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 🙏🏼

It comes from the BMJ.

Why would Labour make this decision?🙄

As l said, it’s come from the BMJ. It’s a lot to do with the amount of paperwork it generates for GP’s. As they no longer have time to do it.

This from 2023 ( attached )

Guessing Theyve had enough now and are rightly pushing for funding

Something to look into - there are a couple of anti-anxiety drugs which are also prescribed for ADHD.

The problem is they aren't first line treatment for anxiety, they tend to come further down the line after other drugs have not worked.

I have two female friends who have been diagnosed with anxiety disorders / depression over the years who eventually were prescribed these drugs. They made a huge difference.

Both have characteristics of ADHD / autism and one has since been diagnosed.

The upside to knowing this is potentially you don't have to go down the route for diagnosis on the NHS but ultimately come to the same conclusion point - and probably sooner and without the hassle of getting into a situation of going for a private diagnosis and having to do shared care / pay for drugs.

Most GPs will need you to go through the process of trying first line drugs initially. If they work, great, but if you don't you have something to potentially suggest / ask for which makes clinical sense.

I forget what the drugs are called but I know it's findable with a bit of research.

Good luck.

My GP has a note on their website that they do not do shared care so pretty much don't ask.

It's appalling.

Thanks very much for this info. I’ll take a look now.

Our GP has stopped doing shared care too.

Is one of them Wellbutrin?

Haven't read all comments so apologise if this has been said (have read most)

Doesn't seem to be any mention of what your son wants?! Just what you want for him. I think that's your starting point right there!!!

It's not your decision if he stays, it's not your decision if he goes through the diagnostic process, it's not your decision whether he takes medication, none of this is your decision to make, and I mean that in the most respectful way.

Have you actually asked him what he wants to do? (Other than stay at uni).

I did say upthread - bupropion (trade name Wellbutrin in the US) unlikely to get U.K. GP to prescribe this as it’s off label for depression in the UK
More possible for a U.K. GP is venlafaxine which also has dopaminergic effects at higher doses

Omg please rtft. His voice (muddled as it may be) is absolutely front and centre here. I genuinely don’t give a shit what he does as long as he is happy and his mental health stays in tact. I have reiterated this multiple times. You do realise that I actually talk to my son, rather than unilaterally make decisions based on a Mumsnet thread?!?

he is confused and has said as much but all he is adamant about is that he wants to stay. I want to support him to do this in the way that causes him the least damage. This has included offering him options (stay/leave/live at home), investing in nd specific therapy, saving for an assessment should he wish, seeking advice on here etc. Genuinely, wtf would you like me to do?! Please people, stop projecting and actually read my posts 🫣🫣. Again, unless you have been in my shoes you have absolutely no idea how complex and draining this is. I would absolutely love a simple life where my 19 year old is independent and thriving - do you think this is fun for me?!

Hiya, this is literally me at this age, I'm autistic and have adhd. I swear by citalopram an SSRI, I've been on and off it since I was 19 (now 39) and never have any negative side effects, it's really helps with the issues autism causes me. I also take adhd meds but even on its own for the first 10 years citalopram helped. It's never dulled any emotions etc for me and just made things less overwhelming. CBT only really helped me with the social anxiety side of things. A work book called Mind over Mood helped me when I was that age with my inability to recognize what emotions I was actually feeling at times. It does help having a diagnosis though so I would definitely go down that route, being able to understand why some things overwhelm you really helps.

Just to add I don’t think the shared care stopping is just for adhd meds. I have children under CMHT too and one of the consultants there said they were seeing it for other meds eg anti depressants too. GPs can prescribe sertraline themselves but I’m not sure about other anti depressants so it is something to think about.

Ive just looked the Mind over Mood book up and it’s highly recommended

Have ordered so huge thanks for that recommendation and @Anonymous07200408 for starting this thread
and the heads up re gps from @Sk73djej , @SpidersAreShitheads and @RedToothBrush

🙏 it’s all so hard and hoping our children find a path that it best for them.

As an aside OP my ds is at Uni and despite the struggles that’s where he wants to be. Like you, it’s hard hearing how they struggle when you can’t be there face to face.

Go to the GP for an assessment about depression first. If he's depressed, it would impact the validity of a neuro assessment.

I think adhd is unlikely in someone who has effortlessly achieved As through most of their academic life. That implies the difficulty isn't linked to executive function. You might want to consider autism assessment instead.

My ds is studying neuroscience leading to basically brain surgery
and achieved As all his life
He has Autism and adhd

Of course you can be intelligent with these. In fact you are more likely to have a high IQ

‘ Nearly 2 percent of children aged 8 or younger have been diagnosed with autism spectrum disorder (ASD). This statistic is well documented today. What’s surprising is that half of these children also have an average or considerably above-average IQ. What’s more, at least two-thirds of people with ASD, particularly those with a high IQ, also have attention deficit disorder’

DH is very bright. Admittedly, he didn’t get As through school and university, but did pass our professional exams first time (no mean feat) and did well enough to get into the top 1% of earners. He did it through applying his hyperfocus and obsessiveness to his work. I have no doubt he has ADHD (hyperactive type), and difficulties with executive functioning; but he’s learnt strategies over his adult life to circumvent them, although it’s harder work for him than the rest of us.

Double check what the age cut off is, as in my old area the cut off was 25.

The whole internalised PDA description makes me think ADHD task paralysis.

Quick update. We have a private assessment for adhd on Monday and I spoke to my friend who is a psychiatrist today. He recommended starting on ssris as well and endorsed the assessment route. I’ll let you know how we get on.

Well done OP. If at all possible I would wait initiating the SSRI’s until the assessment is completed. Best of luck

That’s interesting. Could you explain why? My psychiatrist friend said to start ssris and wait 6 weeks to start stimulants if prescribed.

OK I haven't read the full thread but here's my 2p worth.

I have a ND son who was diagnosed as dyspraxic when he was about 16. His other issues were not causing issues at that stage. No issues with academic performance, always well-behaved and engaged with education. University was a total shitshow for him at the start as he started during Covid and due to the Scottish government's over-cautious approach, was in 4 times in his first year. Struggled through second year, failed his third year and had to take a year on suspension to get himself sorted.

It is hard to disentangle his issues and Covid certainly did not help as it stopped him making any connections whatsoever. He was very down and very low and having his last year at school and first year at uni online was a disaster for him. He saw the GP and was started on a low dose of sertraline and this has helped him considerably. It gave him back the desire and willingness to at least try with social interaction.

When he was placed into academic suspension it was clear something had to change for him to complete his degree. We had to pursue a private diagnosis for ADD (he doesn't have the hyperactive bit) and it was not cheap. It was however a proper diagnostic procedure involving a consultant psychiatrist who also works for the NHS. Our GP agreed to prescribe the medication on a shared care basis. He now takes Elvanse every morning and it has helped enormously with focus and just keeping him stable. He's now back at uni and we think he's doing OK.

So short answer - possibly both. Good luck. Ignore all the people who have probably posted telling you that he's 19 and an adult and blah blah blah.

That’s a very quick wait for an assessment. Does it meet the NICE guidelines?

Actually @Anonymous07200408 having read all your posts - are you actually me? Your son and mine are very similar. We are in Scotland too and the support he has had from uni has been poor. Please feel free to message me if you'd like to chat. It's tough. I get it.

I definitely will. Thank you so much for your empathetic response. Hugely appreciated. I’ll message when I get some headspace this evening - your posts are encouraging. Thank you for reaching out.