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 🙏🏼

Sadly we don’t have right to choose here in Scotland. Maybe I’ll take him to the gp to talk ssris as a first step. I will then have to decide whether to pay for an asd or adhd assessment - I don’t really know if an asd assessment is worth it as it won’t effect any change.

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

Thanks. I will find out if the dyspraxia diagnosis is enough to get the uni support on Monday - then will work out the rest.

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 💐

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)

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.

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.

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.

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.

Thank you all so much for your thoughts - such a rich variety of experience (and all so diverse which is both really helpful and also confusing 😆).

in terms of it being about me (put very kindly and I really want all perspectives) I totally see where you are coming from. The trouble is he himself is really keen to stay. We have totally non judgementally offered him options many times now, including coming home/leaving uni, and very uncharacteristically for such a passive kid he is adamant he wants to stay. This is importance because I know lack of choice can lead to suicidal ideation. Strangely when he comes home ( every weekend where he eats, sleeps and goes out till the early hours with his 3 best home friends) he is more chatty, engaged and present than he has been for a long time. The thought of him dropping out and ending up back on the sofa scrolling X and being totally flat again seems counter productive for him and us. I would do anything to protect his mental health but I’m not sure that’s it - hence the muddle and me trying to scaffold and support him staying - which doesn’t seem to be working academically. He also has lots of siblings that I need to consider. To be honest the supportive parenting stance I take with him is that he’s doing brilliantly and we are so proud of him and have huge faith in him whilst we validate how tough it can be and offer options. The toll it’s taking on me will not be hugely obvious to him although he’s very empathetic and has acknowledged it can be burdensome to us. I’m trying to frame uni as a success whilst recognising the huge academic challenges and not making him feel trapped if that makes sense. In some ways he has surprised us socially.

the de-accommodation is designed partly for nd kids and is much more supportive and tailored than it sounds - designed to help him thrive not survive - look at the eli leibowitz stuff.

i am interested in the stimulant meds unmasking the autism. My other son is prob auDHD and this hasn’t been his or my experience but that may be unusual. As I say, the autism is already more prevalent and he seems ok with that - ie. Social anxiety, some sensory stuff etc - I can’t see how any adhd presentation could be masking it as the symptoms seem to be mainly to do with executive function (0), daydreaming, procrastination, passivity, inability to start or complete tasks, avoidance and overwhelm. I realise these are co-morbid with asd but the executive function seems to speak more to adhd - particularly as he’s doing well socially (eg has put himself out there, tried new societies, gone clubbing and not hated it, loved the Wetherspoons crawl he did this week etc - although enthusiasm from him is “it was quite good” 😆). Please correct me if I’m missing something.

i don’t think there has been trauma - we are very very open with each other. No obsessive or ritualistic behaviour. Hygiene is inconsistent and sometimes problematic (eg wearing dirty trousers and not seeing it as an issue) but I see this as a pda presentation.

please keep the thoughts coming. We are restricted financially to one assessment which is a push in itself so need to prioritise.

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.

I should say we have an amazing team. Dad drops in for a no pressure drink once a week after work, incredible grandparents who see him once a week and take him shopping. All of whom adore him and would do anything to help. He’s a lucky boy in lots of ways.

he’s also connected with friends from home at uni, played tennis with them and joined their football team. It’s all such a monumental effort though. But I am really proud of him. Reluctant to let all that progress go.

I also hopefully have a call with an old friend this weekend who is a very well respected and experienced psychiatrist so am trying to get my thoughts in order as he is super busy and won’t have long to chat.

Totally empathise with all the above and have been through similar. The thought of leaving uni was making my son worse. I hid my worries about uni. It’s such worrying time and hard because they’re adults but still so young and you’re not directly involved.

I know money is tight( it is for us too as we’re funding uni x 2) but he does sound quite complex and if it was me I would get him looked at overall before pushing adhd meds. It’s £500 for a psych appointment I think and you do come away feeling a bit fleeced however whatever is learnt will help with next steps. ADHD meds can vary so much. I’d look for somebody well qualified if you do go down the ADHD diagnosis route.

Ideal!

i am interested in the stimulant meds unmasking the autism. My other son is prob auDHD and this hasn’t been his or my experience but that may be unusual. As I say, the autism is already more prevalent and he seems ok with that - ie. Social anxiety, some sensory stuff etc - I can’t see how any adhd presentation could be masking it as the symptoms seem to be mainly to do with executive function (0), daydreaming, procrastination, passivity, inability to start or complete tasks, avoidance and overwhelm. I realise these are co-morbid with asd but the executive function seems to speak more to adhd - particularly as he’s doing well socially (eg has put himself out there, tried new societies, gone clubbing and not hated it, loved the Wetherspoons crawl he did this week etc - although enthusiasm from him is “it was quite good” 😆). Please correct me if I’m missing something.

Sorry to quote a big paragraph but this could all be part of a spikey ASD profile. I think of it more like a scatter graph than a spectrum. If you listen to the podcast on the BBC, I think it’s 1800 seconds to autsim there is a man on there who holds down a professional job but employs what he refers to as a care worker who had to explain to him that when the microwave instructions say put it on, it meant cook in the microwave and not put it on top.

In terms of assessment a dual assessment for asd and adhd is much cheaper than two seperate assessment. When we paid for DD assessment they I had some minor concerns about potential adhd and they suggest they screen for adhd as part of the assessment , charger for screening but it was looking like adhd they would assess for adhd and not charge for an adhd screening as well as assessmemt. It’s worth chatting to some provider. Private providers will have waiting lists so it’s worth getting on a list and you can change your mind closer to the time.

As someone who works with ND people and has a ND young adult (who refuses any assessment) I’d recommend getting an ADHD assessment and medication for ADHD in the first instance. See how that helps with the overwhelm and coordination. Next look to antidepressants if still required.

Just bear in mind that ADHD is massively over diagnosed, very easy to get a diagnosis for, doesn't really exist according to many in the medical profession and doctors financially benefit from people being on the medication. Also the effects of the drugs on the brain are not reversible

I'm in England so don't know how Scotland varies but I would go for a general 1 hour assessment with psychiatrist who is ND aware, rather than full ASD assessment which takes longer and you already know he has ASD. Then I'd get on the Uni or NHS waitlist for Au/adhd assessment in case this is useful in terms of exam accommodations etc.

There is always one!🙄

You’re incorrect, it’s under diagnosed and under treated in this country.

www.england.nhs.uk/long-read/report-of-the-independent-adhd-taskforce-part-1/

also seek careers advice and work out wether uni is the best option for him. An apprenticeship might be a natural option and a better fit for your son.

Sorry but this has conspiracy theory vibes to it. I’d rather go with (extremely complex and often distressing) lived experience and medical consensus than this rubbish. ADHD meds have been life changing for my other adult son who has used them periodically as and when he needs them for years and is doing brilliantly. Stimulant meds are metabolised very quickly and he goes months without and has 0 side effects.

I will certainly explore but he seems adamant that he wants a degree and seems to be enjoying parts of uni life. Maybe a maths degree is just too difficult.

Exactly all this, it has literally changed the lives of my other 2 children. Hence me pursuing it for the third but I’m glad I checked with a psych first.

I don’t think he sounds depressed given he is socialising . However there are some antidepressant medications that are useful in ADHD and could have somewhat of a dual effect. Bupropion is best for this but off label in the UK (not in the rest of the world) so GP may not be able to prescribe. Venlafaxine and duloxetine are prescribable by UK GPs and have some (less than stimulants) effect on ADHD.