Help me diagnose my 13 year old...?

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Forum -> Parenting our children -> Our Challenging Children (gifted, ADHD, sensitive, defiant)

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amother

Thu, Apr 25 2024, 1:23 am

(It's not that I want to label him, but I'd love if someone could "recognize" him and give advice!)

He is sensory- he covers his ears from sounds like someone blowing their nose, but likes to randomly clap loudly (maybe that's the physical sensation as well). As a baby, he gagged when he crawled on a shag carpet.

He has school refusal - refusal to go to school caused him to be put in a (useless) PHP for 2 weeks and then transferred to public school, where his attendance was better for a while but continues to be a major concern (he recently missed 3 months straight).

He plays too much video games - his favorites are Roblox and Minecraft. We used to have devices in the home for kids to play on but he has no limits. He would rage when I said time was up, sneak time when he wasn't allowed (even waking up in the middle of the night to play!) and lie about it. When he misses school it's because he went to the public library to play for the entire day (recently only coming home when the library closes, sometimes after 8 pm).

Academically he is fine- according to his teachers he can miss a number of days and still pass because he picks up on information so quickly.

He can be violent - he rages very quickly. Triggered when his siblings comment on his misbehaviors, he will lash out, throw things, punch, and hit. He has hit both myself and my husband as well.

His weaknesses - he isn't very socially involved, he isn't self-aware, he used to say self-deprecating things "I'm bad" although now he says "I'm best/better", he has no insight into his situation (he can't explain why he doesn't want to go to school; he claims he isn't addicted to gaming), he is fearful (scared of strong winds and thunderstorms, is afraid of people getting hurt (but not of hurting them!)

His strengths - he is clever and funny, has a huge vocabulary, great at computers, he makes up silly catchy songs that the whole family enjoys, he reads a lot, he is loving to the baby, he can prepare foods for himself and others.

Prior interventions - he got a basic evaluation through the public school district when he first refused school and they found nothing aside from lagging academic skills (due to limited instruction in the frum school); he later had a neuro-psych which diagnosed adjustment disorder with symptoms of depression and anxiety but I'm not sure what he was supposed to be struggling to adjust to, as he has not undergone any recent changes at the time; he was seeing a therapist for over a year but never opened up to him so made no progress.

Things we've considered: depression, anxiety, addiction, mysphonia, autism

Does any of this sound familiar to you?

amother

DarkMagenta

Thu, Apr 25 2024, 1:27 am

Have you considered pandas at all?

Happydance

Thu, Apr 25 2024, 1:50 am

Asd?

amother

Cognac

Thu, Apr 25 2024, 2:05 am

What parenting methods have you tried?

amother

DarkGray

Thu, Apr 25 2024, 9:14 am

Adhd has been ruled out?
Does he eat well? Sleeps regular amount if time?

amother

Tiffanyblue

Thu, Apr 25 2024, 9:17 am

Sounds like asd. Definitely start with a full neuropsych eval it will clarify if it’s adhd, asd or a mental illness.

amother

NeonPurple

Thu, Apr 25 2024, 9:33 am

(Double post)

Last edited by amother on Thu, Apr 25 2024, 9:45 am; edited 1 time in total

teachkids

Thu, Apr 25 2024, 9:38 am

My impulse is to look into adhd with anxiety or asd

amother

NeonPurple

Thu, Apr 25 2024, 9:43 am

Adjustment disorder can happen even if it doesn't seem like there is anything to adjust to (I speak from experience). Usually manifests as depression and or anxiety. It does sound like he has some depression and anxiety, but that doesn't cover all of it.

Definitely some sensory issues (sensitive to loud noise as overstimulation, but also makes noise when understimulated).

Sounds like there are anger management issues, but it could be those are a symptom and not the cause.

Could be ADHD, but not necessarily. Or ODD (opposition defiant), but also not necessarily.

Could be autism, there sounds like there is overlap at least.

I would take him for evaluation again (my adhd was missed the first time).

I would also try another therapist, make sure it is a licensed psychologist who specializes in teens. Not connecting with one therapist could just be a bad match. If he repeatedly can't connect with different therapists, that could also point to autism.

amother

Thu, Apr 25 2024, 11:51 pm

amother DarkMagenta wrote:

Have you considered pandas at all?

Hmm. I looked it up briefly. It sounds like sudden onset is a key factor for that, and he's had his idiosyncrasies since babyhood.

amother

Thu, Apr 25 2024, 11:58 pm

amother Cognac wrote:

What parenting methods have you tried?

Interesting question. My core method has been based off of "How to Talk so Kids will Listen" - I'm big into labeling feelings and gentle methods of encouraging cooperation. I learned about Nurtured Heart Approach but it doesn't sit well with me. It sounds punitive but framed in nicer words. I really like Collaborative Problem Solving but never really made any progress with this child. All he ever seemed to want was device time in exchange for cooperation, and device time itself was the problem! Promising him time in exchange for going to school meant more suffering for him (emotional and physical responses to gaming) suffering for us (anger when told that time was up- slamming devices, knocking over chairs, hitting people, stomping, crying).

Recently, on advice of his (previous) therapist we have been intensely positive to him, not criticizing him (as much as possible) in order to try and prevent further damage to the relationship and convince him that we love him. In return for our tolerance of his behaviors, he skipped school for three months straight...

amother

Fri, Apr 26 2024, 12:02 am

ADHD has not been ruled out, nor has ASD, but also, neither has seemed particularly prominent, in my opinion. It was only recently that ASD was suggested as something to look into. I would guess that he has some symptoms of both, but won't qualify for a diagnosis according to the DSM.

I wonder/worry that no diagnosis will ever fit him. He's just a quirky kid and I'm at my wits end.

I will look into getting another neuropsych though, thanks for the encouragement.

amother

Fri, Apr 26 2024, 12:04 am

amother NeonPurple wrote:

Thank you for this informative post! I appreciate that you took the time to write this and consider the different angles.

amother

NeonGreen

Fri, Apr 26 2024, 8:32 am

Have you researched why he is avoiding school and what have been the consequences?
Has he been treated for the sensory issues?
How's this theory: sensory/ anxiety so avoids school to avoid triggers, uses video games self soothe, rage when left without tools to self soothe.
It also sounds like he doesn't have close relationships which also leads to low self esteem and emotional dysregulation.
This could be within the framework of ADHD/ ASD

amother

DarkMagenta

Fri, Apr 26 2024, 9:29 am

amother OP wrote:

Hmm. I looked it up briefly. It sounds like sudden onset is a key factor for that, and he's had his idiosyncrasies since babyhood.

Plenty of children don't have sudden onset, or a very early onset that was missed and still benefit tremendously from treating infections and inflammation. Just saying.

amother

Sapphire

Fri, Apr 26 2024, 9:33 am

Disruptive mood dysregulation disorder

How's he socially

amother

DarkGray

Fri, Apr 26 2024, 9:38 am

Check out
livesinthebalance.org
You might be helped by trying it out.

amother

Fri, Apr 26 2024, 10:33 am

amother NeonGreen wrote:

I do like this theory. I would think it really fits him. Here are my other thoughts on it:
a) no complaints from teachers in school! He has no outbursts in school, so they have no concerns. When he comes home from school, it's almost always with a smile on his face. He also attended a month of overnight camp last summer and I got zero complaints from them either.
b) I asked him about anxiety and he claims there is nothing. I asked him how he feels when he doesn't get device time on Shabbos and he said it's not an issue for him. It could be that he just isn't really in touch with his feelings/sensations.
c) all he ever claimed to dislike about school is that it's "boring" and "too long." I know those words don't tell a whole story (and his challenge with identifying feelings is making this really challenging) but I'm not sensing any anxiety about school. I've asked him countless times what is challenging about school, if anyone bothers him, hurts him etc. with no indication of anything being an issue.
d) lack of close relationships is certainly concerning, but a challenge I struggle to resolve. He is in public school because he refused to attend the frum school, so he intentionally distances himself from peers there. He also refuses to participate in any organized sports.

I will look it up as well, but what treatments are helpful for sensory issues?

amother

Fri, Apr 26 2024, 10:37 am

amother Sapphire wrote:

Disruptive mood dysregulation disorder

How's he socially

He definitely gets dysregulated when he is removed from devices, and also when people comment on his behaviors, such as siblings teasing him about not going to school, or only liking tablet time. But he hasn't had any outbursts in school (or camp) so he can really hold it together. I will add this to my list of considerations though.

amother

Fri, Apr 26 2024, 10:41 am

amother DarkGray wrote:

Check out
livesinthebalance.org
You might be helped by trying it out.

I've learned and tried Collaborative Problem Solving, which is a method by Stuart Ablon who used to work with Ross Greene. Unfortunately, I think they had a falling out, separated, and went on to market similar methods.
I haven't used CPS recently because I didn't see a lot of success when I did use it. I would have long conversations with my son and get nowhere. He always wanted to settle our differences by me promising him tablet time in exchange for his cooperation. Seeing as tablet time made him less cooperative, I wasn't thrilled by the idea.
This is a good reminder to try again though, and to read Ross Greene's book. Thank you!

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