Should we investigate adhd assessment or anti depressants for my ds19

[Anonymous07200408]

Some advice please from those with kids who have a spiky ND profile. What I really don’t need is the usual suspects who don’t really believe in ND weighing in with scathing remarks - there are a lot on here and I don’t need that kind of wisdom please - this is very difficult for us as a family and sensitive. I am very experienced with ND and work in the field - I know my son is ND but just need some help teasing our depression vs autistic burnout vs ADHD procrastination etc. I am posting to AIBU for traffic even if the ASN boards would probably be a more natural home for this.

my 19yr old ds got a dyspraxia diagnosis in year 3 and ever since then has had various educational and social challenges. Looking back at his report from then there seem to be loads of indications of inattentive type adhd. He had a small, tight group of friends but is very socially anxious and incredibly passive. Identified as very bright from early on - effortlessly managed straight As until his final year where he pretty much took to the sofa/buried his head in the sand and crashed out in exams. Luckily he had an unconditional offer to uni and is now nearly at the end of his first semester.

He has needed an unbelievable amount of scaffolding in every way - socially and academically and in terms of life skills. Luckily he is local so I have been in and out helping him most weeks. He literally seems unable to answer text messages/ engage fully with uni support services etc - to the point he is now very far behind academically and talking about repeating the year. He has actually done really well socially and made a small group of friends who are luckily very proactive but he has already pissed them off by not responding to WhatsApp messages. The amount he has struggled has surprised us. He presents as having a low mood and flat affect and without us chivvying him to get to lectures and friends chivvying him to go out I think he would spend most of his time doom scrolling. He reports as being “ok” and I think he’s enjoying some of the social stuff but his self esteem is on the floor and always has been.

We have now started thinking that we need to do more to help - the situation is untenable. My question is, should we be investigating a private assessment for adhd (i am very sure he has asd but can’t afford an auDHD assessment)? 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).

Or should we be investigating ssris for his mood? I obviously have reservations about side effects (particularly blunting of emotions - they couldn’t be any more blunt tbh) and am not sure if he is actually depressed - he doesn’t really think he is but knows something is wrong.

thank you so much if you’ve got this far - so aibu to get him an adhd assessment with the idea of trialling meds

or ainbu if you think I should look into antidepressants?

any wisdom gratefully received - he is a gorgeous, hilariously funny, self aware, empathetic boy who is suffering at the moment 🙏🏼

I would go down the ADHD meds route first of all. However, bear in mind that a private ADHD assessment will mean you will be paying for medication.

Have you thought of the RTC route? Some providers medicate as well as assess although the waiting time will be longer (not as long as the NHS though).

Once he has tirated on the meds and given them a chance to work, then I think you will be able to look at whether antidepressants might also be needed (or needed instead).

Edited to add that ADHD meds can make autistic traits really come to the forefront and sometimes end up being counterproductive.

Good luck.

I have to say, nothing is screaming ADHD. It’s giving autism with high IQ and demand avoidance primarily. Which often combine to give burnout - which is pretty much what you are describing here. But either way, anxiety and/or depression are very comorbid in neurodiversity. Personally I’d do both if you are convinced there is an element of ADHD there as well.

So he went all through school and nobody did any assessments? That’s quite a poor show from the schools, imo.

Are there decent Student Health Services? Pastoral provision of any kind? Get him to go to both of them and see what they / the Uni are able to do by way of diagnosis and assessment and support. Get as much professional guidance as you can, because it is - as you know - very complicated.

I think if he did badly in his A levels, then unconditional offer or not, he could now be struggling academically because of gaps in his knowledge. That's going to be tough to face up to which could result in the avoidant behaviour you are seeing. It might mean either the course or the institute isn't right for him. It might be that this is what needs unpicking and once that is done hopefully his mood will lift. Not every young person lands in the right place first time. Not to say medication won't help, just that it might no be enough on its own.

Thanks so much for the sensible comments. Our gp does shared care (my other son is medicated) so one he would be titrated it would be ok.

I’m not too worried about asd traits because if he does have adhd it is the very inattentive type (he’s sloth like a lot of the time) so I don’t think they are masking his asd traits currently.

my concern is autistic burnout but not sure where to go with that as he wants to stay at uni and can’t avoid all the demands of being a student. He has a very internalised pda presentation - unlike my other son who is odd/pda.

thanks again for your thoughts.

He was very high achieving and compliant. The school were amazing with my disruptive ND son but ds1 just flew under the radar. I now feel we have failed him. Luckily his dcd dyspraxia diagnosis got our foot in the door for disability services but I have had to drive everything and they will only speak to him (he cannot follow up any admin at the moment). I am going to his first dsa meeting on Monday (organised by me) to advocate for him because he would come out with nothing. I really hope he gets mentoring and study skills support.

He has a very internalised pda presentation

Forget everything else, this will be the biggest challenge. I feel for him and you. Honestly, I think it will probably become too much for him by the sounds of it. If he’s adamant he wants to finish his course could he move back in with you? Presume you are very used to a relaxed, low demand household given both your DC’s diagnosis?

I hear you. He also had a year out (where he travelled semi independently with a friend who is very type A and organised) so his inability to function in some ways at uni has been a shock. Unfortunately he did deskill in his subject. We are in Scotland so he got straight As in highers. He was one mark off an A in his subject for advanced higher which considering he did no work is remarkable. He pretty much failed the other 2.

He could but actually the area he is thriving the most is socially and he is very proud of this. He is enjoying his nights out with his friends etc. I fear coming home would feel like a failure for him and isolate him.

we do have quite a low demand household but I also believe in de-accommodating around anxiety from a supportive parenting perspective (as per Eli leibowitz) so not entirely.

Is there any help available from his university in terms of diagnosis? May well not be, but it might be worth having a look.

I haven’t even checked knowing that waiting lists here are upwards of 5 years. I don’t even think they assess adults through the NHS in our local authority now.

I also struggle to come to terms with a very able kid not being able to follow the pathway of getting a degree. I’m desperate to find a way to support him to do this rather than give up but maybe I’m being naive.

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

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.

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

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

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

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.

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.

no ocd tendencies. The only things that have happened are Covid etc.

Thank you for the empathy and I’m glad your son muddled through. I am having a hard time accepting that this may not work out for him and am also feeling frustrated with myself that I didn’t see this coming and maybe didn’t prepare him as much as I could have.

Thanks - he has probably been in burnout for a few years - I need to look into this stuff.

Interesting thank you. I wish I could access the actual tool - although I do ask him about suicidal ideation often and so far he hasn’t expressed it.

Thank you - maybe we do need to look at ssris. I suppose I’m clinging on to the idea that the dopamine regulation from stimulant meds might fix a few things and spring him into life/away from the passivity but that may be because I am desperate for a quick fix.

I hear you on the over involvement but for kids like mine sometimes that level of intense scaffolding is what they need to help them function enough to be successful. It is, however, beginning to take an intolerable toll on me so that has to be my boundary.

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