How to set household rules with depressed/SI teenager

[Anonymous]

My 16-year-old is neurotypical, I think, but he's also severely depressed and anxious (in therapy; on Prozac; no improvement so far). The symptoms play out in delayed schoolwork, retreating from possible new friends, and especially basic household tasks.

His room is terrible - dirty dishes, clothes everywhere, papers and detritus, a backpack that looks like a toddler's (crumpled papers, chip wrappers, nothing filed in folders or notebooks). He will not do his own laundry - promises to do so, then doesn't. If I do it for him, he promises to put it away, and then doesn't.

He's generally well-behaved except for these problems. I just feel like he's not learning basic life skills about order and keeping his spaces clean. And it's cutting into my work hours - he will not let me clean his room when he's at home, so I take an hour out of my telework day each week to clean his room and do his laundry for him.

A few weeks ago, I lost my temper with this situation - all our carrots and sticks seem to have failed. So I yelled at him, telling him he needed to grow up and take care of himself. I tried to make him clean his room, but instead he burst into sobs, said he couldn't do anything because he feels suicidal all the time and hates himself. He cried for an hour. So did I. (It did not feel manipulative on his part - I don't think he's acting like this to get out of chores.) It was one of the worst days of my life, and probably his, too.

We've subsequently consulted both his PCP and his therapist and they did not suggest outpatient or feel that his SI would turn into actual attempts. I'm not so sure.

But now we feel like we can't enforce basic house rules or he'll fall apart again. We've tried speaking to him gently about the situation; we've even tried bribes. But here we are in the same situation: me taking time off work to clean his room, him ignoring rules about no food in bedrooms, me doing all his laundry, picking up his trash, trying to sort out his school papers.

This is really worrisome because we're starting to look at colleges. I've hired a college counselor, but everything (signing up for an SAT date, choosing colleges to start visiting, etc.) feels like I am dragging him through his tasks like a dead weight. I keep getting angry (not at him, just internally) - he can't or won't do these tasks himself, and scolding him would result in another breakdown.

Not sure what I'm looking for here - just a vent. Maybe we should just leave his room alone until the mess overwhelms him and he learns to deal with it. Maybe we should just look at community colleges and skip the whole college-admissions insanity. I don't know. I just feel like crying all the time - I failed him somehow and I just can't figure out how or why.

[Anonymous]

Anonymous wrote:My 16-year-old is neurotypical, I think, but he's also severely depressed and anxious (in therapy; on Prozac; no improvement so far). The symptoms play out in delayed schoolwork, retreating from possible new friends, and especially basic household tasks.

His room is terrible - dirty dishes, clothes everywhere, papers and detritus, a backpack that looks like a toddler's (crumpled papers, chip wrappers, nothing filed in folders or notebooks). He will not do his own laundry - promises to do so, then doesn't. If I do it for him, he promises to put it away, and then doesn't.

He's generally well-behaved except for these problems. I just feel like he's not learning basic life skills about order and keeping his spaces clean. And it's cutting into my work hours - he will not let me clean his room when he's at home, so I take an hour out of my telework day each week to clean his room and do his laundry for him.

A few weeks ago, I lost my temper with this situation - all our carrots and sticks seem to have failed. So I yelled at him, telling him he needed to grow up and take care of himself. I tried to make him clean his room, but instead he burst into sobs, said he couldn't do anything because he feels suicidal all the time and hates himself. He cried for an hour. So did I. (It did not feel manipulative on his part - I don't think he's acting like this to get out of chores.) It was one of the worst days of my life, and probably his, too.

We've subsequently consulted both his PCP and his therapist and they did not suggest outpatient or feel that his SI would turn into actual attempts. I'm not so sure.

But now we feel like we can't enforce basic house rules or he'll fall apart again. We've tried speaking to him gently about the situation; we've even tried bribes. But here we are in the same situation: me taking time off work to clean his room, him ignoring rules about no food in bedrooms, me doing all his laundry, picking up his trash, trying to sort out his school papers.

This is really worrisome because we're starting to look at colleges. I've hired a college counselor, but everything (signing up for an SAT date, choosing colleges to start visiting, etc.) feels like I am dragging him through his tasks like a dead weight. I keep getting angry (not at him, just internally) - he can't or won't do these tasks himself, and scolding him would result in another breakdown.

Not sure what I'm looking for here - just a vent. Maybe we should just leave his room alone until the mess overwhelms him and he learns to deal with it. Maybe we should just look at community colleges and skip the whole college-admissions insanity. I don't know. I just feel like crying all the time - I failed him somehow and I just can't figure out how or why.

Is there also a psychiatrist looking at the meds or just the PCP?
What do the PCP or therapist recommend as far as the things like keeping room clean? Do they think starting the college preparation process is a good idea right now or better to wait for awhile? How long on Prozac? Is he keeping up with schoolwork? Hygiene? Does he pay attention to what he wears? Are there things he spends time on as escapes (video games or whatever)?
If it's depression it's really hard to overcome the barriers that causes to basic daily tasks. But I don't have specific suggestions, just these are some questions you might think about.

[Anonymous]

ps--I absolutely understand how you are feeling and how helpless you feel. With my kid there were times I swore my heart would literally break. It got better, but it was a very, very long time and was never what I would have imagined when he was little.

[Anonymous]

I hear the pain in your post. I'm sorry your family is struggling so much and know just how difficult it is, especially when I think back with my oldest DS who has ADHD/anxiety. I'll give you the same advice his psychiatrist gave me (and I've posted about before). "Your job is to get your DC through high school without a substance abuse issue and without depression. Everything else can be 'fixed' later."[i] It's excellent advice. It helps you keep your focus on what's most important and where your resources should be directed.

This doesn't mean you don't have expectations, requirements or boundaries for your DS. You and your DS need to be clear and in agreement with them as well as the consequences for when they aren't met. They need to be reasonable and defined up front.

For example, I would let go of a clean bedroom. I WOULD require that there be no food consumed in the bedroom and that if it smells, he must immediately clean it so that it no longer smells. At a minimum, this would be doing his laundry (he needs to do it himself) including washing his sheets AND his pillow. If he doesn't do it, then he loses a privilege. For my DS, it was loss of cell phone or inability to play video games until the smell was gone, laundry done and put away. For DD is was her cell phone and not being able to do extracurriculars except school related things and sports (sports have a LOT of health benefits are weren't on the table).

School: Your DS doesn't not need to go to college immediately after HS. Your DS does need to graduate from HS. He does not need to maintain a certain GPA. He does need to pass the classes required for graduation. So, every week, review what assignments are due the coming week, validate he's completed and turned in all assignments. If not, have him email the teacher and ask when he can stay after school to complete his work. He loses privileges until his teacher has indicated all work is completed. If he doesn't having passing grades in those classes, he needs to contact the teacher for additional support.

College: We had conversations with all our kids that if they expected to go away to college, we needed to see them demonstrate skills independently that were needed - things like keeping up on their school work without oversight, keeping up on their laundry, getting themselves up for school by themselves, signing up for the SAT, applying for schools, etc. My oldest DS did not demonstrate those skills. In February his senior year, as his friends were getting acceptance letters, he had nothing. Didn't even take the SAT despite my reminders or apply anywhere. It was painful to see but even though we knew he was capable, he was unlikely to be successful if he went away to college. We couldn't afford to waste that kind of money and, importantly, we didn't want him to experience an avoidable failure.

My DS, now 21, is doing great. He wanted to go to college so he did 2 years at community college (can't say enough good things about it). He learned all those lessons he should have learned in HS and matured a lot. He's at a 4 year college and is really successful. His grades are good (not great) and he's involved in a lot of activities on campus. There's no way he would have been able to do this right out of HS. It's not just that he didn't have the skills, he wasn't motivated.

There is NOTHING you can do if your DS isn't motivated. You can't make him want what you want. It's hard to step away from that because you know how it should be. But, you have to. Focus on what's important - get him through HS without depression, without a substance issue. Identify the minimum requirements and the consequences when he doesn't meet them. Then, get a glass of wine and take calming breaths. Hugs.

[Anonymous]

11:21 again. I wanted to mention that we also had to establish minimum hygiene requirements - daily showers (including washing hair) and brushing teeth before bed. The first 2 years of HS, it was such a freakin PIA to get him to do it. I have no idea why and, even in calm moments, couldn't get DS to explain. It was also a PIA to get him to comply with 'house rules' - like no food in the bedrooms (he actually got mice in his room), do not leave dirty dishes around the house, do not leave your stuff in the common areas, etc.

I took the approach that when you live with people (whether it's family, friends or roommates), there is a social contract. You do not infringe on anyone's ability to enjoy the common space. You can do whatever you want in your own space as long as there is no impact on anyone else - hence, the no food because vermin will not restrict themselves to a single room. Ugh. Thinking about those days still makes me want to groan.

[Anonymous]

Consider Wellbutrin instead of Prozac. Med change might help a lot.

[Anonymous]

#1 keep it clean. If kid won't clean, clean it for them. Deal with consequences for that separately. Living in filth is not acceptable and makes depression worse. It's not a good natural consequence.

[Anonymous]

You didnt mention a psychiatrist. I know they are hard to find. But it sounds like your child needs a different medication and may have harder to treat depression. If its been 4-6 weeks and the highest dose of Prozac hasnt worked, its time to move on. You need to get him to a psychiatrist ASAP.

[Anonymous]

It sounds like you need more support. Have you tried parenting coaching for you to help you decide which rules to enforce and how?

[Anonymous]

I agree with others that, assuming Prozac isn't brand new for him, you should explore a medication change. Not every SSRI works for every person. SSRIs don't work for every person. Finding the right med can be a lot of guess and check.

Beyond that, I think you need to have expectations but break them down into itty, bitty steps. What you asked should be reasonable, but for right now is just overwhelming for him. So for now maybe it's no food left in his room. Then no food or dishes. At the beginning this may involve you literally going through it with him once a day, helping him identify what's there that needs to go, and then being there while he takes it to the kitchen. You want tiny, accomplish-able goals that will not feel overwhelming to him, and provide support as needed for him to succeed. Then once he's been successfully doing the first step (for at least a week, I'd say) you can move on to the next tiny, tiny step. But seriously, it's hard to overemphasize how tiny it should be. You want him to be successful in making small improvements, and then he can build on that success.

[Anonymous]

How is your therapist? Does your DS talk to them? How many depressed teenagers do they work with. We found there are levels of experience and in a case like this, you may need to level up to a more experienced therapist. Also, I don’t agree that a higher level of care isn’t needed - IOP or PHP if you can get a summer spot and DS is currently going to school.

I would drop your expectations for now. If your DS had cancer and was too tired to clean his room, you would not force it. This is also illness. Treat the illness first.

[Anonymous]

You have to do chores with him. It could actually be bonding to do them together- you’re working together.

[Anonymous]

I am on a Facebook group called Parenting in a Tech World. Recently a parent posted that her son was so exhausted she was making an appt with his Pediatritian - he had zero energy, awful mood, sleeping all day. She even told the kid she was worried and they were testing blood, etc. He agreed.
She came to find out that he was staying up all night online. She took the device and he is back to normal. I'd highly recommend joining the group, it's informative and terrifying.

[Anonymous]

Agree with removing screens, it can make a remarkable difference. Also, get on a waitlist for a neuropsych. I think there may be anxiety and executive function issues in addition to the depression and now is the time to identify and address.

Continue to clean the room, living in filth will not help, I'd suggest he do it with you. A daily shower, shampoo, brushed teeth and clean clothes are also non-negotiable.

Before things got to this point, had he had mood issues? Trouble with friends that could stem from ADD or anxiety? School issues?

Any history of mood issues, bipolar, etc. on either side of the family?

I'd also consider drug testing.

[Anonymous]

Anonymous wrote:I hear the pain in your post. I'm sorry your family is struggling so much and know just how difficult it is, especially when I think back with my oldest DS who has ADHD/anxiety. I'll give you the same advice his psychiatrist gave me (and I've posted about before). "Your job is to get your DC through high school without a substance abuse issue and without depression. Everything else can be 'fixed' later."[i] It's excellent advice. It helps you keep your focus on what's most important and where your resources should be directed.

This doesn't mean you don't have expectations, requirements or boundaries for your DS. You and your DS need to be clear and in agreement with them as well as the consequences for when they aren't met. They need to be reasonable and defined up front.

For example, I would let go of a clean bedroom. I WOULD require that there be no food consumed in the bedroom and that if it smells, he must immediately clean it so that it no longer smells. At a minimum, this would be doing his laundry (he needs to do it himself) including washing his sheets AND his pillow. If he doesn't do it, then he loses a privilege. For my DS, it was loss of cell phone or inability to play video games until the smell was gone, laundry done and put away. For DD is was her cell phone and not being able to do extracurriculars except school related things and sports (sports have a LOT of health benefits are weren't on the table).

School: Your DS doesn't not need to go to college immediately after HS. Your DS does need to graduate from HS. He does not need to maintain a certain GPA. He does need to pass the classes required for graduation. So, every week, review what assignments are due the coming week, validate he's completed and turned in all assignments. If not, have him email the teacher and ask when he can stay after school to complete his work. He loses privileges until his teacher has indicated all work is completed. If he doesn't having passing grades in those classes, he needs to contact the teacher for additional support.

College: We had conversations with all our kids that if they expected to go away to college, we needed to see them demonstrate skills independently that were needed - things like keeping up on their school work without oversight, keeping up on their laundry, getting themselves up for school by themselves, signing up for the SAT, applying for schools, etc. My oldest DS did not demonstrate those skills. In February his senior year, as his friends were getting acceptance letters, he had nothing. Didn't even take the SAT despite my reminders or apply anywhere. It was painful to see but even though we knew he was capable, he was unlikely to be successful if he went away to college. We couldn't afford to waste that kind of money and, importantly, we didn't want him to experience an avoidable failure.

My DS, now 21, is doing great. He wanted to go to college so he did 2 years at community college (can't say enough good things about it). He learned all those lessons he should have learned in HS and matured a lot. He's at a 4 year college and is really successful. His grades are good (not great) and he's involved in a lot of activities on campus. There's no way he would have been able to do this right out of HS. It's not just that he didn't have the skills, he wasn't motivated.

There is NOTHING you can do if your DS isn't motivated. You can't make him want what you want. It's hard to step away from that because you know how it should be. But, you have to. Focus on what's important - get him through HS without depression, without a substance issue. Identify the minimum requirements and the consequences when he doesn't meet them. Then, get a glass of wine and take calming breaths. Hugs.

This is OP - thank you so much for your post. It's so wonderful to hear that your DS is flourishing now.

I'll reach out and see if we can get my DS to a psychiatrist - his PCP is good but I'd rather have a psychiatrist manage his meds. I think he may also need to be screened for ADHD, and have screen time/phone time limited as consequences.

To the person who asked about family history of mood disorder: yes, almost every relative (including myself) suffers from depression and anxiety. Part of it is genetic, I'm sure, but my whole family has had extremely difficult lives - like 7 or 8 on the ACES test. I've tried to keep my son's life as drama-free as possible and to provide for his every need. I keep my own depression away from him and never talk about it at home.

To the PP who suggested watching out for substance abuse: no, that's thankfully not an issue.

Thanks, everyone. Off to cry some more.