Adult son barely eating

[BlueLoris]

DS was diagnosed with inattentive ADHD aged 18. His struggles have worsened as he’s got older and he is now NEET. Aside from the difficulties we’re having with helping him find employment and his increasingly nocturnal living, we’re getting really worried about his eating.
He’s never had a huge appetite and maybe slightly fussy but he’s now hardly eating. We sit down for a meal as a family in the evening, when he’s often not eaten all day and it’s clear to see that he’s struggling to eat, I find it painful to watch. We are pretty good cooks and make an effort with providing food the dcs will like, so it’s not that we’re serving him something awful. We’ve found he actually seems to eat more when he takes his medication because he’s able to come out of his room and make himself something. Today he’s not had medication, not eaten all day and couldn’t eat a roast dinner at 7pm. He’s had one cup of coffee.
when everyone else is asleep tonight, he’ll probably come downstairs and get crisps, chocolate and coffee.
He is now so thin that his collar bones are visible jutting through his T shirt. He weighs less than me (he’s about 5’7”) and I’m 5’1” and size 10.
We’ve asked him so many times but he denies there’s a problem and will not open up.
I’d like to take him to the GP but he refuses.
any ideas what might be going on? Anyone else experienced this?

How old is he?

He’s nearly 20

I would try to log what he eats over a week, then phone an ambulance. What is his weight and therefore BMI?

Once you phone 111, they would instruct an ambulance I think because of the risk of organ failure but it has to be a particular BMI level I think and x amount of days since he ate properly

However, he can refuse to go in the ambulance or refuse to attend hospital.

Could well be a sensory issue around swallowing, textures, feeling sicky.

YOu dont say he is ASD but if he is, this is quite common and different from a bog standard ED.

My son’s medication makes him lose all appetite. But he’s much younger and he makes up for the lack of eating at the weekend when he doesn’t take his medication.

is he depressed maybe?

They’re not going to send an ambulance for that.

Im not sure if they will for an adult but this has happened several times with our children and the carer is instructed by CAMHS to call an ambulance once the BMI gets to a certain level, the young person is then taken in for re feeding.

Im talking 16 and 17 year olds so this is why Im not sure if its the same for an adult but I would go through the same routine personally.

I’d suggest a post in the SEN groups for traffic there. My eldest has autism as well as ADHD (still a child though) and has also gone for stretches where he really struggles to eat and it’s linked to mental health for sure.

For my son when he’s struggling the sensory input of eating around others can be too much so eating in front of TV and away from people can help. Meals at different times. At night.

That and very high calorie meals - there were times he would only eat one meal a day, after dark, on his own - i became the queen of butter cooked lamb with alfredo pasta with a side of peanut and cream toast (you get the idea). Kept him out of hospital at least in the worst times.

I wonder if you can keep high calorie things in the fridge he can easily microwave when he does feel the urge… whatever his comfort foods are like if he likes mac n cheese or jacket potatoes or anything that’s at least not crisps.

What’s his reason for not wanting to eat? Will he agree to see a doctor or to take measures to increase his calories by drinking things like creamy milkshakes.

Having once sat with a screaming teenager in a park who’d broken his leg from a fall and the ambulance took its time as they were busy, I’d be reluctant to call 999 about thin teenager.

My son was exactly the same. He was so skinny his cheek bones were hollow. He did agree to see an adult dietitian who gave advice that he never took but I think it did make him realise how underweight he was so he started making an effort himself.
Now he has settled into a routine where he has “breakfast” about 4pm, “lunch” around 9pm and “dinner” at midnight. I often come down to a tip in the morning but I don’t care cos he’s eating.
I mean he’s still skinny but he’s just nudged into the “healthy” bmi line.

my son is slightly older than yours tho and hadn’t figured it all out by 20 so hopefully he will as he gets older 🤞🏻

Thanks for the helpful replies. He does eat - we’re definitely not at a calling an ambulance stage! His diet is limited though. Peanut butter and jam on toast, tomato soup, pizza. One or two small meals a day. His BMI is underweight, I can’t remember what it is now but I think I will push for him to speak to the GP.
Stocking up on better high calorie foods is a good idea.
I have wondered about depression too.

How many calories do you think he’s eating a day? And when you say fussy. How fussy? Has his eating always been a very narrow range of foods?

I'm surprised that nobody is mentioning anorexia - because he is male? - but of course young men do get it. I would take a look at the beat website, or ring their helpline, to get more details on diagnostic criteria. With ED the associated behaviours are as important as BMI. This can then inform how you talk to the doctor. Good luck.

Some of the ADHD meds are appetite suppressants and can lead to anorexia (anorexia is caused by weight loss when the brain starts to lose weight/fat.)

He really needs a thorough medical check including bloods, ecg and blood pressure and pulse checks. If he’s eating less than 500 calories a day for more than 3 days this would be considered a medical emergency.

Ideally he needs to eat 3 meals and 3 snacks a day, if he’s happy to come up with a meal plan sit down and go through it with him. You may have to make the meals and snacks for him.

I don’t think it’s anorexia. He will eat lots of something if he likes it and the time is right. Part of it is probably linked to ADHD and his messed up sleep pattern. When I say fussy, it’s never been problematic, just doesn’t like a few things. He’s pretty adventurous with food really.
I’ve just told him that if he’s hungry in the night I don’t mind if he cooks pizza or soup rather than eating crisps etc and he agreed. Maybe just saying that to shut me up though!

The young people Im talking about where we were instructed to get them to A+E, were still 'eating' but the calories were around 500-800 a day, and not every day. Thats why you need to log what the intake is as best you can.

What is his BMI. Organ functioning can be affected quite early on.

Higher fat intakes are going to help him though so the peanut butter and pizza if he can get that down him is good.

Men can get eating disorders. It may be that he has developed anorexia maybe as a form of controlling his life or EDNOS due to sensory issues or hyperfocus on something outside of his body which makes attending to his bodily needs feel uncomfortable.

Have you tried to address the sleeping pattern? He will feel better if he lives life in the daytime like everyone else.

We have talked to him about the disordered sleeping but it’s the typical teen problem of staying up late gaming, which is when he is hyper focused. He’s never been a good sleeper and now seems to only sleep a few hours at a time. I’m hoping that if he gets a job, that will resolve it.
He’s still going through the process of getting his ADHD medication to the correct dose, so the clinic is monitoring his weight and blood pressure. The weird thing is, he eats better when he takes the medication.
I don’t think he has an eating disorder because there’s a clear visible difference when he does and does not have an appetite. When he can’t eat he has various tics, will drink loads and you can see him struggle to chew and swallow. Other times he will eat without any difficulty or tics. Anyway, I will see what the ADHD clinic thinks and the GP.

I don’t think you can say that it is or isn’t an eating disorder. What you are seeing as fluctuations in appetite, could be because he’s been restricting his eating (deliberately or not) and then has massive hunger cues and catching up. Or at least catching up a bit.

My 18 yo dd does this. She isn’t consciously aware of her restricting. She has ADHD and is chaotic, won’t have a routine right now, sleep all over the place, and she literally forgets to eat. And because she has autism, she doesn’t get hunger cues until she’s starving.

Are you able to discuss with your ds why he isn’t able to eat those times? And about the difficulty swallowing?

You say he is pretty adventurous with food, yet right now he isn’t. If you were to cook him one a proper meal, as opposed to leaving him to it, would he eat it? And if he would, will he eat cooked meals every day?

It sounds as if your ds’s diet has reduced to very beige foods. There is pretty much no protein in there and no meat if he previously ate that. Or any plant based alternative beyond a bit of peanut butter if not. I’d also be very concerned with that diet. Restricting to a small range of ‘safe’ foods sounds a lot like ARFID. ARFID, which has potentially tipped into anoretic behaviours. Difficulty swallowing / gagging is also a sign of ARFID.

From everything you’ve said, I’d be very concerned. As @likelysuspect said, some people don’t stop eating altogether. Some never restrict to fewer than 1000 calories. I would therefore be looking to getting him to a GP ASAP for basic observations to check his BP and heart rate, which will give an indication of just how much this is affecting him and a referral to adult services. If you have a cuff, I would do this yourself. He needs to be still for at least 10 minutes to get an accurate reading.

It’s important to ascertain stuff like - How much is he losing in a week? How much has he lost? How many calories is he eating in a day? I would be counting his calories every day right now. Ie monitoring the cupboards and seeing what’s missing. It’s a PIA to do this and weigh everything.

Everything you’re describing is exactly what my dd did and she was very ill. Didn’t believe she needed to eat to live in the end.

As @Girliefriendlikespuppies said, the standard is 3 meals and 3 snacks every 2 to 3 hours to stabilise blood sugars and to get the body used to eating again. As an adult, he will need to want to do that for himself. And whilst he’s living with you, he may let you help him with it.

My son was very similar aged 17 - AuDHD, not purposefully restricting calories, just 'not hungry'. We filled the house with high calorie stuff that he sometimes liked: crisps, prawn crackers, tortilla chips, cream cakes, doughnuts, milkshakes etc. And made sure that there were ingredients for things he liked to cook (at midnight). We worked on the principle that his body needed to go back to needing calories - we tried to just kick start hunger by getting any food into him without any pressure and without worrying about quality or healthiness. Obviously this wouldn't work if anorexia was in play!

That sounds really worrying, especially if he’s visibly losing weight and barely eating. I’d be concerned enough to keep encouraging a GP appointment, even if he doesn’t think there’s a problem. ADHD, medication, low mood or an eating issue could all potentially play a part, so it’s important not to assume it’s just fussiness.

I had a similar issue with my DS around that age. He's AuDHD and was struggling with stress and depression along with disordered sleep. Eventually he admitted that he got overwhelmed at the sight of a plate of food and couldn't eat. As with a pp, I ended up filling the fridge with snack food, ready meals he could microwave in the middle of the night, things like pasties he could eat cold, sushi, cured meat and fruit. The main thing for him was stuff that was either very easy to prepare or things he could grab. I also got him multivitamins as for a while his diet wasn't great. He's much better with eating now but still doesnt eat loads.

This sounds incredibly difficult, especially when he isn’t recognising or able to talk about what he’s experiencing. Changes in eating and weight alongside ADHD difficulties are worth discussing with a GP, even if getting him to attend feels challenging.

Thanks for the replies. I will try and track his calories and contact the GP.
It seems he cooked a pizza during the night last night, so he must have taken my suggestion on board.
@Mummyoflittledragon me and DH cook proper meals 6 days a week, so he is given a nutritious meal once a day. Sometimes he’s fine, sometimes, like yesterday, he struggles and I suggest he finishes it later if he’s not hungry. And then sometimes he’ll reheat it at 11pm and sometimes he won’t. If he was left to his own devices, his diet would be processed and beige but does eat a variety of vegetables that I’ve cooked with the evening meal. That’s always the first thing he eats, especially when he’s not hungry.

Pre-cook some pizza & leave it in the fridge for him - they he can eat it cold or pop it in microwave. Load it with his fav calorific toppings.

I can’t believe that people are suggesting an ambulance. That will not get him any faster treatment and it’s not a life threatening emergency. They would just put him in the waiting room with everyone else. Going in by ambulance is not a way to jump the queue.