Nothing Helps! What Can I Do?

Question

I have a 13-year-old who is struggling socially. He has been diagnosed with ADHD, a nonspecific mood disorder, and PTSD. He doesn’t understand how his remarks are insulting to people and how trying to force people to do things with him doesn’t help. He doesn’t like to do anything around the house. I have tried everything, but nothing seems to work. I am involved in the community and run a Special Education PTO, yet I struggle to understand what is going on in my own home, and why some options help other families but not mine.

Dana F., Plainfield, CT


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Ellen Littman, PhD

Dr. Littman is a licensed clinical psychologist specializing in attentional disorders, and a member of Smart Kids’ Professional Advisory Board. Nationally recognized as an expert in gender differences, she co-authored the book, Understanding Girls with ADHD.

At Smart Kids, we appreciate that it’s a particularly poignant dilemma to be knowledgeable and yet so perplexed. As you said, you are aware that your son “doesn’t understand.” You recognize that he is not choosing to alienate others. However, at times, all of us experience a child’s seemingly incomprehensible opposition as rude and even intentional, and we are flooded with frustration.

Most parents I’ve worked with over the years have wondered, in a moment of despair, “Is he a sociopath?” The answer, of course, is no—but the reality is that ADHD wiring interferes with his ability to attend to, process, and respond appropriately to the reactions of others. When he is consumed by his own intense impulses, further fueled by his hormones at this age, it is incredibly challenging for him to regulate his responses. At that moment, he simply is not able to step outside of his own needs and consider others’ perspectives.

In the face of this daunting yet characteristic developmental lag, it may help to remember that the discrepancy between social/emotional development and age-appropriate intellectual development is at the core of the ADHD experience. Regardless of how bright your son may be, these behaviors may be age-appropriate for a 10-year-old boy—his emotional age.

Rather than viewing his negativity as a standoff between you and him, you might think of it as a standoff between his intellect and his impulsive ADHD brain. In other words, your son may hear you and think “Mom really wants me to clean up my room.” However, his ADHD brain demands higher stimulation in order to be fully focused and engaged. So his brain may respond to him by saying, “I refuse to focus on something so boring and unstimulating. Find something with higher stimulation, that offers me a bigger dopamine reward, and then I’ll work with you.”

Much of the treatment for ADHD involves learning to psyche out the brain so it will attend to low stimulation necessary tasks.

Sometimes, the escalation of negative interactions between parent and child can become so “high stim” that it trumps any incentive for sheer intensity. To the ADHD brain, it doesn’t matter if the stimulus is positive or negative as long as it’s intense. And interpersonal struggles can fit that bill. So, one goal might be to try to decrease the emotional temperature of your communications to him. Then, a fairly immediate incentive might look more enticing to his demanding ADHD brain. When he and his brain are on the same page, he’ll be much more likely to do what you ask, and your relationship is much more likely to heal.

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