ADHD presenting mostly at home?

[Anonymous]

I have a 16 year old son.

His older half brother was medicated for ADHD throughout middle/high school - is now off his meds and doing fine in college.

His younger brother has been on ADHD meds for several years, and it is like night and day when he is off/on the medication. He's quite hyperactive and unfocused if we forget to give him Concerta.

The 16 year old in question has always done well in school - he is highly competitive and motivated so gets good grades. I don't think he is perfect in class, and he has told us sometimes it is hard to pay attention when teachers talk the entire class, but he performs and can really lock in when studying in order to get the grades (got all As last year for example). His organization is not great, but I suspect it's pretty standard for 16 year old boys.

I think we've known he has at least mild ADHD, however, just based on behavior at home. But he seemed to be fine without medication so we never got him evaluated.

It's now getting to the point where the ADHD behaviors at home are causing huge family strife. Some small examples -- he almost never rolls up the car windows or locks the car (he's driving our old car now), no matter how many times we ask. We'll ask him to go upstairs and get something and he'll forget what it was he went up there for. When he is the last one in the house, we ask him to double check he locked all the doors - he'll go downstairs to do it, and then in the morning we'll see that he left the doors unlocked. He doesn't seem to be able to read a book for more than 10 minutes at a time (he used to be a reader, now not so much). You can look him in the eye and tell him something and he will literally forget it 30 seconds later. My husband is taking these actions as a huge signs of disrespect and not focusing on our instructions/requests because they just aren't important to him.

My son doesn't think he has ADHD that needs to be treated (some of this may be because he's still growing and he's worried about its impact on growth, though he is now 6 feet tall). Is it weird to get him evaluated when his grades are good? How do you know the difference between a true ADHD inability to focus and listen versus just being a disrespectful teenager who won't do what his parents ask? Is all this stuff just standard teenage behavior?

thank you for any insight.

[Anonymous]

Are these inattentive symptoms showing up for the first time in teenage years? Are there any other reasons (other than the forgetfulness you mentioned) that you've suspected he has ADHD?

There's a lot in between "true ADHD inability to focus and listen versus just being a disrespectful teenager who won't do what his parents ask." Mainly, regular levels of forgetfulness.

Have you tried anything in response to these issues? E.g., he needs to remember to lock the car if he wants to be able to drive. I wonder if the "huge family strife" is coming from family functioning issues rather than his possibly ADHD symptoms. Even if what you mentioned is coming from ADHD, it seems like a massive overreaction for forgetting to lock doors leading to massive family strife.

[Anonymous]

Thanks for the response.

He has always been pretty absentminded. Tell him to go upstairs and get something and he’ll forget what he was supposed to get.

Any of these things occasionally, on their own, would not be a big deal. But let me give you an example just from today.

- I went outside and saw he had left the car doors unlocked and the window down (we have asked him to lock the doors and took the window up probably 100 times. Yesterday when he came home we made him go back out and double check. I think he goes out there looking at his phone and doesn’t even remember what he’s supposed to do)

- I go to grab his laundry and there are wet towels on the floor and on the bed. Again, I’ve asked a million times not to do this.

- I told him this morning to remember his keys because I might not be here after school. He didn’t remember them. I asked him if he remembers me telling him to bring them and he said he had no memory of that.

So that is just today, before 5 pm. And this is literally every day. There are some common sense rules (lock car doors, don’t eat in certain rooms of the house) that he fails to follow a majority of the time. Not once a week. Every day.

We are exhausted because we have to nag him to do every little thing and point out what he is doing wrong constantly. He is understandably tired of being nagged.

And yes, I understand the concept of natural consequences. If he forgets his keys he can’t get into the house. But then the dog doesn’t get let out. Our neighbor just had their car stolen. So the consequences of leaving car unlocked can be severe and don’t only affect him.

I just can’t figure out how much of this is normal and how much is a true inability to focus and hear instructions/directions.

[Anonymous]

Are you sure the good grades are 100% from his own work? No judgment, but if not, then ADHD could be impacting study skills more than you realize.

Maybe it's time for consequences instead of nagging? Natural consequences aren't always enough with ADHD kids/teens because they come too late, or someone else suffers them.

[Anonymous]

Anonymous wrote:Thanks for the response.

He has always been pretty absentminded. Tell him to go upstairs and get something and he’ll forget what he was supposed to get.

Any of these things occasionally, on their own, would not be a big deal. But let me give you an example just from today.

- I went outside and saw he had left the car doors unlocked and the window down (we have asked him to lock the doors and took the window up probably 100 times. Yesterday when he came home we made him go back out and double check. I think he goes out there looking at his phone and doesn’t even remember what he’s supposed to do)

- I go to grab his laundry and there are wet towels on the floor and on the bed. Again, I’ve asked a million times not to do this.

- I told him this morning to remember his keys because I might not be here after school. He didn’t remember them. I asked him if he remembers me telling him to bring them and he said he had no memory of that.

So that is just today, before 5 pm. And this is literally every day. There are some common sense rules (lock car doors, don’t eat in certain rooms of the house) that he fails to follow a majority of the time. Not once a week. Every day.

We are exhausted because we have to nag him to do every little thing and point out what he is doing wrong constantly. He is understandably tired of being nagged.

And yes, I understand the concept of natural consequences. If he forgets his keys he can’t get into the house. But then the dog doesn’t get let out. Our neighbor just had their car stolen. So the consequences of leaving car unlocked can be severe and don’t only affect him.

I just can’t figure out how much of this is normal and how much is a true inability to focus and hear instructions/directions.

I think an eval could be an appropriate next step.

In the meantime, here are some strategies you can try:
-the car thing seems to be a priority, so I would make a list of car expectations that he needs to meet in order to be able to drive. And then brainstorm with him about what could help him meet those expectations. A sticky note in the car reminding him to lock it, never lowering the windows so he does not need to raise them, etc. If he does not meet your expectations, then he cannot drive the car for X days and then he has another chance to show that he is responsible enough to do so.
-focus on the priorities, and let other things go. Maybe it doesn't matter if he eats in not-allowed rooms of the house (this seems like an odd rule anyway) as long as he cleans up.
-Clearly asking him to do something isn't enough, so what else can you help him try? Maybe teaching him to make a morning checklist of what needs to go in his backpack, making to do lists, making lists of your house rules, etc. Maybe an evening checklist that includes several things (e.g., doors are locked, laundry away, backpack packed, etc)

"We are exhausted because we have to nag him to do every little thing and point out what he is doing wrong constantly. He is understandably tired of being nagged." This sounds exhausting. Pull back where you can.

[Anonymous]

Also, have him repeat back to you your directions to help him process it

[Anonymous]

Anonymous wrote:Are you sure the good grades are 100% from his own work? No judgment, but if not, then ADHD could be impacting study skills more than you realize.

Maybe it's time for consequences instead of nagging? Natural consequences aren't always enough with ADHD kids/teens because they come too late, or someone else suffers them.

Yes, I'm sure. I do help him study, help proofread papers, etc. But he is incredibly competitive and works very hard at school.

[Anonymous]

He's masking all day. Then lets down the guard and/or meds wear off at home.