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.

@Dandelionflower

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

How many peer reviewed studies have you read on the side effects of montelukast?

A lot of people 'swore' the MMR changed their children's brains too and it turned out to be bullshit.

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

No it isn't. Not if all the time you were making sure needs were met and adjustments being put in place with or without labels.
When DD1 finally got a label of dyspraxia, it clicked things in to place. But we were already doing pretty much all the suggested adjustments at school and home because we had seen needs and put things in place.

Ultimately, school teachers see hundreds if not thousands of kids. If they aren't jumping up and down saying there is an issue, how is an individual parent meant to recognise it? In the case of DD1, I have a record of something I sent to primary in her y5/6. I was told not an issue. Why shouldn't parents believe the experts?

@haba

Do you have a diagnosis? Is it ADHD? Sorry if that's intrusive.

Not at all. Yes I have a diagnosis and take medication daily which helps with some of the worst parts.

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

I was assessed as an adult and only had symptoms of adhd so I did that specific assessment. Sorry I'm not able to help specifically! I think a psychiatrist would be able to work out which one (or two or three) would suit best.

I'm about to go through the process with my daughter - will book an assessment privately as the NHS waiting lists are not good at all. In England you can go private through Right To Choose, but I think you need to be a little prepared with what you want the assessment for (either adhd or asd or both) when you make the initial appointment with your GP.

While there are a lot of overlapping symptoms, maybe have a read and see if one seems to fit more than the other? Obviously it could be both, but I've heard of the psychiatrist referring for the other assessment during the assessment you go for.

I'm not an expert on asd traits and can only speak of my own experiences with my ex's son (asd) and daughter (suspect adhd-pi) who are the same age. While there was a lot similar about them, the things I noticed were that DSS was capable of sustaining his focus on something whereas for DD it had to be the new exciting flavour of the month. They both tend to be quite obsessive over things, but DS will be obsessed about the same thing for a long time and really become an "expert" on it, while DD will have a new obsession every hour / day / month. She throws herself into it and it's going to be so great, until she gets bored. I never got those same vibes with DSS.

These two "differences" could be completely different when comparing two different children (WOW!!) but what I'm saying is maybe try to identify things that fit more with one diagnosis than the other, and start from there.

It is also, cripez how parenting works. Look, to me SEN are kids who need support at school. I'm not an educationalist or a psychologist, I'm just a mum who has observed something that could be a developmental delay, a personality trait or a normal, if exasperating, teenage stage.

He is not the same as the kids that I do know who have ADHD or autism. He never tantrummed/melt down or took risks or did things which were a problem. I can't be expected to be able to diagnose him for anything, I'm not an educational psychologist.

I haven't failed him - for years the focus had to be on keeping him alive. He's been so behind with his education that is where I've been trying to help catch him up - it wasn't until lockdown I realised he wasn't handing in work on his own, he's sleeping in his clothes, he's only eating a limited diet and that's at odd times. Without the structure of school he's shown that he's a bit lost.

I think you are being a harsh. We are all doing our best, and that really is all there is to offer your kids. It might not be THE best, but, it is my best.

I'm glad I asked because I do agree, once it's all written down it does look a bit "WTF"?

Everybody should be more aware of autism, dyspraxia, dyslexia and ADHD and how they manifest.

We do have to educate ourselves on this stuff to a great extent, but as parents the onus is on us to pick up on any quirks and either watch and wait, or act on them.

The reason I'm so upset in this thread is because over and over again I read testimonies from autistic adults who spent their entire childhoods feeling completely out of step and not knowing why. I can't even begin to put into words how damaging it can be for some children to go through the bulk of their childhood without being understood.

It can often lead to self harm and suicide.

So yeah I am pissed off.

These kids deserve better.

Jesus cripez, judgemental much?

Most of us are doing our best. If I didn't have a diagnosis of ADHD myself and therefore learned a huge amount about it, there's absolutely no way I would have noticed it in DS1. He's just not that significantly impaired by it (yet). The only reason I got him assessed was so that we would be ahead of any problems if they did rear their head in his teens/twenties. Yes, if you look back over his childhood with an ADHD lens, the signs are all there, but while he had difficult behaviour when he was young it was only ever for us, not school/kindergarten. He's bright enough his grades don't suffer. He's not violent (towards anyone except me and not even me any more) and he doesn't disrupt classes. There's really been no reason to question it at all apart from that he is so much like me and I had the background info to compare with.

Everybody should be more aware of asthma. 3 deaths a day of a common condition which is totally manageable for the majority of people.

Everybody should be more aware of the impact of bereavement on young people.

Everybody should be more aware of sepsis. Social isolation. Visual disability. Hearing loss. Social anxiety. Poverty.

I don't disagree, but, I won't feel bad about not taking my kid to see a GP before now. I'm doing my best, that's all I have.

And that's the thing.
A child may have been ill, or lived with domestic violence or alcoholism in the home, or been through parents divorce, or maybe neglected, fostered and adopted, or whatever.
Those are all reasons why a child might be behind the normal curve on development. It is only as they grow older and don't catch up, and the gap actually widens or more differences appear that the background doesn't explain what you are seeing.

I mean, why would a random person link poor motor skills with fussiness around food or not being able to tell the time?

Xposted with your last post. The judgemental comment I was referring to is the one about failing children.

@vivariumvivariumsvivaria

Everybody should be more aware of asthma. 3 deaths a day of a common condition which is totally manageable for the majority of people.

Everybody should be more aware of the impact of bereavement on young people.

Everybody should be more aware of sepsis. Social isolation. Visual disability. Hearing loss. Social anxiety. Poverty.

I don't disagree, but, I won't feel bad about not taking my kid to see a GP before now. I'm doing my best, that's all I have.

We are more aware of asthma. Asthma is picked up a lot more quickly than autism. Look up how long it takes to be diagnosed with autism, compare it to how long it takes to be diagnosed with asthma.

OP, he sounds a bit like my DS2 (who is autistic but very high functioning) and ADD.

DS is now very productive and manages himself well. The trick is to drill the essentials in without fail, every single day, no matter what: food, shower, teeth etc until they finally go into automatic.

You could try and get him interested in some of the things he forgets - ask him to trial different shower gels and say which he prefers. Same with toothpaste. Same with smoothies or healthy snacks (because these might be the most likely sources of food when he is out in the world alone. ) Just go over and over and over the basics every single day. It might feel boring but it's a relief when you realise it's gone in.

@BertieBotts

Xposted with your last post. The judgemental comment I was referring to is the one about failing children.

I am being judgemental. Because I am on the side of the children.

Anyone with any links to the autistic community will know that suicide and self harm are more likely among autistic adults as a result of not being diagnosed as children.

It's a fact.

OP isn't fussed about it. She was doing her best. I say, but what if she wasn't?

Dandelion yes, when DS was anxious they queried the monteleukast.

He was 8 and had realised that people can die and that not breathing well tends to be linked to death. Lots of awful nightmares and anxiety.

I know the consultant did consider taking him off it, but, his lung function was so much improved on it that we decided to watch and wait. His anxiety was short lived, and may well have been a side effect but is long gone.

It is a thing, for sure.

YY vivarium you have nailed it - it's impossible to "be more aware" of every single thing. There simply isn't time in a person's life to be knowledgable enough about all the possible things that could affect a person. That is why we have teachers, doctors, educational psychologists, developmental check ups and so on and so forth - to be experts on a smaller selection of conditions and help spot things before it is too late.

In terms of parenting I would say the most important thing is understanding the concept of a skills-defecit model, that is, "Kids do well if they can" and that if something is presenting as a repeated issue, it is almost never the case that the child "isn't trying hard enough" but that they cannot for whatever reason meet that expectation (yet, ever, in their current situation, etc)

If I could change anything in general parenting education/awareness it would be that. Not awareness of 100 different possible conditions. At least once you know "My child struggles with executive function/sensory issues" that is a starting point to explore and in most cases the relevant conditions will come up. So you don't necessarily need to be aware of loads of possible things. You need to be observant of your own child.

He sounds kind of like a normal teen to me.

All 3 of ours slept late, went to bed late, didn’t move from gaming. Didn’t bother eating stuff they didn’t like. They all turned out fine.

Dd still at home, she’s pretty similar but always forgets her medication unless l give it her. Drives me nuts. She’s nearly 15

cripez Children with autism may well be being failed. But if they are, take it out on the system that trains all the professionals who come in contact with our children day in day out.
The system should be that if a child presents with quirks then it is mentioned to the parents, a screening assessment or whatever is encouraged etc.
At the moment the system doesn't really want to flag children up unless they are causing disruption in class or are years behind. The system can happily keep telling you your child is making progress when in fact they are lagging further behind.
If the experts aren't flagging things, how can you expect a random parent to?

Cripez you won't upset me, if that is what you are trying to do.

Judge away, if it makes you happy. Have whatever opinion about a randomer on MN that you like. Crack on and enjoy yourself.

I am happy with the choices I have made with the information I had at the time. I'm not saying they have always been optimal, but, my conscience is clear.

I've made plenty of fuck ups with him - but, seriously, this isn't one.

@TeenMinusTests

cripez Children with autism may well be being failed. But if they are, take it out on the system that trains all the professionals who come in contact with our children day in day out. The system should be that if a child presents with quirks then it is mentioned to the parents, a screening assessment or whatever is encouraged etc. At the moment the system doesn't really want to flag children up unless they are causing disruption in class or are years behind. The system can happily keep telling you your child is making progress when in fact they are lagging further behind. If the experts aren't flagging things, how can you expect a random parent to?

Parents often expect professionals to be the ones to pick up on autism.

They rarely do.

A lot of a child's diagnosis based on questioning the parents.

The system is shit and it is failing our kids, but I genuinely believe many parents just think it's something for someone else to pick up on.

It isn't.

@vivariumvivariumsvivaria

Cripez you won't upset me, if that is what you are trying to do.

Judge away, if it makes you happy. Have whatever opinion about a randomer on MN that you like. Crack on and enjoy yourself.

I am happy with the choices I have made with the information I had at the time. I'm not saying they have always been optimal, but, my conscience is clear.

I've made plenty of fuck ups with him - but, seriously, this isn't one.

It isn't me you have to answer to.

Sensory issues are a red flag. They are not a learning issue that school will pick up on, not on an EPs radar, they are not developmental or a teenage issue. How did you make sense of this?

Imagine your child was diabetic and had excessive thirst. Would you say all kids are thirsty? No expert told me it was unusual? As a parent you have to report issues for 'experts' to pick up on them.

Your opening post saying your child had no SEN is very telling. Are you attaching shame?

Hi, I'm an adult with ADHD, this sounds highly similar to the issues I deal with. I suggest that you see a doc though. They maybe able to help you better then what I can do.

The system is shit and it is failing our kids, but I genuinely believe many parents just think it's something for someone else to pick up on.

I don't think I entirely agree.

My mum missed my very obvious traits as a child but that's because they didn't really have a detrimental effect on my life (as a whole) as a child. Sure I was forgetful and messy and scatterbrained and daydreaming, but I was also very bright and friendly and sociable. I'm sure misinformation played a part in this, as it does so often in girls with adhd (or boys with P-inattentive type). And she actually worked with children who were diagnosed.

I understand you're primarily talking about asd diagnosis here, but we don't actually know if OPs son even has it. If it's adhd-PI, it's pretty common for people to only experience the debilitating effects as they grow into teenagers. Sure the signs are there as children (I see all of them in my DD10) but I'm not rushing out to get her a diagnosis (I'm only just starting the process now - preparing for high school - and have suspected for years). I've not done it yet because it's not really having a detrimental effect on her life yet.

All the things I struggled with as an adult (poor impulse control, forgetting to eat and drink and shower, risk taking, being organised, not thinking through consequences etc) she has me to do for her right now, so it's not a massive deal. But I have no doubt it will be as she grows up.

Op seems to be going through similar where it's only now with the increased personal responsibility of the teenage years that her DS is struggling. Perfectly understandable.

What would be "failing" is for her not to at least read up on it and speak to a professional.

The parent of a child who spends the majority of time with them is not random. 'Quirks' (what does that even mean - deviation from the norm?) should not be mentioned to parents by teachers. Parents are best positioned to report. And not to teachers. This is a medical issue. Would you wait for a teacher to report 'quirks' consistent with diabetes?

Thank you @winched that's very helpful. We can afford to get a private assessment, so I am going to discuss it with his father. He's younger than @vivariumvivariumsvivaria's son, Y7, and because of Covid he's spent most of this year at home, which suits him fine. I can't really tell yet whether he needs support in school with things because he's barely been there!
But I'd like to be aware and prepared for if that time comes.

KOKO calm your jets. No, I'm not attaching shame, I'm saying that he's not got SEN because I don't think his behaviour has been wildly different from his peers until recently.

cripez you are right, mate. You are not who I need to answer to.