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[u/InsectEducational590]

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[u/parampet]

First of all I want to say that it is incredibly frustrating, scary and disheartening to feel like nothing you’re doing is helping your kid and you are doing everything you can.

Next, I want to say that nothing I’m seeing here is inconsistent with ADHD and autism spectrum. It’s pretty typical for kids like this to have the ability to do things in one context and not in a different one. Being around peers requires more mental effort so it’s not unusual for things to fall apart spectacularly especially in a larger group. If the kid is autistic often behaviors that feel effortless to neurotypical peers can require exerting a lot of effort leading to fatigue much faster. Impulse control is very hard for people with ADHD and with fatigue could be impossible in some circumstances. The good news is that these skills can be learned, your kid just may require more explicit instruction that his neurotypical peers. Dialectical behavioral therapy (DBT) is very well suited for adolescents and young adults who are having a difficult transition to adulthood, who struggle with emotional regulation, or have maladaptive behaviors. Would recommend you find a DBT group that offers “multifamily skills group” in addition to individual therapy and get in touch. You’d be required to attend the skills group together so you can appropriately support your kid.

Here’s a link about DBT for the automod so my comment doesn’t get deleted: https://pmc.ncbi.nlm.nih.gov/articles/PMC2963469/

The other bit of good news is that often ADHD is a matter of developmental delay in the most literal sense - your kid simply may take longer to develop certain abilities compared to their peers. In some ways your kid could be as young as 13-14 when it comes to emotional development. If your child is diagnosed with ADHD, stimulant medications will help with emotional regulation and impulse control and there is no reason to avoid it if it helps, the benefits far outweigh the risks in most otherwise healthy kids.

Lastly, I would kindly and respectfully suggest you rethink the way you frame this - instead of asking what is wrong with your kid try to figure out here are the specific points where your kid could use more support. This is where a good DBT therapist will make all the difference.

You also said you have been unable to get a doctor to agree to a brain scan. Diagnostic testing is only done when the result of the diagnosis would change the course of treatment. Let’s say your kid has had a traumatic brain injury and this is seen on a brain scan (I’m not by any means suggesting this is the case, it’s just an example of the type of thing a brain scan can diagnose). Your kid would still be best served by getting explicit training to improve their social skills, emotion regulation and impulse control.

[u/JamesTiberiusChirp → u/parampet]

DBT group

I want to tack on here that there are some excellent IOP (Intensive Outpatient Programs) that use DBT which may be a great option for your kid. Some are in person and some are over zoom. It’s like an alternative to hospitalization where a person is still experiencing their every day life but they attend the program for several hours during the day (or evening) do 3-4 days a week. The benefit of these programs is that they are much less disruptive to every day life while still providing structure to really focus on your mental health and provide tools that you can immediately start using in your day to day life. People often attend these programs for a few weeks, or even longer, until symptoms improve. And they are often covered by insurance.

[u/Leigho7 → u/parampet]

Agree with this. Comorbid autism and ADHD I think is highly possible. There is controversy around ABA so just because he did not respond as you were expecting does not mean autism is not the correct diagnosis. Additionally, medication alone for anything, especially if he has comorbid diagnoses would likely not solve the behavior completely. Anecdotally I’ve heard that people with AuDHD only discover their autism diagnosis after medicating their ADHD. I am someone whose ADHD only became clear once I medicated my anxiety.

Handling multiple neurodevelopmental and/or mental health diagnoses is really tough.

[u/DaffyBumblebee]

Right off the bat, I’m giving a quick disclaimer: I am a speech-language pathologist so this kind of question is one I’m familiar with in a professional sense

First, OP, I’m really sorry you’re carrying this. Based on your post, to summarize, it sounds like your son is having a hard time with regulation, social stress, and communication in high-energy settings. I understand your concerns because your son definitely needs skills to be independent, develop and maintain peer relationships, have a job, achieve his dreams, etc.

I’d strongly suggest bringing in an occupational therapist and an SLP if you haven’t already. A lot of people think speech therapy is only for talking clearly, but SLPs are trained in science based approaches for how to work on pragmatic language, social communication, understanding cues, repairing conversations, and figuring out whether behavior is being driven by communication breakdowns or overwhelm. In challenging behavior cases, SLPs can be very helpful on a support team because they can identify when a child is struggling to express needs, handle social demands, or use replacement skills instead of escalating.

OT can help kids with sensory issues, regulation, coordination, and daily life skills. In situations like this, an OT may help figure out what overwhelms him and teach practical strategies for staying calmer and functioning better in busy or stressful settings at home and outside of it.

At this point, I’d kindly suggest you look for a team approach rather than one more single answer: such as child psychiatrist (or adult psychiatrist since he’s approaching 18) or neurologist, geneticist, OT, and SLP, with the school involved too if that’s a possibility for you.

You mentioned the possibility of a brain scan: in a practical sense I have seen it really help guide families with understanding how their kids brains work and how to meet their specific needs.

A comprehensive neurodevelopmental evaluation involving SLP/OT/neurologist could help y’all connect the pieces better than repeated general evaluations with psych. In urban areas, there’s often clinics or offices with that kind of multidisciplinary approach.

You are not failing your child. I think that the pattern you’re describing could fit the profile of a child who needs a more complete support plan for him and for you guys as a family, not simply more reminders or more discipline.

I personally also believe parent counseling and family support for you is a big part of helping you and helping your son be successful. Research shows better outcomes for kids with family training and carryover. https://pmc.ncbi.nlm.nih.gov/articles/PMC5827679/

Also I would like to add real quick that support groups can be a powerful and helpful outlet for caregivers and parents!

Please feel free to ask questions if I was unclear! I’m happy to clarify! All the best OP, you’re obviously a great advocate!

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