Teen ADHD w anxiety and depression very low motivation

[Pema20]

curious if anyone has has had luck addressing low motivation in a teen with anxiety and depression along with ADHD and lots of mood dysregulation. Been on Prozac 20 mg for 1.5 years and Adderall. Hates the way Adderall makes her feel -no appetite- but had a very bad reaction to Ritalin. Just cannot motivate to do much. Needs to sleep a lot. Is playing sport a few times a week, but almost never does homework and is struggling in school as a result. Likes the hard classes, but can’t motivate to do the work. Feels incredibly overwhelmed most of the time. Is in Therapy and family therapy, but little progress. Anybody try anything that has worked to improve motivation?

[Mayra0123]

Good morning!

I'm sorry for the long answer, but I have been experiencing this for many years with my daughter ( I also have a son with ADHD) and I have a lot to say,

My daughter is 18 years old. She's diagnosed at age 12 with ADHD and anxiety, which ultimately lead to depression. She is on Escitalopram(Lexapro) for anxiety (see info: choosingtherapy.com/lexapro...c) and methylphenidate for ADHD. My daughter is very sensitive to meds so these are the ones that work best for her at very low dose- Adderall was bad for her because it exacerbated her anxiety-bad heart palpitations, was very jittery and the withdrawal was awful. Middle school was extremely difficult and high school was only a little better. She too really loves the more challenging classes (easy classes are very boring and don't stimulate her enough to remain engaged, but has found that it's very difficult to keep up with them because of her ADHD symptoms. That has led to very low self esteem and very little motivation over time because she feels she can't do anything right and second guessed herself because she's tired of failing at things she likes. ADHD delays the maturity in the executive functions by dysregulating emotions, dysregulating attention and decision making and time management, memory issues among other things. As Dr. Russell Barkley puts it, kids with ADHD are delayed about 30% from their peers (please view this video on how ADHD really affects our kids: youtube.com/watch?v=X5aAp7Q...(Not working as expected?)) We have tried working with a family therapist but from a teen's perspective, it was emotionally draining because she felt that as a family we saw her as a problem to be solved. So after years of asking other parents and seeing different types of therapists and researching and reading everything I could I decided to follow my motherly instinct; it was time to prove to her that she was good enough and could do anything she wanted and feel good about herself regardless of her ADHD and that her life journey was going to look a little different than her friends but just as fulfilling! ADHD is the real issue here.

Moving forward, I hired a psychologist that my daughter at first impression thinks will like ( I researched many that I felt could be a good match and allowed my daughter to choose) Both of us had to like the psychologist-this is very important!

Explained to psychologist privately that the focus needs to be specifically on her ADHD symptoms rather than how it makes her feel- first identify what they are, so treat the source and the symptoms should improve! (ADHD has a spectrum of symptoms)

Figure out what type of learning style my daughters has (visual, auditory, reading/writing, or kinesthetic) and then the psychologist can help her figure out how to use her learning style to create her own interventions/ tools to work with her ADHD (and not against it!) Time management and reaching small and big goals was really important because ADHD interfered with those and made her loose interest and hope in anything she wanted to do but just couldn't! (this was heartbreaking because she so much wants to be good at anything especially at this point in her life) When you get to the realization that you have a passion for something and your condition makes it so hard to achieve, it does something awful to your self esteem! But if you realize that with the right support from your family and friends and specialist that you can get there then you can recover self-worth! She is there now- still nervous but excited about her next phase in life- she just registered at her community college for a degree in graphic design to a pathway into digital film!

I have also told the psychologist that I will be her support at home and so part of the therapy session (the last 10min) is devoted to me privately so that she can teach me the support I need to give my daughter at home (so that I am not nagging her but rather be an executive assistant- this shows my daughter that she's still in charge of her choices) However I am in charge of her medications. (and what she eats but not when she has to eat because her meds dictate that unfortunately- we have learned when she gets hungry enough and that's when she tries her best to eat as much as possible)

Medications; I have been advised by her doctor to make sure she eats a good breakfast with her morning meds because they do suppress appetite the effects of the medication also contributes to her body exhaustion. Blood lab showed deficiencies and she takes supplements which has helped her body feel better. I let her sleep as much as possible because ADHD is exhausting, so i followed her body signals, usually right after school she crashes and a 1 to 2 hour nap followed by a meal of her choice helps her recover and she is in a better mood to tackle her homework! (she may not finish all of it but that's ok because she has extended time from her teachers) this keeps her anxiety down and depression at bay! I give her protein shakes for lunch along with a very small lunch.

I have also placed a 504 plan with the school and have facilitated the connection between teachers and her psychologist

Talk to all her teachers (email mostly) , a lot of teachers have strategies in place already and most of them genuinely do want to help if they feel like they are part of the team!

Lastly, I have learned to ask her "what can I do to help?" (not do for you) instead of telling her this is what you need to do! It's hard to be under scrutiny all the time so I give space to reflect on her own. I no longer get upset when she doesn't do her homework, instead I say "keep in touch with your teacher and let them know you're struggling or that you need more time and follow their advice as best you can! If you get a bad grade, it's ok because you have other opportunities! Basically I changed the way I talked and addressed her. She wants for me to support her and feel good and proud of her and not to always point out how she was struggling, so now I look for what she does well and I point it out! I give her advice only when she asks, I do try to have conversations whenever I get a chance and we find good shows to watch together and try to enjoy our company because she needs activities where she feels she's not being judged (as a mom it's hard to not tell her how to do things and make decisions for her , so I bore her with some of my own experiences but immediately let her know that she is her own person with her own decisions as long as they are mindful!

Read a lot and watch a lot of videos on ADHD and anxiety, I have learned that anxiety really is the feeling that affects her the most (depression comes after anxiety has taken a long toll over a long period of time)

I hope this helps!

[Pema20 in reply to Mayra0123]

thank you so much for this. A lot of what you say resonates. We have also stopped asking her about school and stopped giving her advice. She needs to own where she is at and where she is going. She has a good therapist who she likes a lot, but who had a medical emergency and so was out for the last few months. She’s coming back in the next two weeks. My daughter was seeing someone else in the interim, but is excited to shift back. I too am excited because this therapist will work with me; I have been shocked to learn how many therapists will refuse to work with parents. Two issues, 1. She is really resistant to accepting any executive function support. It’s what she needs, but she won’t have it. 2. She definitely practices homework avoidance and the only way through that as far as I can see it to find ways to tackle it in small bits, but she is resistant and we have let it go, but I am very concerned that avoidance is becoming a habit and getting more ingrained. Finally, she’s stopped taking her meds. How did you get your daughter to accept help or be willing to try solutions? I am hoping too that a shift may help her restart. My daughter shuts everything down saying that won’t work because I am just not motivated. For me it feels like the depression is an obstacle. She is quite negative and critical in general. One more question, I feel like she is depressed about failures of the past and anxious about the future, but avoids addressing the present. have/how have you gotten your daughter to just focus on and be actively engaged in the present?

[Mayra0123 in reply to Pema20]

Hi! Would it be ok to email you the answers with a private email?

[Pema20 in reply to Mayra0123]

sorry, not so keen to shift to email, but happy for anything you’re willing to share in channel. Many thanks for what you have shared already. Super helpful.

[ASLCODATerp in reply to Pema20]

I absolutely agree with what has been said here! We have dealt with all these issues in our family with four of five kids who have ADHD and three dealing with extreme anxiety and depression, and I have found that letting-go of expectations and increasing fun activities is the best way to help the kids relax and feel good in their own skin. (D&D, video games, sports…) The executive functioning skills will not be solved overnight. There is no quick fix. It is a long road to success, but it is possible! Two of our kids are adults now, working things out and have success in their own time and way. It helps me to remember that my kids want to succeed, and there is no set timeline for any of it. They can graduate late, go to college later, etc… it will all work out! They need to feel connected with good relationships. They need to find their thing, and have little wins every day. They need to feel in control. And they need to know that they are doing fine and the future is bright!

[LAJ12345]

my son is 20 and has turned a corner with his symptoms. He was displaying the same symptoms as your daughter.

What has worked for him has been lifestyle changes but he had to come to realisation for himself as he would not take any advice from us until reaching desperation doing things his way. This year after failing for 2 years at school he has enrolled in university and has nearly successfully completed the first semester subjects.

Things that he is doing that is helping:

Avoiding drugs and alcohol

Eating proper healthy meals, avoiding junk food and eating plenty of fruit and veges, protein.

Setting a sensible regular bedtime and waking time and sticking to it even if it means missing football games in the middle of the night.

Reducing screen time to a small amount of catching up a couple of times a day and necessary time for university courses.

Getting outside for a walk first thing in the morning in the bright sunlight,

Reducing light exposure at night before bed.

He takes a clinical dose of Hardys Daily essential nutrients with added vitamers, melatonin before bed, rhodiola rosea, astragalus, ashwaghanda, N acetyl cysteine, and acetyl l carnitine cycling them so he has periods of time off them.

My husband has Parkinson’s and has had trouble with extreme agitation and anxiety on SSRIs to the point that they made him suicidal so I haven’t wanted my son to take them in case he reacts in the same way. My husband also takes the clinical dose of Hardy’s and it has helped with his anxiety.

My son has found watching podcast by Andrew Huberman, a neuroscientist, very helpful to help him to work out how to help himself.

hubermanlab.com/adhd-and-ho...

[Pema20 in reply to LAJ12345]

super helpful. All those things are things we recommend, but so far she’s not interested. She did try Ashwaganda for a while and we thought it helped, but then she stopped. We know she will need to figure things out on her own, it’s so hard to watch though.

[LAJ12345 in reply to Pema20]

Sure is hard. If you can get her to try Hardy's and rhodiola I think they have been the most helpful. And I really found the podcasts helpful in understanding how dopamine etc work and why ADHD people behave certain ways so it helped me know how to react to behaviors like procrastinating, not getting up and going to class and avoiding hard things. Incidentally parkinson's has all the same behaviours and I had already been through it with my husband.

[Pema20 in reply to LAJ12345]

just bought some rhodiola. Thanks for that suggestion.

[LAJ12345 in reply to Pema20]

just watch for interactions with other drugs as they might have an additive effect so monitor for worsening symptoms.

[Knitting20projects]

Has she ever had formal neuropsychological testing for learning disabilities and executive functioning evaluation? She may have additional learning difficulties that haven’t been identified. Unfortunately it can be expensive but might allow additional avenues of EF support. Is a psychiatrist managing her medication trials? If not, I would definitely get their expertise for tailoring meds to try to maximize her med management in light of her difficulties tolerating them. I am saying this with compassion because our son was diagnosed at 4 & had to start medication before age 5. It is a tough road. But I think you are being really smart to advocate so well for her now.

[Pema20 in reply to Knitting20projects]

thank you so much. I got her started with a psychiatrist in January and I think that doc is just starting to home in on what she needs. We met her this week and my daughter seemed happy with the new plan. I would be happy for the neuropsych testing, but not sure my daughter would be willing to do it. She has been super resistant to EF coaching. I do think she could benefit a ton from that, but she needs to be on board with it. We had her signed up with an excellent EF coach last fall, but daughter refused after 8 sessions. School counselor just suggested a 504, which we will likely do. It’s her senior year so pretty late, but might as well. All to say, I agree with you on all fronts. My current thinking is until we get the depression addressed, it will be hard for her to do anything. My daughter really wants to do things on her own and doesn’t like getting help. When she’s not depressed she does great, even with her EF challenges, but lack of motivation does mean she procrastinated a ton.

[Knitting20projects]

Yes, that all makes sense. It’s hard to know what comes first sometimes because having to work harder to be successful can make people feel down & like they’re failing, plus ADHD makes getting interested in subjects she doesn’t find interesting really hard. And it can become a vicious cycle. And she wants independence yet kids/teens with ADHD are 30% younger really in terms of their social/emotional development. Sounds like a good plan to have a psychiatrist help sort out exactly what to address first. As a mom, I would rather endure things myself than feel powerless watching my kids struggle. And I’ve had to do that a lot. Best wishes to you and your daughter.

[Pema20 in reply to Knitting20projects]

I could not agree more with this: “As a mom, I would rather endure things myself than feel powerless watching my kids struggle.”

[GoldenValley]

Yeah my son is the same, the teachers had to call me saying he wasn't doing his homework on several occassions. The teachers recommended me a website for him, I'm not sure if I am allowed to send links here but its a website where you can book 1 hour sessions and their staff members will monitor them whilst they do their work and motivate them. This has been the best solution so far as we schedule sessions in advance and choose what homework/task he will do then and even during the sessions he might do more than 1 homework as that's when he feels more motivated to so. You should see if something like that would your daughter. Hope this helps. The website: tryprocasso.com

[Pema20 in reply to GoldenValley]

thank you!!!

[ProductiveSensei]

Amazing suggestion👏👏 My daughter was also recommended this site by their school, they said the reason why our kids struggle to work at home and this is for all kids and its because there is no authority figure like their teachers who are there to make sure they get their work done like they do at school; at home they're relaxed and are not motivated as they would be at school. With Procasso that's the closest thing they will get to actually working again like they're in school, as they'll be checking in on them, asking them questions, etc. I really recommend the site to anyone reading this.

[Pema20]

Just want to say to all who have replied here so far, I am very grateful for all the constructive suggestions you’ve provided and the stories you have shared. I never expected to get so much feedback, it means a lot. Thank you.