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 don’t really see the point of this thread as you only want 1 answer which will in your eyes validate your actions.

The over diagnosis of mental health issues is at epidemic levels in the UK. In many cases parents are the biggest contributory factor.

I wasn’t in the slightest bit surprised to see you state you already medicate another DC.

I feel sorry for the children. They are being pushed down a path they really don’t need to go down.

I have had multiple different answers and the only ones I am discounting are the conspiracy theory rooted ones. Why do I not medicate my other NT children? Why does my ND adult child decide himself if he would like to take medication on a particular day (because he sees the benefits for things like driving tests/exams)and not on other days? - that is his own lived experience that you are invalidating. Nothing to do with me.

I have had a kid who has struggled for 19 years with undiagnosed neurodivergence - if I am so set in my ways, why are we only reaching this point now? Could it possibly be that he has reached out because he is really struggling and would now like some answers? The parent blaming and shaming is extraordinary - you haven’t lived a day in his or my shoes and yet feel qualified to blame me for his struggles?

Honestly - you really need to give your head a wobble. I am totally open to other people’s advice when it is constructive - ie. I am prepared to accept he may be in autistic burnout rather than have adhd or he may be having a mental health crisis. What I am not prepared to accept as a mental health professional and a mother of 4 very diverse kids is that either he or I are imagining his difficulties. what would you have me do out of interest? Maybe offer some constructive advice rather than just blaming me - if your advice is to leave him to it then I will probably discount it as he is suffering and has told me as much. It would be negligent to ignore this.

And can I just say to those who think they know better than I do, my parents are approaching their 80s. They are posh, stoical, hate psychobabble and would rather die than admit anyone is mentally ill. They accepted his struggles years ago, have embraced the idea of him being ND and are endlessly supportive of him, me and our approach. They actually know him so maybe think about that before you comment on a family and situation you have no knowledge of.

You have pretty much proved my point.

Ok cool 🙄. They have embraced it because they see it to be true.

ADHD isn’t mental illness.

There is no widespread agreement on the extent of overdiagnosis.

Experts including the President of the Royal College of Psychiatrists, state that severe mental illnesses are still under-recognized and underdiagnosed, and that early diagnosis is crucial for preventing more complex, lifelong conditions.

If you click the link you can have access to the depression scale and use it

💯. I also didn’t come on here asking if i was imagining how my son is presenting. I came on asking if in people’s experience he was experiencing a mental health related crisis or an ND related crisis. I know that he is neurodivergent. That much is not up for debate.

Thank you! I did try but I’ll take another look.

He sounds very similar to my son. He had a few problems socially in school and was diagnosed with ASD when he was 15. Flew through his GCSEs on about 60% attendance doing no work at all. We moved him to a different school for sixth form and he struggled with his A levels. He missed his university offer by two grades, but was lucky that they offered him a place anyway.

He took a gap year between School and University and did essentially nothing for the first six months, then got a very part time job.

We had an ADHD assessment for him during his gap year and he started meds just before he started University in September. He's at a local University and lives at home. He is enjoying his course, but is finding it challenging - he has needed quite a lot of help to get his first two assignments done. Currently we are still waiting for DSA, which I think might help. The meds don't seem to have made his autistic traits worse and he is definitely more motivated than he was during his A levels. Socially, he's really enjoying himself.

It sounds as if your son might be burning out to me. I would probably try and get a combined ASD/ADHD assessment and Go from there - would he consider restarting University next year to give him some time out to recover and get started on meds if he does have ADHD?

Good luck. I think too many neurodiverse people are out on SSRIs when they aren't the right thing. The right treatment for neurodiversity is reasonable adjustments/support and ADHD meds if relevant

Exactly and having had children whose mental illness wasn’t treated sooner enough and ended up getting massively worse due to being untreated it’s clear the concerns re under diagnosis are valid.

Quite. And the correlation between undiagnosed ND, mental health crises and suicide are the real issue. Not over diagnosis ffs. I would never pursue an assessment and all it entails because I am NT and the traits my son experiences haven’t been an issue for me. Why anyone would seek to be diagnosed if they don’t need to be is just nonsensical.

Very helpful, thank you. They do sound similar! I think we will go and see what adjustments he can get on Monday and take it from there. He is feeling a lot of shame around his executive functioning and lack of attendance/handing in work so I’m hoping this will help.

Hi - my understanding was that CBT is often ineffective for neurodivergent individuals? Would DBT be a better option to investigate?

Also, do you think this really is a change in functioning levels? It sounds more as if he’s in an environment where the demands have suddenly increased and he’s not able to manage academic, social, and self-care requirements? The OP describes him as being more outgoing, chatty, and engaged. I’m not suggesting that he quits uni or moves back home just yet but it reads as if he can’t yet manage the step up to all three of those areas simultaneously.

I agree that the right kind of therapy could be really helpful but unless OP is extraordinarily lucky, she’s likely to find it difficult to see an NHS practitioner with sufficient knowledge of a mixed presentation. With conditions overlapping each other, you really do need someone with a depth of experience to tease out what’s going on and that’s often sadly lacking, even in those therapists who have some knowledge of neurodivergence. What’s more likely to happen is that ADHD is pushed to the side unless it’s screamingly obvious, and in many cases it isn’t, especially if there are co-morbidities such as ASD and/or dyspraxia. That then leaves the underlying condition untreated, meaning it’s just a sticking plaster on a deeper wound. Would it not make sense for any neurodivergence to be fully diagnosed first before embarking on therapy?

OP, your DS is diagnosed with DCD, have you looked any further into how this can affect an individual? As @Nephthys21 says, the impact on executive functioning can be very significant with DCD alone. Do you think it could be possible that your DS is autistic with DCD rather than being AuDHD and DCD? With limited funds it’s a tricky one for you because it sounds as if he needs a full assessment rather than just picking one 😫 How is his sleep?

So interesting and useful - this is what I came here for, thank you! Definitely possible the dcd could be contributing but again he has a spikey profile because his gross motor skills are excellent. I have found myself wondering if his dcd diagnosis was just masking his ND. His sleep is terrible.

Spiky profiles are really common in neurodivergent people 🙂

And his gross motor skill function could be due to practice. DCD doesn’t mean you’re unable, it just means it’s much harder to learn. My DS really struggles with fine motor skills and initially couldn’t use a game controller. It took him years but he’s very adept now! (Sorry, I don’t mean to teach you to suck eggs!🫣)

One thing you could try tackling immediately is his sleep. That might help him on a practical level with his executive function to some degree. Our GP was willing to prescribe melatonin to DD before she was diagnosed with ADHD, because she already had an autism diagnosis. If your GP is a good one, they should be able to prescribe melatonin because you already have a DCD diagnosis. They might need to submit a consult to the hospital first - some do, some don’t - but you should be able to get it prescribed fairly quickly.

You can also buy melatonin online. I know lots of families who resorted to this as they were stuck on waiting lists for a first diagnosis.

I’ve also heard from many people that autistic traits become more noticeable if ADHD meds are prescribed. But for many people, ADHD is more of a hindrance on a day-to-day level - that’s certainly the case for me.

It might be interesting for you to try and find a good resource that shows how DCD, autism, and ADHD intersect. The presentation can really change when other conditions are present, and that can lead to misdiagnosis. It’s actually quite hard to find something that considers all three properly - which is ridiculous as they often co-exist! It’s fairly easy to find good resources for autism and ADHD, and ADHD and dyspraxia, but all three is what you need! This isn’t brilliant but it’s a starting point:

That’s really helpful in the sense that it helps to explain how complicated it all is 😆🫣. I will definitely look into melatonin - he is very annoyed at himself because he can’t seem to get on top of it.

he’s actually home now and is reporting that the wellbeing service knocked on his door yesterday because of missing a meeting with his student support person. I’m so impressed with the uni and he was quite alarmed but it gives us more ammo for the dsa meeting. Hope that shuts up the naysayers on here - I certainly didn’t contact them myself despite being a nightmare helicopter parent 🤦🏼‍♀️

on the plus side he’s had a great time with all his pals and is discussing getting a house together next year so he is very invested in staying at uni if at all possible.

I've not read all of this - but my daughter who has ADHD and is on her third try of ADHD meds - low mood, severe anxiety but also bloody brilliant and funny and sociable has just started on lisdexamphetamine and oh my god it's changed her life in 5 days- she's back to her self without the crippling anxiety which makes her mood low and isolating herself - she's able to take part in CBT to help her manage her anxiety it's been life changing, it also helps her manage her MH and in conversations with medical professionals to say she has ADHD as they are starting to understand her and offer her new ways to help herself - for example she struggled to drink enough water as she hated asking to go to the loo at schools / sixth form
due to her anxiety and it led to a severe kidney infection (ffs) but knowing she had AdHd and struggled a bit with self care they suggested some really practical solutions that she could implement

Id say progress a diagnosis and then he's able to access specialist medication - if he wants it obvs - good luck

Just a thought, is there alcohol involved on his nights out?
As someone who is autistic pda I know alcohol makes socialising so much easier.
It took me 7 years to do a 3 year degree. The demands of lectures were too much so I ended up just doing the assignments from home and just attended uni for exams. I had a lot of support from the uni. They weren't too interested in a diagnosis they just needed to know how they could help. But I know that getting the right diagnosis means you can use the most suitable strategies.
Hope it works out for him.

That’s so great to hear. Delighted for you and your daughter!

Really glad you got there in the end. I’m heartened my ds uni has already flagged him and offered support so hopefully they will continue in this vein.

strangely lots of his friends don’t drink but yes - he binge drinks compulsively. Not very often but it’s a little concerning to watch - I think it really helps him socially so he is medicating with it - not too problematic yet but keeping an eye. He’s over the awkwardness of small talk with new friends now and they seem to be properly getting along.

I can say on good authority that CBT is not unsuitable for ND patients -
the therapist need to adapt the CBT to the needs of the patient - and in that case CBT can be highly effective -
DBT - dialectic behavioural therapy is designed for borderline personality disorder/ emotionally unstable personality disorder

people with ND and the above would benefit from DBT -
those without the personality disorder may benefit from the emotion regulation skills embedded in DBT but are higjly unlikely so access DBT under NHs without a personality disorder -

definitely don’t write off CBT -
but an experienced therapist who had the ability and flex to tailor the treatment delivery is crucial

So, standard CBT wouldn’t be suitable, only modified CBT with a suitably knowledgeable practitioner?

I think that’s my concern - rarely is that available on the NHS. In our area at least, ND people are referred to a standard CBT practitioner, often with no special awareness of how to modify CBT in the right way to be helpful for ND patients.

I have to confess to not knowing much about DBT but my understanding was that although it was initially developed for BPD, it was found to be effective for neurodivergence, and not just with emotional dysregulation but also sensory issues and anxiety?

I fear you’re right about accessing DBT on the NHS though - services are extremely thin and it’s unlikely to be available.

You may find that specialised study and life skills support for dyspraxia will be the most useful for him at this point. Once he has got back on an even keel with his studies it sounds like he will feel a lot better but he may be really lost about how to match his subject/ course structure with his challenges.

Dyspraxia can impact a lot on university level study. A lot of people seem to think that dyspraxia is about motor skills only but it affects how information is processed and organised and it can be as exhausting to process and produce some types of work as it might be to be doing an obviously physical task that eats up executive function. Not surprising he has little left in the tank for texting etc. (although do check out also there is not some sort of fear of saying/writing the wrong thing in messages, especially if the dyspraxia has led him to mix up messages in groups or to people in the past and he is worrying about that). Once he has had his assessment and got DSA he will get a lot of support for the areas that he finds most challenging. Ideally he would have had this in place for the start of the course so it may not be a bad idea to repeat the year although I would definitely encourage understanding better if he is on the right course for him if things don't pick up once he has all of the study supports in place (probably would use a private educational psychology assessment for this).
Do you follow Prof Amanda Kirby? She has dyspraxia in her family and leads on it being understood and supported in a way to make the most of strengths and support challenges.

We had private assessments for autism, adhd and depression

The assessments are accepted by GPs and mean you can have nhs funded medication
Others have said they don’t, this is not correct

I would get the assessments. Wait time was days for my ds.

Look at the clinic Adhd360
we also used Clinical Partners