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.

This has been really interesting and helpful. Thanks for all the constructive comments.

I'll certainly follow it up with our GP. And I'll read the links and articles that PP have added.

There is very likely a need to rule out that my son has ADHD. So, I'm glad I posted, MN can be very helpful.

Haba ask for a multi-disciplinary assessment.

It really should not be up to you as a parent to suggest the type of diagnosis you are interested in for your child.

Many neurodiverse conditions have traits and symptoms that overlap and it should be up to a team of professionals, usually Paed, OT, SLT and Ed Psych to all see your child in at lest two different settings and establish which condition or conditions they actually have. Some people have more than one condition, but again, it's a matter for medical professionals, not parents.

I've just looked at
www.nhs.uk/conditions/autism/getting-diagnosed/how-to-get-diagnosed/
and
www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/diagnosis/

Both have this basic advice
How to get diagnosed

1. Talk to someone for advice

If you or your child have signs of autism, the next step is to talk to someone about it.

You could speak to:
a GP
a health visitor (for children under 5)
any other health professional you or your child see, such as another doctor or therapist
special educational needs (SENCO) staff at your child's school
Ask them if they think it's a good idea to refer you for an autism assessment

This is where the whole thing can fall apart very easily for assessment for any condition.

If your child is not disruptive and is academically not way behind, GPs, other health professionals, and some SENCOs can be absolutely clueless and just say they "don't see" any difficulty and there goes your chance of an assessment.

When you present the reasons you are asking for an assessment, do make sure you're not fobbed off.

Hello OP, meant to add the SEN magazine and website is worth subscribing to. Lots of helpful practical information and explains which diagnosis have similar traits . Money well spent in my opinion.

Also please do not be upset by some of the replies on here. Your best is good enough because you are not giving up on your child. Your son is very lucky that you care and want to help him. 🙂

Thank you @BlankTimes. What I meant was just do you have three separate assessments if there are traits of three different conditions (for example). I wasn't sure whether people specialised in one condition IYSWIM.
School are unlikely to have observed anything- he's barely been in, and he is a very "under the radar", polite boy, and he's streets ahead academically, mainly because of his special interests. (and obviously because he's a MN child ).

I'm not expecting a diagnosis per se, I just see a significant number of issues he has difficulty with, and if they add up to something then I want him to be supported with that. Hopefully that makes sense, I'm a bit tired

IME if you go for assessment for one thing they will do a very basic screener for other similar things as well, this has a multiple purpose, one if you don't quite meet the criteria for whatever you went for (but are still obviously struggling) there may be something else to flag up. Second if it's completely obvious from the screener that the person may well meet more signs of one thing than another it can point you in another direction. Thirdly a lot of these conditions overlap and are comorbid anyway - TBH I wouldn't be surprised if we find out much further down the line that it's all one group of genes causing everything or that these conditions are all part of a much wider spectrum condition.

@haba there are loads of different tests for different traits.

You end up sounding like one of the cast from Line of Duty using all the acronyms for tests which are given at age-appropriate levels.

Also be prepared to answer loads of questions yourself about early developmental milestones and general social, repetitive, sensory and communicative behaviour.

e.g. Paediatric Sensory OT will test for sensory processing disorder, big questionnaire for you about his reactions to all sensory stimuli.
Also they can test for dyspraxia, usually physical observation of movement and actions, a bit of drawing, threading, larger movements, standing on one leg, nothing out of the ordinary but fun for kids to do, to test gross and fine motor skills and they see loads of things you've never noticed.

SaLT screens for all sorts using tests like WISC for language comprehension, speed of processing, listening skills, conversation skills, following instructions, retention of information and more using stories and asking questions about them. It's not like an exam, the tests are designed to be fun for the kids.

Ed Psych is likely to use several diagnostic tests like ADOS and/or DISCO, diagnostic manuals ICD-10 and DSM-5 each have their own tests for autism, and I don't know the names of the tests for ADD and/or ADHD

How anyone can insinuate a diagnosis done by these medical professionals using these methods is just a "label" is beyond me.

The Paed oversees all of the assessments and in consultation with the others will decide if there's a definite diagnosis or diagnoses to be given.

However, irrespective of the name(s) of the condition(s) that may have been given, the actual reports themselves are a mine of information. Scores are often presented as a centile, so it's very easy for them to identify any areas where your child excels and where your child needs help and exactly how much support should be given in each instance. There are also recommendations for home and school and again, these are specifically made for your child based on their scores in all of the tests. My own experience is that private diagnostics give comprehensive reports whereas NHS ones can be very much less detailed.

If you go private, please do not go for a pre-diagnostic/screening test which is only designed to show if your child could possibly be neurodiverse. They are expensive and let's face it, if you're thinking about diagnosis, you are already aware of that possibility.

You've described me. I'm autistic with inattentive adhd.

I wasnt diagnosed until I was an adult.

I need time to read through all this tomorrow, so marking my place.
Sorry I want the thread to come p on 'Threads I'm on'

Thank you all for the links and resources you kindly posted. I had a good look at it all and then had a gentle chat with DS about "I wonder whether there is something more going on here?".

He is furious. There is nothing wrong with him, I over-react, why would I even think he's needing a diagnosis and there is no way he will see his GP, none.

So, I said, "well, you do x, you don't do y and you need prompting with z. You are not performing in school, you're not eating properly and you are not showing the level of self management that we'd expect of most 15 years olds, as evidenced by a, b, c. It's not that there might be something "wrong", it's just that if you need accommodations then we should look into it. If there is no reason for this behaviour then you are going to have to pull your socks up sharpish because you are not doing your best"

I am, apparently, fussing.

Still, the seed has been planted. See what he says over the next few weeks.

Hi OP. I use an app on my phone (also a web version I leave open in a tab on my tablet) called Todoist. I think it's great. I use the free version. It was recommended on a site for apps to help with ASD. The only thing you need to do is keep checking the app, and only tick stuff off when you've done it. You can set reoccurring tasks at any frequency/ time etc and categorise them. Alarms don't work for me - I swipe + then forget it's gone off.

Oh, thanks, Adventure

I do think that tech might be the solution.

Honestly cripez - are you always this rude, judgemental and downright offensive to people ?
A parent has come on here to ask for support and advice. How do you think it is going to help anyone by being so rude ?

@winched Can I ask about the 'Right to Choose'?
How I would know who to ask to be referred to ? My dd went to the GP in June 2019 to ask for referrals for assessment for both ADHD and Dyspraxia. She is in the final throws of the ADHD assessment, but nothing has happened with the dyspraxia. She comes under adult services now. The GP messed up the referrals in the first place, and when it eventually got to the right place last Easter, they replied to say they weren't adding anyone on to the waiting list due to COVID 19 restrictions.
However, her University are saying they won't make adjustments for her because she doesn't have a diagnosis. Having the right to go somewhere else sounds fantastic, but how would I know where to ask for / which trusts have a reasonable waiting time ?

Bless him, sounds like my son. I think I have the inattentive ADHD although I’m not diagnosed. It would explain all my childhood and choices in adulthood. I have a degree but had to do it via the OU over six years. The actual content I found easy as I’m (sort of) bright 😂. It’s just all the other stuff.... I’m very scatter brained. I can’t sustain a job that requires a lot of attention even though technically I am bright enough. I now work as a support worker and I am literally given a timetable. It’s a practical role where I am constantly “doing” things as I can’t sit at a desk.

I’m very sociable and don’t tick any boxes for autism. I’ve got three kids, and have managed to function but feel like it does get in the way of being able to reach my potential.

I am slowly improving with age. I’m 32 now.

Chilly yes, it's been a bit of a thought provoking experience. I've been reading these assessment forms and thinking that quite a lot of it feels familiar.

I had no idea that binge eating is part of ADHD. And being really good in a crisis? And being unable to do mindfulness? And a bunch of other stuff that has me thinking "WTF?"

It does run in families, I guess...

@vivariumvivariumsvivaria

Wow really? I binge eat too :( although again, I’m getting better with age. I’m shit hot in a crisis, but never knew that was linked. One of our service users fell and broke her leg today and I was the first one that was immediately called on the radio. I perform well in high stimulus situations. Stick me infront of a desk though and I’ll daydream and get no work done. That sounds like sheer laziness but honestly, I just cannot bring myself to do anything like that. The boredom is intense.

As a teenager I rarely left my bedroom and would stay in my pyjamas for days on end. Could never organise myself, washing my hair was an effort, and my room was a mess. I was happy though 🤣.

I had a lot of friends, and I’ve never struggled socially it’s just the executive function.

@BertieBotts

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.

Great post

Chilly Same.

If you are having a heart attack, been in a car crash, suicidal, lost, got a fire, being beaten up - you want me around. I've dealt with all of those - I am very good at prioritising and sorting safety, saying the right things and giving a clear, succinct history to the emergency services.

Our son was chronically and seriously unwell for a long time. Multiple life threatening episodes in clusters. I was really good at dealing with that, at getting him to the right place in time, at dealing with very difficult decisions and distressing situations. There were many times where I thought he was going to die and I had no panic about it, just concentrating on keeping him calm and feeling loved in the moment. I had his funeral planned so that if he did die then I'd not have to think too hard about it because I knew I'd not be able to. That's kind of mad, in retrospect. But, in a crisis, I am very practical and efficient and funerals don't plan themselves and I was trying to look after future-me, I always plan for the worst case scenario and hope to not need it. He is well now (touches wood) but I keep my mental funeral for him up to date in my head incase he takes me by surprise. I don't think that is uncommon in people who have children who have been seriously unwell, but, now that I come to think about it - having a "just incase" list on Spotify is probably a bit odd and not the sensible stress management tool that I think it is.

I was given a prestigious professional award for innovation, I am full of really good ideas that solve big problems in my field. Problems that no one else could pick their way through, but, I have no difficulty with at all. I am an expert in a niche field, but, it's a massive niche and so I am in demand, there is lots of variety in my work - always something new and shiny to get excited about.

I am never fully prepped for meetings, and I advise at a national level - I do a lot of winging it and I manage/get away with it, but, I always think "if I thought about that properly and had done some preparation I could be quite good". I am very good at communicating - basically, dissemination of evidence is my skill.

But, give me a spreadsheet and I might die. We have run out of milk again. Sometimes my personal hygiene is lacking because I run out of time to wash because I get so distracted with rabbit holes of things which are not relevant to the task in hand and before I know it it's dinner time and I'm still in my pjs and haven't brushed my teeth. And I have been busy all day, but, have nothing to show for it.

I had a publisher approach me to write a professional book - two years on and it is still a series of post it notes.

Mindfulness distresses me - who can EMPTY their mind? If I do that then all sorts of thoughts pop up, it's stressful!

I am currently working on five big personal projects - all half done. I can't choose just one to concentrate on because things pop up with the others so I get stuck into that for a couple of days, and then think about the other one, and the other one, and the other one...

I live amongst piles of things to put away/sort. I can clean and I can cook - but it is only ever 80% done at best. Our house is ok, mostly clean, mostly organised, mostly decorated - but, I am embarrassed if people pop round because it never looks as nice as it would if all the things were done.

I feel overwhelmed most of the time. I zone out in the evenings in front of crappy tv with crappy food, and I knit or sew and actually feel relaxed if I have something brainless to watch, something to chew and something to keep my hands busy.

I lose my shit with my family sometimes. I get very cross if I think they are taking me forgrgnted. Especially with my husband. I am not needy, or jealous or insecure, but, I deeply resent it if they are late for something I want to do because I am always waiting on them letting me down. Which isn't something that they do, it's really unfair of me.

I can't imagine having a routine of any description. My husband is routine driven, he even has a poo at exactly the same time every day. He has tasks he does on a Tuesday, every Tuesday, because that is the day you do the task. He knows when insurance needs to be renewed, which day the bins go out. I am never actually very sure which day of the week it actually is. We laugh that if I was head injured and having to answer memory tests at the hospital I'd fail because I don't really know what day or year it is and I can't count backwards in sevens. I can't remember my children's dates of birth, I do know them, but I have to think and I get them all muddled up, which is embarrassing with e.g. the GP.

So, although I've been worried about DS and wanting to help him - I have totally missed that my own behaviour is, well, whatever it is. I'm a bit surprised by the assessment sheets. I just thought I was scatty and lacking discipline.

I think what I'll do is see if I need a diagnosis and some medication and then have a chat with DS.

@vivariumvivariumsvivaria you’ve just described me! Sadly though of the five careers I’ve had I only reached a high (& lucrative) level in one of them in my mid-twenties then became a bit overwhelmed and bored by it and changed direction & never quite managed to have that level of success again. I’m academically able though & can wing it and hyper focus to pass exams where I’ve barely completed any work in the lead up to it.

‘Scatty’ is a word that has followed me throughout my life & the lack of ability to have a routine, the lost days where I’m ‘busy’ but have nothing to show for it, frequent overwhelm, needing to be doing multiple things when I’m ‘relaxing’, the total inability & frustration with an attempt at mindfulness, the piles of stuff, the unfinished projects....all resonate. I’m basically happy, very much live in the moment, have a lot of friends who are a lot of fun (most of whom I’m guessing are very patient with my quirks!) & I’m great in a crisis.

I was diagnosed with primarily inattentive ADHD five years ago at 44 - at the same time as my then 13 year old DS, it was life changing & the relief of knowing why I found some aspects of life so challenging was enormous. I’d highly recommend you go ahead with seeking out a diagnosis too (& be prepared for and understanding with NT friends and family to not ‘get it’, as you know yourself now it’s not well understood & if someone’s brain isn’t wired differently then they often find it hard to understand why you can’t just ‘get organised’ etc) Good luck!

Also this puts in to words how I always felt & thought everyone else did too, until I realised it describes an ADHD brain perfectly!

Errr yeah you've just described me perfectly as well and I have a diagnosis!

Especially resonated with this:

I do a lot of winging it and I manage/get away with it, but, I always think "if I thought about that properly and had done some preparation I could be quite good". I am very good at communicating - basically, dissemination of evidence is my skill.

Had a nice day off yesterday, did some family stuff and had a think about all this stuff.

I'm embarrassed to never have thought about it. All I've managed to do is develop crushing self blame.

I found a company that does online testing. It costs a small fortune, but, I think they'll do shared care if I need meds. If I was tested maybe that would help DS.

Thanks all