teen who refuses to even consider meds or therapy

[Anonymous]

Our teenager recently underwent a neuropsych evaluation and received a diagnosis of ADHD (inattentive). he is very bright but has extremely slow processing speed. He also displays very rigid and inflexible thinking. The psychologist recommended discussing the risks and benefits of meds with a psychiatrist, and recommended therapy for both our teen and our family. My psychologist didn't want to put it in the report because it's no longer in the DSM-V, but she very strongly believes that our teen has Asperger's.

Two problems that are causing me intense frustration:

1) My spouse is incredibly resistant to even going to a psychiatrist to discuss the pros and cons of medication for the ADHD, because "a psychiatrist will never not recommend medication* and it's "a slippery slope." This notwithstanding that my spouse has been on antidepressants for years -- i.e. my spouse doesn't *not* believe in the value of medications. My spouse wants to "try therapy first."

2) My teen absolutely refuses to consider either the possibility of medications or therapy. My child believes in "overcoming any issues by himself." He also doesn't see that he *has* any issues and has an answer for why everyone *but* him has the problem.

My kid is doing fine in school -- I am going to seek an IEP based on the ADHD/processing speed issue. But our family life involves so much strife and conflict because of my kid's rigid and inflexible thinking and it has a huge impact on his two younger siblings and on my spouse and myself.

How can I get my spouse on the same page as me? How can I get my kid to agree to even consider meds or therapy? I have had long discussions with both of them and I feel absolutely stuck. We did the neuropsych evaluation (not our teen's first) for real reasons that my spouse and I agreed on, and now I feel like out of the three of us I'm the only one who wants to move forward and actually do something to help my teen (outside of the IEP).

And if you have any recommendations for a stellar psychiatrist who is great at meds and also great at discussing risks/benefits and not just whipping out the prescription pad, as well as a great therapist who can help with the rigid/inflexible thinking/Asperger's piece, I would be very grateful. Preferably in MoCo.

[Anonymous]

Anonymous wrote:Our teenager recently underwent a neuropsych evaluation and received a diagnosis of ADHD (inattentive). he is very bright but has extremely slow processing speed. He also displays very rigid and inflexible thinking. The psychologist recommended discussing the risks and benefits of meds with a psychiatrist, and recommended therapy for both our teen and our family. My psychologist didn't want to put it in the report because it's no longer in the DSM-V, but she very strongly believes that our teen has Asperger's.

Two problems that are causing me intense frustration:

1) My spouse is incredibly resistant to even going to a psychiatrist to discuss the pros and cons of medication for the ADHD, because "a psychiatrist will never not recommend medication* and it's "a slippery slope." This notwithstanding that my spouse has been on antidepressants for years -- i.e. my spouse doesn't *not* believe in the value of medications. My spouse wants to "try therapy first."

2) My teen absolutely refuses to consider either the possibility of medications or therapy. My child believes in "overcoming any issues by himself." He also doesn't see that he *has* any issues and has an answer for why everyone *but* him has the problem.

My kid is doing fine in school -- I am going to seek an IEP based on the ADHD/processing speed issue. But our family life involves so much strife and conflict because of my kid's rigid and inflexible thinking and it has a huge impact on his two younger siblings and on my spouse and myself.

How can I get my spouse on the same page as me? How can I get my kid to agree to even consider meds or therapy? I have had long discussions with both of them and I feel absolutely stuck. We did the neuropsych evaluation (not our teen's first) for real reasons that my spouse and I agreed on, and now I feel like out of the three of us I'm the only one who wants to move forward and actually do something to help my teen (outside of the IEP).

And if you have any recommendations for a stellar psychiatrist who is great at meds and also great at discussing risks/benefits and not just whipping out the prescription pad, as well as a great therapist who can help with the rigid/inflexible thinking/Asperger's piece, I would be very grateful. Preferably in MoCo.

Curious why the psychologist didn't give your child an ASD diagnosis if she felt he had Asperger's?

Did the psychologist go through the results with him (either alone or with you and your husband?). He is a teenager, may listen more to a professional, and at any rate is old enough to be a participant in decisions about his schooling and future.

[Anonymous]

If your son's behavior is impacting the family, then you do need family therapy.

You can make him go to the psychologist, but you definitely cannot make him take medication, in my opinion.

Why are you pushing an IEP if he is doing fine in school? What services will he get?

Why did the psychologist not give him an ASD diagnosis?

I think that you probably also need individual therapy to figure out the best balance between helping your child, giving your child autonomy, and seeing to the needs of the entire family.

[Anonymous]

Yes, the psychologist discussed the results both separately with my spouse and me (twice) and with my teen.

What if my teen decides that he simply refuses to accept any help, whether meds, therapy, or both? I don't see how we force him into anything -- persuasion and discussion hasn't gotten me anywhere. Yes he is old enough to be a participant in decisions -- but his behavior is significantly negatively affecting the whole family dynamic. What if I can't persuade him into therapy? The rest of us just suffer? I feel we are at an impasse. My respect for his self-determination and my need to help my entire family not simply revolve around him and his behavioral issues are in conflict.

[Anonymous]

With respect to the IEP, he is doing *fine* (not failing) but not meeting his potential. He has always had executive functioning issues with how long it takes to get his homework done. Part of the issue is that I don't think the middle school curriculum is particularly challenging and he has learned to compensate somewhat especially as he is extremely bright. He has had struggles in school since early elementary. We did a full neuropsych in 2nd grade that did not result in an ADHD diagnosis but I think that neuropsych missed the boat.

He is going to a high school program next year that will be much more challenging. He also does very poorly on timed tests and those are going to start increasing with APs, SAT/ACT, etc. His psychologist has very specific recommendations such as extended time for tests, etc. The differential between his processing speed and his intelligence is extremely marked and explains a lot about why he can do perfectly on homework and then get Bs on tests (especially in math in which he is very advanced) because he ran out of time.

[Anonymous]

I may have worlds most stubborn ADHD 11 year old, and we have been fighting this exact battle this year. Her teenage brother is also ADHD, which was easy to treat because he understood there was a problem. DD refused to acknowledge the diagnosis for months. DH says we are playing the long game with her. Which is true. Here's what I have:

You have to be on the same page as DH, especially in the presence of your child. If you allow him to divide and conquer you will never survive.

I agree with PP that you can force therapy to some extent, but you really can't force meds. It's not like you can pin your child down and shove a pill down his throat each morning.

Our step one was a therapist-- our DD has an anxiety/ADHD diagnosis, and needed help on the anxiety piece. We got really lucky, and found a psychologist who comes to our house. I told DD she needed to "interview" someone to help her. The psychologist came and took it from there. Fortunately, they clicked.

Step 2 was meds, and it took us a while to get there. Once we had the therapist on board, the therapist helped. It seems mean, but we started pointing out places where DD's ADHD was affecting her life. She was so used to it, she didn't realize that treatment could help with things like not leaving her instrument and homework at home. She also wanted to attend the same FCPS AAP Center MS as her brother and take 7th grade Algebra honors, and we told her she would have to treat the ADHD in a way that her therapist and psychiatrist signed off on, or we weren't signing her up for the extra stress and academic pressure.

There was also some outright bribing involved. She got a reward for meeting with the therapist. She participated in the school 504 meeting, despite being very unhappy about it, because it was agree that she could bring a used laptop to school for writing. So, she tolerates the other elements of the 504because she likes the laptop.

In short, a combo, of patience and carrot and stick. Good luck! This is a tough area to deal with.

[Anonymous]

Anonymous wrote:With respect to the IEP, he is doing *fine* (not failing) but not meeting his potential. He has always had executive functioning issues with how long it takes to get his homework done. Part of the issue is that I don't think the middle school curriculum is particularly challenging and he has learned to compensate somewhat especially as he is extremely bright. He has had struggles in school since early elementary. We did a full neuropsych in 2nd grade that did not result in an ADHD diagnosis but I think that neuropsych missed the boat.

He is going to a high school program next year that will be much more challenging. He also does very poorly on timed tests and those are going to start increasing with APs, SAT/ACT, etc. His psychologist has very specific recommendations such as extended time for tests, etc. The differential between his processing speed and his intelligence is extremely marked and explains a lot about why he can do perfectly on homework and then get Bs on tests (especially in math in which he is very advanced) because he ran out of time.

It sounds like you need 504 accommodations, not an IEP (IEP requires specialized instruction in order to access the curriculum). You are going to need to get the whole family into therapy to make sure he will USE the accommodations if you get the school to agree to them. Many students resist things like extra time once they reach his age.

[Anonymous]

Even if he won't go to therapy, the rest of your family can go.

[Anonymous]

Anonymous wrote:Yes, the psychologist discussed the results both separately with my spouse and me (twice) and with my teen.

What if my teen decides that he simply refuses to accept any help, whether meds, therapy, or both? I don't see how we force him into anything -- persuasion and discussion hasn't gotten me anywhere. Yes he is old enough to be a participant in decisions -- but his behavior is significantly negatively affecting the whole family dynamic. What if I can't persuade him into therapy? The rest of us just suffer? I feel we are at an impasse. My respect for his self-determination and my need to help my entire family not simply revolve around him and his behavioral issues are in conflict.

Can you elaborate a bit more on how his behavior is impacting your family? What you have said so far doesn't sound so bad... Maybe your son is right?

[Anonymous]

You can find a good psychiatrist who will discuss medication with your husband. He or she will most likely recommend meds, but it is very helpful to have an expert explain how and why they work. You can try therapy first, but with a resistant teen, you are not likely to have much success without meds. (Therapy with no results is expensive, but I can see your husband's point.) Is there any anxiety? Because my inflexible teen benefitted greatly from anti-anxiety meds.

We had a different situation with our therapy-resistant DS- it was critical that he get in to therapy (major depression and severe anxiety). We cut off everything - money, phone, rides anywhere, haircuts... there was no assistance from us outside the house unless he attended his therapy appointments. We were desperate and it worked. (We also paid him to go, which was a suggestion that several therapists gave us and also helped.)

I agree with PPs that it will be helpful for you (and DH) to go regardless. (And may be even more helpful depending on the level of participation you get from DS.)

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, the psychologist discussed the results both separately with my spouse and me (twice) and with my teen.

What if my teen decides that he simply refuses to accept any help, whether meds, therapy, or both? I don't see how we force him into anything -- persuasion and discussion hasn't gotten me anywhere. Yes he is old enough to be a participant in decisions -- but his behavior is significantly negatively affecting the whole family dynamic. What if I can't persuade him into therapy? The rest of us just suffer? I feel we are at an impasse. My respect for his self-determination and my need to help my entire family not simply revolve around him and his behavioral issues are in conflict.

Can you elaborate a bit more on how his behavior is impacting your family? What you have said so far doesn't sound so bad... Maybe your son is right?

I am not looking for family therapy via the SN board, or a judgment by a non-professional based on whatever anecdotes I present. We have a son who has gone through a professional neuropsych examination by a Ph.D. with 30 years' experience in the field, and it is her professional opinion that my son would benefit from discussing meds with a psychiatrist as well as from therapy. Both my spouse and my son refuse to consider the former, and my son refuses to consider the latter. I am doing my best to be a good, involved parent and addressing the issues that are causing my son and my family to have problems. I am not going to type out a bunch of stories because I actually don't care whether you think my son is right to resist professionally-recommended treatment or not and your giving your opinion on that issue is not at all helpful.

My post is asking for similar experiences and recommendations from families in similar situations (i.e. spouse and/or child resistant to following up on psychologist's recommendations) who have BTDT, and recommendations for psychiatrists and therapists who are helpful in this type of situation. The post at 11:45 was super-helpful (thanks, PP!) and is what I'm looking for in terms of learning from families who have struggled with similar issues.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yes, the psychologist discussed the results both separately with my spouse and me (twice) and with my teen.

What if my teen decides that he simply refuses to accept any help, whether meds, therapy, or both? I don't see how we force him into anything -- persuasion and discussion hasn't gotten me anywhere. Yes he is old enough to be a participant in decisions -- but his behavior is significantly negatively affecting the whole family dynamic. What if I can't persuade him into therapy? The rest of us just suffer? I feel we are at an impasse. My respect for his self-determination and my need to help my entire family not simply revolve around him and his behavioral issues are in conflict.

Can you elaborate a bit more on how his behavior is impacting your family? What you have said so far doesn't sound so bad... Maybe your son is right?

I am not looking for family therapy via the SN board, or a judgment by a non-professional based on whatever anecdotes I present. We have a son who has gone through a professional neuropsych examination by a Ph.D. with 30 years' experience in the field, and it is her professional opinion that my son would benefit from discussing meds with a psychiatrist as well as from therapy. Both my spouse and my son refuse to consider the former, and my son refuses to consider the latter. I am doing my best to be a good, involved parent and addressing the issues that are causing my son and my family to have problems. I am not going to type out a bunch of stories because I actually don't care whether you think my son is right to resist professionally-recommended treatment or not and your giving your opinion on that issue is not at all helpful.

My post is asking for similar experiences and recommendations from families in similar situations (i.e. spouse and/or child resistant to following up on psychologist's recommendations) who have BTDT, and recommendations for psychiatrists and therapists who are helpful in this type of situation. The post at 11:45 was super-helpful (thanks, PP!) and is what I'm looking for in terms of learning from families who have struggled with similar issues.

I think I'd look into family therapy if I were you to address the specific behavioral concerns that affect the family. I think you can require him to come as a parent.

[Anonymous]

Anonymous wrote:You can find a good psychiatrist who will discuss medication with your husband. He or she will most likely recommend meds, but it is very helpful to have an expert explain how and why they work. You can try therapy first, but with a resistant teen, you are not likely to have much success without meds. (Therapy with no results is expensive, but I can see your husband's point.) Is there any anxiety? Because my inflexible teen benefitted greatly from anti-anxiety meds.

We had a different situation with our therapy-resistant DS- it was critical that he get in to therapy (major depression and severe anxiety). We cut off everything - money, phone, rides anywhere, haircuts... there was no assistance from us outside the house unless he attended his therapy appointments. We were desperate and it worked. (We also paid him to go, which was a suggestion that several therapists gave us and also helped.)

I agree with PPs that it will be helpful for you (and DH) to go regardless. (And may be even more helpful depending on the level of participation you get from DS.)

Thanks, this is really helpful -- I hate to think about having to go the route of forcing my son, but I can see how that might be where we end up. As I've said to my spouse -- I'm really concerned that our son won't benefit from therapy without also having meds to help with the rigid/inflexible thinking. This has always been a kid who has an infinite capacity to be stubborn -- think of the immovable object. I have two other kids and know plenty of other kids for whom this is not the case, so I have a very good sense of what's within normal limits and what's not. His rigid thinking is only getting worse as he gets older -- I wonder if there's a puberty-onset component here too, and we can see it starting to cause problems not only within the family but outside, too.

We didn't get an anxiety diagnosis for my son but on the other hand that was not a significant issue we had asked the psychologist to look into. My husband has (and is being treated for) anxiety and depression, I have major depression and ADHD, and my youngest has been in therapy for anxiety (but no meds) before, so I wouldn't be surprised about any diagnosis in a similar vein for my son or my other kids but I can't say we have a diagnosis (and I am not sure whether our psychologist looked for it).

[Anonymous]

I think I have PTSD from years of trying to persuade DH that

1. DS really did have issues, whatever they were;
2. once they were confirmed, that he did really need an IEP and services because hello, he was non-functional;
3. once he was failing late elementary with all the school support imaginable, that he really did need medication.

OP, what can I say? It took YEARS for me. And that was only fighting with DH - DS was too young and compliant. I can only wish you the best of luck. You know what's best for him.

[Anonymous]

I'm sorry you have to deal with this OP.

I was one of those anti-meds teenagers. Here are some things that worked:
1. I got to pick my psychiatrist and therapist. (Yes, that's right. I got to pick. And I was 14.) I went through probably about 10 before settling on one I liked. And he wasn't cheap. (Sorry Dad!)
2. I got to choose whether to take the meds or not.

It's important for your kid to know that if he doesn't like the meds he can just stop taking them. You just want him to give it a try. Same with your husband. Maybe make a deal that if your son tries them for a month (or however long the psychiatrist recommends) you will get him a new ipod or itunes gift card or whatever bribe you feel comfortable with. Tell DH that if, in a month, he is unhappy with the effects of the medication on DS, you will agree to not bring it up again. Go ahead and bribe DH too (I bet you could think of something ).

Also, it was helpful that it stopped being about what was WRONG WITH ME. The people who are saying try family therapy might be on the right track. It sounds awfully hurtful to be thought of as the messed up one who's making everyone else unhappy. In my case, there were major family dynamics contributing to my problems, but my parents and older siblings definitely did a lot of "why are you doing this to us?" Once it stopped being about what I was doing to everyone else, things got a lot better.

I'm still unhappy with the CBT therapist who wanted me to "change my distorted thinking" and everything would be better. No amount of positive thinking was going to change my troubled family situation. The therapist who helped me learn coping strategies to deal with the bad situation was much more helpful.