the pathway for assessment for ADHD (inattentive-type) and possible ASD. He was also investigated for dyspraxia from a very young age, but never got a firm diagnosis.

@winched do you have a diagnosis? Is it ADHD? Sorry if that's intrusive.

How does one get ones child assessed when traits could be ADHD or asd or dyspraxia?

This is one of the deficits of ADHD. I subscribe to a Canadian magazine called Additude which has a very good website, forum and articles with practical suggestions for my DS2. Worth a look. Good luck and don't give up.

Sorry, just another one coming along to recommend you read up about inattentive ADHD and see if it fits. Good luck

@vivariumvivariumsvivaria

REDUCES LIFE EXPECTANCY?

Because people forget to take their medication? Or exercise? Or eat?

Oh man, yes, I get it. Hadn't thought of that, but, yes, that is my worry, he's not looking after himself in a way that I'd expect at 15. And kids who have been chronically ill tend to rebel at some point against their treatment regime.

Yes because we don't take care of ourselves very well - poor diet, not drinking water, poor sleep/sleep routine, running on stress as a medication, forgetting meds etc etc etc. Self medicating with drugs is also an issue.

Plus if you have impulsive traits you might be more likely to get in and accident, take drugs, drink too much, get involved in extreme sports etc etc

It's definitely not something to be taken lightly (and it's not a fucking gift!). It's far from a mild impairment, it's very disabling and can cause physical and mental health issues, limit your success at work, limit your ability to maintain relationships etc etc.

This video is excellent in terms of describing it in no uncertain terms! Prepare yourself (plus it's 3 hours long!):

The sensory issues with labels and socks are classic ASD, are obviously not learnt behaviour and present well before teens.

Hence rather objective and not prone to second guessing all kids do this.

@winched thank you, I didn’t realise sensory issues can also be part of ADHD too. I’ve learned something new 😊

@TeenMinusTests, I am also dyspraxia as well as autistic so maybe the lines are blurred with my own issues. Thank you for clarifying!

To add to the point about reducing life expectancy, the same can be true of autism too. Also suicide rates are extremely high in autistics especially in those that received a late diagnosis. diagnosis of autism or ADHD can help massively in your son’s confidence and understanding of himself and the world around him. I would urge you to try and get a diagnosis. Late/ lack of official diagnosis can have devastating consequences on mental health, confidence and happiness. It is so much more than a ‘label’. My own diagnosis aged 40, was life changing. It helped me learn how to build relationships, accept myself and how to begin identifying and coping with my own long list of executive functioning challenges and sensory issues. Diagnosis is a gift for many of us. Many people find it helps them, even if they appear to the outside world to be managing just fine

@vivariumvivariumsvivaria

Well, cripez it is quite hard to know how much is personality, immaturity, hangover from being unwell as a small kid, laziness and normal teen behaviour. That's the thing about neurodiversity, it can be quite hard to spot, especially if the person themselves masks or is not anxious about things.

This is certainly all food for thought. I don't know he'd meet diagnostic criteria, I'll get reading on the resources you have all so kindly shared.

Oh man, this feels like more than I was expecting, but, yes, why on earth did I not wonder about this before?

Well it is hard, nobody is denying that. You literally just said you hadn't wondered about it before.

Honestly, how could you not? You have autism in your family.

OP. Don't beat yourself up about not having considered this before.

Your child is your child.
At primary they are maybe a bit different, but maybe that is immaturity, or because they were ill or something. None of the teachers raise a SEN and they're meant to be the experts, right?
Then they get to secondary. Maybe you don't see their friends so much, so there is less to compare them with. They are building skills, so that's good. They're managing OK.
The teachers at parents even may mention they are a bit distractable, or a bit disorganised. But not all the teachers, and that's just teenagers isn't it. Again none of these teachers ever come out and say there is an underlying issue. Even if you tentatively raise a concern they say oh lots of teens are like that.
You certainly don't think about it, because you are so close. You don't even notice half the adjustments you make. And anyway they aren't like Uncle Fred with Autism, or cousin Mary with dyspraxia, so why would you consider those issues.
Eventually a crunch point comes, GCSEs, off to college, or whatever. And you post on MN. The 'collective mind' asks loads of questions and puts 2 and 2 together and people suggest 3 or 4 or 5 or 6 as the answer.
It helps you to realise things that were just 'quirks' are actually recognisable traits of a known condition.
And then you know where to start.

At least this has been us with both our DDs.

@TeenMinusTests

OP. Don't beat yourself up about not having considered this before.

Your child is your child.
At primary they are maybe a bit different, but maybe that is immaturity, or because they were ill or something. None of the teachers raise a SEN and they're meant to be the experts, right?
Then they get to secondary. Maybe you don't see their friends so much, so there is less to compare them with. They are building skills, so that's good. They're managing OK.
The teachers at parents even may mention they are a bit distractable, or a bit disorganised. But not all the teachers, and that's just teenagers isn't it. Again none of these teachers ever come out and say there is an underlying issue. Even if you tentatively raise a concern they say oh lots of teens are like that.
You certainly don't think about it, because you are so close. You don't even notice half the adjustments you make. And anyway they aren't like Uncle Fred with Autism, or cousin Mary with dyspraxia, so why would you consider those issues.
Eventually a crunch point comes, GCSEs, off to college, or whatever. And you post on MN. The 'collective mind' asks loads of questions and puts 2 and 2 together and people suggest 3 or 4 or 5 or 6 as the answer.
It helps you to realise things that were just 'quirks' are actually recognisable traits of a known condition.
And then you know where to start.

At least this has been us with both our DDs.

This is literally word for word account on how to fail a child with SEN. I'm sorry but it is.

My dd was on Montelukast for asthma and it seemed to completely rewire her brain.